Weight Gain

The weight gain is an important issue of discuss in everyones life.. Even mine too.. The first thing someone ask us while meeting us after few weeks even is about weight only mostly.. may be gain or loss..Either of is important for us.

Weight of the person depends mainly on the nourishment and genetic background of him.. Most of us have normal weight gain during our life time but mostly occurs in the Toddler period and the adolescent and young adult periods of our life time....

Whatever may be the thing weight for height in terms of BMI(Basic Metabolic Index) plays a vital role in determining whether ta person is obese or not..


BMI=     Weight in Kilograms     
          Square of  Height in metre


BMI values...
                      <16           - Severely Underweight
                        16-18.5    -Underweight
                       18.5-25    -Normal
                       25-30      -Overweight
                       30-35      -Obese class I
                       35-40      -Obese class II
                       >40        -Obese class III


The rapid weight is normal only pregnancy that too to a certain extent only....Otherwise its mostly abnormal and has a deleterious effect on us.. Mostly Increased weight gain is due to over eating or over feeding, hypothyroidism,sedentary work,High carbohydrate and fat diet mostly junk foods..This will lead on to obesity which is the most deadly disease for man kind causing lots of diseases consequently like atheroslerosis,Myocardial infarction,hypertension,stroke,diabetes mellitus ....

The only best way for prevention and treatment weight gain is a mixed balanced diet(based on the requirement for the concerned person depending on his type of work ) with adequate exercise..
Surgical treatment of morbid obesity is Liposuction. Liposuction yield good results physically immediately but has to be maintained through strict diet and exercise

Pregnancy

The thing that prevents the extinction of us and one of the things we humans r good at... It is a gift for the females.

It is the result of the successful fertilisation of the ovum by the sperm.. The earliest symptom of pregnancy is missing of the consecutive menstruation. But this is not a sufficient symptom,there many other signs and diagnostic tests to confirm pregnancy.

Preg-card

• Simple and the reliable test is the urine preg-card test that can detect pregnancy as early as 4-6weeks.It is based on the fact that in pregnancy there is rapid increase in the beta-HCG levels that can be detected in urine.
• One more confirmatory test is the Ultrasound investigation .. There will be an gestational sac that can be detected by this from 4th week of gestation... Many signs are the ultrasound findings confirming the diagnosis



Ultrsound finding

• Symptoms on the patient side include early morning vomitting,fetal movements etc

Precautions during pregnancy:

• Avoid self medication even for simple ailments.
• Avoid intercourse beyond 3 months of pregnancy
• Compete routine medical consultations
• Simple exercises
• More fluid intake
• Listen and follow instructions from ur doctor that is the important thing

Hair loss

This is the only problem that every man worry about atleast once in a month.... It starts to occur commonly during the early twenties but may vary .... 

The main cause is hereditary but few more causes may be

• Improper care
• pollution
• mal nourishment
• stress
• fungal infection
• iatrogenic (mainly chemotherapy)
• unknown reasons

Some extent of frontal hair line regression is common in males due to the testosterone which is unpreventable.

The loss over the vertex is mostly hereditary can be reverted to some extent medically ( commonly used is minoxidil) .. but there too will be an initial increased loss followed by growth .. takes around 3 to 4 months of continuous application ...

But when there is only temporal hair is remaining its best go for hair implantation nothing else could be fruitful.

Common infections like taenia and dandruff can cause temporary hair loss.. hair growth occurs soon after treating the cause ....

In females baldness is not that common ,  may be due to 

• hereditary
• post menopause
• chemotherapy for various auto immune diseases, cervical cancers that are common in females

Sinus

It refers to cavity that may contain suppurative fluid, blood or just air  like in case of those in our skull.

In day to day life a doctor will come across atleast 5 patients or persons complaining to have a sinus problem...
Normally there are air cavities in the skull of us to reduce the weight of our comparitively  large head resting on small joints of the cervical vertebrae.

There is also a blood filled cavities in our cranial cavity besides brain like cavernous sinus,superior saggital, sigmoid ....

But the commonly referred by the patient is the sinuses in the skull.

Most unbearable pain is the headache which is the common complaint of the patients sinusitis...To be honest I m a victim of it... It is the inflammation of the mucosa lining the cavity .. It is not so bad that it shouldnt get inflammed, it is recurrent beyond recovery that causes the disease.
Pollution is a most important cause.

