Raghu

[meetdrraghu]

[meetdrraghu]

C.S.O.M.: Clinical Features Dr. Vishal Sharma. Definition Chronic (> 3 months) pyogenic infection of middle ear cleft mucosa, characterized by persistent.

[a-soul-like-you]

It’s interesting for me. Now I am really interested in ENT (ear, nose, throat), also known as otolaryngology. These specialists are surgeons that operate in these regions of the body. They remove your tonsils and ear wax, lol. They are also known as head and neck surgeons (different from neurosurgeons) I’m attracted to this specialty for a number of reasons:

Most complex, beautiful, and interesting anatomy of the head and neck

Mix of medicine and surgery (provides variety)

Working with generally healthy patients, so doing mostly quality of life operations instead of life saving operations (neurosurgeons). As a result I would not be dealing with very sick/critically ill patients

Less training time than neurosurgery (5 years post-med school vs 7)

Insane variety of operations (ear, nose, and throat), both extremely short cases to very long cases (30 secs to 12 hours)

Serious depth of knowledge that no one else in the hospital has

The absolute necessity of high attention to detail and fine motor skills

A lot of flexibility in how you want to practice (ear, nose, throat, or combination of two or more)

Get to work with other specialists like plastics and neurosurgeons

A mix of everything clinically/surgically: a little plastics, a little neuro, a little infectious disease, a little ortho, etc

Extremely high tech surgical instruments

Generally better lifestyle than neurosurgery so that I can spend time with my family

The people are known to be the happiest and most content of the surgical specialties across the board

The specialties of ENT include:

Otology/neurotology (Ears)

Rhinology (Nose and sinuses)

Laryngology (Throat)

Head and Neck (includes cancer)

Facial Plastic and Reconstructive Surgery

Pediatrics

The ones that interest me the most are otology, laryngology, head and neck, and FPRS. Otology because you get to improve/restore hearing. Laryngology because you get to improve/restore voice. Head and neck because you get to do temporal bone operations (overlaps with neurosurgery). I’m interested in FPRS only for those that had congenital malformations or acquired malformations (trauma, accidents, cancer). Just reconstructive surgery. I’m not interested in cosmetics at all. Cosmetics refers to those operations for celebrities and those that want to “look good”. 

I’m definitely interested in academics after residency so that I can still do those very interesting and complex cases. I’m more interested in just teaching and operating, and not giving up any of that time for research (which will probably be required, unfortunately)

Neurosurgery is what I wanted to do for the longest time, to be honest. But I feel like I would still get to do some things in the brain and near the brain that neurosurgeons don’t get to do like cochlear implants (restore hearing). Also, one thing that I don’t like much about neurosurgery is the high amount of spine work, like 60%. I would rather operate almost completely on the brain.

[medicowesome]

Study group discussion: Tonsils and pharynx review questions

Why is cleft palate a contraindication to tonsillectomy?

The tonsil is situated at the anterior end of oropharynx. So if the person already has cleft palate and you remove the tonsil.. You are removing an extra support to the palate. This can lead to velopharyngeal insufficiency, that is, nasal voice (rhinolaila aperta) and nasal regurgitation.

15 year old boy presents with recurrent epistaxis which can’t be controlled by adrenaline douches. Diagnosis?

Nasopharyngeal fibroma.

Why adrenaline ain’t working?

Vessels here are just endothelium lined with no muscle coat.

I found these concepts absolutely amazing so I thought of posting them here. More random questions on this discussion here.

-IkaN

[medicalstate]

On March 27, 1897, whilst eating some soup, [J.W.] aspirated a bone. This accident was followed by attacks of violent cough and dyspnoea, which, however, became gradually less… On direct laryngeal examination by mean of Kristein’s spatula, the patient being seated with his head strongly deflected to the left, I saw in the right principal bronchus a white mass. On the following day I introduced, under cocaine anaesthesia, a straight tube of 9 millimeters diameter and of 25 centimeters length through the larynx and the trachea until I came near the foreign body. The curvature of the trachea was thus removed, and the foreign body could be seen distinctly. I had great difficulty in catching hold of the foreign body, using a pair of slender forceps which had specially and quickly been made. The difficulties were great, as at that time…I was still without the necessary practice which enables one to look easily, and even more to operate, through long tubes. Eventually I succeeded in catching the bone and in extracting it. The patient was able to return home the following day.

