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Showing posts with the label Internal medicine

Ataxic gait

This type of gait can be seen in cases of cerebellar or sensory ataxia. Cerebellar ataxia and gait: The problem here lies with the coordinating mechanisms in the cerebellum and its connecting systems. The gait is a clumsy, staggering, unsteady, irregular, lurching, titubating and wide-based. The patient may sway to either side, back or forward. Leg movements are erratic, and step length varies unpredictably. The patient is unable to follow a straight line on the floor (to walk tandem). With a lesion of the cerebellar vermis, the patient will exhibit a lurching, staggering gait but without laterality, the ataxia will be as marked toward one side as the other. Cerebellar ataxia is present with eyes both open and closed; it may increase slightly with eyes closed but not so markedly as in sensory ataxia. A gait resembling cerebellar ataxia is seen in acute alcohol intoxication. With a hemispheric lesion the patient will stagger and deviate toward the involved side. In disease l

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 cavities are variously

Type 2 Diabetes Mellitus - Exercise benefits and regime

The positive benefits of exercise in a diabetic patient include: 1) cardiovascular risk reduction, 2) reduced blood pressure, 3) maintenance of muscle mass, 4) reduction in body fat and weight loss, 5) lowering plasma glucose (during and following exercise) and 6) increasing insulin sensitivity. Also since the diabetics lack the normal glucoregulatory mechanisms, they are more prone to be affected by either hypo or hyperglycemia if exercising. That is why it is better to have the blood glucose monitored before, during and after the exercises. It is not advised to do exercises if the blood glucose level is below 5.6 mmol/L or more than 14 mmol/L with ketones present. The exercise regime recommended is as follows: 1) At least 150 minutes of moderate to vigorous exercise per week distributed over at least 3 days. One example of such a moderately intense exercise is brisk walking. 2) Ideally resistance training should also be done for 3 non consecutive days per week. e.g. sm

Statins and muscle weakness

Muscle weakness is a well known side effect of statin use. This symptom is very commonly ignored both by the patients and the doctors. Recent studies suggest that the higher potency statins i.e the ones causing a bigger drop in cholesterol/mg of active product are also the ones more likely to cause muscle weakness as a side effect. In order of potency the statins are as followed : 1) Rosuvastatin 2) Atorvastatin 3) Simvastatin 4) Pravastatin 5) Lovastatin So, it is always better not just to look at the altered hepatic functions during follow up visits. Do ask about the adverse side effects also and use a less potent statin if required.

Colchicine - complete information

Introduction: Colchicine is an alkaloid isolated from the autumn crocus, Colchicum autumnale. It is actually present in the corm of the plant, the underground swollen part of the stem. Pharmacokinetics: Colchicine is absorbed readily when taken in orally. It reaches peak plasma levels within 2 hours.  It has a serum half-life of 9 hours.  Colchicine is partially deacetylated in the liver and the unchanged drug and its metabolites are excreted in the bile and undergo intestinal reabsorption. Colchicine is found in high concentrations in leucocytes, kidneys, the liver and spleen. Most of the drug is excreted in the feces but 10 to 20% is excreted in the urine and this proportion rises in patients with liver disorders. For patients with creatinine clearance of < 50 mL/min, colchicine must be avoided or used at a lower dose. Colchicine is also distributed into breast milk. Pharmacodynamics: Colchicine relieves the pain and inflammation of gouty arthritis in 12-24 hou

Pulmonary embolism due to metallic mercury

Above is a chest radiograph of a schizophrenic patient. He was delusional about being a doctor. He used to read a lot of medical books and mastered the art of taking blood pressure. During an episode of psychosis, he broke the blood pressure apparatus and injected the mercury into his vein. We can see in the X-ray that there is micro-embolism of the liquid mercury to the pulmonary arterioles, mostly to the dependent areas and the arrow indicates a small pool of the mercury in the right ventricle.

Popliteal artery cyst

This is a popliteal arteriogram of a 27 year old male who presented with pain in left calf when exercising. Signs of deep vein thrombosis were negative but there was minimal swelling at the left ankle. A palpable pulsatile mass could be felt on the popliteal fossa. On arteriography a filling defect was obtained as shown in the picture above. CT scan confirmed that the cyst was within the popliteal artery wall.

Insulin - Structure

Insulin is a protein hormone. It was the first protein to be shown to have a precisely defined amino acid sequence. This work was done by Federick Sanger in 1953.  As shown above in two colours, the insulin molecule consists of 2 peptide chains.  a) The blue coloured chain is the A chain. It has 21 amino acids and a sisulphide bond within itself.  b) The yellow colour represents the B chain. It is larger with 30 amino acids.  Both chains are connected by 2 disulphide bridges.  Porcine and bovine insulins differ from human insulin at 1 and 3 positions of the amino acids respectively. 

