Saturday, 8 March 2014

The Path to Success in Science.

Honestly, i will agree with the saying that the world of medicine is quite amazing and frightening.
It thus poses to us questions on how to attain in this competitive and quite challenging world.
It makes every medic question themselves about what next, what choices do we have to make and what is their impact in the future of our professional lives?
In all of this confusion in the life of an everyday medic, a professor of Medical sciences in the Institute of Molecular Medicine  ( Maria Mota) advises that we possess these Characters  to move on:

In all, be open to opportunities she said. You have to know what will keep you passionate as a Doctor.

She is a Doctor who trained in Portugal, United Kingdom and United States but still identifies with Malaria.
To know more, check out

Sunday, 2 March 2014


This is a long overdue write up. February 28th was the day set aside to celebrate this unique disease.
Its unique because it is rare. Rare enough to be classified as an Orphan disease.
Its highly misdiagnosed by Doctors and you possibly never knew it exist.
Don't worry, it take only about few lines in most text.
Possibly, you are asking yourself then why should i take interest?
Well, it will surprise you to know that its still mainly regarded as rare because it is frequently not diagnosed and because few works are available on it.

Brief History:
Paul Langerhans discovered the cell in skin-----1868
Eosinophilic Granulosa----------------- 1865
Hand schuller christian----------------- 1893
Letter-man Siwes Disease--------------1924
Histiocytosis X-------------------------1953
Langerhan Cell Histiocytosis------------1973
In every continent around the world, there has been at least a record over the last couple of years.

Langerhan’s cell histiocytosis (LCH) is a rare disease of unknown etiology that occurs mainly in children. It is the proliferation of cells of similar phenotypic features as dendritic Langerhan’s cells. Its incidence according to the American Histiocyte Society is 1: 200,000
    In Ukraine, there is no record of National incidence yet but in Lugansk, a city in east of Ukraine, incidence ranged from 1-2 in every 300,000 children.
So come along, as we discuss the peculiarities of this disease in our next Post.

Saturday, 22 February 2014

Lithopedion " Stone Child"

Today, as the incidence of this disease is increasing and recent record of it Nigeria, there is a need to discuss the stone baby and possibly get someone challenged to start a research on what could cause this disorder.
The first case was recorded in 1554 and now 450 years from its first diagnosis, we have recorded about 300 cases in different countries in the world(France, Rome, Denmark, USA, Jamaica, Thailand, China, Brazil, Morocco,, South Africa, South Korea,, Ghana, India,Congo, Colombia and now Nigeria amidst several others) yet there is no medical literature and neither are there published research work on this matter.
On May 5th 2013, we discussed about this topic in a blog post on this page, You can view 

Calcification processes that lead to lithopedion formation are very rare. Technology and advanced medical care has prevented many cases from developing into lithopedions. In recent case studies it has been found that lithopdeions are found in underdeveloped countries. The absense or limited forms of health care, along with cultural differences, prevent patients from seeking the medical attention that is needed. Since lithopedions do not pose a threat to the health of the pregnant woman, women often do not seek treatment to deliver their baby. Many women have been shown to live with a “stone child” for many years, and have been able to have other children while the calcified fetus remains in the body.
But today, record of it occurring in Developed countries are arising and a need for new generation of doctors to seek out its etiology is needed for effective treatment and prevention.
The earlier recorded cases have all occurred in patients with relatively good health before intra-uterine fetal death (Premature and in Post Dated) cases happened and due to low economic condition or cultural believes of sleeping baby have refused treatment. Thou in very few, it has been asymptomatic. To note is also the fact that cases of twin has been recorded.
But what brings question to my heart as a medic  is the perculiarity of the Nigerian case in which patient had VVF( vesico- vaginal Fistula) beforehand and the conclusion of practitioners as reported by social media that it has occurred due to low water intake by VVF patients. 
 Hence, i ask of your own opinion of what the cause could be? If and why Ultrasonically it can be viewed?
 Further information or studies could be referred to. 
As always, you can comment below or send in a mail.