Gustav Killian, 1902.

Direct endoscopy of the upper air-passages and oesopghagus; its diagnostic and therapeutic value in the search for and removal of foreign bodies. J Laryngol Rhinol Otol 17:461, 1902.

(via medicalstate)

[artsciencenursing-blog]

[spooniestrong]

I know this is common knowledge to most of us, but for the new Spoonies, we need to educate :-)

[cranquis]

This graphic has some good stuff — but here’s the not-so-good portions that I, as a physician, do not agree with (plus sources when applicable):

"Tylenol and Antibiotics" are NOT a “dangerous drug interaction to avoid" — in patients with bacterial infections + fever, we often use acetaminophen and an antibiotic together. However, since acetaminophen is primarily metabolized by liver, and most antibiotics undergo liver metabolism AT VARYING LEVELS, it is wise to be wary of taking both of these medication categories together — especially if you already have a pre-existing liver condition (in which case, you shouldn’t be taking acetaminophen at all, unless your liver doc said it’s ok!). But not all antibiotics are created equal, so don’t just lump "antibiotics" into this warning. In most cases, low/normal doses of acetaminophen, used for a few days of fever/pain control while concurrently undergoing standard-dose antibiotic therapy, will not nuke your liver.

Aspirin does NOT interact w/ “diabetes meds" to cause low blood sugar. The graphic doesn’t specify whether they mean insulin or oral meds such as glucophage, but regardless — aspirin is actually used often (and according to clinical studies, not ENOUGH) among diabetic patients, in order to help decrease their risk for cardiovascular disease. Aspirin can RARELY cause low blood sugar if given to children by itself, though. Sources: Epocrates.com, UpToDate.com

Birth Control (I assume they mean Hormonal Contraceptives — which are only one category of “birth control”) and Antibiotics do NOT interact… 99.98% of the time. I run into this flat-out medical myth all the time, and here’s the skinny: the ONLY antibiotic proven to decrease hormonal contraceptive efficacy (for “The Pill”, “The Patch” and “The Ring”) is Rifampin (which is used very rarely, mainly for treatment of tuberculosis). Planned Parenthood has addressed this before. UpToDate.com has this to add: “In spite of anecdotal reports of oral contraceptive failure, other antibiotics [besides Rifampin] have not been proven to affect the pharmacokinetics of [oral contraceptives]. For women taking antibiotics other than rifampin with oral contraceptives, back-up contraception is not required.” [BONUS TIP: “Vaginal miconazole suppositories and creams (i.e. Monistat, etc) do not appear to affect serum steroid levels in women using the contraceptive vaginal ring.” That’s not an antibiotic at all, but an interesting fact I didn’t know before, so there you go.]

Incidentally, the interaction between St. John’s Wort and Antidepressants is true — but did you know that St. John’s Wort CAN also interact with hormonal contraceptives? (See the Planned Parenthood link above; also Epocrates.com). Since many more people take St. John’s Wort (an over-the-counter herbal treatment) than Rifampin, that would be a useful addition to this type of infographic. 

Besides all that: the other specific interactions on this graphic are correct to the best of my medical knowledge/training, and the “General Rules” section is terrific.

As a doctor who also thrives on social media, I love medical infographics — except when they mix in (unsourced) health mis-information. Infographics are powerful, and we must be careful to create mis-infographics which may pre-condition patients into incorrectly “avoiding”/ignoring a doctor’s recommended treatment, just because the pretty graphic they saw online had already labeled that treatment as a “dangerous drug interaction”.

