Monday 29 July 2013

Drug of choices for flukes and roundworms infestations

********Flukes (trematodes)--> Drug of choice*************

Schistosoma haematobium(bilharziasis)
Schistosoma mansoni
Schistosoma japonicum
Clonorchis sinensis (liver fluke);opisthorchis species
Paragonimus westermani (lung fluke)
Fasciolopsis buski (large intestinal fluke)
Heterophyes heterophyes; Metagonimus yokogawai (small intestinal flukes)--- For all DOC is Praziquantel

****************************************************

********Roundworms (nematodes)--> Drug of choice********

Taenia solium,Taenia saginata--> Praziquantel

Ascaris lumbricoides (roundworm)--> Albendazole or pyrantel
pamoate or mebendazole

Trichuris trichiura (whipworm)-->Mebendazole or albendazole

Necator americanus (hookworm);
Ancylostoma duodenale (hookworm); Trichostrongylus species--->Pyrantel pamoate

Strongyloides stercoralis (threadworm);Onchocerca volvulus (onchocerciasis)--> Ivermectin

Enterobius vermicularis (pinworm)--> Mebendazole or pyrantel
pamoate

Trichinella spiralis (trichinosis)--> Mebendazole

Cutaneous larva migrans (creeping eruption)-->Albendazole or ivermectin

Visceral larva migrans; Capillaria philippinensis (intestinal
capillariasis)-->Albendazole

Angiostrongylus cantonensis -->Thiabendazole

Wuchereria bancrofti (filariasis);
Brugia malayi (filariasis); tropical
eosinophilia; Loa loa (loiasis)--->Diethylcarbamazine

Dracunculus medinensis (guinea worm)-->Metronidazole

Thursday 4 July 2013

Selected Examples of Human Chemical Carcinogenesis

BCME = Bis chloromethyl ether; HBV = hepatitis B virus; 4-ABP = 4-aminobiphenyl; ALL = acute lymphoblatic leukemia.

Best mnemonic for Biological transmission

"P"ropagative--> the agent merely "P"ropogates(multiplies) in vector, but no change in form eg: "P"lague

"C"yclo"P"ropagative--> the agent "C"hanges in form and "P"ropagates (e.g Malaria parasite in mosquito) "CPM"

"C"yclo-"D"evelopmental--> Agent undergoes only "D"evelopment but no multiplication eg. "D"racunculiasis, microfilariasis

Wednesday 3 July 2013

Caroli's Syndrome:

Abnormal saccular dilatation of the intrahepatic biliary tree,usually affecting the whole liver. Extrahepatic biliary tree is affected in one quarter of the patients.

Signs include recurrent cholangitis {fever,chills,pain(if gallstone present)}. Hepatic abcess may b also there.

Complications include hepatic stone and cholangiocarcinoma.

Cholangitis may b treated with Antibiotics. Partial ressection and hepatic transplantation may b required.

Monday 6 May 2013

How to differentiate Bronchial Asthma and Chronic obstructive pulmonary disease (COPD)


Chronic obstructive pulmonary disease (COPD) refers to a group of lung diseases that block airflow and make breathing difficult.
Emphysema and chronic bronchitis are the two most common conditions that make up COPD. Chronic bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs. Emphysema occurs when the air sacs (alveoli) at the end of the smallest air passages (bronchioles) in the lungs are gradually destroyed.

Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Common symptoms include wheezingcoughing, chest tightness, and shortness of breath.

References: 
^ NHLBI Guideline 2007, pp. 11–12
                   
http://www.mayoclinic.com/

Saturday 4 May 2013

Cephalosporins classification:


Cephalosporins classification:
  • I generation - parenteral: Cefazolin, oral: Cefalexin, Cefadroxil. Active against Streptococcusspp. (S.pyogenes, S.pneumoniae) and methicillin resistant Staphylococcus spp.
  • II generation parenteral: Cefuroxime, oral: Cefuroxime axetil, Cefaclor. Active against Streptococcusspp., Staphylococcus spp, Neisseriaspp., E.coli, Shigellaspp., Salmonellaspp., P.mirabilis, Klebsiellaspp., P.vulgaris, C.diversus
  • III generation parenteral: Cefotaxime, Ceftriaxone, Ceftazidime, Cefoperazone, Cefoperazone/Sulbactam, oral: Cefixime, Ceftibuten. Active against Streptococcus spp., S.aureu, exceptMRSA,meningococci, gonococci, H.influenzae, M.catarrhalis, Enterobacteriaceae
  • IV generation parenteral: Cefepime. Active against Enterobacter spp., C.freundii, Serratiaspp., M.morganii,P.stuartii, P.rettgeri.
  • V generation: Ceftobiprole, Ceftaroline

