Tuesday, July 27, 2021
Thursday, July 22, 2021
Babeosis mnemonic
Friday, June 25, 2021
Lesch Nyhan syndrome - Mechanisms (Revised post)
Hello friends! Let's refresh our biochemistry knowledge today.
Tetrahydrobiopterin itself is derived by a series of reactions in which GTP cyclohydrolase is a rate-limiting enzyme.
Now HGPRTase deficiency causes depletion of GTP thereby ultimately depleting tetrahydrobiopterin.
In fact, GTP cyclohydrolase mutations are known to cause dopa-responsive dystonia and phenotype similar to Lesch-Nyhan syndrome.
-Kirtan Patolia
Celiac Disease (Spectrum of Manifestations)
Hello friends! I hope all of you are doing well. Today I wanted to share with you the many faces of Celiac Disease. Although considered as the disease which chiefly causes gastrointestinal symptoms, the entire spectrum of possible manifestations it can cause is quite broad.
Some significant associations are as follows:
1.) GI- Enteropathy associated T-cell lymphoma (EATL), Microscopic colitis
2.) Liver- NASH
3.) Spleen- Functional Asplenia (SLE & Amyloidosis being other notable causes)
4.) CNS- Seizures with posterior cerebral calcification, Neuro-psychiatric symptoms, Ataxia
5.) Hematology- Evans syndrome
6.) Pulmonary- Diffuse alveolar hemorrhage
Here is the full spectrum. Hope you like it.
-Kirtan Patolia
Wednesday, June 23, 2021
Tuesday, June 22, 2021
Friday, June 11, 2021
Hormone Basics - Part 1
Hormones are divided into 2 groups
Group 1 hormones- Act via nuclear receptors
Type 1- Have cytoplasmic receptors with effector elements in the nucleus e.g Steroid hormones (cortisol), Gonadal hormones (Androgens, estrogens, progesterones)
Mnenonic- There is only 1 General Secretary
Type 2 -Directly act at the nucleus e,g, vit D,vit A, Thyroxine
Mnemonic-Directly AcT at the nucleus
Group 2 hormones- Act via the cell membrane surface receptors
1. GPCR- Very extensive, will require a second post
2.Tyrosine Kinase- All Growth factors(Except TGF alpha and beta) and Insulin (Tip to remember: TKI or tyrosine kinase inhibitors are used in a lot of malignancies, there's abnormal growth in malignancies and hence TKIs stop that growth, also I in TKI will remind you of insulin, Insulin causes fat to grow!!)
3. JAK-STAT(cytokine receptor) Mr. JAcK is a Drunkard!! all he needs is PEG
Prolactin,
Erythropoietin,
Growth hormone.
(Pro tip: GH and PRL are called as twin hormones, JAK STAT mutations are involved in Myeloproliferative disorders say Polycyathemia and erythropietin is needed there)
4.Serine threonine Pathway: This pathway is a perfect BAIT for the hormones.
Bone morphogenic protein
Activin
Inhibin
Trasformation growth factor alpha and beta
That's all for today!
Have fun and stay safe!
How did you find the post?
Let me know in the comments section below!
Dr. ShilPill
Wednesday, June 9, 2021
IgG4-related systemic disease mnemonic
It is chronic disease characterized by fibrosis and sclerosis of various tissues due to infiltration with lymphocytes that secrete IgG4. Manifestations include sclerosing sialadenitis, retroperitoneal fibrosis, autoimmune pancreatitis, Riedel thyroiditis, tubulointerstitial nephritis, and other fibrosclerotic conditions.
That's all!
Thank you.
Sunday, June 6, 2021
Dengue classification
- Dengue from Harrison’s IM https://youtu.be/MYVxisW4EPw
WHO 1997 classification :
Dengue fever — >2 of the following
●Headache
●Retro-orbital or ocular pain
●Myalgia and/or bone pain
●Arthralgia
●Rash
●Hemorrhagic manifestations (eg, positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis, gum bleeding, blood in emesis, urine, or stool, or vaginal bleeding)
●Leukopenia
Dengue hemorrhagic fever — The cardinal feature of DHF is plasma leakage due to increased vascular permeability as evidenced by hemoconcentration (≥20 percent rise in hematocrit above baseline). In the setting of DHF, the presence of intense abdominal pain, persistent vomiting, and marked restlessness or lethargy, especially coinciding with defervescence, should alert the clinician to possible impending DSS.