[sarquena]

For every block:

First Aid, of course!

Goljan’s Rapid Review Pathology+Goljan’s lectures or Pathoma for pathology.

Costanzo and BRS review, sometimes affectionately called “Baby Costanzo,” for physiology.

For specific blocks:

A good atlas and textbook for…

[humans-killed-me-deactivated201]

[biomedicalephemera]

Oral manifestations of childhood illnesses

1. Oral thrush - Caused by the Candida fungus overgrowing on the mucous membranes of the mouth. Also known as candidiasis when it occurs elsewhere on the body (such as vaginal candidiasis). 2. Varicella - Chicken pox. Have you ever had chicken pox in your mouth? It’s awful. 3. Stomatitis herpetica or Aphthosa [Herpetic stomatitis] - Caused by the same herpes infection of the mouth that causes cold sores, but blisters and mild ulceration can occur. This condition usually occurs when the child first contracts Herpes simplex I. 4. Stomatitis ulcerosa or Scorbutus - The oral manifestation of scurvy in children. The bone weakness, dry mouth, and immune dysfunction in scurvy often causes tooth weakening, loosening, and extreme gingivitis. 5. Follicular tonsillitis - The “standard” childhood tonsillitis, with infection of the palatine tonsils. If the infection doesn’t subside, removal of the tonsils is still the most common treatment. 6. Diphtheria - There are many oral manifestations of diphtheria, including “pseudo-membranes” covering the trachea, severely impairing breathing. The exotoxins exuded by Corynebacterium diphtherium can also cause thick, thrush-like patches in the pharyngotrachea.

Pediatrics: The Hygienic and and Medical Treatment of Children. Thomas Morgan Rotch, 1901.

[usmleaid]

Faggot cell is a term used for cells normally found in the Hypergranular form of Acute Promyelocytic Leukemia (FAB - M3).  This term is applied to these Promyelocytes (not blast cells) because of the presence of numerous Auer rods in the cytoplasm.Promyelocytes in Hypergranular form of Acute Promyelocytic Leukemia with abundant Auer Rods in cytoplasm.

[pro-choice-and-pro-voice-deacti]

To start off Birth Control Appreciation Day, I decided to make an informative masterpost on contraceptives! I hope this helps anyone who may want more information on their birth control or someone trying to decide what kind of birth control is best for themselves! Happy (birth control) hunting! - Paige

DIFFERENT TYPES OF BIRTH CONTROL:

Birth Control Pills - [x] [x]

Mini Pill (Progesterone-only Pill) -  [x]

The Patch (Ortho Evra) - [x] [x]

The Shot (Depo-Provera) - [x] [x]

Birth Control Sponge - [x] [x]

Vaginal Ring (Nuva Ring) - [x] [x]

Spermicide - [x] [x]

Implant (Implanon and Nexplanon) - [x] [x]

IUDs (Mirena, Skyla, and ParaGard) - [x] [x]

Condoms (Male and Female) - [x]

Withdrawal (Pullout Method) - [x] [x]

Diaphragm - [x] [x]

Breastfeeding - [x]

Cervical Cap - [x] [x]

Sterilization (Male and Female) - [x]

Abstinence - [x] [x]

Fertility Awareness-Based Methods (FAMs) - [x] [x]

COMMON QUESTIONS ABOUT BIRTH CONTROL:

Do certain medications make my birth control less effective?

Can I delay or eliminate my period with my birth control?

Will my pregnancy tests come out with an accurate result while I’m on birth control?

Can I use several birth control pills at once in replace of an emergency contraceptive?

Does birth control cause weight gain?

What should I do if I miss a pill?

What should I do if the condom breaks or slips off inside of me?

If I’m on the ring or the patch and I forget to replace it on the right day, do I need to use backup?

I’ve heard that the birth control ring can pop out. What should I do if this happens?

Can birth control increase my risk of getting cancer?

Can you change your mind after having a tubal ligation or vasectomy?

Is it normal to spot or bleed in between periods while on birth control?

