Medicine Hack

It is also called as Gustilo-Anderson classification. It is a well established system to establish the severity of the open fracture. e.g. if you are on night duty and you have to phone the orthopedic surgeon regarding a case, you just have to tell which type it is according to the Gustilo's classification, instead of describing the fracture in details. The classification goes as follows: Typ e I - Puncture wound < 1 cm, minimal contamination, low energy and simple fracture Type II - Laceration > 1 cm; moderate soft tissue damage with adequate bone coverage Type IIIA - Extensive soft tissue damage, often associated with high energy trauma, massive contamination but adequate bone coverage Type IIIB - Extensive soft tissue damage with periosteal stripping and bone exposure, flap coverage is usually required Type IIIC - Arterial injury associated and requiring repair

Bennett's fracture is an unstable intra articular fracture of the base of the first metacarpal bone.  It extends into the carpometacarpal (CMC) joint and is  the most common type of fracture of the thumb. It is nearly always accompanied by some degree of subluxation or frank dislocation of the carpometacarpal joint and this subluxation/dislocation makes the fracture unstable. The mechanism of injury is that when an axial force is applied against a partially flexed metacarpal, there is a resulting fracture of the base of that metacarpal and usually associated with subluxation/dislocation.  This fracture is common in cases of fall on thumb usually from bicycles and punching to a hard object. If intraarticular fractures (such as the Bennett's fractures) are allowed to heal in a displaced position, significant post-traumatic osteoarthritis of the base of the thumb can occur.

Type I – A transverse fracture through the growth plate ( incidence is about 6-7%) Type II – A fracture through the growth plate + metaphysis and sparing the epiphysis (incidence is about 70-75% ) Type III – A fracture through growth plate + epiphysis, sparing the metaphysis (7- 8% incidence) Type IV – A fracture through all three elements growth plate + metaphysis + epiphysis (8-10% incidence) Type V – A compression fracture of the growth plate

The table above shows how chronic kidney diseases are classified. Risk factors include hypertension, diabetes mellitus, autoimmune disease, older age, African ancestry, a family history of renal disease, a previous episode of acute renal failure, and the presence of proteinuria, abnormal urinary sediment, or structural abnormalities of the urinary tract. Stage 0 Not commonly included in many classifications but in this stage there is no kidney damage evident but patients have one or more risk factors mentioned above. Stage 1 Kidney damage is there demonstrated by persistent proteinuria, abnormal urine sediment, abnormal blood and urine chemistry, abnormal imaging studies but GFR i.e kidney function will be normal. Stage 2 Kidney damage is there and slight decrease in kidney funtion. Stage 3-5 The older term chronic renal failure corresponds to these stages. It is characterized by a progressive, significant and irreversible kidney damage with a GFR < 60 for 3 month

A simple mnemonic to remember how the carpal bones are arranged is: " S he  L ooks  T oo  P retty;  T ry  T o  C atch  H er" S caphoid L unate T riquetrum P isiform T rapezium T rapezoid C apitate H amate Last reviewed on: 1 September 2015

We have 2 classic regimens that have been used on a large scale. 1) Multiple component insulin regimen Here, usually a basal insulin level is maintained by a long acting insulin like glargine insulin (lantus) injected at night. Then short acting insulin analogues are injected just after breakfast, lunch and supper. In total the patient has to do 4 injections per day. 2) Twice a day pre-mixed insulin This is more commonly used. It consists of twice daily injected mixture of an intermediate acting insulin like NPH insulin and a short acting insulin or regular insulin in a ratio of 70:30. 2/3rd of the total insulin requirement is given in the morning and the remaining 1/3rd at night. The total number of injections is 2 per day. For the patients' convenience, the second regimen seems better as he/she has to do only 2 injections but the first regimen i.e multiple component insulin regime is actually the better of the two. Studies have recently shown that a better HbA1c goal i

Bronchial asthma is considered to be well controlled if the patient experiences cough, shortness of breath and wheezing less than 3 times/week during the day, less than 3 times/month of night time awakenings and no asthma related interference with normal activity. Recently it has been found that only 1/3rd of asthma patients can be categorized as being into the well controlled group.