Sunday, 2 February 2014

Have you heard of third hand smoking:linked to liver, lung and skin problems

While the physical evidence of secondhand smoke can be seen wafting through the air, thirdhand smoke is a more clandestine health threat. The invisible remnant of tobacco smoke that clings to surfaces and even dust, thirdhand smoke is linked to several adverse health effects in a new study published in PLOS ONE.
According to the researchers, from the University of California-Riverside (UCR), tobacco smoke affects around 1.5 billion smokers worldwide, but several billion more are at an "underappreciated health risk" from cigarette smoke exposure.
Although many parents who smoke may protect their children from exposure to secondhand smoke, the researchers say the effects of thirdhand smoke are also dangerous.
They cite previous research suggesting that children living with adults who smoke in the home are absent from school 40% more days than children who do not live with smokers.
Medical News Today recently reported on a study that suggested secondhand smoke exposure is linked to hospital readmission for asthmatic children.
But researchers from this latest study say thirdhand smoke is left on surfaces and ages over time, becoming increasingly more toxic. The team suggests second and thirdhand smoke are just as harmful as firsthand smoke.

Health impacts of thirdhand smoke

And the threat does not only apply to smokers, the team explains. Even after smokers move out of a house or hotel, thirdhand smoke and its accompanying carcinogens remain.
Mother and child playing together on a rug in front of a sofa and a pile of soft toys.
Hidden danger? Thirdhand smoke can cling to fabrics, surfaces and even dust, leaving increasingly toxic carcinogens - even after the smoker has moved out.
To conduct their study, the team - led by Prof. Manuela Martins-Green of UCR - studied the effects of thirdhand smoke on mice, looking at "several organ systems under conditions that simulated thirdhand smoke exposure of humans," Prof. Martins-Green explains.
After exposure to thirdhand smoke, these mice showed alterations in several organs and excreted levels of a tobacco carcinogen that are similar to those found in children confronted with secondhand smoke.
In detail, the thirdhand smoke increased lipid levels and non-alcoholic fatty liver disease, which is a forerunner to cirrhosis, cancer and cardiovascular disease. It also increased collagen production and inflammatory cytokine levels in the lungs, which has implications for fibrosis, pulmonary disease and asthma.
The mice also showed poor healing of wounded skin and exhibited hyperactive behavior.
Prof. Martins-Green comments on their findings:
"The latter data, combined with emerging associated behavioral problems in children exposed to second and thirdhand smoke suggests that with prolonged exposure, they may be at significant risk for developing more severe neurological disorders."
The team says their results form a basis for future studies looking at the harmful effects of thirdhand smoke in humans, potentially informing regulatory policies aimed at prevention.

'Still much to learn'

In the recent past, measures to reduce smoking in the US have resulted in positive outcomes. A recent study suggested that smoking controls have saved 8 million lives since 1964.
And other research showed that smokers who wish to quit are more successful in cities that have banned smoking in public places.
Still, Prof. Martins-Green says there is a "critical need" for more animal studies to analyze the biological effects of thirdhand smoke exposure.
"Such studies can determine potential human health risks, design of clinical trials and potentially can contribute to policies that lead to reduction in both exposure and disease," she adds.
In other studies, the team has learned that thirdhand smoke exposure brings about changes that can lead to type 2 diabetes in non-obese individuals.
Prof. Martins-Green says:
"There is still much to learn about the specific mechanisms by which cigarette smoke residues harm non-smokers, but that there is such an effect is now clear."
"Children in environments where smoking is, or has been allowed, are at significant risk for suffering from multiple short-term and longer health problems, many of which may not manifest fully until later in life," she adds.
Written by 

New cream with silver nanoparticles could block HIV transmission

According to the Centers for Disease Control and Prevention, more than 1.1 million people in the US are infected with human immunodeficiency virus. But new research has detailed the creation of a cream that has proved effective against transmission of the infection in laboratory tests.
Previous research from the University of Texas, in collaboration with the University of Monterrey in Mexico, found that silver nanoparticles may be able to stop transmission of human immunodeficiency virus (HIV).
Now, the research team has used the findings to create a vaginal cream that can block HIV transmission.
Humberto Lara Villegas, of the University of Monterrey and co-author of the study, says that in order for HIV to infect immune cells of its host, a protein called GP120 helps the virus bond to the cells.
He explains that the silver nanoparticles attach themselves to the GP120 protein and block it, meaning HIV is unable to infect immune cells.
Commenting on the creation, Lara Villegas says:
"Normally, the medication used against the virus act within the cell to avoid its replication. This is a very different case, given that the nanoparticle goes directly against the HIV and no longer allows its entry to the cell."