But my opinion is that we cant blame other factors inspite of we ourselves helping the disease to occur..Yes ..just think of the life style .. we are becoming more and more sedentary so we breathe partially only i m the force respiration.. To make it more clear these sinus lined by mucosa secretes mucus,that is cleared by the ciliary action but this action has to be helped by respiration... this brought about by the negative force created in the nasal cavity during inspiration that creates a suction force and during expiration the air is flushed in to these cavities thus  helping in the clearing of the secretion mainly in the maxillary sinus in which the clearing should occur against gravity. It is easily flooded with secretions causing a focus for micro organisms that will further augment inflammation and destruction of the cilia which creates vicious cycle...
The symptoms of sinusitis is Headache,nasal puffiness,fever ,rhinorrhoea..
The treatment include anti histaminics to reduce secretion, NSAIDs to give symptomic relief .. Acut conditions mostly requires addition of antibiotics...

FESS

In chronic conditions surgery (FESS- Functional endoscopic sinus surgery)  is needed. this is done to improve the drainage of the sinus

Myelography

Indication:

• Largely superseeded by CT and MRI
• It is used in patients in whom MRI are contraindicated
• To screen whole spinal cord and cauda equina for compressive and expanding lesions
• To visualise roots
• To diagose spinal vasculature abnormalities

Complications:

• Headache after 24hrs
• Low back ache
• Herniation of the posterior cranial fossa contents in cases of raised intracranial tension
• Hemorrhage in cases of traumatic Lumbar puncture while injecting dye
• Spinal arachnoiditis
• acute deterioration if there is compressive lesion Direct neurotoxicity like seizures,encephalopathy but resolves in 48hrs
• allergy to contrast

NEET/CET

As for i can understand this pattern is a better one.The exam is an National Eligibility /Entrance Test.It aims at admitting candidates all over india to colleges all over india through single ranking system and also rising the standard of the candidates admitted.This system has its own advantages and disadvantages

Advantages:

• For Under Graduates Exam:

1.  The most important advantage is there is an equal possibility for every candidate to get admitted to all colleges all over india and the standard is also rised
2. The number of seats is increased.
3. The syllabus is only one if ther is only one exam country wide so there is no confusion for the candidate in preparation 

• For Post Graduates  Exam:

1.  Same advantages as for under graduates

Disadvantages:

• For Under Graduates Exam:

1. Large proportion of the students are taught in there respective state board syllabus but this exam is based on the CBSE syllabus which makes it difficult for those students.
2. Some of the students who are not exposed to using computers may face practical difficulty during exams

• For Post  Graduates Exam:

1. i feel there is no prob.....

UG exam syllabus is in link http://www.mciindia.org/ but pattern and model question paper is yet to be published.. kindly share ur views through comments

Kidney

They are normally two in the human body, placed on either side of the vertebral column in the lumbar region.The blood supply is via renal vessels originating from the descending aorta at the level of L1.It regulates  its function mainly through the renin angiotensin system.The main function is excretion of the waste and harmful metabolites from the blood.The functional unit is nephrons.There are about 2.4 million nephrons totally. the nephrons join the collecting duct which in turn drains into the renal calyces which opens into renal pelvis that continues as the ureter.They retro peritonial organs.


Functions:

• Maintain the fluid-electrolyte balance in the body
• Excretion of the toxic metabolites
• drug metabolisation
• Erythropoiesis through erythropoietin

Pathologies:(common)

Polycystic disease

• Polycystic disease

• Nephrotic syndrome
• glomerular nephitis
• renal stones
• renal failure
• renal cell carcinoma

Cancer

It is a lethal disease that commonly occurs in an elderly individual.. can also occur in children also.. In old age a wide variety of organs are affected like lung,liver,pancreas,bladder,prostate,female genital tract,colon,stomach,blood and brain but in children leukemia is the most common one..The cause is mainly genetic mutation,life style etc.But the most common cause in elderly is lifestyle,chronic diseases,radiation,infection etc.In children the most common cause is genetic mutation..
The patient may be asymptomatic initially but later non specific symptoms may occur like swelling, loss of weight, non healing ulcers.
Metastasis:
spread of cancerous cells occur in many patients and it is called metastasis.It occurs by