    Reference: J Am Pharm Assoc, Pharmacists Association:

Monday 29 April 2013

DIAGNOSTIC CRITERIA OF MULTIPLE MYELOMA

DIAGNOSTIC CRITERIA OF MULTIPLE MYELOMA :

Major:
1.PLasmacytoma
2.Bone marrow plasmacytosis >30% of plasma cells
3.Monoclonal globin spike IgG > 35/L, or IgA >20g/L
4. Light chain excretion on urine electrophoresis > 1g/24hours

Minor:
1.Bone marrow plasmacytosis, 10-30% plasma cells
2.Monoclonal globulin spike, IgG < 35 g/l or IgA <20g/L
3. Lytic bine leaions
4. NOrmal IgM < 500mg/L, IgA < 1g/L or IgG < 6g/l

Criteria 
1. 1 major and 1 minor
or 
2. 3 minor that should include 1 and 2 of minor criteria.

Reference: Harrison's Principles of Internal Medicine 18th Edition

Differential diagnosis of dementia


Flow diagram for the differential diagnosis of dementia.



The percentage contributions of various diagnoses
are approximate. *The list of secondary causes of dementia
is not exhaustive.
CNS = central nervous system;
CSF = cerebrospinal
fluid;
MR = magnetic resonance imaging.
 

Framingham Criteria for Congestive Heart Failure


Framingham Criteria for Congestive Heart Failure
Diagnosis of CHF requires the simultaneous presence of at least 2 major criteria or 1 major criterion in conjunction with 2 minor criteria.
Major criteria:
·        Paroxysmal nocturnal dyspnea
·        Neck vein distention
·        Rales
·        Radiographic cardiomegaly (increasing heart size on chest radiography)
·        Acute pulmonary edema
·        S3 gallop
·        Increased central venous pressure (>16 cm H2O at right atrium)
·        Hepatojugular reflux
·        Weight loss  >4.5 kg in 5 days in response to treatment

Minor criteria:
·        Bilateral ankle edema
·        Nocturnal cough
·        Dyspnea on ordinary exertion
·        Hepatomegaly
·        Pleural effusion
·        Decrease in vital capacity by one third from maximum recorded
·        Tachycardia (heart rate>120 beats/min.)
Minor criteria are acceptable only if they can not be attributed to another medical condition (such as pulmonary hypertension, chronic lung disease, cirrhosis, ascites, or the nephrotic syndrome).
The Framingham Heart Study criteria are 100% sensitive and 78% specific for identifying persons with definite congestive heart failure.
Reference:
  1. McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: theFramingham study. N Engl J Med. 1971 Dec 23;285(26):1441-6. [Medline]

Reid index


The Reid index is a pathological measurement of mucosal gland proliferetion in chronic bronchitis.

Assessed by comparing the thickness of the mucous glandular tissue verses the distance from epithelium to the level of cartilage.

An index of < 0.4 is considered to be within normal limits.

A greater value is the most pathognomonic indicator of chronic bronchitis.

Stomach cell types and substance secreted


Wednesday 17 April 2013

Bone within Bone appearance

Bone within Bone appearance: Sickle cell anemia, Osteopetrosis.