Positive results in laboratory tests

He says the cream has been tested in the laboratory using human tissue samples of cervical mucous membrane. It was found to effectively block HIV transmission.
Lara Villegas notes that the cream works in less than 1 minute following application and is protective against virus transmission for up to 72 hours.
The researchers say although the cream is for vaginal use, the sexual partner will also be protected against the virus.
Silver nanoparticles
Using silver nanoparticles (pictured), researchers have created a vaginal cream that has proved effective in blocking HIV transmission.
Image credit: Investigación y Desarrollo
However, Lara Villegas stresses that although there have been no negative side effects from the silver nanoparticles so far, the team will carry out further investigation to be sure.
The next steps will be to test the cream on mice that are modified with human immune cells, before moving on to clinical trials in humans.
The researchers note that the cream may also help to protect against other sexually transmitted infections, such as the human pappilloma virus (HPV), as the silver nanoparticles should be able to block this virus using the same process it uses to block HIV infection.
The team is also in the process of creating a diagnostic kit. The kit will use blood tests to predict whether an HIV-positive individual will respond to antiretroviral treatment.
They hope the kit will provide these results within hours, and that it will help clinicians to ensure their patients receive the best possible treatment for HIV.
Medical News Today recently reported on a study suggesting that targeting HIV with radioimmunotherapy may abolish the virus from infected cells.
Written by 

Tuesday, 21 January 2014

Paroxysmal Nocturnal Hemoglobinuria :Predisposing factor for Leukemia

The term "nocturnal" refers to the belief that hemolysis is triggered by acidosis during sleep and activates complement to hemolyze an unprotected and abnormal RBC membrane. However, this observation was later disproved. Hemolysis has been shown to occur throughout the day and is not actually paroxysmal, but the urine concentrated overnight produces the dramatic change in color.
This disease has been referred to as the great impersonator because of the variety of symptoms observed during the initial manifestation and course of paroxysmal nocturnal hemoglobinuria (PNH). The clinical syndrome can present in 3 types of symptoms including (1) an acquired intracorpuscular hemolytic anemia due to the abnormal susceptibility of the RBC membrane to the hemolytic activity of complement; (2) thromboses in large vessels, such as hepatic, abdominal, cerebral, and subdermal veins; and (3) a deficiency in hematopoiesis that may be mild or severe, such as pancytopenia in an aplastic anemia state. The triad of hemolytic anemia, pancytopenia, and thrombosis makes paroxysmal nocturnal hemoglobinuria (PNH) a truly unique clinical syndrome.Paroxysmal nocturnal hemoglobinuria (PNH) has been reclassified from purely an acquired hemolytic anemia due to a hematopoietic stem cell mutation defect. This change in concept was brought about by the observation that surface proteins were missing not only in the RBC membrane but also in all blood cells, including the platelet and white cells.Paroxysmal nocturnal hemoglobinuria (PNH) has been reclassified from purely an acquired hemolytic anemia due to a hematopoietic stem cell mutation defect. This change in concept was brought about by the observation that surface proteins were missing not only in the RBC membrane but also in all blood cells, including the platelet and white cells.The common denominator in the disease, a biochemical defect, appears to be a genetic mutation leading to the inability to synthesize the glycosyl-phosphatidylinositol (GPI) anchor that binds these proteins to cell membranes.

