Medicine Hack

Mitral facies is one of the cutaneous manifestations of systemic diseases. The pathology in question here is mitral stenosis. Mitral facies refers to rosy cheeks (bright circumscribed flush over the malar bones) with a bluish tinge. The rose colour is because of the dilatation of malar capillaries while the bluish tinge is because of the cyanosis. This facies is usually seen in long standing cases of severe mitral stenosis associated with pulmonary hypertension and low cardiac output.  The picture above is that of a patient with chronic severe mitral stenosis. Yet, the rosy cheeks are not that prominent. The reason for this is that the patient underwent mitral valve replacement surgery and thus the cutaneous signs are regressing.  Red cheeks may also be seen in weather-beaten people i.e. those who work a lot outside in the open air. Purple cheeks may be seen in congestive heart failure. Finally, in systemic lupus erythematosus (SLE) the cheeks will have a red raised erupti

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

Introduction: Platelets are also called as thrombocytes. Size: they are very small discs with diameter varying from 1 to 4 micrometers. The normal concentration of platelets in the blood is between 150,000 and 450,000 per microliter. Formation: They are formed in the bone marrow from megakaryocytes. The latter are extremely large cells in the marrow and they fragment into the minute platelets either in the bone marrow or soon after entering the blood. Destruction: The platelet has a half-life in the blood of 8 to 12 days. Then it is eliminated from the circulation mainly by the tissue macrophage system. More than one half of the platelets are removed by macrophages in the spleen, where the blood passes through a latticework of tight trabeculae. Platelets do not have nuclei and cannot reproduce. Yet, they have many functional characteristics of whole cells. 1) Actin and myosin molecules are present in their cytoplasm. They are contractile proteins similar to those found in

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.

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

1) Lymphatic: Filariasis, Pressure by growths like tumours, Radiation, Chronic lymphangitis 2) Traumatic: Bruises, Sprains, Fractures 3) Infections: Cellulitis, Boils, Carbuncles 4) Metabolic: Gout 5) Venous: Varicose veins, Venous thrombosis 6) Hereditary: Milroy's disease

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.