asthma

https://docs.google.com/file/d/0B3Z76BXdum8FZE1GRTR3SFpZVVE/edit?pli=1

asthma

psoriasis

1. Regarding psoriasis:

A.                The prevalence is 1-3%     T (affecting about 2 % of population)

B.                 Can be induced by chloroquine T

C.                 Itchy is a dominant feature F

D.                Associated with increase DNA synthesis T

E.         Calciptriol is one of the treatment T

TB

Chest X-Ray Findings that Can Suggest ACTIVE TB

This category comprises all findings typically associated with active pulmonary TB. An applicant with any of the following findings must submit sputum specimens for examination.

1. Infiltrate or consolidation - Opacification of airspaces within the lung parenchyma. Consolidation or infiltrate can be dense or patchy and might have irregular, ill-defined, or hazy borders.
2. Any cavitary lesion - Lucency (darkened area) within the lung parenchyma, with or without irregular margins that might be surrounded by an area of airspace consolidation or infiltrates, or by nodular or fibrotic (reticular) densities, or both. The walls surrounding the lucent area can be thick or thin. Calcification can exist around a cavity.
3. Nodule with poorly defined margins - Round density within the lung parenchyma, also called a tuberculoma. Nodules included in this category are those with margins that are indistinct or poorly defined. The surrounding haziness can be either subtle or readily apparent and suggests coexisting airspace consolidation.
4. Pleural effusion - Presence of a significant amount of fluid within the pleural space. This finding must be distinguished from blunting of the costophrenic angle, which may or may not represent a small amount of fluid within the pleural space (except in children when even minor blunting must be considered a finding that can suggest active TB).
5. Hilar or mediastinal lymphadenopathy (bihilar lymphadenopathy) - Enlargement of lymph nodes in one or both hila or within the mediastinum, with or without associated atelectasis or consolidation.
6. Linear, interstitial disease (in children only) - Prominence of linear, interstitial (septal) markings.
7. Other - Any other finding suggestive of active TB, such as miliary TB. Miliary findings are nodules of millet size (1 to 2 millimeters) distributed throughout the parenchyma.

Diazepam

Diazepam ( /daɪˈæzɨpæm/), first marketed as Valium ( /ˈvæliəm/) byHoffmann-La Roche, is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex.


 It is commonly used for treating anxiety, insomnia, seizuresincluding status epilepticus, muscle spasms (such as in cases of tetanus),restless legs syndrome, alcohol withdrawal, benzodiazepine withdrawal andMénière's disease.


Adverse effects
Adverse effects of diazepam include anterograde amnesia (especially at higher doses) and sedation, as well as paradoxical effects such as excitement, rage or worsening of seizures in epileptics. 
Benzodiazepines also can cause or worsendepression. 

Long-term effects of benzodiazepines such as diazepam include tolerance, benzodiazepine dependence and benzodiazepine withdrawal syndrome upon dose reduction; additionally, after cessation of benzodiazepines, cognitivedeficits may persist for at least six months and may not fully return to normal; however, it was suggested that longer than six months may be needed for recovery from some deficits.^[4] 


Diazepam also has physical dependence potential and can cause serious problems of physical dependence with long term use. 

asia chart

http://boneandspine.com/spine/what-is-asia-score-and-how-it-helps-in-classification-of-spinal-injury/

Complete androgen insensitivity syndrome (CAIS)

Complete androgen insensitivity syndrome (CAIS)

Definition?

Complete androgen insensitivity syndrome (CAIS) is a condition that results in the complete inability of the cell to respond to androgens.^[1][2][3] 

What happened?

·        The unresponsiveness of the cell to the presence of androgenic hormones prevents the masculinization of male genitalia in the developing fetus, as well as the development of male secondary sexual characteristics at puberty,

·        but does not significantly impair female genital or sexual development.^[3][4] 

As such, the insensitivity to androgens is only clinically significant when it occurs in genetic males (i.e. individuals with a Y chromosome, or more specifically, an SRY gene).^[1] 

All affected individuals are phenotypically female; they develop a normal female habitus, despite the presence of a Y chromosome.

clasificaion

CAIS is one of three types of androgen insensitivity syndrome, which is divided into three categories that are differentiated by the degree of genital masculinization:

·        complete androgen insensitivity syndrome (CAIS) is indicated when the external genitalia is that of a normal female, 

Androgen insensitivity syndrome is the largest single entity that leads to 46,XYundermasculinization.

Diagnosis

CAIS can only be diagnosed in normal phenotypic females.^[2] 

·        It is not usually suspected unless the menses fail to develop at puberty, or an inguinal hernia presents during premenarche.^[1][2] 

·        As many as 1-2% of prepubertal girls that present with an inguinal hernia will also have CAIS.^[1][18]

·        A diagnosis of CAIS or Swyer syndrome can be made in utero by comparing akaryotype obtained by amniocentesis with the external genitalia of the fetus during a prenatal ultrasound.^[2][61] 

Hydralazine

Hydralazine

Hydralazine (apresoline) is a direct-acting smooth muscle relaxant used to treat hypertension by acting as a vasodilator primarily in arteries and arterioles. 