FANCONI SYNDROME: A predisposing factor for Leukemia

Fanconi syndrome is a renal syndrome of idiopathic origin and it is also characterized by poluria, polydipsia and dehydration.
Fanconi syndrome is due to various causes, some inherited and some acquired. The incidence of each of these conditions is different, although almost all of them are rather rare. The circumstances surrounding this disorder remains an object of debate. The major area affected is the proximal tubules.
Its been proposed that one of these mechanisms explains its pathogenesis
 The 3 main categories in which they can be classified are (1) alterations in the function of the carriers that transport substances across the luminal membrane, (2) disturbances in cellular energy metabolism, and (3) changes in permeability characteristics of the tubular membranes.
The pathogenesis has further been linked up with cystinosis in children.The disease is caused by the accumulation of cystine in renal tubule cells.

The clinical features that cause patients to seek medical care include polyuria, polydipsia, bouts of dehydration (sometimes associated with fever), bone deformities, and impaired growth. Less often, the reasons for investigation are laboratory findings such as proteinuria, hypokalemia, hypophosphatemia, and hyperchloremic metabolic acidosis.

Then remember that due to its effect on bone and kidney production of hormones, Leukemia and Anemia do occur. 

Tuesday, 24 December 2013

Merry christmas

I wanna wish u a merry Christmas.
With all the love in my heart, i wish you a very merry Christmas. Thank you for being part of my life in 2013. Thank you for your wonderful comments and your constant contribution.
Have yourself a very merry Christmas day.
Lots of love
The ramblings of a medic- Augustina.

Wednesday, 4 December 2013

Oral cavity Examination.( Sequel to hospital practice 1)

Hey friends,
 Thanks so much for the Encouragement and love shown towards this blog. I do have us in mind all the time but sometimes i do really get busy. Nevertheless, i am sorry if you had expected more than i am giving. I will work on it.
 To the business of the day:
In clinical examination, of utmost importance is examining the mouth of your patient and it will surprise you how much it can reveal if you do or miss if done otherwise.

The oral cavity:
With respect, ask your patient to open his/ her mouth and note stay some comfortable centimeters off as that is done but close enough to perceive the mouth  Fetor.Also ensure you ask them to protude their tongue and remeber to observe all the anatomical surfaces. Then observe the cavity for:
1.Nodular lesions
2.Buccal ulcers
3.Purpuric lesion
4.Parotid Enlargement
5.Dry oral mucosal
7.Alcoholic fetor
9.Small chin
10. Absence of lower jaw
11. Deviations or paralysis
12. Non-mobile soft palate
13. Exudate in oro-pharyngeal region
14. Bulging Tonsilitis

The tongue:check for the following
1. Deviation in position in oral cavity
4.Coatings: whitish, black, brownish, presence of exudate
5. Beefy Tongue
6. Palor
7. Dehydration
8. Ulcers
9. Tumours
10. Tongue Tie

Beefy tongue


Exudative lesions on the inferior surface.


Saturday, 30 November 2013

The Menstrual Cycle

Is defined as the periodic cyclical shedding of pro-gestational endometrium accompanied by blood flow through the vagina.

Is made up of 2 cycles.
1. Ovarian cycle: Follicular, Ovulatory and Luteal phases
2. Uterine Cycle: Menstrual, Proliferative and secretory phases

Normal values
Menstrual cycle: 28+/- 7
Menstrual Phase/menstruation:4+/-2
Blood loss:40mls+/-20
Due to variation in menstrual cycle duration, ovulation happens at different periods. In a 21 day cycle at day 7, in a 28 days cycle at 14th day and in a 35 day cycle, it occurs at day 21.
Components of normal menstruation discharge.
Endometrial cells
Blood cells
Vaginal epithelial cells
mast cells

Of note is that normal menstuation blood do not flow in clots except debris in it and this is due to presence of fibrinolysin as its component. Hence it is of use in differential diagnosis is menometrorrhagia.
The cause of menstruation remains multi- theoretical but the most referenced remains progesterone and estrogen deprivation.

