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.