Courtesy: DAMS 

CHROMOSOMES AND ASSOCIATED DISORDERS



Chromosome 1: Rh system / neuroblastoma
Chromosome 2: Cystinuria/hypobetalipoproteinemia
Chromosome 3: RCC/ALKAPTONURIA
Chromosome 4: Huntingtons chorea/achondroplasia/parkinsons disease 
Chromosome 5: FAP/colorectal carcinoma/cri-du-chat syndrome
Chromosome 6: HLA system(short arm) /MHA antigen/DM
Chromosome 7: Cystic fibrosis
Chromosome 8: Osteoporosis
Chromosome 9: ABO blood group / friedreich’s ataxia
Chromosome 10: Apert syndrome Charcot-Marie-Tooth disease Charcot-Marie-Tooth disease, type 1 Charcot-Marie-Tooth disease, type 4 Cockayne syndrome congenital erythropoietic porphyria Cowden syndrome Crouzon syndrome Hirschprung disease multiple endocrine neoplasia type 2 Pfeiffer syndrome porphyri Usher syndrome Usher syndrome type I Wolman syndrome
Chromosome 11: Sickle cell anaemia/beta thallasemia/wilms tumour/MEN -1/ataxia telengiectasia/human insulin gene/PTH gene
Chromosome 12: PKU/vWF/CA testes
Chromosome 13: Retinoblastoma/osteosarcoma/wilsons ds
Chromosome 14: Familial HOCM/ alpha 1 antitripsin deficiency
Chromosome 15: Marfan’s syndrome/albinism/pradder willi syndrome/angelman syndrome
Chromosome 16: Alpha thallasemia/adult PKD
chromosome 17: Carninoma breast(BRCA1)/medulloblastoma/neurofibromatosis-1/ovarian tumour/ P 53 gene
Chromosome 18: Erythropoietic protoporphyria hereditary hemorrhagic telangiectasia Niemann-Pick disease/Type C porphyria Selective Mutism Edwards syndrome (Trisomy 18)
Chromosome 19: Myotonia dystrophica/gene for insulin receptor
Chromosome 20: MODY type 1 DM/prions disease
Chromosome 21: Homocystinuria/amyloidosis…folic acid transport..
Chromosome 22: Meningioma/acoustic neuroma/NF -2/Di-George syndrome
Chromosome Xq: Gene for androgen insensitivity syndrome/ fragile X syndrome/ Testicular feminisation/ X-SCID/ X linked agaamaglobulinemia/ Fabry ds/ Lesch- Nyhan/ Hemophilia B/ Hemophilia A/ Hunter syndrome/ G6PD deficiency
Chromosome Xp – Ocular albinism/ Chr Granulomatous Ds/ DMD/ Menkes syndrome

Image Courtesy: topnews.in

Tuesday 16 April 2013

DINNER FOR MEDICAL STUDENTS!


Pseudogout


The xanthine oxidase inhibitor allopurinol


The xanthine oxidase inhibitor allopurinol is by far the most commonly used hypouricemic agent and is the best drug to lower serum urate in overproducers, urate stone formers, and patients with renal disease. It can be given in a single morning dose, 100–300 mg initially and increasing up to 800 mg if needed. In patients with chronic renal disease, the initial allopurinol dose should be lower and adjusted depending on the serum creatinine concentration.

Musculoskeletal Manifestations of Crystal-Induced Arthritis


Monday 8 April 2013

IHS diagnostic criteria for Migraine


In 1988 the International Headache Society published criteria for the diagnosis of a number of different headache types . Those for some of the common headaches are reproduced below for migraine with and without aura, cluster headache, tension-type headache, and cervicogenic headache.

11 Health Benefits of Pomegranate Juice~


1)Fights Breast Cancer

Studies in Israel show that pomegranate juice destroys breast cancer cells while leaving healthy cells alone. It may also prevent breast cancer cells from forming.

2) Lung Cancer Prevention
Studies in mice show that pomegranate juice may inhibit the development of lung cancer.

3) Slows Prostate Cancer
It slowed the growth of prostate cancer in mice.

4) Keeps PSA Levels Stable
In a study of 50 men who had undergone treatment for prostate cancer, 8 ounces of pomegranate juice per day kept PSA levels stable, reducing the need for further treatment

5) Protects the Neonatal Brain
Studies show that maternal consumption of pomegranate juice may protect the neonatal brain from damage after injury.

6) Prevention of Osteoarthritis
Several studies indicate that pomegranate juice may prevent cartilage deterioration.

7) Protects the Arteries
It prevents plaque from building up in the arteries and may reverse previous plaque buildup.

8) Alzheimer's Disease Prevention It may prevent and slow Alzheimer's disease. In one study, mice bred to develop Alzheimer's disease were given pomegranate juice. They accumulated significantly less amyloid plaque than control mice and they performed mental tasks better.

9)Lowers Cholesterol
It lowers LDL (bad cholesterol) and raises HDL (good cholesterol).

10) Lowers Blood Pressure
One study showed that drinking 1.7 ounces of pomegranate juice per day lowered systolic blood pressure by as much as 5 percent.

11) Dental Protection
Research suggests that drinking pomegranate juice may be a natural way to prevent dental plaque.

