Oral Rehydration Therapy

Hello everyone! :D
Indian Academy of Pediatrics is celebrating the ORS week where we create awareness about Oral Rehydration Therapy :)

Oral Rehydration Therapy (ORT) is a treatment for dehydration associated with diarrhea.

ORS saves millions of children a year from death due to diarrhea.
But sadly, even today children die due to diarrhea in some developing countries.
Sometimes people don't understand that praying is not enough, treatment should also be given. They should not be negligent when it comes to health.
We have a quotation, "Dawa and Dua" are essential to save a person's life.
Dawa means medicine & Dua means Prayer.
So I give equal importance to both the factors in our lives, faith and medicine, and this was the basis of my poster for the ORS awareness week :)

Francis Bacon said, ''Hope is a good breakfast, but it is a bad supper."

ORS awareness poster

So lemme tell you about ORS ^_^
You see, normally our body pumps out fluid in the intestine during digestion
This fluid has a high concentration of sodium
Nearly all of this fluid is reabsorbed by the intestine, in an healthy individual, to maintain a balanced sodium level in the body.

During diarrhea, liquid secreted in the intestinal lumen passes the gut so quickly that very little sodium and water is absorbed. This is why, heavy continuous diarrhea can be a very dangerous and potentially life-threatening condition within hours.
This is the reason why you need sodium and water replenishment via ORT

Why is glucose needed?
The co-transport of sodium into the epithelial cells via the SGLT1 protein requires glucose or galactose. Without glucose or galactose present, intestinal sodium will not be absorbed.

Remember: Glucose is never more than 110mMol/lit to avoid the risk of osmotic diarrhea.

Why is sodium citrate or sodium lactate or NaHCO3 used?
The alkali loss due to diarrhea causes acidosis. It is corrected :)

I also wrote a poem as a part of this program, even though I'm VERY bad at rhymes :D

The ORS says :

"I'm oral rehydrating solution,
I help balance water distrubution.

Whatever the cause maybe,
Whether it's rotavirus or cholera,
and it's causing vomitting or diarrhoea,
utilize me properly in this era.

I'm a medicine that barely costs,
So when water from the body is lost,
Don't hesitate to use sugar and salt,
& put dehydration to a halt.

I've saved millions of lives,
But still some don't survive.
So please create awareness about me,
& let people use me wonderfully."

Please create awareness.. If you know a mother with a child, educate her about diarrhea. Let people know. You never know, you could save a life. :)

-IkaN

Update: I won the first prize for this poster in National ORS week conducted by Indian Pediatric Association ^__^

Stockholm syndrome

Recently, this word has been haunting me.. So.. Let's see what's it about!

Stockholm syndrome is a psychological response sometimes seen in an abducted hostage, in which the hostage shows signs of loyalty to the hostage-taker, regardless of the danger (or at least risk) in which the hostage has been placed.

Stockholm syndrome

A song by Muse from the album Absolution is of the same name
It has always got me wondering.. Is the song about memories holding you captive?
Even when those memories have the capacity of hurting you, you still don't let go and set yourself free.. You still don't forget.. Even when you want you.. But you just can't..
The verse however let's you decide what perspective you choose to have.. The abusers or the victims.. But the chorus expresses the syndrome well..

I heard it on the television series, White Collar too..
Neal Caffrey: No. There are things about this life I'm not ready to give up.
Mozzie: Do you even know what this life is anymore? I mean, you're... on a leash. You're still in prison. You have Stockholm syndrome.
Let's analyze Mozzie's view.. Giving up THE final score for what? Stockholm syndrome it is!
I feel Caffrey's pain throughout the series though.. Because the hardest part isn’t choosing, it’s learning to live with the choices you make T_T

I also know someone whose WhatsApp status is Stockholm syndrome.. Professional secrecy shall prevent me from commenting any further.. :D
[And damn, he is good at using these laws against you!]

