What's Wrong With My Gallbladder, Doc?

A quick mini-post to help you make a quick diagnosis.

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Please remember to practise caution as the presentations may overlap.

Thank you for reading.

- Ashish Singh

Post-LP Headache

Hey guys! 

Here's all you need to you know about that nasty headache some patients get, after a lumbar puncture (LP).

How common?
Up to one-thirds of all cases.

What are the risk factors?
None. Despite years of anecdotal advice to the contrary, none of the following has ever been scientifically shown to be a risk factor: position during or after the procedure; hydration status before, during or after; amount of CSF removed; immediate activity or rest post-LP.

When does it happen?
Within 24 hours of LP.

How does it present?
Let's SOCRATES the pain here.

Site: Frontal > Occipital
Onset: Acute
Character: Dull aching
Radiation: None
Association: Mild neck stiffness, nausea
Time Course: Lasts for 2 days to 2 weeks
Exacerbating factor: Sitting upright or standing, and so the relieving factor is lying down
Severity: Varies 

What is the pathology?
Thought to be continued leakage of CSF from the puncture site and intracranial hypotension. Other neuro-vascular mechanisms may be involved.

How do I prevent it?
Using the smallest practical needle and keeping the bevel facing up. Before withdrawing the needle, reinserting the stilette.

How do I treat it?
It's self limiting. Can use analgesia, as per WHO Pain Ladder. In extreme cases, can also involve an anaesthetist for an epidural 'blood patch'.



Know something you'd like to add? Let me know.

Thank you for reading. Have a nice rest of the day, you.



- Ashish Singh

Ashman beat

Hello!

What's an Ashman beat?

An aberrant PVC, usually of RBBB morphology, which follows a short RR interval and is preceded by a relatively prolonged RR interval.

The mechanism is pretty cool!

Retinoic Acid and Malignancy

Hello Awesomites !

This is going to be short post.
Relevant for exams.

All trans retinoic acid is used in APML (ACUTE PROMYELOCYTIC LEUKEMIA)

Cis retinoic acid and derivatives like 13-cis-retinoic acid (13-cRA) reduces second aerodigestive tract tumors in patients with resected head and neck cancers.
13-cis RA is used in Neuroblastoma.

Happy studying.
-Upasana Y.

Differentiation syndrome

Hello Awesomites !

AML (M3) also known as acute promyelocytic leukemia.
The drug is ATRA+As2o3 ( All trans retinoic acid +arsenic trioxide).

After few days from therapy :-
unexplained fever,
acute respiratory distress with interstitial pulmonary infiltrates,
and/or a vascular capillary leak syndrome
leading to acute renal failure.

Suspect :-

Differentiation syndrome (DS), formerly known as retinoic acid syndrome, is the main life-threatening complication of therapy with differentiating agents (all-trans retinoic acid [ATRA] or arsenic trioxide [ATO]) in patients with acute promyelocytic leukemia (APL).

The differentiation of leukemic blasts and promyelocytes induced by ATRA and/or ATO may lead to cellular migration, endothelial activation, and release of interleukins and vascular factors responsible of tissue damage.

 Roughly one quarter of patients with APL undergoing induction therapy will develop the DS.

Treatment -
Early therapy with intravenous corticosteroids. The use of invasive diagnostic techniques, such as bronchoscopy and bronchoalveolar lavage or lung biopsy, is not usually required in patients with suspected DS and respiratory distress with lung infiltrates.
Be careful with invasive procedure as these patients have concomitant coagulopathy (DIC like state)

The early administration of high-dose dexamethasone at the onset of the first signs or symptoms of DS is crucial, since it appears to dramatically reduce mortality of this complication.

 HAPPY STUDYING :)
-Upasana Y.

Route of bisphosphonate administration mnemonic

Mini post!

IVZ: Intravenous zoledronic acid (once a year)

oRAl: Oral bisphosphonates are Risedronate and Alendronate

- IkaN

Denosumab

Hi! Long time no see :)

This post is on Denosumab!

MOA:
- Monoclonal antibody against the receptor activator of nuclear factor κB ligand (RANKL)
- Reduces bone resorption by inhibiting the development of osteoclasts

Route: SC
Dosing: Administered twice yearly

Quinsy Complication

This post is written by Sweta Senthil.
I don't know why she targeted me to make this mnemonic but it makes sense to remember the complication of Quinsy.

So mnemonic is "OJAS Pee"

Edema of larynx
Jugular Vein Thrombosis
Abscess of Lung/Pneumonitis
Septicemia, Spontaneous hemorrhage
Parapharyngeal Abscess

That's it!

IOLs- most important optical zone

Most common answer would be the centre.

That however is not the case as the light rays pass undeviated right through the centre.

In fact, phakic IOLs have an opening right in the centre for aqueous to circulate.

The most important part is the pericentral area, as the refracted rays through this area get focussed on the macula.

-Sushrut

Bell's phenomenon

It is the motion of the eyeball during lid closure and is a reflex between the occulomotor and the facial nerves.  There are 4 types-

1. Normal- Upward and outward movement of
                           the eyeball.

2. Inverse- Upward but inward movement.*

3. Reverse- Downward movement.*

4. Perverse- Lateral movement.

*Some authors opine that inverse is downward and outward while reverse is upward and inward.