• Local spread
• Lymphatic spread
• Hematogenous spread 

Management:

•  main stay of management includes chemotherapy and radiotherapy
• surgical removal of the tumour/lesion area giving a tumour free margin is done in many cases
• In cases of advanced conditions and very elderly patients supportive management is done 

Cytokines-functions

1. Immunity                 : IL-1,IL-6,Interferon gamma,TNF-alpha,IL-12
2. Lymphocyte growth: IL-2,IL-4,IL-12,IL-15,TGF-beta,IL10
3. Chemotaxis             : C-C(T cells) & C-X-C (macrophages & tissue cells)
4. Stimulate Hematopoiesis through c-kit,GM-CSF,G-CSF

                           

B-Cell Lineage

In the order of  maturation....

• Hemopoeitic stem cell -CD 34+
• Pro-B cells- CD10,CD19,CD34,CD79a& Tdt +
• Pre B cell -CD19, CD 79a
• Immature B cell CD19,CD20,CD21,CD22,CD79a & surface IgM
• Mature B cell CD19,CD20,CD21,CD22,CD79a, sIgm, sIgD
• Plasma cells CD 20,CD21,CD 22,CD23,CD38,BCL-6
• Memory cells CD20,CD21,CD22,CD23 BCL-6

MHC Class II

• Encoded in regions HLA-D which has 3 sub regions HLA-DR ,HLA-DP &HLA-DQ
• Antigen binding cleft is alpha1 and beta 1 domains
• Bind to exogenous antigens
• Recognised only by CD4+T cells
• Distribution restricted to Antigen presenting cells namely macrophages,dendritic cells and beta cells
• Expression by other cells especially endothelial cells and fibroblasts can be induced by Interferon gamma

MHC Class I

• Antigen binding cleft alpha 1&2 domains
• present in all nucleated cells and platelets
• encoded by HLA-A,HLA-B & HLA-C
• Bind and display peptide that are derived from proteins such as viral antigens synthesised within the cells
• recognised only by CD8+T cells
• Has an extensive tissue distribution.

Major histocompatablity complex(MHC}

They are essential for the T-cell function through the antigen presenting cells.They encoded in the genes in the short arm of chromosome 6..They are also known as HLA since they were first isolated from Leukocytes.They are classified into Class I ,Class II &Class III. Class I & II are involved in antigen presentation while Class III is involved in complement fixation.

Multiple myeloma

It is a lymphoproliferative disorder associated with monoclonal gammopathy that can present as abnormal bone fractures,renal failure,blood disorders,hypercalcemia etc.

One of the characteristic feature is Bence Jones proteins.

Diagnosis is established by a bone marrow examination which will show presence of plasma cells >30%in the marrow.

Diagnostic criteria:

• Clone bone marrow plasma cells >10%
• Presence of serum/urine monoclonal protein
• Evidence of end organ damage like hypercalcemia (Sr calcium >11.5mg/dl),Renal insufficiency(Sr creatinine >1.73mmol/L),Anemia (Hb <10g/dl),Bone lesions

Treatment:

    The main stay of treatment includes Corticosteroids in combination with Chemotheraphy (thalidomide,bortezomib,melphalan)

Allergies

It is a condition in which there is an increased immunological response by the body to a substance.There is a wide spectrum of manifestation of symptoms ranging from simple itching to life threatening anaphylaxis.
Manifestations may be itching,urticaria,eosinophilia,angioedema,anaphylaxis..These reactions are mediated through IgE mediated. For it to occur the body must have been initially sensitised with particular allergen.It is an hypersensitivity reaction.
Types of Hypersensitivity :

1. Type I-immediate hypersensitivity
2. Type II-Antibody mediated
3. Type III-Immune complex mediated
4. Type IV- T-cell mediate

It comes under type I hypersensitivity.It is mediated by IgE  secreted by B-cell, IgE binds to the mast cells causing the release of mediators for the reaction on exposure to the same antigen again.This whole process occurs within minutes,hence the name.