In psychology, Stockholm syndrome is a psychological phenomenon in which hostages express empathy and have positive feelings towards their captors, sometimes to the point of defending them.
This sounds like some milder form of sadism..
You know you've got the Stockholm syndrome when you hear yourself saying, “I know what he’s done to me, but I still love him” ;)

Did you know?
The syndrome is named after the Norrmalmstorg robbery of Kreditbanken at Norrmalmstorg, Stockholm, Sweden, in which the bank robbers held bank employees hostage and the victims became emotionally attached to their victimisers, and even defended their captors after they were freed from their six-day ordeal.. This is the art of brainwashing! :O

This blog post doesn’t reflect the thoughts or opinions of either myself, my family, my friends, or my dragon :P
Blogging about psychology does get you all serious.. Lighten up and stay awesome! :)

-IkaN

Awesome Twosome Drugs

So today I was asked two fixed dose combinations of drugs which antagonize each others side effects..
Lemme tell you about the combinations I thought of! :D

First.. *drum roll*
Aluminum hydroxide & Magnesium Trisilicate!
These two are antacids ie neutralize gastric acids

Magnesium salts act fast & Aluminum salts are slow acting
Magnesium salts act as laxatives & Aluminum salts are constipating
Magnesium salts hasten gastric emptying & Aluminum salts delay it

So.. What do you get when you mix em together? Dose reduction & minimization of systemic toxicity! ^_^

They are indicated in hyperacidity gastritis, reflux  esophagitis, dyspepsia

Second combination is seen in OCPs [Oral Contraceptive Pills]
Levonorgesterol & Ethinyl estradiol

Progesterone inhibits the frequency of LH secretory pulses & estrogen inhibits FSH secretion
So estrogen and progesterone synergise to inhibit ovulation
Estrogens increase the risk of endometrial carcinoma while progestin given concurrently blocks the risk..

So use em together!

Side effects of medicines combined (:

Each coin has two sides.. The trick is to use both sides to your benefit.. Team up!

Lemme know if know of any other such combinations.. Where the evils come together for the good without creating a dilemma..
Please do comment or email me and let me know.. :)

"I make bad look so good" -Megamind ;)
Have a nice day lol

-IkaN

Neuromuscular (myoneural) junction

Neuromuscular junction labelled

 Hello, lovely folks!

Lets learn something about the neuromuscular junction!
Refer the diagram as you read.. Otherwise it might not make sense to you..

1 As the nerve suppplying skeletal muscle reaches its termination it divides into a number of terminal buttons or end feet

2 The endfeet contains many small clear vesicles that contain acetyl choline, the transmitter at these junctions!

3 The endings fit into depressions in the motor plate - the thickened portion of the membrane at the junction

4 Underneath the nerve ending, the muscle membrane of the end plate is thrown into a number of folds called the junctional folds

5 The space between the nerves and the thickened membrane is comparable to a synapse! (Remember, this is a chemical synapse and there shall be delay.. In chemical synapses there is no delay)

 6 Ach muscle type nicotinic receptors are concentrated at the tops of the junctional folds of membrane of motor end plate

7 Only one nerve fibre ends on each end plate, with no convergence of multiple units

THIS, my dear friends, is known as the neuromuscular junction or myoneural junction

That's all! ^_^
You can use this as a ready made short note :P

Oh.. One more thing, in one of my first year vivas, I was asked what are the two types of Acetylcholine receptors..
The answer is nicotinic and muscarinic receptors.. There is an interesting story about how they were named!
Muscarinic receptors were named as such because they are more sensitive to muscarine.. isolated from a mushroom! :O
Nicotinic receptors could be opened by nicotine and hence the name!
Imagine someone naming you dust because you are sensitive to it! [That was a lame attempt to crack a joke on hypersensitivity reactions.. I should stop typing now :D ]

-IkaN

PS: I apologize for the awful diagram.. It's from one of my old notes, when I had no intentions of blogging :D
If time permits I'll update the diagram.. Till that you may rely on Google :)

If you do not heal yourself, you die

In some cases of myocardial infarction, the clot spontaneously resolves itself, this is the healing process.

