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
6.Halitosis
7.Alcoholic fetor
8.Stomatitis
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
15.Teeth

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

Beefy tongue

Sores


Exudative lesions on the inferior surface.

                                           Peace.


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
Histiocytes
Macrophages
Vaginal epithelial cells
mast cells
Prostaglandin
Fibrinolysin

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.

    Focus Assessment with sonography for trauma.

    Focused assessment with sonography for trauma (FAST), on the other hand, is an important and valuable diagnostic alternative to DPL (Diagnostic Peritoneal Lavage) and CT that can often facilitate a timely diagnosis for patients with BAT(Blunt abdominal Trauma)
    The benefits of the FAST examination include the following:
    • Decreases the time to diagnosis for acute abdominal injury in BAT
    • Helps accurately diagnose hemoperitoneum
    • Helps assess the degree of hemoperitoneum in BAT
    • Is noninvasive
    • Can be integrated into the primary or secondary survey and can be performed quickly, without removing patients from the clinical arena
    • Can be repeated for serial examinations
    • Is safe in pregnant patients and children, as it requires less radiation than CT
    • Leads to fewer DPLs; in the proper clinical setting, can lead to fewer CT scans (patients admitted to the trauma service and to receive serial abdominal examinations)

    Contraindications to Thrombolysis

    Absolute contraindications to thrombolysis include active internal bleeding, history of hemorrhagic stroke, head trauma or major surgery within four weeks, recent thromboembolic CVA and persistent uncontrolled hypertension.

    Friday 8 November 2013

    The Essence of Life

    Hi everyone, I know its been quite a while. Thank you all for the messages, keep them coming.


    Yeah, really i have been doing a lot of thinking on what the real essence of life is.
    Life is defined as the existence of an individual human being.
    As doctors we learn on how to care for people to preserve their lives
    Every single disease has a downward toll it could take and cause death and this is what we work to prevent (the downward toll) but many as medical professionals seem to forget this, we think we are healers. Well i wouldn't agree with anyone on that because all we try to initiate is the physiological healing process and if the body doesn't arise to the challenge then our quest will be futile.
    Yeah, we seem to witness people die and babies given birth to but yet we don't have power over life only God has but then do we acknowledge him for it. We have lost consciousness of the fact that he is the author of life for funny reasons
    1. We have still gotten the breath of life
    2. Every thing seems to be going on fine in our life

    But well after all this said and done
    After all this achievements
    After this unending race
    What will you be remembered for; A snake passing by a rock leaving no landmarks??
    Nay, is that what its all going to be at the end?
    Take a minute, close your eyes and take a deep breathe, ask yourself why you are still living? Why God has chosen to keep you alive to achieve purpose, many are gone 6fts below now not because they planned for it. So what is your purpose, to keep seeking this unending earthly treasures?
     Possibly, you are even counting days to becoming a doctor--- you got a set out plan on how to become a consultant, fellow, professor, a politician, whatever? But is it not all Vanity with no fulfillment and satisfaction if God is not in it, i solemnly tell you there is a continual lust to keep running and if your gaze are on things that will go with the wind, then its all a messed up life.
    Seek eternal treasures and i tell you the treasures of this earth will be added unto you and the race would be worthwhile because you are assured of the future.
    So my beloved ones get understanding with all thy getting.


    Yeah, its the ramblings of a medic......
                                              PEACE.

    Friday 27 September 2013

    SUMMER PRACTICE 1

    After 6 weeks of clinical rotations, taking me to a teaching hospital and private hospital facilities in Nigeria, i have finally seen what it seems like to be a working doctor.It has been quite an adventure, and I feel I have grown much not only as a physician-in-training but as a person. I've seen the start of  life when we delivered  newborn patient during OB/Gyn, and the end of another when I took turns performing CPR,but thank God she woke up. I’ve been amazed at how adaptable the human body can be,, but I’ve also been perplexed at how vulnerable our bodies can be at the same time, with a fine line between life and death.
    It’s easy to get emotional with cases like these, as we are all human beings with feelings, but we learn to set emotions and biases aside for the time being and focus on treating the patient to the best of our abilities, no matter if the patient is the victim or the criminal. While we strive to understand the mechanisms behind disease and how to manage them, much of medicine still remains mysterious and beyond control of even the most trained of physicians. It’s been a pleasure and honor to be able to experience the world of medicine.

    1. Writing H&Ps

    During your clinical years, residency, and beyond, you’ll be writing a lot of notes on the patients you see. The most common types of notes you’ll write are H&Ps (aka History & Physical or the similarly related Consult Notes) and SOAP notes (aka Progress Notes). The H&P is the note you write when you see a patient for the first time, in which you record the patient’s initial complaints, findings, and background history. Naturally, knowing how to write H&Ps requires knowing how to do a thorough interview and physical examination. There is no one single way to write the H&P, Consult, or SOAP notes, and you’ll notice that different doctors may write them slightly differently. Regardless, here are the basic components of the H&P:
    • CC — Chief Complaint (or Reason for Consult if you’re writing a consult note)
    • HPI — History of Present Illness
    • ROS — Review of Systems (N/V, Diarrhea/Constipation, HA, CP, SOB, etc.)
    • PMH — Past Medical History
    • PSH — Past Surgical History
    • Medications
    • Allergies
    • SH — Social History (smoking/EtOH/drugs, occupation)
    • FH — Family History
    • VS — Vital Signs (temperature, blood pressure, pulse rate, respiratory rate, oxygen saturation)
    • PE — Physical Exam Findings (General, HEENT, Neck, CV, Pulm, Abd, Ext, Neuro. Psych)
    • Lab Results (CBC, CMP and other labs when applicable)
    • Assessment and Plan