The Bell's phenomenon is of importance in ptosis and lag ophthalmos surgeries .

-Sushrut

T cells in traumatic optic neuropathy- summoning the devil😈

Traumatic optic neuropathy is a tough nut to crack. High dose steroids and surgical decompression were the empirical modes of management. There is an ongoing search to save the optic nerve in trauma.

The innate adaptive T cell response has been deemed to be protective in traumatic optic neuropathy. It supposedly acts against the self directed antigens in traumatic optic neuropathy. The response can be augmented or induced depending upon an individual.

Other modalities are monisialogangliosides, neurotropic growth factors, and gene transfer of anti inflammatory cytokines.

A new group of steroids, the 'lazaroids' (great name that!) or 21 amino steroids provide free radical binding capability inherent to the group sans the glucorticoid activity.

-Sushrut

Being street-smart during interviews: Apps/Websites

We all like free money $$$, don’t we? Doctors, engineers or any other profession you can think of! These days, we are living in a world which is full of apps and nearly all of us have smartphones. What if I tell you that you can use your phone to make money just by doing what you normally do?
Well, these apps and websites are really useful to save money, get some of your money back, get cash and to redeem many offers!

1- Google rewards
A very simple app by Google in which you have to answer a survey and get money from that. For Iphone users, you can redeem each 2 dollars or let them accumulate (survey value can be as low as 10 cents up to 50- 60 cents or even more). For Android users, you can use the money to buy apps/rent movies ..etc in Play Store.
 It is said online that when you go to new places the app may send you more surveys. Keep your location service turned on. The process may take sometime but anyway, you lose nothing, it’s free :D
Go download the app from App store or Play store now!

2-Ibotta
Ibotta is one of the available rebate apps. Check the offers in the app, tick them and then buy the thing you need from available places- whether online via the app or in-store-. Nearly all the superstores (Walmart, Kroger, Target) and famous online stores (Amazon) are there. You can redeem your money after you accumulate 20 dollars via Vimeo or PayPal. You get money when you refer friends and you all may get money when you all work as one team!
Here is the link for the app, let us make one big team :D
https://ibotta.com/r/avalwqu.
(better to open the phone using your phone directly)


3- Sweatcoin
As this app advertises itself: “It pays to walk”. This amaaazing app converts your steps into “sweatcoins”. You can use your sweatcoins to redeem many offers through the apps. As of now, one of the offers is an iphone XS or a 1000$ cash if you collect 20000 sweatcoins in 2 years! Offers include small electronics, clothes, music services...etc.
This app can be your friend during the whole match journey as well as when you go to the gym, you ll collect these coins without even trying :D
Psst..one more thing, when you refer anyone, both of you will get 5 sweatcoins so use the link below to download it..Get 5 sweatcoins for free and refer your friends.
This app will literally encourages you to “move it move it”
https://sweatco.in/w/murad665752

4- MileagePlus X (from United)
One of the best apps to travel for free! When you collect 10K or 12.5K miles through this app, you can simply book a flight for free using the miles you earned!
Many merchants are included within this app (Starbucks, Airbnb, The Home Depot, Uber, Walmart, Under Armour..etc). Just buy a gift card through the app and use it to pay at these places whether in-store or online. Miles range from as low as 0.5 Mile per each dollar spent to 12 Miles per dollar with some offers time limited. Before buying from any store, check this app and see if you can get some miles :)
The app also has MileagePlus dining which will give you miles when you eat in participating restaurants! Treat yourself and your stomach and get some free miles :D


5- Google Express
This nice app from google will not let give you money per se but it will help you in comparing the price of one product between different stores (Walmart, Target..etc). It comes with a cool 20$ (up to 20$) off your first purchase through the app.

6- Retailmenot and Slickdeals
These 2 websites will have deals and coupons for different things. Check them, crop or copy the coupon, buy for less.
www.retailmenot,com
https://slickdeals.net

7--Honey (extension)
Add this extension to your browser and it ll look for any working coupon that your can use when you are doing your online shopping on Amazon.

Let me know if you know other apps that should be added to this list!

-Murad :)

Human milk bank

Hello Awesomites!

Update for community medicine:-

Because some infants could not be fed by their mothers (early demise of mothers or chronic illness), humans have adopted substitute feedings.

1.Human breast milk bank (recent advance)

2.Infant formula feed

3.Fortified human milk for premature infants

The MoHFW launched the National Human Milk Bank at Lady Hardinge Medical College-the first government-run human milk bank, and at present, the country’s largest.

The human milk bank and lactation counselling centre, 'Vatsalya - Maatri Amrit Kosh', will collect, pasteurise, test and store milk donated by lactating mothers and make it available for infants in need.

Aanchal, the mother’s milk bank established in 18 district government hospitals of Rajasthan.

Beneficiaries will mainly be premature babies (born below 32 weeks of gestation) and IUGR (intrauterine growth restriction) infants.

Following is the link for further read and research :-

Key guidelines for human milk bank

Recent news article on human milk bank

Happy Studying!

Upasana Y.