But at the same time the atheroma can worsen, there maybe haemorrhage & disruption exposing the thrombogenic components causing expansion of the atheroma.

So do you get what I'm talking about? In life too we can either choose to heal or worsen our condition, it's your decision really.. To feel better or worse about the smallest thing or the biggest problem you think you have..

Do you choose to heal?

-IkaN

Oxytocin

Heyy guys I know its' too late for a valentines day blog post.. But why need a day to celebrate love?
Lemme tell you about Oxytocin.. The love hormone <3

Oxytocin is secreted by the posterior pitutary.

Physiological roles:
Labour - It contracts the uterus & facilitates birth by a G protein receptor.
Milk ejection reflex - It causes contraction of the myoepithelial cells to let down milk. Remember it isn't responsible for production of milk. Only secretion or ejection more appropriately.
It is also a neurotransmitter (Love is in the air) ;)

It is a peptide that's why it is inactive orally [Destroyed by the acid in the stomach]
It is generally administered by iv or im routes

Uses:
Induction of labour: Either prematurely or in case of postmaturity.
Uterine inertia: When uterine contractions are feeble & labour is not progressing satisfactorily.
Postpartum haemorrhage: Hypertensive patients where ergometrine is contraindicated.
Breast engorgement: Due to inefficient milk ejection reflex. Nasal spray before feeding infant is given.

Do you know Oxytocin and Anti-diuretic hormone ADH  are both octapeptides & have 6 common amino acid residues but differ at position 3 and 8?
Water intoxication because of ADH like action of large doses given along with i.v. fluids can be a fatal complication in renal insufficiency and toxaemia of pregnancy.

Another cool fact: Myoepithelial cells are more sensitive to Oxytocin than the Myometrium

That's all! :)
Happy 13th April ^_^"
-IkaN
(Inspired by Andrea Martins)

Inflammatory pain & NSAIDs

Inflammation causes release of many different cytokines & growth factors.

Stimuli in the inflamed area that would normally cause only minor pain produce an exaggerated response (hyperalgesia) and normally innocuous stimuli such as touch cause pain (allodynia)

Many of the cytokines and growth factors facilitate perception and transmission in cutaneous areas as well as in the dorsal horn.

Prostaglandins induce hyperalgesia by affecting the transducing property of free nerve endings.

Prostaglandins and other inflammatory molecules facilitate activation of tetrodoxin resistant Na+ channels in the dorsal root ganglion (which give rise to unmyelinated C and Adelta fibres both conducting
nociceptive stimuli)

This is how prostaglandins produced during inflammatory states significantly increase the excitability of nociceptive nerve fibres.

So if you prevent this peripheral sensitization, hyperalgesia is reduced.
This is how NSAIDs work.

Note that NSAIDs do not affect the tenderness induced by direct application of PGs, but block the pain sensitizing mechansim induced by bradykinin, TNFalpha, interleukins (ILs) and other algesic substances.

That is why, NSAIDs are more effective against inflammation associated pain.

So now you know :)
Have a nice day

-IkaN

Viruses and Passion

Viruses are strange, they do not feed & by some definitions are not living things.
A virus simply exists to reproduce itself & only "comes alive" inside a living cell.

I feel that the living cell is our passion.. & without passion we'd simply exist.. Lifeless..
The "living cell" makes us enthusiastic.. To live life..

It maybe anything.. You maybe passionate about photography, cooking, learning new facts or as small as discovering a new piece of music =)
But that small thing.. Brings us to life.. It does make you feel alive, doesn't it?
Passion is your living cell & without it.. You feel just like a non-living thing..