    2. Writing SOAP Notes

    As I stated above, the first note you write of a patient will be the H&P note. Every subsequent time you visit the patient, you’ll write a Progress Note (aka SOAP Note), to update on the progress of your patient’s hospital stay and make updated plans. The Progress Note is often called the SOAP note because of the acronym of its four components: Subjective, Objective, Assessment, and Plan. Often, you’ll see that the assessment and plan written together as one section with the listing of the assessed diagnoses, and the plans written under each diagnosis. Here are the basic components of the SOAP note:
    •  S — Subjective is what the patient says. It could be quotes, or it could be information that the patient tells you. You also write the symptoms the patient denies having here.  i.e. “Pt c/o mild lower abd pain but says otherwise ‘doing well’. Denies N/V/HA/CP/SOB…” etc.
    • O — Objective is what you find out about the patient, from physical examination, vitals, or lab values that you looked up about the patient. i.e. “NAD, HRRR, lungs clear, Abd soft/NT, no edema. Vitals: 97°-80-12-110/70. Labs: WBC 5.0, Hb 9.1….” etc.
    • A — Assessment is a brief statement summarizing the big picture of how the patient is doing. i.e. “28 yo G1P1 EDC 9/2/12 s/p ND day #2 doing well…” etc.
    • P — Plan is what you plan to do for this patient, like which medication you will prescribe, what the patient should do, what further test you want to order for the patient, or when the patient should follow up. i.e. ” continue post-partum care, repeat complete blood count in the morning, control pain with motrin…” etc.


    3. Reading Radiographs

    You’ll also encounter many situations during your rotations in which you’ll need to read X-rays, ultrasounds, CTs, and MRIs, whether it’s a chest X-ray during your internal medicine rotation, pelvic ultrasound during your OB/Gyn rotation, or CT of the abdomen during your surgery rotation prior to an abdominal aortic aneurysm repair.

    4. Knowing Lab Values and Vital Sign Values

    Knowing the normal reference values for vital signs and lab results will save you time and headache . Know what the lab values mean, and what their relationships are to each other (i.e. Increased BUN and Creatinine with a BUN/Cr ratio >20 usually means renal failure due to pre-renal cause, AST > ALT in alcoholic liver damage, etc.). Know important formulas like the Winter’s Formula and the calcium correction formula for hypoalbuminemia.  Know the cut-offs for normal blood pressure, pre-hypertension, and hypertension. Know cut-off values for BMI. Know cut-off values for pre-diabetes and diabetes at fasting and 2-hour post-prandial. 

    5. Learn Abbreviations

    You will find that in practice, abbreviations are extensively used, and you will need to know them to understand patient charts and doctors notes, as well as to write your own notes. Here are some common abbreviations you’ll see during your rotations:
    • Pt — Patient
    • c/o — complains of
    • s/p — status post, meaning a procedure is completed (i.e. s/p appendectomy in 2006, meaning the patient had an appendectomy in 2006).
    • c (with a dash over it) — with
    • Ø — no
    • HA — headache
    • MMM — moist, mucosal membranes
    • PERRLA — pupils equal, round, and reactive to light and accomodation
    • EOMI — extraocular movements intact
    • RRR — regular rate and rhythm
    • CTAB — clear to auscultation bilaterally (referring to the lungs)
    • SOB — shortness of breath
    • CP — chest pain
    • ND/NT — non-distended/non-tender
    • RUQ, LUQ, RLQ, LLQ — right upper quadrant, left upper quadrant, right lower quadrant, left lower quadrant.
    • N/V — nausea and vomiting
    • AAOx3 — alert and oriented to person, place, and time (the patient knows who he/she is, where they are, and what day it is)
    • AAOx2 — alert and oriented to person and place, but not time (the patient knows who he/she is, where they are, but not what day it is)
    • AAOx1 — alert and oriented only to person (the patient knows who he/she is, but not where they are or what day it is)
    • NKA, NKDA — no known allergies, no known drug allergies
    • NC — non-contributory
    • BID — twice per day
    • TID — three times per day
    • PO/IV/IM — by mouth, intravenous, intramuscular
    • DNR/DNI — do not resuscitate/do not intubate

    6. Performing a Focused Patient Encounter

    While during Basic Sciences we learn how to do a full exam and interview, which can take up to an hour to do. But in the clinical setting, we will need to learn how to do a much shorter, more focused patient encounter, meaning completing both the interview and physical exam within 15 minutes or less.  

    7. Knowing Trade Names

    While you won’t be tested on trade names on any of the licensing exams, you will quickly pick up the trade names of drugs as you go through your clinical rotations. The trade names are used as frequently as the generic names in practice, and everyone in the medical teams you will work with will know both, so try to make the effort to remember them. 
    PEACE.