Mediators:

• Histamines
• Leukotrienes
• PAF
• Prostaglandins

Management:

• The main stay of management is the complete avoidance of the stimuli.
• Desensitisation of the allergen with serial exposure of the patient with varied subclinical concentrations of the antigen.
• Most of the cases respond well to symptomatic management with anti histaminics and time
• Active management is  life saving in cases of angioedema and anaphylaxis.In these cases epinephrine is the life saving drug, along with intravenous fluids.

Blood pressure

It is the common complaint nowadays in most of the patients.
Normal values varies with age.In cases of children mostly it  is not given much of importance. In children it varies with height.
In case of adults the normal is systolic <130mm Hg, diastolic <90 mm Hg.But we cant diagnose a person as an hypertensive based on single reading.Atleast 3 readings on 3 consecutive days most be higher than mentioned.
Hypertension is one of the most common disease and one of the most common cause of death world wide.
It is an end organ disease. It affects most of the organs among which most important is brain,kidney,retina(part of eye). It is also a main risk factor for atherosclerosis which in turn causes a lot of diseases in the body,most commonly heart attack(myocardial infarction).Hence screening is essential.
The age of onset is decreasing due to the unhealthy life style.
Causes:

1. Essential hypertension( unknown cause)
2. Renal failure
3. hyperthyroidism,hyperparathyroidism,cushing'syndrome etc
4. Drugs like corticosteroids,NSAIDs,Oral contraceptive pills

Risk factors:

1. Hereditary
2. Diabetes mellitus
3. Obesity
4. Unhealthy lifestyles

Iron deficiency anaemia- Diagnosis

Symptoms & Signs:

                -Certain clinical conditions carry an increased likelihood of the disease.,Pregnancy, adolescence, periods of rapid growth, and an intermittent history of blood loss of any kind should alert the clinician of the same. 

                 -A cardinal rule is in an adult male it is due to gastrointestinal blood loss until proven otherwise. 

                  -Signs depend on the severity and chronicity of the disease in addition to the usual signs—fatigue, pallor, and reduced exercise capacity.

                  -Cheilosis (fissures at the corners of the mouth) and koilonychia (spooning of the fingernails) are signs of advanced deficiency.

                  -The diagnosis is typically based on laboratory results.

Laboratory diagnosis:

                     -The serum iron level represents the amount of circulating iron bound to transferrin. The TIBC (Total iron binding capacity)is an indirect measure of the circulating transferrin. The normal range for the serum iron is 50–150 micro gm/dL; the normal range for TIBC is 300–360micro gm/dL.
                      -In the disease- serum iron is < 30micro gm/ dL &
                                                                     -   TIBC is >360 micro gm/dL
                      -Transferrin saturation, which is normally 25–50%, is obtained by the following formula: serum iron x 100 ÷ TIBC. the disease is associated with saturation levels below 18%.
                      -Adult males have serum ferritin values averaging about 100 micro gm/L, while adult females have levels averaging 30micro gm/L. As iron stores are depleted, the serum ferritin falls to <15 micro gm/L. Such levels are diagnostic of absent body iron stores.
                      -Peripheral smear will show hypochromic RBC & microcytosis

                    

Iron deficiency anaemia-Causes

It is the most common cause of decrease in hemoglobin world wide.

Causes:

        1.Increased demand for iron and/or hematopoiesis

                  -rapid growth in infancy or adolescence

                  -pregnancy

                  -erythropoietin therapy

        2.Increased iron loss

                  -chronic blood loss

                  -menses

                  -acute blood loss

                  -blood donation

                  -phlebotomy as treatment for polycythemia vera

        3.Decreased iron intake or absorption

                  -inadequate diet

                 -malabsorption from disease (sprue, Crohn's disease)

                 -malabsorption from surgery (post-gastrectomy)

                 -acute or chronic inflammation

GERD(Gasro-Esophageal Reflex Disorder)

It is a condition caused due to gastric contents into the esophagus and proximal structures.