Does certain hormonal birth controls affect my blood pressure?

Can being overweight affect my birth control’s effectiveness?

Can certain birth controls lower my libido?

EMERGENCY CONTRACEPTIVES:

Types of EC: Plan B / Ella / ParaGard IUD - [x] [x]

What are emergency contraceptives?

How do they work?

How well does it work?

What are the side effects?

When should I take an emergency contraceptive?

Are emergency contraceptives less effective the heavier you are?

If I am under the age of 18 in the US, can I buy emergency contraceptives without my parent’s knowledge or consent?

If I take an emergency contraceptive today, am I covered if I have unprotected sex tomorrow?

Will taking emergency contraceptives too many times affect my fertility?

To find more questions and answers about emergency contraceptives, you can go here.

Información anticonceptivos de emergencia es disponible en Español, aquí.

OPTIONS FOR PEOPLE WITH ALLERGIES AND/OR CERTAIN PREFERENCES:

Condoms for people with latex allergies.

Condoms for vegans. [x] [x] [x]

Other vegan contraceptive options.

Different types of birth control without estrogen.

Contraceptives without any hormones.

Birth control methods that are useful to people with religious concerns. [x] [x]

OTHER BENEFITS OF TAKING BIRTH CONTROL:

Taking oral contraceptives can help lower the risk of endometrial and ovarian cancer.

Using birth control helps treat acne.

Birth control can help treat the pain caused by Endomitriosis.

Contraceptives offer relief to people with Polycystic Ovarian Syndrome (PCOS).

Anemia can be avoided/treated by using birth control.

Irregular periods can become more regulated by using birth control.

The pill can lead to fewer ectopic pregnancies.

MYTHS ABOUT BIRTH CONTROL (All the myths below are dispelled through the links given):

Emergency contraceptives and birth control pills cause abortions.

Free contraceptives and/or condoms makes people participate in risky sexual behavior.

The pill makes you gain a lot of weight.

Douching after sex prevents pregnancy.

You have to start your birth control on a Sunday.

Taking the pill for a long time can make you infertile.

Hormonal contraceptives protect you from contracting STIs.

You don’t need to be on birth control while breastfeeding.

I won’t get pregnant my first time having sex.

The Pill is effective immediately after you take it.

I won’t get pregnant if I shower or pee after sex.

My body needs a rest from birth control at least once a year.

Emergency contraceptives are affected by alcohol.

[aspiringdoctors-blog]

This is wonderful!

[md-admissions]

As someone who has had to ask these questions as a young adult and now answers most of these questions on rotation and for family and friends, such a thorough list is wonderful.

[micdotcom]

This “miracle drug” can cure 150 million people of Hepatitis C … but there’s one problem

It’s astronomically expensive, and no one wants to pay for it.

For those who suffer from Hepatitis C — an estimated 150–200 million people worldwide — a drug called Sofosbuvir (being sold as Sovaldi) may have seemed like the answer. After gaining approval in the U.S. last December, Sovaldi has been the most effective cure to date when it comes to suppressing the virus. Experts have called it a “major breakthrough” and a “turning point,” and deservedly so — the drug’s success rate speaks for itself. 

Read more | Follow policymic

[neurosciencestuff]

Tool helps guide brain cancer surgery

A tool to help brain surgeons test and more precisely remove cancerous tissue was successfully used during surgery, according to a Purdue University and Brigham and Women’s Hospital study.

The Purdue-designed tool sprays a microscopic stream of charged solvent onto the tissue surface to gather information about its molecular makeup and produces a color-coded image that reveals the location, nature and concentration of tumor cells.

 ”In a matter of seconds this technique offers molecular information that can detect residual tumor that otherwise may have been left behind in the patient,” said R. Graham Cooks, the Purdue professor who co-led the research team. “The instrumentation is relatively small and inexpensive and could easily be installed in operating rooms to aid neurosurgeons. This study shows the tremendous potential it has to enhance patient care.”