    WPW--Wolf-Parkinson-White Syndrome

    • Wolf-Parkinson-White Syndrome (WPW) is a reentrant rhythm disturbance that can degenerate into malignant wide complex tachydysrhythmias, which can be life-threatening.
    • The likelihood of WPW with atrial fibrillation degenerating into ventricular fibrillation is exceedingly rare at 0.1%.
    • Nodal agents, such as beta blockers, calcium channel blockers and adenosine, should not be used in wide complex tachycardias or atrial fibrillation for therapeutic or diagnostic purposes if WPW is suspected.
    • Preferred agents for wide complex tachycardias where WPW is suspected are class 1A (e.g., procainamide) or class 3 (e.g., amiodarone) agents. ACLS 2005 guidelines emphasize the use of amiodarone in patients with depressed cardiac function (EF<40%).
    • Electrolyte disturbances (e.g., hypokalemia, hyperkalemia and metabolic acidosis) can increase the risk for arrhythmia and Sudden Cardiac Death.

    Thursday 19 September 2013

    GLASGOW AND BLANTYRE COMA SCALE


    Yeah, i am back again. I really wanted to make out time for another write-up b4 the week ran out. lol

    My first time on rotation in an A&E ward, i had taken time to try to study and take in the images of things, situation and attitude of  patients, family members and the medical staff. In the process of looking around like a lukman in a busy room, i noticed a coma scale pasted on the wall and i snapped it........
    I had hardly gone through it before a resident doctor asked me if i could grade a patient in a comatose state with Glasgow. Well i was so glad to say i could, so lucky me.
    Then in pediatrics ward i was asked about the scale again and this time i wasn't lucky cos the consultant said what coma scale is used for grading in children that are not talking yet and thus i loooooooked ............
    Well we will get back to the remainder of the story l8r.
    This is the scale:

    Pls note the differences between both 
    There is no minimum of 0 in Glasgow, its 3 but in Blantyre there could be 0.
    Blantyre total is 5 and Glasgow is 15
    Both are used to grade improvement or deterioration in comatose patient
    In Glasgow 7-9 is seen as the red-zone
    In Blantyre its 2 that is redzone

    You can thank me later but you could do well to add more differences and similarities not mentioned.
    PEACE


    Tuesday 17 September 2013

    Some Thoughts About Diabetes


    20121119-121019.jpg
    A colorful all-natural veggie-filled lunch.
    Rotating in endocrinology and working with many individuals with diabetes have really given me a peek into the life-long lifestyle challenges of living with diabetes. For those who become dependent on insulin, seemingly worse than the multiple daily injections and finger pin pricks before each meal is the freedom that is taken away when one lives with diabetes: the freedom to eat spontaneously, the freedom to eat certain classifications of food, the freedom to eat certain amounts of food. Every meal becomes a daily concern. There’s the pressure to have a strict routine eating habit, eating a consistent amount for each meal day after day, and to space apart meals to correspond with the dose and duration of the insulin. The complications that come years after, like kidney failure, blindness, nerve damage, and gangrenous hands and toes that lead to amputation are even worse, and unfortunately, I’ve seen quite a few patient that suffer further more from these.
    Personally, seeing what diabetic patients have to go through everyday really makes me want to eat healthier, avoid sugar, and exercise more, doing whatever it takes to decrease the risk of diabetes. Right now, it makes me hesitate every time I eat something sweet. . Seeing what the patients have to go through with diabetes and the difficulty of its management makes me so worried about developing the disease. I don’t ever want myself, or anyone else, to have to go through some of the experiences of the patients I’ve seen.
    so live healthy. 
    peace

    Monday 16 September 2013

    BASIC TISSUE TYPES.

    Hello, everyone. I really do apologize as i do know this page is long overdue for a new post.
    It was really a busy summer holiday and settling down after resumption hasn't been quite easy. Anywaz, i will try to make up for it. Lets get to business....

    I was just going thru some stuffs and i  began to wonder why we had to cram the types of tissues that make up the human body in those days of histology. Well i beg ur pardon if you didnt cram it but well i did so looking back now i cant but laugh. 
    This is it:

    cell--------------tissue-----------------organ-----------system

    so if that is it, remember dis, every organ u decide to envision in ur mind has 
    1. epithelial lining
    2. its supplied and supported by vascular and connective tissues
    3. it has musculature
    4. its innervated by a nerve.
    Thats all...   Peace

    Sunday 1 September 2013

    Welcome Back To School............

    Happy new month
    Happy new season
    Happy new session
    Wishing us all the very best this new academic year.

    Tuesday 11 June 2013

    AZOTEMIA

    Azotemia refers to an elevation of blood urea, nitrogen and creatinine levels and is largely related to reduced GFR. It is without clinical manifestations but can be seen in biochemical index.

    Its progression to clinical manifestations and systemic biochemical abnormalities is termed UREMIA.  Uremia is not characterized by failure of renal excretory functions only but also by a host of metabolic and endocrine alterations incident to renal failure. There are also secondary manifestations like uremic gastroenteritis, pheripheral neuropathy and cardiovascular involvements ( uremic pericarditis).

    Azotemia can be classified by its pathological relation to the kidney as
    1. Pre-renal: it include any extra renal disease that reduces perfussion of the kidneys and reduce GFR.
    2. Renal: includes diseases of the kidney and occurs in Nephritic syndrome, renal failure
    3.Post-renal: occurs as a result of obstruction to urine flow.

                                                                                                                            PEACE

    Monday 10 June 2013

    FATIGUED at end of school year?

    Its a privilege  to make out time to write again. I am so sorry i have been missing in action for a while.
    Well today, i will be expressing my view on fatigue.