Wednesday, 27 November 2013

 "Cancer is not just a medical challenge. Survivorship needs involve the entire span of a patient's physical, emotional, social and financial experience--all of which bear great influence on healing and quality of life. Doctors can and should broaden their view of this disease and form or affiliate with multidisciplinary practices or clinics that can offer a comprehensive approach to survivorship care. A diagnosis of cancer is the beginning of an entirely new life for the patient, and doctors need to embrace that reality in order to enhance the prospects of successful treatment and the ultimate well-being of their patients."

Indeed, with few notable exceptions (e.g., minor surgical resection of skin cancer) oncology treatment leaves people more disabled than they were prior to diagnosis and exposes them to long-term complications and potentially secondary malignancies. Of course, an uncontrolled malignancy would eventually result in mortality, but it’s important to recognize the significant morbidities that result from cancer therapies.

Thus, the idea that survivorship should be a distinct phase of cancer care is taking hold and is the healthcare model of the future. Issues being discussed in survivorship includes:

  • Pain

  • Fatigue

  • Deconditioning

  • Reduced physical strength

  • Reduced range of motion of joints

  • Decrease cardiovascular capacity

  • Depression/Anxiety

  • Osteoporosis/Osteopenia

  • Heart disease (future)

  • Diabetes (future)

  • Second malignancies

  • Recurrence of primary malignancy
  • Friday, 22 November 2013

    Pathophysiology of Acute Coronary Syndrome.

    Acute coronary syndromes result from coronary plaque disruption that exposes the vascular basement membrane to circulating blood cells and plasma components. Exposure of the basement membrane leads to generation of a thrombus.

    The formation of a thrombus consists of four distinct phases: platelet adhesion, activation, aggregation, and stabilization. The first step in this process is endothelial disruption, or plaque rupture, which exposes subendothelial collagen and other platelet-adhering ligands, such as von Willebrand factor (vWF) and fibronectin. Platelet receptors bind these ligands, causing adhesion of a thin platelet monolayer. Adhesion occurs primarily through binding of platelet glycoprotein IIb/IIIa receptors to collagen and GP Ib receptors to von Willebrand factor. The adhered platelets become activated and release alpha granules, which contain adenosine diphosphate (ADP), thromboxane, and serotonin. These substances, as well as other platelet agonists, cause local vasoconstriction and further activate surrounding platelets. Aspirin, a cyclooxygenase inhibitor, inhibits the synthesis of some of these thrombogenic substances, therefore slowing thrombogenesis activation. Platelets skimming along blood vessel walls recognize and adhese to certain proteins in the basement membrane including collagen, fibronectin and others. These and other platelets in this microenvironment are then activated by platelet agonists (ADP, epinephrine, thrombin, thromboxane A2, etc). Plaque disruption releases tissue factors that activate factor VII and the extrinsic coagulation pathway. The platelet surface activates both the extrinsic and intrinsic coagulation pathways, leading to the formation of thrombin. Thrombin converts fibrinogen to fibrin, thus providing a fibrin mesh that stabilizes the aggregate. Heparin inhibits this stabilization phase of thrombogenesis by combining with antithrombin III to inactivate factor X and prevent thrombin formation.

    Platelet activation results in a conformational change of the platelet glycoprotein IIb/IIIa receptor on the surface and promotes externalization of the IIb/IIIa glycoproteins within. Each platelet contains 40,000 to 80,000 surface IIb/IIIa receptors and an additional 20,000 IIb/IIIa glycoproteins stored interiorly. Once platelet activation occurs, the glycoprotein IIb/IIIa receptor readily binds divalent fibrinogen molecules, thus cross-linking the adjacent platelets. Known as "platelet aggregation," this process results in a local platelet plug at the site of endothelial injury.

    Activated platelets express 40,000-80,0000 glycoprotein IIb/IIIa inhibitors on their cell surfaces. Fibrinogen, a bivalent protein freely circulating in the serum, can then bind at each end to a glycoprotein IIb/IIIa receptor on two different platelets. This will quickly lead to a platelet –fibrinogen –rich thrombus in a coronary artery at the site of the initial plaque rupture. 

    If the thrombus obstructs flow of blood to downstream myocardium, ischemia or frank infarction is the result.