Coomb's test!

Coomb's test refers to two clinical blood tests used in  immunology. The two Coombs tests are thedirect Coomb,s test , and the indirect Coombs test .

The more commonly used test, the Direct Coombs test, is used to test for autoimmune hemolytic anemia.

In certain diseases or conditions an individual's blood may contain IgG antibodies that can specifically bind to antigens on the red blood cell surface membrane, and their circulating red blood cells can become coated with IgG alloantibodies or IgG autoantibodies. Complement proteins may subsequently bind to the bound antibodies.

 The direct Coombs test is used to detect these antibodies or complement proteins that are bound to the surface of red blood cells; a blood sample is taken and the RBCs are washed (removing the patient's own plasma) and then incubated with antihuman globulin (also known as Coomb"s reagent). If this produces agglutination of RBCs, the direct Coombs test is positive, a visual indication that antibodies  are bound to the surface of red blood cells.

The indirect Coombs test is used in prenatal testing of pregnant women, and in testing blood prior to a blood transfusion. It detects antibodies against RBCs that are present unbound in the patient's serum. In this case, serum is extracted from the blood, and the serum is incubated with RBCs of known antigenicity. If agglutination occurs, the indirect Coombs test is positive.

Inguinal canal,hernia and descent of testis

Here is an animation describing all the three....

http://www.sh.lsuhsc.edu/gallery/tools/inguinal/testis16.swf

Mnemonic-Clotting factors

Mnemonic:

Foolish People Try Climbing Long Slopes After Christmas Some People Have Fallen

Fresher's Party Tonight Come Lets Sing And Call Seniors. Please Have Fun.

Best prayer ;)

May those who love us love us,
and those who do not love us,
may God turn their hearts,
and if He cannot turn their hearts
may He turn their ankles
that we may know them by their limping.

iphone is now a stethoscope!

Apple has an amazing new app known as iStethoscope converts your iphone into stethoscope. I'm amazed to see iphone's versatility.It allows you to listen to your heatbeat and see your heartrate, or listen to other quiet sounds around you. For best results use normal headphones and press the bottom of an to your bare chest. Alternatively, use your earphones and lightly press the inline microphone to the pulse in your neck to hear your heart beating clearly! With a little practice you should be able to find a nice clear sound - when you do, iStethoscope will tell you your current heart rate.


Here is the preview of the app:










Tutorial where to place the iphone and how to use it?



I hope iphone doesn't replace doctors..... ;)

Fetal circulation!

This is a animation that found out on Google which describes fetal circulation and i guess it will help you in visualizing fetal circulation. Here is the link, Enlighten yourself:

http://www.keele.ac.uk/depts/ms/Flash/cardio.swf

Another reason to be careful of females "DENGUE"

We have to be careful of females because dengue is caused by female anopheles.hahaha.......Jokes apart!! Dengue is spreading in north India and all hospitals are full with dengue patients.There is a need to be aware about dengue and to make you people aware about dengue,here are some FAQs about dengue:

What is dengue fever?

Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with symptoms such asheadache, fever, exhaustion, severe muscle and joint pain, lymphadenopathy, and rash. The presence of fever,rash, and headache and other pains)] is particularly characteristic of dengue. Other signs of dengue fever include bleeding gums, severe pain behind the eyes, and red palms and soles.

Dengue strikes people with low levels of immunity. Because it is caused by one of four serotypes of virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed.

How is dengue fever contracted?

The virus is contracted from the bite of a striped Aedes aegypti mosquito that has previously bitten an infected person. The mosquito flourishes during rainy seasons but can breed in water-filled flower pots, plastic bags, and cans year-round. One mosquito bite can inflict the disease.

The virus is not contagious and cannot be spread directly from person to person. There must be a person-to-mosquito-to-another-person pathway

What are dengue fever symptoms and signs?