    Its ending of school session around the world and we as students are all eager to finish school year and start our vacation. As it seems, due to this reason, quite a couple of us are just in school in body but our mind is off school. I wonder if its nostalgic feelings about having 2 months of our own timetable or .......
    Well i really can't say what the reason for this is as we struggle to read and pass our exams in time.
    On my end, i have discovered many are in a state of  FATIGUE. 
    Fatigue could be physical or mental.

    Tiredness is a psychological state of being. It is a transient decrease in maximal cognitive performance resulting from prolonged periods of cognitive activity. It can manifest as somnolence or lethargy. It is also being regarded as mental fatigue and can't be clinically measured.

    Whereas, physically fatigue people can be clinically observed and treated with rest and other beneficial therapies. This form of fatigue can be measured as body fluid indexes could show changes. sleep deprivation in these end period alongside with continuous studying and reduced eating could cause this and note its just for a while because its reversible.

    So friends, i indulge you all to finish the race in time. Put in more efforts, don't relent, keep pushing and remember the G- factor for with God alone is success possible.

                                                                                                                                                PEACE
                                                                                                                                                   

    Monday 27 May 2013

    Post 101


    Non-medic friend: “Hey, how was your day?”
    CMM: “Oh, yeah it was pretty good…had class all day though.”
    Non-medic: “I heard that medical students dissect rats…isn’t that really gross??”
    CMM: “Well…erm….we don’t dissect rats actually….we dissect other stuff.”
    Non-medic: “What do you dissect then?”
    CMM: “Uhhh..people.”
    *cue freak out from non-medic, with much proclaiming of “urghghghgh how could you do that?”, “omggggggg I’m gonna be sick?!” etc.*
    The medical school that I attend (which shall remain anonymous in case the GMC decide to slay me for anything I may say in the future) uses cadaveric dissection as a way to teach anatomy, alongside lectures obviously.  We dissect from for a considerable amount of time each week, starting in the very first week of first year.
    And yes, it was and is really pretty gross.  The first time we dissected, the entire class was silently freaking out, worrying who was going to be the one to faint or vomit or burst into tears.  Interestingly, as far as I am aware, that didn’t happen to anyone, and I have only ever seen one person faint in the dissecting room and I think that was just from standing up for too long rather than from touching a dead body.
    Whilst dissecting, most of the time my thoughts are along the lines of “Where the fuck is the bloody nerve…oh there is it…oh wait no.  Aaah don’t cut my fingers off. Oh there it is…is it??  Nah….  I’m hungry, yay only 10 minutes till home time!” but every now and again it’s more like “Muscles muscles muscles omg this person was actually a person with thoughts and feelings and a family.  This person got up every morning and put socks on the feet which I am ripping apart with my scalpel.  They probably ate pizza and sandwiches and knew how to swim.  This was someone’s best friend.  They would’ve started school and been terrified.  They had a job, they had a car, then had a house.  They watched TV and read books.  In short, they are just like me.”.
    And I’m relieved I have those thoughts.  Intrusive and distracting as they are, I hope I never forget that these people are not just corpses filled with formaldehyde.  They had stories and lives and dreams.  And they were wondering, generous, thoughtful people who had the courage and selflessness to decide to donate their bodies to my medical school for teaching purposes.
    Every time we go into the dissecting room, we come scarily close to death.  With the exception of seeing some horrendous car crash, or having a relative pass away or attending a funeral, most people live their lives avoiding death.  This is not the same for medical students or doctors.  Every day we come are faced with our own mortality, we see the fact that life is so precarious and so finite that when we are gone, we are gone.  I’m going to assume that as I get older, I will become less emotionally involved with these things – people have told me that you never forget your first patient, but after that, it’s only the odd few who really make an impact on you.  Deep down, I hope I never lose the shocking innocence I have.  The fact that every time I interview a patient, I feel sad for them and don’t stop thinking about them for days.  The fact that I will never, ever forget the face of the cadaver I spent the year dissecting.  But then, I suppose it would be hard to practice Medicine like this without ending up in a Psychiatric ward something, and I really hope that doesn’t happen to me!

    Monday 20 May 2013

    lithopedion or stone baby


    In an ectopic pregnancy, if the dead foetus is too large to be re-absorbed by the mother's body it becomes a foreign body to the mother's immune system. To protect itself from possible infection the mother's body will encase the foetus in a calciferous substance as the tissues die and dehydrate.
    As the calciferous wall builds up, the foetus is gradually mummified becoming a lithopedion or stone baby.
    Probably you have never heard of it, it does exist.
    Dissected Foetus
    Dissected stone baby
    Lithopedion Baby
    A stone baby

    KOBOKO VS MEDICINAL DRUGS IN ATTENTION DEFICIT HYPERACTIVITY DISORDER.



