Sunday, 30 June 2013

Eruption of permanent teeth

Eruption of permanent teeth
"Mama Is In Pain, Papa Can Make
1st Molar - 6 yrs
1st Incisor - 7 yrs
2nd Incisor - 8yrs
1st Premolar - 9yrs
2nd Premolar - 10yrs
Canine - 11 yrs
2nd Molar - 12yrs
3rd Molar - 18 - 25 yrs

Thursday, 27 June 2013

Myasthenia Gravis

Most specific test to diagnose myasthenia gravis:: Anti-AchR antibody test
Most sensitive test to diagnose myasthenia gravis:: Single fibre electromyography

Thursday, 20 June 2013

Dua layer

New layer of eye (Dua's Layer) has been discovered

Dua's layer according to Harminder Singh Dua from university of Nottingham is an extra layer in the cornea that has not been detected previously. It is hypothetically 15 micrometres thick, the fourth layer from the front, and located between the corneal stroma and Descemet's membrane. Despite its thinness, the layer is very strong and impervious to air. It is strong enough to withstand up to 2 bars (200 kPa) of pressure.

Wednesday, 19 June 2013

2013 : FDA Approved Drugs

1. Kynamro (mipomersen sodium); For the treatment of homozygous familial hypercholesterolemia, Approved January 2013
2.Tocilizumab (ocilizumab ) - For the treatment of Polyarticular Juvenile Idiopathic Arthritis, Approved May 2013
Also Indicated in
a. Rheumatoid arthritis
b. Castleman's disease
3. Canakinumab) : For the treatment of Systemic Juvenile Idiopathic Arthritis, Approved May 2013
4. Cysteamine bitartrate) : For the management of nephropathic cystinosis, Approved May 2013
5. Regorafenib : (oral multi-kinase inhibitor ) For the treatment of gastrointestinal stromal tumor, Approved February 2013
6. Radium Ra 223 dichloride : For the treatment of prostate cancer with bone metastases, Approved May 2013

Sodium valproate: side effects

V omiting
A lopecia
L iver toxicity
P ancreatitis/ P ancytopenia
R etention of fats (weight gain)
O edema (peripheral oedema)
A norexia
T remor
E nzyme inhibitor

Friday, 14 June 2013

Patau syndrome


fatal metabolic bone disease. ranging from the rapidly fatal perinatal variant, with profound skeletal hypomineralization and respiratory compromise to a milder, progressive osteomalacia later in life. Tissue
non-specific alkaline phosphatase (TNSALP) deficiency in osteoblasts and chondrocytes impairs bone mineralization, leading to rickets or osteomalacia. The pathognomonic finding is subnormal serum activity of the TNSALP enzyme, Perinatal hypophosphatasia is the most pernicious form of hypophosphatasia. In utero, profound hypomineralization results in caput membraneceum, deformed or shortened limbs during gestation and at birth and rapid death due to respiratory failure. Stillbirth is not uncommon and long- term survival is rare. Neonates who manage to survive several days or weeks suffer increasing respiratory compromise due to rachitic chest disease and hypoplastic lungs, and ultimately, respiratory failure. Epilepsy
(seizures) can occur and prove lethal ( vide infra). Excessive osteoid may encroach on the marrow space and result in myelophthisic anemia . In radiographic examinations, perinatal hypophosphatasia is readily distinguished from even the most severe forms of osteogenesis imperfecta and congenital dwarfism. Some stillborn skeletons show almost no mineralization; others have marked bony undermineralization and severe rachitic changes; occasionally, there can be peculiar complete or partial absence of ossification in one or more vertebrae. In the skull, individual membranous bones may calcify only at their centers, giving areas of the unossified calvaruim the illusion that cranial sutures are widely separated when they are in fact functionally closed. Another unusual radiographic feature is bony spurs that protrude laterally from the midshafts of the
ulnae and fibulae. Oftentimes, a flail chest from rib fractures, rachitic deformity, etc. leads to respiratory
compromise and pneumonia. Hypercalcemia and hypercalcenuria are also common and may explain the nephrocalcinosis, renal compromise, and episodes of recurrent vomiting. Radiographic features are striking
though ge Hypophosphatasia in childhood has variable clinical expression. As a result of aplasia, hypoplasia, or dysplasia of dental cementum, premature loss of deciduous teeth (i.e. before the age of 5) occurs.
Frequently, incisors are shed first; occasionally almost the entire primary dentition is exfoliated prematurely. Dental radiographs sometimes show the enlarged pulp chambers and root canals characteristic of the “shell teeth” of rickets. Patients may also experience delayed walking, a characteristic waddling gait, complain of stiffness and pain, and have an appendicular muscle weakness (especially in the thighs) consistent with nonprogressive myopathy. Typically, radiographs show rachitic deformities and characteristic bony defects near the ends of major long bones (i.e. “tongues” of radiolucency projecting from the rachitic growth plate into the metaphsysis). Growth retardation, frequent fractures and osteopenia are common. The metabolic basis of hypophosphatasia stems from a molecular defect in the gene encoding tissue non-specific alkaline
phosphatase (TNSALP). TNSALP is an ectoenzyme tethered to the outer surface of osteoblast and chondrocyte cell membranes. TNSALP normally hydrolyzes several substances, including inorganic
pyrophosphate (PPi) and pyridoxal 5’- phosphate (PLP) a major form of vitamin B 6. The most sensitive substrate marker for hypophosphatasia is an increased pyridoxal 5’-phosphate (PLP) plasma level, which often correlates with disease severity.

Monday, 10 June 2013

Clinical tests

Pulse amplitude

The  contour of the pulse wave is normally rounded and dome-shaped. As the pulse is measured with the three finger tips, an assessment can be made of the ascending portion, the crest and the descending portion of each wave. This can help infer the etiology of an existing problem. The amplitude of a pulse wave can be graded on a scale from 0-4, where:
O = absent
1 = barely palpable
2 = average intensity
3 = strong
4 = bounding

Mile stones


Saturday, 1 June 2013


Criminal Nerve of Grassi: A branch of the right posterior vagus which passes to the left behind the oesophagus, ending in the gastric cardia
The nerve of Latarjet: The posterior nerve of the lesser curvature is a branch of the anterior vagal trunk which supplies the pylorus.