Current surgical methods rely on the surgeon’s trained eye with the help of an operating microscope and imaging from scans performed before surgery, Cooks said.

"Brain tumor tissue looks very similar to healthy brain tissue, and it is very difficult to determine where the tumor ends and the normal tissue begins," he said. "In the brain, millimeters of tissue can mean the difference between normal and impaired function. Molecular information beyond what a surgeon can see can help them precisely and comprehensively remove the cancer."

The mass spectrometry-based tool had previously been shown to accurately identify the cancer type, grade and tumor margins of specimens removed during surgery based on an evaluation of the distribution and amounts of fatty substances called lipids within the tissue. This study took the analysis a step further by additionally evaluating a molecule associated with cell growth and differentiation that is considered a biomarker for certain types of brain cancer, he said.

"We were able to identify a single metabolite biomarker that provides information about tumor classification, genotype and the prognosis for the patient," said Cooks, the Henry Bohn Hass Distinguished Professor of Chemistry. "Through mass spectrometry all of this information can be obtained from a biopsy in a matter of minutes and without significantly interrupting the surgical procedure."

For this study, which included validation on samples and use during two patients’ surgical procedures, the tool was tuned to identify the lipid metabolite 2-hydroxyglutarate or 2-HG. This biomarker is associated with more than 70 percent of gliomas and can be used to classify the tumors, he said.  

A paper detailing the results of the National Institutes of Health-funded study will be published in an upcoming issue of the Proceedings of the National Academy of Sciences and is published online.

In mass spectrometry molecules are electrically charged and turned into ions so that they can be identified by their mass. The new tool relies an ambient mass spectrometry analysis technique developed by Cooks and his colleagues called desorption electrospray ionization, or DESI, which eliminated the need for chemical manipulations of samples and containment in a vacuum chamber for ionization. DESI allows ionization to occur directly on surfaces outside of the mass spectrometers, making the process much simpler, faster and more applicable to surgical settings.

The tool couples a DESI mass spectrometer with a software program designed by the research team that uses the results to characterize the brain tumors and detect boundaries between healthy and cancerous tissue.  The program is based on earlier studies of lipid patterns that correspond to different types and grades of cancer and currently covers the two most common types of brain tumors, gliomas and meningiomas. These two types of tumors combined account for about 65 percent of all brain tumors and 80 percent of all malignant brain tumors, according to the American Brain Tumor Association.

Additional classification methodologies and metabolite biomarkers could be added to tailor the tool to different types of cancer, Cooks said.

The brain surgery was performed in the Advanced Multi-Modality Image Guided Operating suite, or AMIGO at Brigham and Women’s Hospital.

Dr. Nathalie Agar, director of the Surgical Molecular Imaging Laboratory within the neurosurgery department at Brigham and Women’s Hospital, led the study.

[quotethat]

Sometimes it is the smallest thing that saves us: the weather growing cold, a child’s smile, and a cup of excellent coffee.

[theentclinic]

It is really difficult to understand the situation of a person, who is suffering from hearing loss. Many people’s life is ruined because of their inability to hear voices. Although about half of all cases of hearing loss are easily preventable but meanwhile, it is really a painful experience.

[theentclinic]

You cannot imagine what situations they have been going through who have problems with hearing. Hearing problem is a kind of disorder, which decreases the quality of life. You might be aware of how it becomes hard to manage life by looking at someone’s life who is suffering from deafness.

[diseasesinthreewords]

Great picture by the Muscle Dystrophy Association. Friedreich’s ataxia in three words:

Spine. Sclerosis and degeneration of dorsal root ganglion, spinocerebellar tracts (ataxia of all four limbs), lateral corticospinal and posterior columns (loss of position and sensation of vibration).

Heart. Hypertrophic cardiomyopathy is the norm (more than 50% of cases), but atrial fibrillation, and resultant tachycardia can also occur.

GAA. In most cases, the mutant gene contains expanded GAA triplet repeats on an intron.