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.

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.

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 !

Colles' fracture

Hey Awesomites! Today I am gonna talk about Colles' fracture (a short post).

"It is an extra-articular fracture of the distal metaphyseal region of the Radius (at its cortico-cancellous junction) with dorsal impaction and angulation, caused due to a fall on outstretched hand (FOOSH) resulting in displacement of the fractured part of bone distally as well as radially."

Fall on outstretched hand resulting in displacements seen in Colles' fracture

Note that there is dorsal angulation and impaction in Colles' fracture as opposed to volar angulation in Smith's fracture, when seen in X-ray (AP and lateral views).

Displacements seen in Colles' fracture mnemonic- SLID
- Supination
- Lateral shift and tilt
- Impaction of bone fragments
- Dorsal shift and tilt.

Clinical features: mnemonicise the features here.

Dinner Fork deformity- Normally the styloid process of radius is at a lower level than the ulnar styloid. In Colles' fracture, the dorsal displacement and impaction of Radius results in shortening of the bone and places the radial styloid at the same level or a little higher than the ulnar styloid. Hence the patient presents with such a deformity resembling a dinner fork.

Thats all
- Jaskunwar Singh

Churg Strauss Syndrome

Hello awesomites, I am kind of obsessed with fancy syndromes. So here is one of them.

Churg Strauss Syndrome (CSS) also known as Eosinophilic granulomatosis with polyangitis or allergic granulomatosis.
It is a rare  autoimmune condition, that causes inflammation of small and medium sized blood vessels.

Manifests in 3 stages-
Early stage (Prodromal stage) : Present as
Asthma or
Allergic Rhinitis
Sometimes with nasal polyps and sinusitis
(Remember 'A'  is the first letter, so it should always come first)

Second stage : Abnormally increased eosinophils= Hypereosinophilia
Which causes tissue damage mostly lung and digestive tract.
Manifestations are Night sweats, weight loss, cough, abdominal pain, GI bleeding, fever, purpura

Third stage: vasculitis- which leads to infarction which further leads to atrophy
Further progression leads to complications.
But not all patients develops all three stages, or progress in the same order.

Pathophysiology - Its a Autoimmune disorder where different cell types are responsible for immune response especially Eosinophils, T&B cells, endothelial and epithelial cells. Mainly it is Th2 mediated reaction.

Complications can be life threatening -
(Most Grievous)
M- Myocardial involvement is the most common complication and most common cause of death in CSS patients
G- GI bleeding, GI perforation, Glomerulonephritis, Glomerulosclerosis,
Granulomatous appendicitis

Treatment - Conventional treatment includes glucocorticoids like Prednisolone and immuno suppressive drugs like Azathioprine, cyclophosphamide.
Newer drugs direct against specific cytokines like mepolizumab have additional steroid sparing property angood tolerability. Use of  Rituximab is under investigation and limited to few cases.

That's all.  :)

Galeazzi fracture- dislocation

This is a counterpart of Monteggia fracture- dislocation.
It also has two components: Fracture of distal- third of Radius and dislocation of the distal radio- ulnar joint. Mnemonicise it from here.

The mechanism of injury is the same as in Monteggia fracture and dislocation (fall on an outstretched arm causes an axial load on a hyperpronated forearm; Hyperpronation injury). The more distal the fracture, greater are the problems encountered in wrist and hand movements and more are the deforming forces that cause muscular and soft- tissue injuries.

A must to mention here is about Anterior Interosseous nerve (AIN) palsy and Wrist drop.

A patient with Galeazzi fracture and dislocation may present with the AIN palsy (while PIN is common in case of Monteggia fracture and dislocation) that may cause paralysis of flexor policis longus and flexor digitorum profundus thus resulting in a loss of pinch mechanism between thumb and index finger.

Wrist drop may also be a presenting complaint that results from an injury to the radial nerve and also due to weakness of brachioradialis and extension of wrist and thumb. The patient cannot bear the weight of the hand.