After being bitten by a mosquito carrying the virus, the incubation period ranges from 3 to 15  days before the signs and symptoms of dengue appear. Dengue starts with chills, headache, pain upon moving the eyes, and low backache. Painful aching in the legs and joints occurs during the first hours of illness. The temperature rises quickly as high as 104 F (40 C), with relative low heart rate (bradycardia) and low blood pressure (hypotension). The eyes become reddened. A flushing or pale pink rash comes over the face and then disappears.

Fever and other signs of dengue last for two to four days, followed by a rapid drop in body temperature  with profuse sweating. This precedes a period with normal temperature and a sense of well-being that lasts about a day. A second rapid rise in temperature follows. A characteristic rash appears along with the fever and spreads from the extremities to cover the entire body except the face. The palms and soles may be bright red and swollen.

What is the treatment for dengue fever?

Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue, the treatment is purely concerned with relief of the symptoms (symptomatic). Rest and fluid intake for adequate hydration is important. Aspirin andnonsteroidal anti-inflammatory drugs should only be taken under a doctor's supervision because of the possibility of worsening hemorrhagic complications. Acetaminophen(Tylenol) and codeine may be given for severe headache and for the joint and muscle pain (myalgia).

What is dengue hemorrhagic fever?

Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes abdominal pain,hemorrhage (bleeding), and circulatory collapse (shock). DHF is also called Philippine, Thai, or Southeast Asian hemorrhagic fever and dengue shock syndrome.

DHF starts abruptly with high continuous fever and headache. There are respiratory and intestinal symptoms with sore throat, cough,nausea, vomiting, and abdominal pain. Shock occurs two to six days after the start of symptoms with sudden collapse, cool, clammy extremities (the trunk is often warm), weak pulse, and blueness around the mouth (circumoral cyanosis).

In DHF, there is bleeding with easy bruising, blood spots in the skin (petechiae), spitting up blood (hematemesis), blood in the stool (melena), bleeding gums, and nosebleeds(epistaxis). Pneumonia is common, and inflammation of the heart (myocarditis) may be present.

Patients with DHF must be monitored closely for the first few days since shock may occur or recur precipitously (dengue shock syndrome). Cyanotic (bluish) patients are given oxygen. Vascular collapse (shock) requires immediate fluid replacement. Blood transfusions may be needed to control bleeding.

The mortality (death) rate with DHF is significant. It ranges from 6%-30%. Most deaths occur in children. Infants under a year of age are especially at risk of dying from DHF.

Is there an effective treatment for dengue hemorrhagic fever (DHF)?

As with dengue, there is no specific medication for DHF. It can however be effectively treated by fluid replacement therapy if an early clinical diagnosis is made. Hospitalisation is frequently required in order to adequately manage DHF.

What can be done to reduce the risk of acquiring dengue?

There is no vaccine for preventing dengue. The best preventive measure for residents living in areas infested with Aedes aegypti is to eliminate the places where the mosquito lays her eggs, primarily artificial containers that hold water. Items that collect rainwater or are used to store water (for example, plastic containers, big drums, buckets, or used automobile tires) should be covered or properly discarded. Pet and animal watering containers and vases with fresh flowers should be emptied and scoured at least once a week. This will eliminate the mosquito eggs and larvae and reduce the number of mosquitoes present in these areas. Tests for Dengue CBC - WBC Count, Platelet Count, Haematocrit S. Protien, S. Albumin Liver Function Tests Urine - microscopic haematuria Dengue IgG & IgM. How can dengue fever be diagnosed? The diagnosis of dengue is usually made clinically. The classic picture is high fever with no localising source of infection, a rash with thrombocytopenia and relative leukopenia - lowplatelet and white blood cell count. Dengue infection can affect many organs and thus may present unusually as liver dysfunction, renal impairment, meningo-encephalitis or gastroenteritis. Fever, headaches, eye pain, severe dizziness and loss of appetite. Hemorrhagic tendency (positive tourniquet test, spontaneous bruising, bleeding from mucosa, gingiva, injection sites, etc.; vomiting blood, or bloody diarrhea) Thrombocytopenia (<100,000 platelets per mm³ or estimated as less than 3 platelets per high power field) Evidence of plasma leakage (hematocrit more than 20% higher than expected, or drop in hematocrit of 20% or more from baseline following IV fluid, pleural effusion, ascites, hypoproteinemia) Encephalitic occurrences. Dengue shock syndrome is defined as dengue hemorrhagic fever plus which is the worst stage of dengue has symptoms,such as:   Weak rapid pulse, Narrow pulse pressure (less than 20 mm Hg) Cold, clammy skin and restlessness.