    ADHD today is the most commonly studied child psychiatric disorder
    and well there there had been a say from the beginning of time for its cure.
    Foolishness is bound in the heart of a child; but the rod of correction shall drive it far from him. (Holy Bible prov22vs15).
    Recently, i came by a comic picture of the typical Nigerian cane (koboko) with a tag that its been saving life since...........it was discovered it could bring pain that will make a child sober and think. However this brings us to the daily increase in number of children being diagnosed of this illness and it brings this question to mind, Do we have it in Africa?
    "ADHD is found to be as prevalent on the African continent as in
    Western countries (Meyer, 1998; Meyer, Eilertsen, Sundet, Tshifularo,
    & Sagvolden, 2004). The predominant Western approach to
    understanding mental disorders is based on a biomedical perspective that
    regards primary syndromes as universal and similar across diverse human
    cultures. A basic question is to what degree behaviour and its disturbances
    are affected by culture".
    The inability to inhibit behavioral responses leads to risk taking
    behaviour like drug and alcohol abuse, tobacco smoking, premarital and
    promiscuous sex, driving anger and traffic offences, accident proneness,
    compulsive buying and tattooing and body piercing (Barkley, 2004;
    Barkley, Fischer, Smallish, & Fletcher, 2004; Carroll, Riffenburgh,
    Roberts, & Myhre, 2002; Fillmore & Rush, 2002; Kahn, Kaplowitz,
    Goodman, & Emans, 2002; Lam, 2002; Molina, Bukstein, & Lynch, 2002;
    Roberts & Tanner, Jr., 2000; Tercyak, Lerman, & Audrain, 2002).
    A high incidence of crime, substance abuse, and especially the very
    high rate of HIV infection in South Africa, and its possible relationship to
    ADHD, necessitated an investigation into the prevalence and neuropsychological manifestations of the disorder.
    So how true is this, will the African child have to be subjected to those drugs Americans think has its management abilities or do we go back to our use of native admonishments like local koboko, pankere and its like?
    Pls do comment as ur feedbacks are of utmost importance.

    Wednesday 8 May 2013

    Mitosis



    It consists of two main stages.
    Karyokinesis : This is the main part of cell division, which is the division of the nucleus. It is further divided into four stages.
    • Prophase : The nucleus of the cell breaks apart. The individual chromsomes are visible as the chromatids condense.
    • Metaphase : The centromeres of the chromosomes align along what is called as the metaphase plate.
    • Anaphase : The chromatids separate and get pulled apart by the mitotic spindles forming two arrangements.
    • Telophase : The chromatids condense and form the two daughter nuclei of the cell.
    Cytokinesis : This stage happens simultaneously with Telophase. It is the final stage where a cleavage is created in the cytoplasm and the cell separates into two daughter cells. The two daughter nuclei pass into the daughter cells.

    Individual Brain cells....


    UCLA study shows that individual brain cells track where we are and how we move

    Using virtual reality, neurophysicists determine how environmental stimuli and brain rhythms generate our neuronal maps of the world

    Place cells
    Place cells in the real world (l) and in virtual reality. (Click for details.)
    Leaving the house in the morning may seem simple, but with every move we make, our brains are working feverishly to create maps of the outside world that allow us to navigate and to remember where we are.
     
    Take one step out the front door, and an individual brain cell fires. Pass by your rose bush on the way to the car, another specific neuron fires. And so it goes. Ultimately, the brain constructs its own pinpoint geographical chart that is far more precise than anything you'd find on Google Maps.
     
    But just how neurons make these maps of space has fascinated scientists for decades. It is known that several types of stimuli influence the creation of neuronal maps, including visual cues in the physical environment — that rose bush, for instance — the body's innate knowledge of how fast it is moving, and other inputs, like smell. Yet the mechanisms by which groups of neurons combine these various stimuli to make precise maps are unknown.
     
    To solve this puzzle, UCLA neurophysicists built a virtual-reality environment that allowed them to manipulate these cues while measuring the activity of map-making neurons in rats. Surprisingly, they found that when certain cues were removed, the neurons that typically fire each time a rat passes a fixed point or landmark in the real world instead began to compute the rat's relative position, firing, for example, each time the rodent walked five paces forward, then five paces back, regardless of landmarks. And many other mapping cells shut down altogether, suggesting that different sensory cues strongly influence these neurons.
     
    Finally, the researchers found that in this virtual world, the rhythmic firing of neurons that normally speeds up or slows down depending on the rate at which an animal moves, was profoundly altered. The rats' brains maintained a single, steady rhythmic pattern.
     
    The findings, reported in the May 2 online edition of the journal Science, provide further clues to how the brain learns and makes memories.
     
    The mystery of how cells determine place
     
    "Place cells" are individual neurons located in the brain's hippocampus that create maps by registering specific places in the outside environment. These cells are crucial for learning and memory. They are also known to play a role in such conditions as post-traumatic stress disorder and Alzheimer's disease when damaged.
     
    For some 40 years, the thinking had been that the maps made by place cells were based primarily on visual landmarks in the environment, known as distal cues — a tall tree, a building — as well on motion, or gait, cues. But, as UCLA neurophysicist and senior study author Mayank Mehta points out, other cues are present in the real world: the smell of the local pizzeria, the sound of a nearby subway tunnel, the tactile feel of one's feet on a surface. These other cues, which Mehta likes to refer to as "stuff," were believed to have only a small influence on place cells.
     
    Could it be that these different sensory modalities led place cells to create individual maps, wondered Mehta, a professor with joint appointments in the departments of neurology, physics and astronomy. And if so, do these individual maps cooperate with each other, or do they compete? No one really knew for sure.
     
    Virtual reality reveals new clues
     
    To investigate, Mehta and his colleagues needed to separate the distal and gait cues from all the other "stuff." They did this by crafting a virtual-reality maze for rats in which odors, sounds and all stimuli, except distal and gait cues, were removed. As video of a physical environment was projected around them, the rats, held by a harness, were placed on a ball that rotated as they moved. When they ran, the video would move along with them, giving the animals the illusion that they were navigating their way through an actual physical environment.
     