Diagnosis:- X- rays of forearm (AP and lateral view)

Treatment:- Complete reduction and fixation is important to restore the functions of limb. Galeazzi fracture and dislocation is best treated with Open Reduction and Internal fixation (ORIF). In children, closed reduction is the procedure of choice due to skeletal immaturity.

Monteggia fracture- dislocation

Monteggia fracture- dislocation has two components- fracture of upper- third part of ulna (bone of medial side) and simultaneous dislocation of proximal part (the head) of Radius. Check out the mnemonic to memorise it here.

The injury is caused by a fall on an outstretched hand with the forearm forced into excessive prone position (hyperpronation injury).

Types of Monteggia fracture and dislocation (Bado's classification) :-
Type I- Extension type- Angulation of proximal part of ulna anteriorly and dislocation of the head of Radius anteriorly. This type is seen in 60% patients.

Bado type I lesion (most common)

(Note- Posterior Interosseous nerve may get paralysed in Monteggia fracture and dislocation that is a result of anterior radial head dislocation in type I of Bado, unless reduced by manual pressure).

Type II- Flexion type- Fracture of proximal part of ulna and posterior dislocation of radial head.
Type III- Lateral type- Fracture of ulnar metaphysis and dislocation of head of Radius laterally.
Type IV Combined type Fracture of ulnar as well as radial shafts with dislocation of radial head anteriorly.


Diagnosis of Monteggia fracture and dislocation:- Check for both components- the fracture as well as displacement coz there could be an isolated fracture of ulna as due to nightstick injury.
X- rays of the forearm (Antero-posterior and lateral view) are diagnostic.

Treatment- Conservative management in children with closed reduction (resetting of bones and casting) accompanies the high risk of displacement thus causing malunion.
Standard treatment procedure in Monteggia fracture and dislocation is Osteosynthesis of the ulnar shaft (Open Reduction and Internal fixation) in children as well as adults to improve stability of the radio-ulnar joint and mobilise so as to prevent stiffness.


Thats all
- Jaskunwar Singh

Aminoglycoside made easy, simplified and decoded!

Hey everyone!
In this post, I write about everything about Aminoglycosides antibiotic in Mnemonic form :)

Potter syndrome mnemonic

Hey wait its not the Harry potter syndrome or sequence ;p
The term was first coined by Edith Louis Potter but it's a misnomer and more of a Potter sequence or the Oligohydramnios sequence. So here's the mnemonic of some of the clinical features: POTTER

P- Pulmonary hypoplasia
O- Oligohydramnios
T- Twisted face (Potter facies)
T- Twisted skin (wrinkly skin)
E- Extremity (limb) defects
R- Renal agenesis (bilateral)


That's all
- Jaskunwar Singh

Occupation and Ophthalmology : Clinical Pearl

Hello everyone.
I'm back with another ophthalmology post. This one is more of a clinical post , something that would be important to you in any specialty! Hope you like it. :)

So our life is all about being a successful doctor at the moment. Cause we wanna be good at our jobs !
Everyone wants to succeed at the work place. But there are loads of occupational hazards or diseases that we end up acquiring or aggravating due to the kind of job we do.

In this post I'll be talking to you about what ocular diseases can occur in Association with certain occupations.

1. Pterygium
- Occur commonly in farmers, driving school teachers and construction workers.
- Due to  exposure to sunlight for a long duration of time.

2. Fungal corneal ulcer or other fungal infections of the eye
- can occur commonly in farmers again. Because they are at a higher risk of vegetative trauma

3. Computer vision syndrome :
- seen in people working with electronic devices on an extensive level.
- the complains include dry eye , headache , eye strain , neck and shoulder aches.
- Simple tip for prevention - called the 20 20 20 rule.
Every 20 minutes look away from the screen for at least 20 seconds at an object about 20 feet away.
- Frequent blinking.
- Use of Lubricant for the eye.
- Use of anti glare screen/ spectacles.

