Tuesday, March 7, 2017

Study group discussion: PGE and congenital heart diseases

We had a discussion on this question on our study group today :)

PGE causes clinical worsening in an infant with?
A. PS without VSD
B. Hypoplastic left heart syndrome
C. Obstructive TAPVC
D. Obstruction in Aorta

Let's work this out - choice by choice!

Acute intermittent porphyria mnemonic

Acute intermittent porphria - AIP - That's the mnemonic!

Asbestosis and Silicosis mnemonics

Here are a few mnemonics to help you not mix these conditions up!

Monday, March 6, 2017

Hyperthermia in Pontine Haemorrhage

Hey guys!

This post will be focused on the pathophysiology of Hyperthermia in Pontine Haemorrhage( which may manifest as the Locked-in Syndrome, remember that super-awesome House episode? <3 )

1. First try the easy simple reason. Hypothalamus has been basically cut off from the body below pons and there has been Haemorrhage. Therefore, there will be a Sympathetic outflow causing peripheral vasoconstriction. Meanwhile the internal visceral organs are still functioning and consequently producing heat. So without hypothalamus, the body's ability to produce heat has transcended it's ability to lose heat.

2. The next reason is a bit "cooler", literally. Our body hates Hypothermia more than Hyperthermia, thanks to evolution. (Ice Age!!!) Now there is no central thermoregulation but peripheral one is still intact. And the peripheral thermoreceptors are much more sensitive to lower temperatures or basically cold environment. Once again, without the Hypothalamus, the body is defending itself too vigorously against Hypothermia as to contribute ironically to Hyperthermia.

3. This reason is the only one which you should know since this will explain how Baclofen, a GABA-B Agonist works to treat this Hyperthermia. Remember the Medial Forebrain Bundle, it connects Hypothalamus to a lot of structures, one of them being Nucleus Raphe in the Pontine reticular formation. This is a very crucial portal in control of Sympathetic nervous system outflow by Hypothalamus. Simply speaking, if the body is hot, Hypothalamus will send inhibitory (GABAergic and Dopaminergic) signals to this nucleus and if the body is cold, it will send excitatory (Glutaminergic and Serotonergic) signals. And apparently this connection is lost in Pontine Haemorrhage, so we substitute it with a drug.

P.S. Now you can guess how Bromocriptine and Apomorphine cause Hypothermia. :)

-VM

Fact of the day: Blood coagulopathies in Familial Hypercholesterolemia

Hello

It is known since long that familial hypercholesterolemia is associated with increased risk of cardiovascular disease as a consequence of atherosclerotic plaques in blood vessels. But Its NOT due  to high cholesterol levels in blood !!

The cause of such consequences lies in genetics. Genetic aberrations in patients with FH include variations in Prothrombin gene which increases coagulation and clot formation. This ultimately blocks the arteries by forming plaques!

Heart patients with FH also have higher concentrations of Fibrinogen and Factor VIII in their blood in addition to other factors, compared to healthy ones.

People with familial hypercholesterolemia tend to live a longer life than those with low cholesterol levels, suggesting a minor role of high cholesterol in pathogenesis of the disease.

However, cholesterol is still associated with other systemic diseases, though recently LDL has been considered 'good' too!


That's all
- Jaskunwar Singh

Sunday, March 5, 2017

Fact of the day: Proton pump inhibitors and osteoporosis

Chronic PPI usage is associated with an increase occurrence of bone fractures, at present, the likely mechanism of this affect, is not at all clear.

The assumed mechanism is that long-term PPI use leads to decreased intestinal absorption of calcium resulting in negative calcium balance, increased osteoporosis, development of secondary hyperparathyroidism, increased bone loss and increased fractures.

An acidic environment in the stomach facilitates the release of ionzed calcium from insoluble calcium salts, and the calcium solubilization is thought to be important for calcium absorption. 

That's all!
Happy studying!
-IkaN

Saturday, March 4, 2017

Facts and Fallacies: Almonds for Migraine

Hello

Some people who suffer from migraine are found to be deficient in magnesium and certain  vitamins. This proves to be one of the factor for causing such attacks!

Almonds are rich in magnesium and vitamin B2 ( riboflavin ) and contain salicin, an anti-  inflammatory agent and ingredient in aspirin. So 10- 12 almonds a day, equivalent to 2 aspirins helps in preventing acute attacks of migraine.

However, for those who are allergic to salicin, almonds may even trigger migraine attacks! Therefore prior testing is important in such cases.

Many recent updates and drugs have become available to treat the attacks but no single one is effective in long- term. For those deficient in magnesium and allergic to salicin,  infuse magnesium sulfate solution i.v.  over 3- 5 minutes.


That's all
- Jaskunwar Singh

Thursday, March 2, 2017

The story of Medicowesome (With Q&A)

Here's the video to the many questions people have asked me till date:
How did Medicowesome start? How do you manage blogging and studying? etc etc.

Pediatric milestones mnemonic

Another awesome video by Shilika!

Fact of the day: Multi- vitamin supplements beneficial for schizophrenics

Hello

Recent studies suggest that high- doses of vitamin B help in reducing the symptoms of schizophrenic patients and those with other neuropsychological disorders, when added to the normal treatment in early stages. (Source)


- Jaskunwar Singh

Wednesday, March 1, 2017