The World as I see it by Albert Einstein

I came across an astounding essay by Albert Einstein, “The World as I see it”. There are many things that one can acquire from this great essay by one of the greatest man this earth has ever seen….
“How strange is the lot of us mortals! Each of us is here for a brief sojourn; for what purpose he knows not, though he sometimes thinks he senses it. But without deeper reflection one knows from daily life that one exists for other people — first of all for those upon whose smiles and well-being our own happiness is wholly dependent, and then for the many, unknown to us, to whose destinies we are bound by the ties of sympathy. A hundred times every day I remind myself that my inner and outer life are based on the labors of other men, living and dead, and that I must exert myself in order to give in the same measure as I have received and am still receiving…
“I have never looked upon ease and happiness as ends in themselves — this critical basis I call the ideal of a pigsty. The ideals that have lighted my way, and time after time have given me new courage to face life cheerfully, have been Kindness, Beauty, and Truth. Without the sense of kinship with men of like mind, without the occupation with the objective world, the eternally unattainable in the field of art and scientific endeavors, life would have seemed empty to me. The trite objects of human efforts — possessions, outward success, luxury — have always seemed to me contemptible.

“My passionate sense of social justice and social responsibility has always contrasted oddly with my pronounced lack of need for direct contact with other human beings and human communities. I am truly a ‘lone traveler’ and have never belonged to my country, my home, my friends, or even my immediate family, with my whole heart; in the face of all these ties, I have never lost a sense of distance and a need for solitude…”

“My political ideal is democracy. Let every man be respected as an individual and no man idolized. It is an irony of fate that I myself have been the recipient of excessive admiration and reverence from my fellow-beings, through no fault, and no merit, of my own. The cause of this may well be the desire, unattainable for many, to understand the few ideas to which I have with my feeble powers attained through ceaseless struggle. I am quite aware that for any organization to reach its goals, one man must do the thinking and directing and generally bear the responsibility. But the led must not be coerced, they must be able to choose their leader. In my opinion, an autocratic system of coercion soon degenerates; force attracts men of low morality… The really valuable thing in the pageant of human life seems to me not the political state, but the creative, sentient individual, the personality; it alone creates the noble and the sublime, while the herd as such remains dull in thought and dull in feeling.

“This topic brings me to that worst outcrop of herd life, the military system, which I abhor… This plague-spot of civilization ought to be abolished with all possible speed. Heroism on command, senseless violence, and all the loathsome nonsense that goes by the name of patriotism — how passionately I hate them!

“The most beautiful experience we can have is the mysterious. It is the fundamental emotion that stands at the cradle of true art and true science. Whoever does not know it and can no longer wonder, no longer marvel, is as good as dead, and his eyes are dimmed. It was the experience of mystery — even if mixed with fear — that engendered religion. A knowledge of the existence of something we cannot penetrate, our perceptions of the profoundest reason and the most radiant beauty, which only in their most primitive forms are accessible to our minds: it is this knowledge and this emotion that constitute true religiosity. In this sense, and only this sense, I am a deeply religious man… I am satisfied with the mystery of life’s eternity and with a knowledge, a sense, of the marvelous structure of existence — as well as the humble attempt to understand even a tiny portion of the Reason that manifests itself in nature.”