4. Miner's nystagmus :
- seen in coal workers.
- Photophobia and night blindness may accompany the Nystagmus.

5. Glass blower's cataract :
- Occurs in glass makers.
- infrared rays cause damage to the lens producing this kind of cataract.

6. Welder's flash :
- seen in welders.
- It's a form of Photokeratitis
- Occurs due to UV rays
- causes abrasion , conjunctivitis and eye strain.

That's all for today !
Hope this helped.
Stay awesome !

~A.P.Burkholderia

Glycogen Storage Diseases : Mnemonic

Hi everyone.
I'm back with a short post. This one is about Glycogen storage diseases which, again,  we all hate to remember  :'D Hope you like it.

So Remember :

Very Pompously CAMe Her Tears.

1. Very =  Von Gierke's
2. Pompously = Pompe's
3. C = Cori's / Forbe's 
4. A = Anderson
5. M = McArdle's
6. Her = Her's (we'll at least Remember this one :'D)
7. Tears = Tarui's

So that's that.
Now how do we remember which is Muscular and which is hepatic ?
Simple.

Remember :
The Muscular get kissed under the Mistle Toe.

So the ones involving the Muscles are :
Mistle = McArdle
Toe = Tarui's.

Also remember :
Pompeii the city was a wh*re. So it went everywhere and hence Pompe's is both Muscular and Hepatic.

That's all for now. It may seem like a lot of crap to simply memorize these Glycogenosis but you'll realise they form an excellent aid for memory :D and are super important whether you want to do USMLE or Indian PG.
So c'mon ! Burn those Glycogens in your liver and get some Glucose into your head ;)
Stay awesome.
Happy studying.

At risk babies criteria mnemonic

Hey Awesomites

How do we define and on what basis do we label a newborn as an "at risk baby"? Well, it is very important to make a right approach to the risks and factors which affect the health of a newborn. So I just mnemonified the factors in a very simple way. Just remember the words: RISK APPROACH 

R- Referral weight- check for the weight of the baby. It should not be less than 70% of the referral weight (taken to be approximately 2500g), i.e. a newborn less than 1800g body weight must be referred to a paediatric health care centre for further investigation.
I- Insufficient breastfeeding- check for maternal and infant factors affecting the supply of milk.
S- Spacing (between subsequent pregnancies) less than 2 years
K- Kilograms of weight loss during first 2 months after birth- 5-10% weight loss in the first 10 days of life in a breastfed baby is normal. Investigate into the matter if the baby loses excess weight.
A- Acute episodes of illness (congenital or environmental factors)
P- Plural birth (or twin birth) or Premature birth
P- Parental illness is a must to check to determine risk of inherited disorders and illness in the newborn.
R- Raised birth order (five or more)
O- One parent
A- Active mother- Ask about her occupation and if she is working and about her lifestyle.
C- Constant failure to gain weight during the first few months of life
H- History of previous pregnancy and death of any sibling, if any must be taken into consideration.


Thats all
- Jaskunwar Singh

The GLUT's : Mnemonic

Hello everyone !
I'm back with another short post on biochemistry.
It's about the Glucose transporters which we all hate :D So let's get down to it.

GLUT - Short for Glucose Transporters , are channels present in our body that bring about glucose uptake. They are forms of Facilitated transport mechanism and basically occur across a Concentration gradient.

Now it's important for us to understand their location , function and regulation if we want a good understanding of Glucose metabolism. But this can get a little tedious , hence this post.

There are a total of 4 major GLUTs. Out of which one is dependent on insulin and the others are not.
So first we're doing insulin independent ones.

Remember :

BBB
Kid's LiPs are
PiNK.

~~~~~

GLUT 1 -
Remember : BBB.

B - Blood ( The RBCs)
B - Baby  (So fetal tissue)
B - BBB ( The Blood brain barrier itself )

~~~~~

GLUT 2 -
Remember :  Kid's LiPs

Kid's - Kidneys
Li - Liver
Ps - Pancreatic Beta cells

~~~~~

GLUT 3 -
Remember : PiNK

Pi - Placenta
N - Neurons
K - Kidneys

_____________________________
Now we come to the Dependent one.
~~~~~
GLUT 4 -
Remember :
Father Mother Depend.

