Medicine Hack

The diagram shows a beta cell of the islet of pancreas and will explain how local factors regulate secretion of insulin from it. Glucose enters the cell via the GLUT-2 transporter. Inside the cell there is metabolism with the generation of ATP. This causes the ATP-sensitive K+ channel to close, as shown in A. Closure of this channel leads to cell membrane depolarization. This in turn allows calcium ions to enter the cell via another calcium channel, shown in B. Increased intracellular calcium activates calcium dependent phospholipid protein kinase. This leads to exocytosis of insulin granules. Diaxozide acts by opening the K+ channel. This leads to loss of K+ and causing membrane hyperpolarization. This prevents Ca2+ from entering, protein kinases are not activated and thus there is no exocytosis of insulin granules... 

1. Maddrey (modified) Discriminant Function score of greater or equal to 32 indicates a high risk (30-50%) risk of mortality at 30 days. The risk is even higher is there are signs of hepatic encephalopathy. Scores should be repeated at day 7. 2. MELD stands for Model for End stage Liver Disease. It is used to estimate 90 days mortality. Poor prognosis if score is greater than 18. Score should be repeated at day 7.

Exacerbations of COPD are more commonly seen during the winter season (nearly 1.6 times more frequently). The main cause of these exacerbations is infection with the respiratory virus, rhinovirus. Frequent exacerbations have been shown to lead to a faster decline in the lung function, poorer quality of life and increased mortality. A recent study showed that COPD exacerbations in colder periods of the year take longer to recover from and are more likely to involve cough or coryzal symptoms. The exacerbations in the cold seasons also have a greater impact on daily activity, with patients spending more time indoors and being more likely to be hospitalized with respiratory viral infection.

It is the case of a 16-yr old female who came to the emergency department with complaints of low back ache for the past week. She has had similar symptoms in the past but now the intensity is increasing. There is no associated numbness or weakness of extremities. She did not have any weight loss. There was neither urinary nor fecal incontinence. On examination she had an obvious limp. Lumbar spines: mild tenderness lower lumbar spines, no deformity, range of motion was normal, no stigma of spina bifida. Lower limbs length showed a discrepancy of 1.5cm being shorter by 1.5cm on the left side. Left ankle in inversion and with hyperlaxity while left ankle was stiff and with restricted inversion. X-ray of Lumbar Spines showed a spina bifida. Impression of Spina Bifida occulta was made.