H. Pylori - diagnosis and treatment

We usually use the serological test ( anti H. Pylori anti bodies ) to test for the presence of the micro organism in our setting. But unfortunately this least expensive method is also the least accurate one. The sensitivity of this test is 85% while its specificity is only 79%.
The more accurate tests with a sensitivity and specificity of around 95% include:
1) Urea breath test,
2) Fecal antigen test.

N.B:
Sensitivity refers to the % of ill persons who are correctly identified as having a particular disease.
Specificity refers to the % of healthy persons who are correctly identified as not suffering from a particular disease.

Treatment:
Eradication treatment that we usually use includes a PPI (proton pump inhibitor) and 2 antibiotics for 14 days, the regimen with the greatest proven efficacy. It includes:
1) Cap Omeprazole 20 mg B.D +
2) Tab Clarithromycin 500 mg B.D +
3) Cap Amoxicillin 1 g B.D or Tab Metronidazole 500 mg B.D if allergic to amoxicillin.

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Hypokalemia - Potassium replacement calculation

DEFINITION Hypokalemia is defined as a serum potassium level of less than 3.5 mmol/L. Normal level= 3.5-5.5 mmol/L. It is encountered in >20% of patients. Patients are usually asymptomatic but severe arrhythmias and rhabdomyolysis can occur. Non-specific complaints include easy fatiguability and skeletal muscle weakness. The preferred method of replacement is via the oral route but at times this is not possible. The article below will give you an idea about how to calculate the amount of KCl to be given I.V. 1) Potassium deficit in mmol is calculated as given below: K deficit (mmol) = (K normal lower limit - K measured ) x kg body weight x 0.4 2) Daily potassium requirement is around 1 mmol/Kg body weight. 3) 13.4 mmol of potassium found in 1 g KCl . ( molecular weight KCl = 39.1 + 35.5 = 74.6) Suppose we get an asymptomatic patient of 70 Kg with a serum potassium level of 3.0 mmol/L and he is on nil by mouth but having...

Endomysium, Perimysium and epimysium - definition, histology

Each muscle fibre is closely surrounded by connective tissue. This acts as a support for the muscle fibres and unites them to each other. 1) Each muscle fibres is surrounded by delicate connective tissue that is called the endomysium . 2) Individual fasciculi are enclosed by a stronger sheath of connective tissue called the perimysium . 3) The entire muscle is surrounded by connective tissue called the epimysium . This is illustrated by the schematic diagram below. 1= perimysium, 2= endomysium, 3= fasciculus. At the junction of a muscle with a tendon, the fibres of the endomysium, the perimysium and the epimysium become continuous with the fibres of the tendon. First published on: 27 December 2016

The plantar reflex - Babinski's sign

The plantar response is an important test to identify an upper motor neuron lesion. PROCEDURE To elicit it, the muscles of the lower limbs must be relaxed. The outer edge of the sole of the foot is stimulated by firmly scratching a blunt object like a key or a stick along it from the heel towards the little toe. This is what Joseph Babinski did in the year 1896. He described the 'great toe sign' that year and then in 1903 the 'toe abduction or fan sign'. Nowadays, a final medial movement across the sole of the metatarsus is also done. i.e. we start at the heel to the little toe and finally arcing to the big toe. The final arcing movement is absent in the original Babinski plantar response test. Babinski sign refers to a combination of 'the great toe sign' and the 'fan sign'. SIGNIFICANCE The normal response is plantar flexion of the toes (down going) and they are drawn together. More precisely, there is flexion of the big toe and addu...

Edema - Definition, pathophysiology, causes, clinical features

DEFINITION Edema is an abnormal presence of excessive fluid in the interstitial space. PATHOPHYSIOLOGY The movement of water and low molecular weight solutes such as salts between the intravascular and interstitial spaces is controlled primarily by the opposing effect of vascular hydrostatic pressure and plasma colloid osmotic pressure. Normally the outflow of fluid from the arteriolar end of the microcirculation into the interstitium is nearly balanced by inflow at the venular end. A small residual amount of fluid may be left in the interstitium and is drained by the lymphatic vessels, ultimately returning to the bloodstream via the thoracic duct. Either increased capillary pressure, diminished colloid osmotic pressure or inadequate lymphatic drainage can result in an abnormally increased interstitial fluid i.e. edema. An abnormal increase in interstitial fluid within tissues is called edema, while fluid collections in the different body cavi...

Gram staining - Procedure, mechanism, explanation

INTRODUCTION The Gram stain was developed in 1884 by the Danish bacteriologist Hans Christian Gram. It is one of the most useful staining procedures because it classifies bacteria into two large groups: 1) gram-positive and 2) gram-negative. PROCEDURE 1) A heat-fixed smear is flooded with a basic purple dye, usually crystal violet. Because the purple stain imparts its color to all cells, it is referred to as a primary stain . 2) After 1 minute, the crystal violet is drained off and washed with distilled water. The smear is then covered with Gram's iodine, a mordant or helper . When the iodine is washed off, both gram-positive and gram-negative bacteria appear dark violet or purple. 3) Next, the slide is washed with alcohol (95% ethanol) or an alcohol-acetone solution. This solution is a decolorizing agent which removes the purple from the cells of some species but not from others. When the procedure is carried out, the slide is held ...

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