Clinical Presentation:

• symptoms- heart burn and regurgitation
• Atypical chest pain
• Extraesophageal manifestations-cough,laryngitis,asthma and  dental erosions. Also  there may be sinusitis,pulmonary fibrosis,pharyngitis and recurrent otitis media.
• Response to therapeutic trial of PPI can be diagnostic but a negative response does not exclude the disease

Investigation:

• Endoscopy to rule out other causes of such esophageal symptoms, like eosinophilic esophagitis,candidial esophagitis etc
• 24hrs esophageal pH monitoring (investigation of choice)
• Esophageal manometry to identify motos process contributing to refractory symptoms

Treatment:

•  Antacids,histamine-2 receptor antagonists,PPI may relieve symptoms in mild and intermittent conditions
• PPI(Proton Pump inhibitors) are more effective than other treatment modalities.
• In conditions not responding to medical treatment,they are surgically managed by Nissen's Fundoplication

Oligoclonal Bands

Electrophoresis of serum and CSF separates protein components by size and charge.They may be present in both serum and CSF.When present in CSF alone, it indicates intrathecal synthesis of immunogloblins.This pattern is seen in 95% cases of established multiple sclerosis, it can also occur in chronic meningitis,neurosarcoid,neuromeningitis and SSPE 

Peripheral neuropathy

These patients will complaint of numbness in hands and feet that progresses proximally in a distribution classically termed as 'glove &stocking'
Causes:

1. Idiopathic (most common)
2. Diabetes mellitus
3. Vit B12,E deficiencies
4. Carcinoma
5. Drugs eg : isoniazid,dapsone,vinca alkaloids,cisplatin, gold, metronidazole
6. Paraproteinemias eg : myeloma
7. Rare causes like amyloidosis,GBS,sarcoidosis etc

Investigation of choice:

             Nerve conduction studies

Heinz bodies

These are red cell inclusion bodies made of insoluble denatured proteins.They are seen when the red cells are stained with methyl violet stain and supravital staining.


Sample to be taken: Blood mixed with EDTA.

Significance:They are are seen close to the RBC membrane.they are removed in the spleen and so their presence is frequent in splenectomy.
Causes:
        1.Oxidative hemolysis
                          -chlorates,phenacetin etc
                          -G6PD deficiency and other enzymopathies
        2.Unstable hemoglobins

Anaemia

 It is defined as the decrease in the circulating red cell mass.The criteria is Hb(hemoglobin) <12gms/dl in women and <14gms/dl in men.. In terms of hematocrit the criteria is <36% in women and <41% in men.
Classification:
        Based on the etiology
                                           1.Due to blood loss
                                                       - acute
                                                       - chronic
                                           2.Due to decreased RBC production
                                           3.Due to increased RBC destruction
Diagnosis:
       Symptoms&Signs:
                  -Fatigue is the most common presentation.
                  -Headache,tinnitus.exercise intolerance,oligomenorrheoa may be present
                  -On examination pallor,tachycardia,hypotension,edema,kilonychia,angular chelosis,glositis may be present.
      Laboratory investigation:
                     -Hb <12gms/dl in women and <14gms/dl in men
                     -Hct<36% in women and <41% in men
                     -Normal range of Mean corpuscular volume(MCV) 80-96 femtolitres(fl);<80fl indicates microcytosis;>96fl indicates macrocytosis
                     -Reticulocyte index(RI) is a measure of the response of the bone marrow.
                              RI=%reticulocyte X (estimated Hct/normal Hct)
nomal value is 1.0 to 2.0 ; <2.0 indicates decreased production; >2 indicates loss of blood or hemolysis.
                    -Peripheral smear for studying number and morphology of blood cells

                    -Bone marrow biopsy is indicated in cases where cause is not clear.

Hypoglycemia

It is a clinical entity that arises as a consequence of a dropping of blood sugar level below 40mg/dl( normal- 70-120mg/dl) . This causes a common symptom of giddiness,may cause even seizures.Everyone would have experienced its symptoms on a day when we starving from the morning.But because of the liver and pancreas the blood sugar level becomes near normal saving us from collapsing.
           Causes :
                       1.Drugs like insulin,sulfonylureas,ethanol
                       2.hepatic,renal and cardiac failure,sepsis
                       3.Hormone deficiencies like cortisol,growth hormone or both,glucagon and epinephrine(in insulin deficient diabetes)
                       4.Endogenous hyperinsulinism like insulinomas etc
                       5.Postgastrectomy
                       6.galactosemia
                       7.Idiopathic
           Treatment :
                    oral glucose 20grams; if the patient is not able to take orally the intravenous glucose 25mg. sometimes inj.glucogan can be given i.m or sc