Wednesday 3 April 2013

ECG CHANGES IN CHAMBER HYPERTROPHIES/ENLARGEMENTS


CHAMBER HYPERTROPHIES/ENLARGEMENTS ::

LEFT ATRIAL ENLARGEMENT
-- Left atrium forms the later part of the P wave. Hence enlargement of left atrium will produce an increase in the duration of the P wave, as well as delayed depolarization leading to "Double peaks" in P wave
-- Also called " P - mitrale "
-- This is evident very clearly in Chest leads 
-- P wave is generally > 120 ms
Image : LAE ... typical "bipeaked " P mitrale
 







RIGHT ATRIAL ENLARGEMENT

-- Right atrium forms the initial part of the p wave... hence Right atrial enlargement will produce Peaked/Tall P wave, and not widen the duration of P wave.
-- Refered to as P - pulmonale
-- Tall peaked P wave is seen in lead II and many leads (especially in right precordial leads) 
-- P wave is Pointed
-- Usually > 2.5 mm

Monday 1 April 2013

Normal CT Scan:

Normal CT Scan:

It is worth spending a few minutes familiarising yourself with the appearances of a normal CT scan. It is much easier to detect abnormalities once you are accustomed to normal appearances. The scan below is a slice through the human brain and you should imagine that you are viewing it as if looking up from the patient's feet. Therefore, the patient's left is to the right of the screen. The shape of the ventricles is quite distinctive and they are shown outlined in green and orange. The presence of the third ventricle in the midline is one of the first things to look for. If the third ventricle is either not visible, or shows signs of shift away from the midline, this suggests that there is an abnormality. The basal cisterns is the fluid filled space around the back of the midbrain outlined here in purple. Blood clots, or swelling of the brain may cause this to become narrowed, or not visible altogether. Note in this scan, that the frontal horns of the lateral ventricles are symmetrical, with the septum between them in the midline.

Sunday 31 March 2013

Respiratory System examination

Here's a summary of salient features of
Respiratory System examination in common chest conditions. 

This is a simple guide for students during examination and in actual patient management. Remember, no investigation substitutes for a thorough clinical examination. 

HOLT ORAM SYNDROME

HOLT ORAM SYNDROME

BACKGROUND: Also called as heart-hand syndrome, is an inherited disorder, first described in 1960 by Holt and Oram in a 4 generation family with ASD and thumb abnormalities
GENETICS: Autosomal dominant inheritance with complete penetrance. Due to mutations in TBX5 on long arm of chromosome 12, which is important in development of heart and hand
Clinical features:
Hand defects: Always present. Includes carpal bone fusion, absent radius, absent or triphalangeal thumb

Cardiac defects: Present in 75% of patients. Includes ASD(mc), VSD, conduction defects, AF, anamolous venous return

PROGNOSIS: Depends on severity of cardiac lesions. In mild lesions near normal life expectancy.

This is an image from a Holt Oram syndrome patient showing hand abnormalities

Clinical Features in Patients with Wilson Disease


Clinical Features in Patients with Wilson Disease

Hepatic
·         Asymptomatic hepatomegaly
·         Isolated splenomegaly
·         Persistently elevated serum aminotransferase activity (AST, ALT)
·         Fatty liver
·         Acute hepatitis
·         Resembling autoimmune hepatitis
·         Cirrhosis: compensated or decompensated
·         Acute liver failure

Neurological
·         Movement disorders (tremor, involuntary movements)
·         Drooling, dysarthria
·         Rigid dystonia
·         Pseudobulbar palsy
·         Dysautonomia
·         Migraine headaches
·         Insomnia
·         Seizures

Psychiatric
·         Depression
·         Neurotic behaviours
·         Personality changes
·         Psychosis

Other Systems
·         Ocular: Kayser-Fleischer rings, sunflower cataracts
·         Cutaneous: lunulae ceruleae
·         Renal abnormalities: aminoaciduria and nephrolithiasis
·         Skeletal abnormalities: premature osteoporosis and arthritis
·         Cardiomyopathy, dysrhythmias
·         Pancreatitis
·         Hypoparathyroidism
·         Menstrual irregularities; infertility, repeated miscarriages

Image Courtesy: www.eurowilson.org
Text Reference: 
http://www.wilsonsdisease.org

Types of Insulin: Brand Name, Generic Name, Onset of Action, Peak and Duration:

Types of Insulin: Brand Name, Generic Name, Onset of Action, Peak and Duration:

Anatomical Differences in Sympathetic and Parasympathetic Divisions

Anatomical Differences in Sympathetic and Parasympathetic Divisions

Thursday 28 March 2013

Migraine Symptoms, Signs and Treatment



Mnemonic: Side Effects of Morphine


Human chorionic gonadotropin

Info: Few points regarding
Info: Few points regarding Human chorionic gonadotropin

• hCG can be detected in maternal urine after 7-8days of ovulation

• The rapidly rising hCG seen between 3-4 and 9-10 weeks gestation coincides with the proliferation of immature trophoblastic villi and the extent of the syncytial layer

• Plasma levels increase, doubling in concentration every 2-3 days between 60 and 90 days of gestation.

• The average peak hCG level is approximately 110,000 mIU/mL and occurs at 10 weeks gestation

• Between 12 and 16 weeks, average hCG decreases rapidly with the concentration

•Levels continue to fall from 16 to 22 weeks at a slower rate.

•During the third trimester mean hCG levels rise in gradual, yet significant, manner from 22 weeks until term.

•hCG levels are comparatively higher in women bearing female fetuses.

•Human chorionic gonadotropin may stimulate steroidogenesis in the early fetal testes resulting in virilization and sexual differentiation in males

Text Source: endotext.org
Image: acubaby.com

Saturday 23 March 2013

Liver test patterns(LFT) in Acute hepatocellular necrosis and Alcoholic hepatitis cirrhosis


Info: Liver test patterns in Acute hepatocellular necrosis and Alcoholic hepatitis cirrhosis

Approach to a patient with liver disease:

Approach to a patient with liver disease:

Reference: Harrison
 

Child-Pugh Classification of Cirrhosis

Child-Pugh Classification of Cirrhosis 

Important Diagnostic Tests in Common Liver Diseases

Important Diagnostic Tests in Common Liver Diseases

Diagnosis of alcohol dependence: CAGE questionnaire

A clinically helpful approach to diagnosis of alcohol dependence and abuse is the use of the CAGE questionnaire, which is recommended in all medical history-taking.

One "yes" response should raise suspicion of an alcohol use problem, and more than one is a strong indication that abuse or dependence exists.

Points to remember about Jaundice:


Friday 22 March 2013

Types of encephalopathy.

Some examples include:

•Mitochondrial encephalopathy: Metabolic disorder caused by dysfunction of mitochondrial DNA. Can affect many body systems, particularly the brain and nervous system.

•Glycine encephalopathy: A genetic metabolic disorder involving excess production of glycine

•Hepatic encephalopathy: Arising from advanced cirrhosis of the liver

•Hypoxic ischemic encephalopathy: Permanent or transitory encephalopathy arising from severely reduced oxygen delivery to the brain

•Static encephalopathy: Unchanging, or permanent, brain damage

•Uremic encephalopathy: Arising from high levels of toxins normally cleared by the kidneys—rare where dialysis is readily available

•Wernicke's encephalopathy: Arising from thiamine deficiency, usually in the setting of alcoholism

•Hashimoto's encephalopathy: Arising from an auto-immune disorder

•Hypertensive encephalopathy: Arising from acutely increased blood pressure

•Chronic traumatic encephalopathy: Progressive degenerative disease associated with multiple concussions and other forms of head injury

•Lyme encephalopathy: Arising from Lyme disease bacteria, including Borrelia burgdorferi.

•Toxic encephalopathy: A form of encephalopathy caused by chemicals, often resulting in permanent brain damage

•Toxic-Metabolic encephalopathy: A catch-all for brain dysfunction caused by infection, organ failure, or intoxication

•Transmissible spongiform encephalopathy: A collection of diseases all caused by prions, and characterized by "spongy" brain tissue (riddled with holes), impaired locomotion or coordination, and a 100% mortality rate. Includes bovine spongiform encephalopathy (mad cow disease), scrapie, and kuru among others.

•Neonatal encephalopathy: An obstetric form, often occurring due to lack of oxygen in bloodflow to brain-tissue of the fetus during labour or delivery

•Salmonella encephalopathy : A form of encephalopathy caused by food poisoning (especially out of peanuts and rotten meat) often resulting in permanent brain damage and nervous system disorders.

•Encephalomyopathy: A combination of encephalopathy and myopathy. Causes may include mitochondrial disease (particularly MELAS) or chronic hypophosphatemia, as may occur in cystinosis.