    As a comparison, the researchers had the rats — six altogether — run a real-world maze that was visually identical to the virtual-reality version but that included the additional "stuff" cues. Using micro-electrodes 10 times thinner than a human hair, the team measured the activity of some 3,000 space-mapping neurons in the rats' brains as they completed both mazes.
     
    What they found intrigued them. The elimination of the "stuff" cues in the virtual-reality maze had a huge effect: Fully half of the neurons being recorded became inactive, despite the fact that the distal and gate cues were similar in the virtual and real worlds. The results, Mehta said, show that these other sensory cues, once thought to play only a minor role in activating the brain, actually have a major influence on place cells.
     
    And while in the real world, place cells responded to fixed, absolute positions, spiking at those same positions each time rats passed them, regardless of the direction they were moving — a finding consistent with previous experiments — this was not the case in the virtual-reality maze.
     
    "In the virtual world," Mehta said, "we found that the neurons almost never did that. Instead, the neurons spiked at the same relative distance in the two directions as the rat moved back and forth. In other words, going back to the front door-to-car analogy, in a virtual world, the cell that fires five steps away from the door when leaving your home would not fire five steps away from the door upon your return. Instead, it would fire five steps away from the car when leaving the car. Thus, these cells are keeping track of the relative distance traveled rather than absolute position. This gives us evidence for the individual place cell's ability to represent relative distances."
     
    Mehta thinks this is because neuronal maps are generated by three different categories of stimuli — distal cues, gait and "stuff" — and that all are competing for control of neural activity. This competition is what ultimately generates the "full" map of space.
     
    "All the external stuff is fixed at the same absolute position and hence generates a representation of absolute space," he said. "But when all the stuff is removed, the profound contribution of gait is revealed, which enables neurons to compute relative distances traveled."
     
    The researchers also made a new discovery about the brain's theta rhythm. It is known that place cells use the rhythmic firing of neurons to keep track of "brain time," the brain's internal clock. Normally, Mehta said, the theta rhythm becomes faster as subjects run faster, and slower as running speed decreases. This speed-dependent change in brain rhythm was thought to be crucial for generating the 'brain time' for place cells. But the team found that in the virtual world, the theta rhythm was uninfluenced by running speed.
     
    "That was a surprising and fascinating discovery, because the 'brain time' of place cells was as precise in the virtual world as in the real world, even though the speed-dependence of the theta rhythm was abolished," Mehta said. "This gives us a new insight about how the brain keeps track of space-time."
     
    The researchers found that the firing of place cells was very precise, down to one-hundredth of a second, "so fast that we humans cannot perceive it but neurons can," Mehta said. "We have found that this very precise spiking of neurons with respect to 'brain-time' is crucial for learning and making new memories."
     
    Mehta said the results, taken together, provide insight into how distinct sensory cues both cooperate and compete to influence the intricate network of neuronal activity. Understanding how these cells function is key to understanding how the brain makes and retains memories, which are vulnerable to such disorders as Alzheimer's and PTSD.
     
    "Ultimately, understanding how these intricate neuronal networks function is a key to developing therapies to prevent such disorders," he said.
     
    In May, Mehta joined 100 other scientists in Washington, D.C., to help shape President Obama's BRAIN Initiative (Brain Research through Advancing Innovative Neurotechnologies), with the goal of trying to tease out how this most complicated of organs works.
     
    Other authors of the study included Pascal Ravassard, Ashley Kees and Bernard Willers, all lead authors, and David Ho, Daniel A. Aharoni, Jesse Cushman and Zahra M. Aghajan of UCLA. Funding was provided by the W.M. Keck foundation, a National Science Foundation career award grant and a National Institutes of Health grant (5R01MH092925-02).
     
    The UCLA Department of Neurology, with over 100 faculty members, encompasses more than 20 disease-related research programs, along with large clinical and teaching programs. These programs cover brain mapping and neuroimaging, movement disorders, Alzheimer's disease, multiple sclerosis, neurogenetics, nerve and muscle disorders, epilepsy, neuro-oncology, neurotology, neuropsychology, headaches and migraines, neurorehabilitation, and neurovascular disorders. The department ranks in the top two among its peers nationwide in National Institutes of Health funding.

    Sunday 28 April 2013

    Alzheimer's' patient


    What I wouldn’t give to hear your voice

    What  wouldn't i give to hear your voice
    And know its you
    Its not death that is worst…
    Its seeing those you love and having no idea who they are
    Seeing someone that meant so much to you in one lifetime…
    And can’t remember how significant they were,
    Its having to sleep at the police station
    Because you couldn’t remember the way home,
    Its forgetting your name…
    And how old you are,
    Living a life of your own in your head
    Regardless of those around you
    Forgetting significant memories
    That meant so much to us
    How exasperating not to know the children you gave life
    And lay in your bossom,
    For those who complain about life,
    Think of what life would be if you forgot…
    If you had no memories to keep
    And no one to call loved
    But remember,
    Even if my mind forgets…
    My heart will always remember
    Alzheimers could take away my mind,

    Saturday 20 April 2013

    Finding The Right Occasion for our Heeled shoes: Striking a balance between fashion and health.