By relaxing vascular smooth muscle, vasodilators act to decrease peripheral resistance, thereby lowering blood pressure and decreasing afterload.^[1]

However, this only has a short term effect on blood pressure, as the system will reset to the previous, high blood pressure necessary to maintain pressure in the kidney necessary for natriuresis. The long term effect of antihypertensive drugs comes from their effects on the pressure natriuresis curve.

mode of action

Hydralazine increases guanosine monophosphate levels, decreasing the action of the second messenger IP₃, limiting calcium release from the sarcoplasmic reticulum of smooth muscle. This results in a vessel relaxation. It dilates arterioles more than veins.^[2]

It recently has been identified as a nitric oxide donor.^[3]

Activation of hypoxia-inducible factors has been suggested as a mechanism

clinical use

Hydralazine is not used as a primary drug for treating hypertension because it elicits a reflex sympathetic stimulation of the heart (the baroreceptor reflex). The sympathetic stimulation may increase heart rate and cardiac output, and in patients with coronary artery disease may cause angina pectoris or myocardial infarction.^[1] Hydralazine may also increase plasma renin concentration, resulting in fluid retention. 

In order to prevent these undesirable side-effects, hydralazine is usually prescribed in combination with a beta-blocker (e.g., propranolol) and adiuretic.

Hydralazine is used to treat severe hypertension, but again, it is not a first-line therapy for essential hypertension. However, hydralazine is the first-line therapy for hypertension in pregnancy, with methyldopa.

Premenstrual syndrome (PMS)

Premenstrual syndrome (PMS) is the occurrence of
cyclical somatic, psychological and emotional symptoms
that occur in the luteal (premenstrual) phase of
the menstrual cycle and resolve by the time menstruation
ceases.

Prevalence


Premenstrual symptoms occur in almost all women
of reproductive age, but in only about 5 per cent are
they sufficiently severe to cause significant problems.



The symptoms of PMS may include any of the
following:
• bloating
• cyclical weight gain
• mastalgia
• abdominal cramps
• fatigue
• headache

MCBAH F

forceps delivery

http://www.moondragon.org/obgyn/procedures/forceps.html

atenolol in pregnancy

Vacuum Delivery System

Kiwi Complete Vacuum Delivery System

Barnes Neville Forcep

causes of secondary amenorrhea

Sheehan syndrome

Sheehan syndrome, also known as Simmonds' syndrome or postpartum hypopituitarism or postpartum pituitary necrosis, is hypopituitarism(decreased functioning of the pituitary gland), caused by necrosis due to blood loss and hypovolemic shock during and after childbirth. Pituitary damage unrelated to pregnancy is called Simmonds' disease.


features

• Most common initial symptoms of Sheehan's syndrome are agalactorrhea (absence of lactation) and/or difficulties with lactation.^[2] 
• Many women also report amenorrhea or oligomenorrhea after delivery.^[2] 

• In some cases, a woman with Sheehan syndrome might be relatively asymptomatic, and the diagnosis is not made until years later, with features of hypopituitarism.^[2]

• Such features include secondary hypothyroidism with tiredness, intolerance to cold, constipation, weight gain, hair loss and slowed thinking, as well as a slowed heart rate and low blood pressure.

• Another such feature is secondary adrenal insufficiency, which, in the rather chronic case is similar to Addison's disease with symptoms including fatigue, weight loss,hypoglycemia (low blood sugar levels), anemia and hyponatremia (low sodium levels). 

• Such a woman may, however, become acutely exacerbated when her body is stressed by, for example, a severe infection or surgery years after her delivery, a condition equivalent with an Addisonian crisis.^[2] 

• Gonadotropin deficiency will often cause amenorrhea, oligomenorrhea, hot flushes, or decreased libido.^[2] Growth hormone deficiency causes many vague symptoms including fatigue and decreased muscle mass.

Placenta accreta

Placenta accreta is a severe obstetric complication involving an abnormally deep attachment of the placenta, through the endometrium and into themyometrium (the middle layer of the uterine wall). There are three forms of placenta accreta, distinguishable by the depth of penetration.

The placenta usually detaches from the uterine wall relatively easily, but women who encounter placenta accreta during childbirth are at great risk ofhaemorrhage during its removal.

diagnosis 

Placenta accreta is very rarely recognised before birth, and is very difficult to diagnose. 

A Doppler ultrasound can lead to the diagnosis of a suspected accreta and an MRI will give more detail leading to further suspicion of such an abnormal placenta. 

However, both the ultrasound and the MRI rarely confirm an accreta with certainty. 

While it can lead to some vaginal bleeding during the third trimester, this is more commonly associated with the factors leading to the condition. 

In some cases the second trimester can see elevated maternal serum alpha-fetoprotein levels, though this is also an indicator of many other conditions^[3].

During birth, placenta accreta is suspected if the placenta has not been delivered within 30 minutes of the birth. Usually in this case, manual blunt dissection or placenta traction is attempted but can cause haemorrhage in accreta.