Now there is a really cool thing you can learn from viruses..
Once cell lysis occurs, they free themselves of the past and they find a new cell..
They never stop living.. They keep moving on & exploring life as it comes..
I guess you have to read more about viral replication to understand what I'm talking about ^_^"

Anyway I hope you get what I meant to say..
Be passionate & keep moving forward :)
-IkaN

You can handle it

My mom tells me that God gives the grace & strength to the mother to take care of her child..
Come to think of it, the milk secretion starts from the mammary glands after the birth of the infant.. The milk ejection reflex happens just on time, when the baby suckles on the nipples..

You see, life doesn't put in front of things you can not handle..
I like to believe that with great responsibility comes great power is bestowed.

"I don't think that we're meant to understand it all the time. I think that sometimes we just have to have faith.
Maybe God has a bigger plan for me than I had for myself" -Nicholas Sparks

So go with the flow & have faith.. No matter how tough you think life might get :)
Have a nice day with loads of positive energy ^_^

-IkaN

Author's diary - An introduction

Hello everyone..

I'm introducing a new section on my blog.. Which is personal notes from the author.. It is not exactly the informative section of the blog but more about what medicine teaches us.. How we can relate it to our day to day life.. Stuff like that.. Hope you an amazing time reading ^_^

It also contains blabber :P

-IkaN

Why lactate dehydrogenase in Light's criteria?

LDH is an enzyme found in almost all cells.

Tissue injury releases LDH.

If it's level is elevated in the plasma or extracellular fluid, that indicates cell death or cell membrane injury :O

It happens in all cases of exudates.. Inflammation remember?

Hence, LDH can be used to differentiate between transudate & exudate :)

-ikaN

Exudate & Transudate

Hello everyone!

Whenever you find fluid in the body which is out of the circulatory system you need to differentiate whether this fluid is an exudate or a transudate (Only if it is in pathologically significant amounts!)

I'll let you know why this is important in a while.. Keep reading.

Hypersensitivity types mnemonic

Hypersensitivity is a state of altered reactivity in which the body reacts with an exaggerated immune response to what is perceived as a foreign substance.

What if you had no idea which hypersensitivity reaction they are talking about in the exam? Disaster right?

Well.. I got it sorted for you.. Remember, "ACID"

Type I - Anaphylaxis
Type II - Cytotoxic
Type III - Immune complex mediated
Type IV - Delayed type of hypersensitivity

Hypersensitivity types mnemonic

There is another type V Autoimmune disease.. Some people put it in type II though..

Wanna remember the disorders too?
Okay.. here you go..

Type I AAA
Atopy
Allergy
Asthma

Type II GATE
Goodpasture's syndrome
Autoimmune hemolytic anemia
Thrombocytopenia
Erythroblastosis fetalis

Type III EARSS
Extrinsic allergic alveolitis (Hypersensitivity pneumonitis)
Arthus reaction
Rheumatoid arthritis
Serum sickness
Systemic lupus erythematosus (SLE)

Type IV CMCM
Contact dermatitis
Mantoux test
Chronic transplant rejection
Multiple sclerosis

Type V GMG
Graves' disease
Myasthenia Gravis

Hope this helps..
Have an amazing year :)


-IkaN

Updated: Image on 25th Oct, 2013.

Wanna reblog? Here's the link to the tumblr post!

Mechanism of invasion and metastasis of tumor cells comic

I made this very short comic.. Hope you understand! :)

Mechanism of invasion of tumor cells

Cadherins and catenins

Laminin and fibronectin

Type IV collagenase, cathespin D, urokinase type plasminogen activator

Autocrine motility factors and thymosin beta 15

That's all!

-IkaN

Classification of antihypertensives

Heyy guys! I'm back.. And this post is the coolest.. I have put in all my creativity!

What are anti-hypertensives?
They are used to treat high blood pressure ^_^

This post is like a mnemonic..
So lets get to the classification..
How to remember?
ABCD!
A is for awesome.. Medicowesome ;)

That's all for today!

Hope you had fun!

-IkaN

Fulminant liver failure and Hepatitis E

Hey guys! Do you know what is fulminant liver failure?