According to the guidelines, a DHF diagnosis requires all of the following be present:
●Fever or history of acute fever lasting 2 to 7 days, occasionally biphasic
●Hemorrhagic tendencies evidenced by at least one of the following:
•A positive tourniquet test – The tourniquet test is performed by inflating a blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressures for 5 minutes. A test is considered positive when 10 or more petechiae per 2.5 cm (1 inch) square are observed. The test may be negative or mildly positive during the phase of profound shock. It usually becomes positive, sometimes strongly positive, if the test is conducted after recovery from shock.
•Petechiae, ecchymoses, or purpura.
•Bleeding from the mucosa, gastrointestinal tract, injection sites, or other locations.
•Hematemesis or melena.
●Thrombocytopenia (100,000 cells per mm3 or less) – In healthy individuals, 4 to 10 platelets per oil-immersion field (100x; the average of the readings from 10 oil-immersion fields is recommended) indicates an adequate platelet count. An average of 3 platelets per oil-immersion field is considered low (ie, 100,000 per mm3).
●Evidence of plasma leakage due to increased vascular permeability manifested by at least one of the following:
•A rise in the hematocrit equal to or greater than 20 percent above average for age, sex, and population.
•A drop in the hematocrit following volume-replacement treatment equal to or greater than 20 percent of baseline.
•Signs of plasma leakage such as pleural effusion, ascites, and hypoproteinemia.
Dengue shock syndrome — DSS consists of DHF with marked plasma leakage that leads to circulatory collapse (shock) as evidenced by narrowing pulse pressure or hypotension.
●Rapid and weak pulse.
●Narrow pulse pressure ( ≤20 mmHg) or manifested by: observed early in the course of shock.
•Hypotension for age – observed later or in patients who experience severe bleeding.
Hypotension is defined to be a
- SBP 80 mmHg for those < 5 years of age
- SBP 90 mmHg for those equal to or > 5 years of age.
•Cold, clammy skin and restlessness.
WHO 2009 classification —
Dengue without warning signs —>2 of the following
●Nausea/vomiting
●Rash
●Headache, eye pain, muscle ache, or joint pain
●Leukopenia
●Positive tourniquet test
Dengue with warning signs — any of the following
●Abdominal pain or tenderness
●Persistent vomiting
●Clinical fluid accumulation (ascites, pleural effusion)
●Mucosal bleeding
●Lethargy or restlessness
●Hepatomegaly >2 cm
●Increase in hematocrit concurrent with rapid decrease in platelet count
Severe dengue —at least one of the following :
●Severe plasma leakage leading to:
•Shock
•Fluid accumulation with respiratory distress
●Severe bleeding
●Severe organ involvement:
•Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≥1000 units/L
•Impaired consciousness
•Organ failure
- Sudden high-grade fever (≥38.5°C) Children have high fever but are generally less symptomatic than adults during the febrile phase. The febrile phase lasts for three to seven days, after which most patients recover without complications.
- What is Biphasic fever ("saddleback") ? - 1st febrile phase remits & recurs approx 1 to 2 days later & this 2nd febrile phase lasts 1 to 2 days.
- Serum aspartate transaminase (AST) levels are frequently elevated; the elevations are usually modest (2 to 5 times the upper limit of normal values), but marked elevations (5 to 15 times the upper limit of normal) occasionally occur.
- Between days 3 and 7 of the illness, you must watch for signs of vascular leakage. Corresponding clinical manifestations may include persistent vomiting, increasingly severe abdominal pain, tender hepatomegaly, development of pleural effusions and/or ascites, mucosal bleeding, and lethargy or restlessness; laboratory findings may include a high or increasing hematocrit level (≥20 percent from baseline) concurrent with a rapid decrease in the platelet count
- The vast majority of DENV infections that progress to a critical phase result from secondary infections more than 18 months after the first infection.The critical phase lasts for 24 to 48 hours.
Wednesday, June 2, 2021
Study smarter not harder- Active recall, the foolproof method to ace any test
If I ask an average student about their preferred study strategy the answer most likely would be Highlighting, summarising, and re-reading. Making aesthetically pleasing notes in a myriad of colours may be appealing to many but is passively re-reading already familiar content an effective study strategy?
Two of the most effective study strategies I have come across are active recall and spaced repetition. In this post, I will be talking about the science behind this method. I’ll cover spaced repetition in another post.