PATHOPHYSIOLOGY:
TREATMENT:
To reduce weight, early morning exercise is recommended but question is why?
Let's get back to basics before answering this question.
Body has three sources of blood glucose to maintain level uniformly.
1) Food.
2) Liver Glycogen.
3) Gluconeogenesis.
Now, Liver Glycogen can provide energy for around 12-18 hours. Gluconeogenesis uses lots of energy to maintain blood glucose level. Between dinner and breakfast we have gap of around 12 hours. This mean before taking breakfast liver glycogen stock is null! And body is using now gluconeogenesis to maintain blood glucose level and as you know it's going to take hell lots of ATPs to maintain it. Also, exercise uses lots of energy. Hence both in turn helps in reducing body weight.
What is wrong with evening workout?
Suppose a person has taken lunch around 2 pm and he's working out around 5-6 pm. Which stores will be used by body to maintain glucose level - food obviously! Hardly any Liver glycogen is used up. Also extra food will be stored.
That's all!
-Demotional bloke
Hello!
Here are some quick points + mnemonics on Vasopressin!
1. Effects are preserved during hypoxia and severe acidosis and catecholamine-resistant states.
Mnemonic: Vasopressin presses when other pressors can't press the vasculature anymore.
2. Vasopressin decreases norepinephrine requirement.
3. Onset: fast, offset: fast.
Mnemonic: VasopressIN is IN and OUT fast.
4. It is often weaned off last in patients on multiple pressors for the same reason.
5. Used in:
- Refractory hypotension (potentiates the actions of over vasoconstrictors)
- Esophageal variceal bleed
- Cardiac arrest
Non ICU indications: vWD, DI, hemophilia
That's all!
-IkaN
Hello, let's dissect fat necrosis in this post.
Fat necrosis is seen where fat concentration is more or lipase concentration is more.
Example- Injury to Breast or Omentum tissue or in Acute pancreatitis with gall stones or alcohol intake.
Alcohol intake leads to activation of lipase enzyme. This lipase enzyme converts lipids to fatty acids. Always remember fatty acids loves calcium! This love affair leads to formation of "Fatty acids - Calcium complex formation". This is called as "Saponification".
This gives yellow - white chalk like color. This helps surgeon to identify fat necrosis.
For prognosis we use serum calcium level. Why?
Suppose there is severe pancreatitis. This leads to more activation of the lipase enzyme. This leads to formation of the fatty acids. More fatty acids, more saponification. Hence less calcium level in serum!
Low calcium level suggest bad prognosis!
Hello! This is Ultra short post regarding Chediak higashi syndrome! Hope you like it.
In normal person, when bacteria is engulfed by WBCs, they are carried to lysosome enzyme by LYST protein.
LYST protein stand for Lysosomal transfer protein.
Defect in LYST protein causes Chediak Higashi syndrome. It is autosomal recessive disorder.
No LYST protein so no phagocytosis of macrophages. Hence recurrent infections.
Clinical features:
1) Recurrent infections.
2) Absence of Melanin - Albinism.
LYST also helps in transfer of melanin to superficial layer of skin
3) Decrease in Myelin formation - Delayed conduction.
4) Hemorrhage.
LYST helps in maturation of megakaryocytes to platelets.
Confirmation: Incomplete digestion of bacteria leads to formation of "Giant granules inside cell"
Mnemonic:
CHEDIAK
C- CNS involvement
HE- Hemorrhage
DI- Decrease immunity
A-Albinism
That's it!
-Demotional bloke.
Hallux valgus is also known as bunion. T or F
T
●Hallux valgus (HV) deformity (ie, bunion) is a common, potentially debilitating deformity consisting of lateral deviation of the hallux on the first metatarsal . The etiology is unknown. The deformity is more common among women and shod populations.
●Although HV is easily recognized by clinical examination, radiographs may be necessary to determine the presence of articular damage . Neither radiographic nor clinical appearance provides the basis for surgical referral, which is determined by patient pain and disability.