Fulminant means occurring suddenly, rapidly, and with great severity or intensity :O

Fulminant hepatic failure is generally used to describe the development of encephalopathy within 8 weeks of the onset of symptoms in a patient with a previously healthy liver..

It occurs in pregnancy.. mostly due to a viral cause..
The prevalent viral cause of ALF [acute liver failure] in pregnancy is Hepatitis E..


In fact, liver failure is the most common feature in Indian women during the second and third trimesters of pregnancy

The immunity is altered during pregnancy and the hormonal status is also different..
So, the diminished immunity and high level of steroid hormones influence viral replication and expression during pregnancy

That's all for today!
Take care ^_^
And drink boiled water!

-ikaN

Prophylaxis of Hepatitis B and Hepatitis D

Hey guys!
Guess what? I did an amazing microbiology seminar today on this topic..
So thought of posting it on the blog as well :D

Prophylaxis of Hepatitis B

Avoid sharing personal items

• Don't share needles, razors, toothbrushes, manicure tools or other items that could bear contaminated blood.. [Don't share a bloody thing! ;)]

• Don't allow yourself to be pierced or tattooed with non-sterile equipment

• Make sure your barber uses clean razors, manicure and pedicure items


Behavior Modification

• Use a new latex or polyurethane condom every time you have sex, particularly if you have multiple sex partners.

• Limit alcohol intake. [Love your liver :) ]

• If you are a medical professional, follow good practices for using and disposing of needles. [Or a wanna be doc like me!]

Passive Immunoprophylaxis

•  Hepatitis B Immune Globulin (HBIG) is a sterile solution of ready-made antibodies against Hepatitis B

• HBIG is prepared from human blood from selected donors who already have a high level of antibodies to Hepatitis B and used in passive immunoprophylaxis

• Passive immunoprophylaxis is used in:

• Newborns of mothers infected with Hepatitis B
• After liver transplantation

[I know you are probably wondering why liver transplant! See sometimes as a last resort to Hepatitis you need to get a liver transplant.. So better not get infected with the same virus again eh?]

Active immunization

• The vaccine contains one of the viral envelope proteins, Hepatitis B surface antigen (HBsAg).

• It is produced by yeast cells, into which the genetic code for HBsAg has been inserted.

• Three doses of vaccine are required to achieve effective immunization

[I know most of you haven't got a vaccine against Hepatitis B yet.. So get vaccinated please!]

Mixed Immunization

Infants born to mothers infected with Hepatitis B virus should be treated with Hepatitis B immune globulin and hepatitis B vaccine within 12 hours of birth, with the second and third doses of vaccine given at one and six months of age.

Prophylaxis of Hepatitis D

• Hepatitis D only occurs in those who have hepatitis B

• Hepatitis D virus depends on HBV to develop, all the preventing measures that someone can take are regarding also the prevention against Hepatitis B virus

• So the vaccine against Hepatitis B, prevents both Hepatitis B and Hepatitis D infection

• Unfortunately, there is no vaccine available against the hepatitis D virus for people who are already infected with hepatitis B virus

Thats all.. Thank you so much for visiting & reading.. I appreciate all your support! ^_^
Have a rocking weekend \m/

-ikaN

Vasomotor reversal of Dale

Do you know that a particular neurotransmitter can act on different types of receptors?
So it's not the neurotransmitter but the receptor on which the response depends upon
Hence depending upon the receptor a varied effect is obtained! :O

An awesome example of this is the neurotransmitter adrenaline.
It acts on two types of receptors.. Alpha and beta receptors.
Alpha receptors cause vasoconstriction where as beta receptors mediate vasodilation.
Beta receptors are more sensitive.

So large i.v. infusion of adrenaline causes vasoconstriction which increases blood pressure via the alpha receptors.
But after a while, there is a re-uptake and dissipation of adrenaline.
This decreases the adrenaline concentration.
Which doesn't stimulate the alpha receptors but is enough to stimulate the sensitive beta receptors.
Hence there a secondary fall in blood pressure.

