Wednesday, February 1, 2017

Second Heart sounds: Quick review

Hello everyone,
Heart sounds are quite interesting and musical topic, something that makes more sense by practicing rather than just reading theoretically. This post is completely dedicated to second heart sound.

Second heart sound (S2)
It is produced during closure of pulmonary and aortic valve.
It is a high pitched sound.

A neonate with cyanotic heart disease (Case #1)

A 24-hour-old newborn, born to a diabetic mother, appears blue in all extremities. He is found to have a single, loud S2 murmur. He is given NICU support. CXR hows cardiomegaly with, an apparent narrowing of the superior mediastinum and increased pulmonary vasculature markings.

Diagnosis? Treatment till surgery is performed?

Anti-epileptic drugs, CYP450 induction and inhibition mnemonic

Cytochrome P450 aka CYP450 has the alphabets C and P:

C for Carbamazepine
P for Phenytoin

GABA A and GABA B receptor agonist antagonist mnemonic

Here's a super short post.

Flumazenil acts on the GABA-A receptor and baclofen acts on the GABA-B receptor.

How do you remember this?

Tuesday, January 31, 2017

Whatsapp study group (Public)

This is... Experimental.
We do realize the group capacity is just 256 members, so all of you guys won't necessarily fit in.

Because all members will be added without verification... This is more risky. Even though we have 10+ admins :)

The rules are obvious - No forwards, no non medical talks, no wishing / greeting on occasions & no bothering other people via personal message.

Updated on Jun 17, 2017

Since the first public group is full (and a huge success), we created a second one: https://chat.whatsapp.com/561vU4UDy7V99K1ZmG6miH

To join one of the private strictly monitored study groups, follow the email procedure.

Sunday, January 29, 2017

Psoriatic arthritis mnemonic

A simple one: PSORIATIC

P- Pencil-in-cup deformity

Pencil-in-cup deformity

S- Sausage-like digits
O- Onycholysis and Onychodystrophy
R- Rheumatoid factor negative
I- Ivory phalanx (increased bone density)
A- Arthritis multilans
T- Telescopic fingers
I- Itchy skin
C- Cold weather (more severe)


Thats all
- Jaskunwar Singh

Noonan syndrome mnemonic

Hey Awesomites!

NOONan syndrome- the name tells it all :D

Liposomal Preparations : A Quick Review

Hello everyone !
This is a short post about Liposomal delivery systems. Hope this introduces you to the concept nicely.

What are Liposomes ?
- They are vesicles made of Cell membrane phospholipids. In pharmacology, they can be used as Drug delivery systems.

What advantage does a Liposomal preparation offer in comparison to a regular preparation?
- The Liposomal preparation consists of the desired drug loaded into the Liposomal vesicle. This vesicle is resistant to degradation in the gut and can be customized to open up in selective tissues.
- Thus , it increases Bioavailability of the drug and hence , the action of the drug is more predictable and sustained !

∆ Is this even used at all? Or is it just an extra thing we learn which is never used ?

(- I'm  so glad you asked. )
Here's a list of drugs that have commercially available Liposomal preparations :

Remember : ABCD GIV

Amphotericin B
Bupivacaine
Vitamin C
Doxorubicin And Daunorubicin

Glutathione
Irinotecan
Vincristine

- Liposomal preparations have totally revolutionised the usage of Amphotericin B! Which is the drug of choice for a host of fungal infections and even Leishmaniasis.

- With the anti cancer drugs like Doxorubicin​ , innovative methods such as targeting the drug to a specific organ have been formulated so that the cytotoxicity is limited to the organ in question only ! Thus optimizing the absorption as well as the action !

What a marvellous delivery system , isn't it ?

I hope this post helped you!
Stay awesome.

Saturday, January 28, 2017

H. pylori infection : Facts and Fallacies

Here are some interesting facts about cytotoxin- associated gene A (CagA)- positive strains of H. pylori and its role in esophageal and gastric carcinoma.

- Chronic Helicobacter pylori infection results in lower gastric acid secretion by inducing atrophic gastritis, thus hinting to have an inverse association with EC.
- H. pylori infection reduces ghrelin synthesis due to loss of P/D1 cells in the fundus and body of stomach which decreases gastrointestinal motility and induces delay in gastric emptying, thus increasing the risk of GERD.
- Also the CagA positive strains induce fluctuations in the levels of somatostatin, gastrin, dopamine and other essential hormones, which might cause increased reflux symptoms and metaplastic changes in chronic cases.
- Upregulation of proinflammatory cytokines and impaired TNF-alpha levels might play a role in pathogenesis of esophageal and gastric carcinoma. Extragastric diseases such as Colorectal polyps, nonalcoholic fatty liver disease, dental caries, coronary heart disease, the parkinson's disease, and iron deficiency anemia are also associated with H pylori infection through multiple signaling pathways.

Inspite of much evidence, there have been arguments and debates on the underlying mechanisms in causing esophageal carcinoma. A meta- analytic study, on the other hand has recently concluded that CagA- positive strains of H. pylori have a protective role in EAC while there is no such clear association with ESCC.

Thats all
- Jaskunwar Singh

Steroids and the Eye : Utility Review

Hello everyone ! I'm back with another post on Opthalmology ! Hope you like it.

Uses of Steroids in Ophthalmology -

1. Prophylactic - PC
- Post op Cataract - 6w
- Corneal grafting.

2. Therapeutic - Go from anterior to posterior. We use it in every layer of the eye !

- Lids - Intralesional for Chalazion

- Conjunctiva - Phlyctenular Conjunctivitis.

- Sclera and Episcleral tissue - Scleritis and Episcleritis.

- Cornea - Contra indicated - As it affects healing and may cause super infections.

- Uvea - Anterior and Posterior Uveitis. Purulent Uveitis - Endophthalmitis ; Panopthalmitis.

- Retina - Diabetic Retinopathy Intravitreal Triamcinolone.

- Nerve - Optic Neuritis ( Multiple Sclerosis ) - Methyl Prednisolone

3. Others :
- Secondary Glaucoma due to the Inflammatory etiology.

~~~~~~~~~

Precautions :

- Avoid in any ulcer cases as it can delay healing of the ulcer or aggravate fungal or herpetic ones.

- Can cause Cataract - Posterior Subcapsular. (Generally when given systemically)

- Can cause Glaucoma ( Generally when used Topically. )

Hope you liked it !
Stay awesome !