Tests performed in diagnostic abdominocentesis

Diabetes Mellitus - Definition / Criteria for diagnosis

Definition: It is a group of metabolic disorders that is characterized by hyperglycemia which is due to a relative or absolute deficiency in insulin. There is usually a defect in insulin secretion, a defect in insulin action or a combination of both.  Criteria for diagnosis: 1) An Fasting Plasma Glucose   ≥  7.0 mmol/L (126 mg/dL),  2) A Plasma Glucose    ≥  11.1 mmol/L (200 mg/dL) 2 h after an oral glucose tolerance test, 3) An HbA1c    ≥    6.5% or 4) A Random Plasma Glucose concentration    ≥   11.1 mmol/L (200 mg/dL) accompanied by classic symptoms of DM (polyuria, polydipsia, polyphagia, weight loss).  Note: 1) Fasting means no calorie intake for the past 8 hours. 2) For the glucose tolerance test, we must use 75 g of anhydrous glucose dissolved in water. 3) The diagnostic HbA1c test should be performed using a method certified by the National Glycohemoglobin Standardization Program (NGSP) and standardized or traceable to the Diabetes Control and Complications Trial (D

Chronic Obstructive Pulmonary disease - Definition

COPD is a preventable and treatable systemic disease state characterized by a progressive airflow limitation that is not fully reversible and associated with an abnormal inflammatory response of the lungs to noxious particles and gas. Note that the new definition according to GOLD/ATS and ERS does not talk anything about the disease being a mixture of chronic bronchitis and emphysema, though these conditions are very frequently encountered in COPD and also the fact of being 'not fully reversible' distinguishes this disease from the other chronic obstructive condition which is bronchial asthma.

Centriacinar / Centrilobular emphysema

In a classical lesion, dilated and destroyed respiratory bronchioles coalesce in series and in parallel to produce sharply demarcated emphysematous spaces. They are separated from the acinar periphery (the  lobular septa) by intact  alveolar ducts and sacs of normal size, as shown by the diagram below.  The lesions vary in quality and quantity even within the same lung. There is striking irregularity of involvement of lobules, and even within the same lobule. The lesions are usually more common and become more severe in the upper than in the lower zones of the lung. Most affected are the upper lobe, particularly the posterior and apical segments, and the superior segment of the lower lobe as depicted below.  This type of emphysema is commonly seen in chronic cigarette smokers. For classification of emphysema, follow this link:  Emphysema

Aminotransferases (Transaminases)

Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are measured by the serum glutamic-oxaloacetic  transaminase (SGOT) and serum glutamic-pyruvic transaminase (SGPT) respectively. They are important markers of hepatocellular injury. Normal values:   (varies from lab to lab but on average) ALT : 7-41 U/L AST: 12-38 U/L AST can be found in various tissues like cardiac/skeletal muscles, kidney, brain and liver. ALT is limited primarily to the liver and thus ALT is a more specific reflection of hepatocellular disease than AST. The highest elevations of both enzymes are seen in viral, toxin-induced and ischemic hepatitis.  On the other hand, alcoholic hepatitis usually gives a lower raise of around < 300 U/L.  AST/ALT ratio is a useful indicator. a) A ratio of > 2 is highly suggestive of alcohol-induced hepatic injury. b) A ratio of > 1 and cirrhosis is often seen in patients of chronic hepatitis B infections. c) A ratio of < 1 is commonly seen in

Delirium - definition, common causes, physical examination

Definition: Delirium is defined by the acute onset of fluctuating cognitive impairment and a disturbance of consciousness. Cognition includes memory, language, orientation, judgement, conducting interpersonal relationships, performing actions (praxis), and problem solving. Delirium is thus marked by short-term confusion and changes in cognition. There is also rapid improvement in most cases when the causative factor is identified and eliminated. Abnormalities of mood, perception, and behavior are common psychiatric symptoms. Tremor, asterixis, nystagmus, incoordination, and urinary incontinence are common neurological symptoms. Common causes of delirium: 1) Central nervous system disorder Seizure (postictal, nonconvulsive status, status) Migraine Head trauma, brain tumor, subarachnoid hemorrhage, subdural, epidural hematoma, abscess, intracerebral hemorrhage, cerebellar hemorrhage, nonhemorrhagic stroke, transient ischemia 2) Metabolic disor

Left ventricular function - normal echocardiography values

Women Men Measure Reference Range Abnormal Reference Range Abnormal Mildly Moderately Severely Mildly Moderately Severely Linear method Endocardial fraction shortening, % 27-45 22-26 17-21 ≤16 25-43 20-24 15-19 ≤14 Midwall fractional shortening, % 15-23 13-14 11-21 ≤10 14-22 12-13 10-11 ≤10 2D method Ejection fraction, % ≥ 55 45-54 30-44 < 30 ≥ 55 45-54 30-44 < 30