Vasomotor reversal of Dale

So what happens if you block only the alpha receptors?
A fall in blood pressure due to beta mediated vasodilation!
This is known as vasomotor reversal of Dale :D

To be specific, the receptors involved are Alpha 1 and Beta 2 receptors.
You may remember the mnemonic, ABCD, Alpha - Constriction, Beta - Dilation! :D

That's all!

Have an amazing weekend! :)

-IkaN

Updated: Mnemonic on 28 Nov, 2013.
Related posts: Noradrenaline and adrenaline mnemonic

Clotting factors mnemonic

Hello everyone! =D

Clotting factors are substances in the blood that act in sequence to stop bleeding by forming a clot.

Here's a mnemonic to help you remember them ^___^

Clotting factors mnemonic

Fasciculus gracilis and cuneatus

Hey guys.. Let's draw the sensory tracts that are found within the dorsal white column of the spinal cord!
Might as well read about em too ^_^

What I like to do is write down the points with the diagrams [As you guys already know]
So lemme present to you.. my notes! =D

Their primary responsibility is to carry sensory information regarding discriminative senses (viz., proprioception, vibration, stereognosis, and two-point discrimination) to higher centers
I've drawn a feather for fine touch, tuning fork for vibration and closed eye for stereognosis! [In case you didn't understand ^_^ ]
 

Here is the description point wise.. :)

Sensory regions covered by Cuneatus and Gracilis mnemonic
GRAcilis - Walk GRAcefully (Lower extremities and lower trunk)
CunEATus - EAT with your hands (Upper extremities and upper trunk)
Remember: Crude touch is NOT carried by this tract
It is carried by the anterior spinothalamic tract

That's all :)

-IkaN

Sciatic nerve distribution and Sciatica

Hey guys.. I'm gonna tell you about Sciatica today!

But first, lets see a summary of the distribution of the sciatic nerve ^_^

The sciatic supplies nearly the whole of the skin of the leg, the muscles of the back of the thigh, and those of the leg and foot

It is the largest nerve in the body! :O

It has the tibial part which is a ventral division of anterior primary rami of L4 L5 S1 S2 S3 nerves

and the common peroneal part.. the dorsal division of anterior primary rami of L4 L5 S1 S2

[My mnemonic was CD.. Common peroneal - Dorsal division & since C is the 3rd alphabet so its smaller than T which is the 20th letter of the alphabet.. hence it has lesser nerve roots]

Sciatica - The compression or irritation of Sciatic nerve.. which causes pain..

Now how does that happen? :O
It may be due to tumors, pregnancy or infection of muscles [causing inflammation and irritation]
I'll elaborate on spinal disc herniation and Piriformis syndrome :D

Nerves called the spinal nerves or nerve roots, branch off the spinal cord and pass out through a hole in each of the vertebrae called the foramen
Now if you have studied the spinal cord well.. You'll know that the spinal disc are right up against the nerve..
If herniation of disc occurs.. It'll push up against that nerve.. which will create pain that is transmitted all the way down to the sciatic nerve

Also there is a muscle called Piriformis.. which runs from the sacrum to the hip.. in most people muscle is on top of the sciatic nerve.. Which is normal
In some people the nerve pierces the muscle.. which causes compression of the nerve and hence the Piriformis syndrome

Course of Sciatic nerve - Description is pending and will be updated later :)

Diagnosis:
The Straight leg raise, also called Lasegue's sign is done to determine whether the patient has a herniated disk
With the patient lying down on his back.. the examiner lifts the patient's leg while the knee is straight
If pain in the sciatic distribution is reproduced between 30 and 70 degrees passive flexion of the straight leg the test is positive

Tenderness in the area of the sciatic notch indicates Piriformis syndrome



Low back and leg pain? Check Sciatica! :D

That's all!
Thank you so much for reading :)

-ikaN