●There is little evidence that conservative treatments are useful in the treatment of HV. Nevertheless, we suggest patients without debilitating symptoms avail themselves of conservative therapies before being referred for surgery.
Possible treatments include:
•Shoe modification: wide, low-heeled shoes, or specially altered shoes with increased medial pocket for first metatarsophalangeal (MTP) joint to minimize deforming forces
•Orthoses to improve support and alignment
•Night splinting to improve toe alignment
•Stretching and/ormobilization/manipulation to maintain joint mobility
•Medial bunion pads to prevent irritation
•Ice applied after activity to reduce inflammation
•Analgesics: acetaminophen or NSAIDs
●We suggest that patients with severe pain or dysfunction and those whose symptoms do not improve under a conservative treatment regimen be referred for surgical repair.
Approximately 150 surgical procedures for the correction of HV deformity have been described. Few prospective, randomized trials evaluating these procedures have been performed. Patients should be referred to a foot surgery specialist with experience repairing HV deformity.
●Managing patient expectations about surgery is important. Patients should understand that 10 to 25 degrees of valgus angulation is normal at the MTP joint, and that resolution of postoperative pain and swelling may require several months. Most patients will remain unable to fit into narrower shoes.
Do not forget to look up pictures of how a bunion looks.
Over and out.
Atropine poisoning is also called as Anti-muscarinic poisoning.
It is caused due to ingestion of :-
1) Datura plant
2) Atropa belladona
3) Hyoscyamus
4) Anti-histamine drugs
5) Anti-psychotic drugs
6) Anti-depressants like TCA
7) Anti-Parkinsonism
Clinical features:
Let's go from head to toe!
1) Brain:
Atropine causes following symptoms
-Hallucinations
-Confusion
-Delirium
Also called as Mad as hatters!
Remember: Atropine drives you crazy!
2) Eyes:
AcH causes constriction of pupils. No or less AcH causes Mydriasis
Fun fact 1: In ancient times, women used to apply Atropa belladona in eye for attracting men by dilating pupil.
Fun fact 2: Most of the dinner dates are candle night dinner, why? To dilate pupils and look attractive.
Also described as "Blind as a bat"
Remember: Atropine makes you look seductive!
3) Eyes and Mouth:-
AcH is responsible for secretion of saliva and tears.
Lack of AcH action causes - Dry mouth and Dry eyes.
Also described as "Dry as a bone"
Most common feature in Adults.
Remember: Atropine Dries you!
4) Face:
AcH causes constriction of blood vessels. Atropine blocks this action and hence causes dilation of the blood vessel. Hence this causes flushing of face.
Also described as - Red as a beet.
Remember: Atropine makes you blush!
5) Body temperature:
AcH is responsible for secretion of the glands. Lack of secretion causes decrease or no cooling effect. Hence it causes-Hyperthermia.
Also described as - Hot as a hare
Most common feature in children.
Remember: Atropine makes you hot!
Most common cause of death is Respiratory paralysis.
Next common is Shock.
I remember all this feature with the help of story:
I went on a candle night dinner with hot girl. Ofcourse, she was blushing because I'm crazy to have dry resins after dinner! (Okay that's lame and I know!)
Key points:-
Candle night dinner - Mydriasis
Hot-Hyperthermia
Blushing-Flushing of face
Crazy-Deliruim, Hallucination and confusion
Dry resins-Dry secretion
Treatment:
1) Supportive treatment:
Gastric lavage using Tannic acid : To remove unabsorbed poison. Avoid potassium permagnate.
Forced acidic diuresis: Because Atropine is an alkaline drug
Seizures are treated by Diazepam
Patient is kept in dark quiet room-To avoid hallucination.
Ice bags given to treat maintain temperature.
2) Antidote: Physostigmine since it crosses BBB.
That's it
-Demotional bloke.