    This really isn't  my idea but its a write-up that was requested for. I can remember it started when within the university environment in daytime on an uneventful day a lady passed by on heels. These were the comments it generated
    1. Must you Ladies wear heels?
    2.Do you know the anatomical implication as a medical student?
    3.Why do you go on heels when you know you will have to struggle on it?
    4. When did heels become an everyday wear?
    The questions went on and all i could do was laugh because i do know i am guilty of this too. Funnily it even reminded me of a colleague that almost fell on her wedge booties when she was on her way to class and on her way back home. Then, i can remember when the American first family and the beautiful ladies of the house were described(their style and modesty) and this issue arose, the writer made mention of the fact that on their flats foot wears  their styles were always still unique. But seriously i would agree to the fact that heel shoes have now become a menace in our society and i am wondering out loud about who told us we were too short or needed them to look good.


     High heels may turn heads, but new research shows the long-term cost of wearing them is even steeper than the sky-high price tag of some coveted brands.
    Along with aching feet and a variety of foot deformities, years of high-heel wearing can actually alter the anatomy of the calf muscles and tendons, according to a study by researchers in England, published online July 16 in the Journal of Experimental Biology.
    The incline of high heels causes the calf muscles to contract. Over time, this causes the muscle fibers to shorten and the Achilles tendon to thicken, so much so that some women feel pain when they try to walk in flats or sneakers.
    “You put on heels, you are going to deform your body. End of story,” said New York City podiatrist Dr. Johanna Youner, a spokeswoman for the American Podiatric Medical Association who was not involved with the research. “High heels look beautiful, but the body isn’t meant to wear them. There is no way around it.”
    For the study, Marco Narici of Manchester Metropolitan University and colleagues recruited 80 women aged 20 to 50 who had been wearing heels of at least 2 inches almost daily for two years or more. Of those, 11 said they experienced discomfort when walking in flatter shoes.
    When compared with women who did not wear heels, ultrasounds revealed the women who wore heels had calf muscle fibers that were 13 percent shorter, while MRIs showed the Achilles tendon, which attaches the heel bone to the calf muscle, was stiffer and thicker.
    “This is a great study that looks at the mechanism of how high heels may cause grief and aggravation to the woman wearing them,” said Marian Hannan, a senior scientist at the Institute for Aging Research at Hebrew SeniorLife in Boston, who was not involved in the research. “This may have an impact on how future shoes are designed and help the industry understand how women can be slaves to fashion but not suffer so much physical discomfort.”
    It’s not a big leap to know that shoes that hurt can’t be good for you, Youner said. For example:
    • High heels put stress on the back and knees. Squeezing into high heels with narrow toe boxes can cause a condition called Morton’s neuroma, a painful thickening of tissue between the third and fourth toes.
    • Haglund’s deformity, sometimes called the “pump bump,” occurs when back straps of heels dig into the tissue around the Achilles tendon. Too-tight shoes can bring on bunions, an enlargement of bone or tissue at the base of the big toe that pushes the big toe toward the second toe.
    • Pointy shoes can worsen hammertoe by forcing the toes to bend at the middle joints, eventually causing them to stay bent and rigid even when barefoot.
    • And then there are those uneven-sidewalk wipeouts that lead to ankle sprains and breaks


    REMEMBER TODAY ISN'T THE BEST OF YOUR LIFE. YOU STILL HAVE A WHOLE LOT OF IT AHEAD. BE WISE


    Endometriosis


    Recently trending has been the story of Nike Oshinowo-Soleye, a Nigerian businesswoman, socialiteentrepreneur and former pageant director. She has discussed her travails on her journey in life as she battles with endometriosis. 
    The pain and reflection explained by her story kept me on my toes at a further glimpse into 
    the disease in discussion and here it is.
     To this note i will be posting in brevity what basics are known about the disorder.

    Endometriosis is a common health problem in women. It gets its name from the word, endometrium , the tissue that lines the uterus or womb. Endometriosis occurs when this tissue grows outside of the uterus on other organs or structures in the body.female reproductive system including fallopian tube, ovaries, uterus, cervix, vagina and endometriosis
    Most often, endometriosis is found on the:
    • Ovaries
    • Fallopian tubes
    • Tissues that hold the uterus in place
    • Outer surface of the uterus
    • Lining of the pelvic cavity
    Other sites for growths can include the vagina, cervix, vulva, bowel, bladder, or rectum. In rare cases, endometriosis has been found in other parts of the body, such as the lungs, brain, and skin.
    The most common symptom of endometriosis is pain in the lower abdomen or pelvis, or the lower back, mainly during menstrual periods. The amount of pain a woman feels does not depend on how much endometriosis she has. Some women have no pain, even though their disease affects large areas. Other women with endometriosis have severe pain even though they have only a few small growths.
    Symptoms of endometriosis can include:
    • Very painful menstrual cramps; pain may get worse over time
    • Chronic pain in the lower back and pelvis
    • Pain during or after sex
    • Intestinal pain
    • Painful bowel movements or painful urination during menstrual periods
    • Spotting or bleeding between menstrual periods
    • Infertility or not being able to get pregnant
    • Fatigue
    • Diarrhea, constipation, bloating, or nausea, especially during menstrual periods
    Recent research shows a link between other health problems in women with endometriosis and their families. Some of these include:
    • Allergies, asthma, and chemical sensitivities
    • Autoimmune diseases, in which the body’s system that fights illness attacks itself instead. These can includehypothyroidismmultiple sclerosis, and lupus.
    • Chronic fatigue syndrome (CFS) and fibromyalgia
    • Being more likely to get infections and mononucleosis 
    • Mitral valve prolapse, a condition in which one of the heart's valves does not close as tightly as normal
    • Frequent yeast infections
    • Certain cancers, such as ovarian, breast, endocrine, kidney, thyroid, brain, and colon cancers, and melanoma and non-Hodgkin’s lymphomaGrowths of endometriosis are benign (not cancerous). But they still can cause many problems. 
    • To see why, it helps to understand a woman's menstrual cycle. Every month, hormones cause the lining of a woman's uterus to build up with tissue and blood vessels. If a woman does not get pregnant, the uterus sheds this tissue and blood. It comes out of the body through the vagina as her menstrual period.
    • Patches of endometriosis also respond to the hormones produced during the menstrual cycle. With the passage of time, the growths of endometriosis may expand by adding extra tissue and blood. The symptoms of endometriosis often get worse.
      Tissue and blood that is shed into the body can cause inflammation, scar tissue, and pain. As endometrial tissue grows, it can cover or grow into the ovaries and block the fallopian tubes. Trapped blood in the ovaries can form cysts, or closed sacs. It also can cause inflammation and cause the body to form scar tissue and adhesions, tissue that sometimes binds organs together. This scar tissue may cause pelvic pain and make it hard for women to get pregnant. The growths can also cause problems in the intestines and bladder.