Father - Fat
Mother - Muscles ( Cardiac / Skeletal)

Now how do we remember this ?
In general the Mother and Father are who we depend on ! But in biochemistry the mother and father themselves depend on insulin. ! And the baby ( BBB etc) are independent.

Got it ?
Hope this helped.
It's something I've struggled with.
Anyway.
Happy studying. !
Stay awesome

~A.P.Burkholderia

Electronic Fetal Heart Rate monitoring interpretation (VEAL CHOP mnemonic)

Hello!

So do you guys know about the VEAL CHOP mnemonic?

Variable decelerations - Cord compression
Early decelerations - Head compression
Accelerations - Oxygenation
Late decelerations - Placental insufficiency

Well, it has one kind of periodic FHR change pattern missing. That's the sinusoidal pattern associated with fetal anemia!

For those who don't know, let's run through them quickly :)

Step 2 CK: Screening for Gestational Diabetes Mellitus (GDM)

Hello!

As you guys already know, GDM diagnosis can be accomplished with either of two strategies:
“One-step” 75-g OGTT or “Two-step” approach with a 50-g (nonfasting) screen followed by a 100-g OGTT for those who screen positive.

But what if, in the exam, you are asked to choose a screening test for GDM...
And the options contain both:
- One hour 50 gram glucose load test (1-h 50-g GLT)
- Two hour 75 gram oral glucose tolerance test (2-h 75-g GTT)
... Then which one do you choose?

Niemann-Pick disease notes and mnemonic

Hello!

Niemann-Pick disease (NPD; also called sphingomyelin-cholesterol lipidosis) is a group of autosomal recessive disorders associated with splenomegaly, variable neurologic deficits, and the storage of sphingomyelin.

The Burkholderian Culture : From the Authors' Diary

Hello everyone ! I'm A.P.Burkholderia , and I'm back with another post

Now a lot of people have been asking me why my name is that. Some have assumed it's my actual surname (Like our very own IkaN, but that's a whole 'nother story) while others have unraveled the mystery of the Burkholderian terminology (Like the ardent PSM-proponent Jay ). So before any more of you are boggled by this Burkholderian business I figured let's talk about why this organism is fancy enough to earn the charm of being my pen-surname. :P

So Burkholderia is a Gram negative rod. And it is one of a kind - Cause It's a Non Fermenter ! So if you were to make a TSI plate it would give you alkaline in the slant as well as the butt (LOL). Only few other organisms like Pseudomonas and Acinetobacter are non fermenters. So it's a total Aerobe and it can be checked with "High and Leifson Oxidation Fermentation media". Another cool name :D 

It's got 3 different types : 

B. cepacia 

B. mallei 

B. pseudomallei.

Now I love how it's called "Mallei". In Hindi 'Malai' means 'Milk Skin'. I find that hilarious. 

Also, 'Mai Lai' means 'I shall bring '. I find that really funny too. ( Burkholderia , Main Laiii !)

But other than that , it's a pretty serious bug. 

It causes Cepacia syndrome in Cystic Fibrosis,  which presents as a form of Bronchiectasis or Serious pneumonia. 

It can cause Meiloidosis which has a presentation similar to TB and another one called 'Glanders'. 

It shows a safety pin appearance when seen under the microscope on staining with Geimsa. 

Other than this , it's a very hard big to get rid of. 

It's almost resistant to all antibiotics and only the Carbapenems may work ! 

So this is why I love this bug. 

It's cool , it's classy and it's hard to get. :p 

Other than that , I love saying the name! *Burkholderia* 

I might do a video some day on this :p and how to say it right. 

Till then , Ciao! 

Stay awesome. 

*Burkholderia out*

Top 10 series: Digoxin