The website http://www.aip.org has a great collection of many other essays from some of the greatest men and women. You must visit this website for more of such essays.

The Medical Song!!

Every Medical student is tired of taking history, cramming drug names, remembering symptoms,diseases etc.So, am i…

So here is a song by “The Amateur Transplants“ named “Finals countdown” that tells our story.Check it out!!!

Fever!

Fever which is also known as pyrexia is an increase of more than 1°C or any rise in maximal temperature.

Normal temperature is between 36°C and 37.5°C with diurnal variation of 1°C with lowest temperature at 2-4 am and maximum temperature in afternoon.

Measuring of temperature

The body temperature is measured with a mercury thermometer, which is kept in position for about a minute.

Usually temperature is recorded in the axilla. However, it can be measured in mouth, in ear and in rectum.

Severity of fever

1.               Mild Fever 37.2°C – 37.8°C

2.               Moderate Fever 37.8°C – 39.4°C

3.               High Fever 39.4°C- 40.5°C

4.               Hyperpyrexia >40.5°C

Types of Fever

1.  Continuous Fever: Temperature remains above normal throughout the day and does not fluctuate more than 1 °C in 24 hours, e.g. lobar pneumonia, typhoid, urinary tract infection,brucellosis, typhus, brucellosis, etc.

2.   Remittent Fever: Temperature remains above normal throughout the day and fluctuates more than 1 °C in 24 hours. This is most common, e.g., typhoid, Infective endocarditis, etc

3.   Intermittent Fever: Elevated temperature is present only for some hours of the day and becomes normal for remaining hours, e.g., malaria, kala-azar, pyaemia, or septicemia

4.    Hectic or Septic: The temperature variation between peak and nadir is very large and exceeds 5°C,e.g., septicaemia, etc

5.     Pel Ebstein type: There is a regular alteration of recurrent bouts of fever and afebrile periods. The temperature may take 3 days to rise, remains high for 3 days and remits in 3 days, followed by apyrexia for 9 days seen in Hodgkin’s lymphoma.

6.    Low Grade Fever: Temperature is present daily especially in the evening for several days but does not exceed 37.8C at any time, e.g.,tuberculosis.

Causes of fever

1.               Infections: Bacterial, viral, fungal, parasitic, etc.

2.               Various skin inflammations: boils, or abscess

3.               Immunological diseases: lupus erythematosus, sarcoidosis, inflammatory bowel diseases, Kawasaki disease

4.               Tissue destruction which can occur in hemolysis, surgery, infarction etc

5.               Cancers, most commonly kidney cancer and leukemia and lymphomas

6.               Metabolic disorders: gout , porphyria, acidosis,dehydration.

7.               Traumatic: crush injury

8.               Physical agents: Heat stroke

Pathophysiology

Temperature is ultimately regulated in the hypothalamus. A trigger of the fever, called a pyrogen, causes a release of prostaglandin E2 (PGE2). PGE2 then in turn acts on the hypothalamus, which generates a systemic response back to the rest of the body, causing heat-creating effects to match a new temperature level.

Use

Fever can aid in host defense. There are certainly some important immunological reactions that are sped up by temperature, and some pathogens with strict temperature preferences could be hindered. Fevers may be useful to some extent since they allow the body to reach high temperatures, causing an unbearable environment for some pathogens. White blood cells also rapidly proliferate due to the suitable environment and can also help fight off the harmful pathogens and microbes that invaded the body.

Fever has several important functions in the healing process:

·                Increased mobility of leukocytes

·                Enhanced leukocytes phagocytosis

·                Endotoxin effects decreased

·                Increased proliferation of T cells

·                Enhanced activity of interferon

Treatment

Fever may or may not be treated. Sometimes people may recover themselves. The ibuprofen is an effective antipyretic.Acetaminophen / paracetamol is also widely used.