      What causes endometriosis?

      No one knows for sure what causes this disease, but experts have a number of theories:
      • Since endometriosis runs in families, it may be carried in the genes, or some families have traits that make them more likely to get it.
      • Endometrial tissue may move from the uterus to other body parts through the blood system or lymph system.
      • If a woman has a faulty immune system it will fail to find and destroy endometrial tissue growing outside of the uterus. Recent research shows that immune system disorders and certain cancers are more common in women with endometriosis.
      • The hormone estrogen appears to promote the growth of endometriosis. So, some research is looking at whether it is a disease of the endocrine system, the body’s system of glands, hormones, and other secretions.
      • Endometrial tissue has been found in abdominal scars and might have been moved there by mistake during a surgery.
      • Small amounts of tissue from when a woman was an embryo might later become endometriosis.
      • New research shows a link between dioxin exposure and getting endometriosis. Dioxin is a toxic chemical from the making of pesticides and the burning of wastes. More research is needed to find out whether man-made chemicals cause endometriosis.
      • Endometrial tissue may back up into the abdomen through the fallopian tubes during a woman's monthly period. This transplanted tissue could grow outside of the uterus. However, most experts agree that this theory does not entirely explain why endometriosis develops.


      There is no cure for endometriosis, but there are many treatments for the pain and infertility that it causes.  The treatment you choose will depend on  symptoms, age, and plans for getting pregnant.
      How is endometriosis treated?

      Pain medication. For some women with mild symptoms, doctors may suggest taking over-the-counter medicines for pain. These include ibuprofen (Advil and Motrin) or naproxen (Aleve). When these medicines don't help, doctors may prescribe stronger pain relievers.
      Hormone treatment. When pain medicine is not enough, doctors often recommend hormone medicines to treat endometriosis. Only women who do not wish to become pregnant can use these drugs. Hormone treatment is best for women with small growths who do not have bad pain. Hormones come in many forms including pills, shots, and nasal sprays. Common hormones used for endometriosis include:
      • Birth control pills to decrease the amount of menstrual flow and prevent overgrowth of tissue that lines the uterus. Most birth control pills contain two hormones, estrogen and progestin. Once a woman stops taking them, she can get pregnant again. Stopping these pills will cause the symptoms of endometriosis to return.
      • GnRH agonists and antagonists greatly reduce the amount of estrogen in a woman's body, which stops the menstrual cycle. These drugs should not be used alone because they can cause side effects similar to those during menopause, such as hot flashes, bone loss, and vaginal dryness. Taking a low dose of progestin or estrogen along with these drugs can protect against these side effects. When a woman stops taking this medicine, monthly periods and the ability to get pregnant return. She also might stay free of the problems of endometriosis for months or years afterward.
      • Progestins. The hormone progestin can shrink spots of endometriosis by working against the effects of estrogen on the tissue. It will stop a woman’s menstrual periods, but can cause irregular vaginal bleeding. Medroxyprogesterone) (Depo-Provera) is a common progestin taken as a shot. Side effects of progestin can include weight gain, depressed mood, and decreased bone growth.
      • Danazol is a weak male hormone that lowers the levels of estrogen and progesterone in a woman's body. This stops a woman's period or makes it come less often. It is not often the first choice for treatment due to its side effects, such as oily skin, weight gain, tiredness, smaller breasts, and facial hair growth. It does not prevent pregnancy and can harm a baby growing in the uterus. It also cannot be used with other hormones, such as birth control pills.
      Surgery. Surgery is usually the best choice for women with severe endometriosis — many growths, a great deal of pain, or fertility problems. There are both minor and more complex surgeries that can help. Your doctor might suggest one of the following:
      • Laparoscopy can be used to diagnose and treat endometriosis. During this surgery, doctors remove growths and scar tissue or burn them away. The goal is to treat the endometriosis without harming the healthy tissue around it. Women recover from laparoscopy much faster than from major abdominal surgery.
      • Laparotomy or major abdominal surgery that involves a much larger cut in the abdomen than with laparoscopy. This allows the doctor to reach and remove growths of endometriosis in the pelvis or abdomen.
      • Hysterectomy  is a surgery in which the doctor removes the uterus. Removing the ovaries as well can help ensure that endometriosis will not return. This is done when the endometriosis has severely damaged these organs. A woman cannot get pregnant after this surgery, so it should only be considered as a last resort.