Medical Internship

Hello well I am after a long pause back on the track with you all to share more information, and my experiences. Last year after becoming a medical graduate I completed my internship. So during that period I did not have any time whatsoever, basically, to treat myself. So here we are. But now I feel more competent and confident. And that’s good for me as well as my patients. But I didn’t like my internship. Can you believe we were on-call 24 x 7 for 365 days. (And mind you there were no extra duty payments). 


And we were the most junior people. And we were signature dependent. So we had to take the blame always, but never complained. what to do, it’s part of the training. Without that it cannot become qualified doctors who are eligible to practice independently. And the unofficial saying was there are no human rights during the internship. If you fall ill you can take leave but if it is more than two weeks you have to repeat that period, no exceptions.

CPK Enzymes

There are different isoforms of CPK enzyme. These isoforms are known as CPK enzymes. Those are CPK-BB (Which is present in the brain cells) CPK-MM (Present in the skeletal muscles) CPK-MB (Present in the myocardial cells) Isolation of these different CPK enzymes ( isoforms) provide a significant therapeutic value. For an example in a myocardial infarction the blood level of CPK-MB is elevated. In an injury to skeletal muscles the blood level of CPK-MM is elevated. So the plasma level of CPK enzymes can be used to diagnose various diseases. This provides a great therapeutic tool for the doctors to uphold the health of the patient.
Elevation of CK is an indication of damage to muscle. It is therefore indicative of injury, rhabdomyolysis, myocardial infarction, muscular dystrophy, myositis, myocarditis, malignant hyperthermia and neuroleptic malignant syndrome. It is also seen in McLeod syndrome and hypothyroidism. The use of statin medications, which are commonly used to decrease serum cholesterol levels, may be associated with elevation of the CPK level in about 1% of the patients taking these medications, and with actual muscle damage in a much smaller proportion.

How does paracetamol / acetaminophen relieve pain?

How does paracetamol / acetaminophen relieve pain?

Free nerve endings are responsible for the perception of pain. There are some chemical mediators of pain like bradykinin which stimulate free nerve endings and causes pain sensation. Drugs like paracetamol / acetaminophen are called NSAID s or Non Steroid Anti Inflammatory Drugs. These drugs inhibit a class of enzymes called COX ( cycloxygenase ) There are three types of cycloxygnase. COX-1, COX-2 and COX-3. COX is responsible for the synthesis of prostaglandins in various parts of the body. Prostatglandin sensitize free nerve endings to chemical mediators of pain So when the prostaglandin production decreased pain sensation decreases. Paracetamol also known to be a selective inhibitor of COX-3.

How does Codeine cause constipation


Codeine, a closely related substance to morphine (so codeine is also an opioid) converted in the body to morphine. Codeine is readily absorbed by mouth and it does not have the dependent effect of morphine. But since it is converted in the body to morphine it can cause various gastro-intestinal symptoms. So codeine increases the tone and reduces the motility of many parts of the gastro intestinal tract. This can delay the gastric emptying and considerably reduces the absorption of the other drugs. It can also increase the pressure in the biliary system since it increases the contraction of the gallbladder and increase the tone of the biliary sphincter. So codeine should be avoided in patients with biliary colic caused by gallstones. This action on gastro intestinal smooth muscles can cause severe constipation in some patients and it can be very troublesome to them.

Importance of plants

Importance of plants

Plants are important for human life in many ways. Without plants animal life on the planet earth would be almost impossible.
Importance of plants as a food source
Plants make up the largest proportion in our diet. Plants are much more important than the larger trees for this purpose since in many countries the staple diet comes from rice or wheat.
Importance of plants to maintain the balance in the echo-system
Plants are really necessary to maintain the balance in the echo-system. For an instance plants are necessary to cycle C on the planet. CO2 in the air taken in to the plants and stored in the carbohydrates. In the present time human activities have reduced the amount of plants on the planet. So all the cycles are now changing. Because of this now the humans feel the importance of plants more and more.

Importance of plants in medicine
Plant extracts contain many chemical compounds which are biologically active within the human body. For centuries humans have used plants and plant extracts to treat various disease conditions and more recently to produce new drugs. Still most of the plants carry a large number of unidentified compounds which can be really useful of making new drugs and for the identification of lead compounds. This can be very important in making new treatments available to diseases like AIDS.

Natural foods which can cause Vitamin A toxicity

Most of the people think that it is impossible to develop vitamin toxicity by consumption of the natural foods. But this is a myth. Even though vitamin toxicity develops very rarely with natural foods but it is usually due to the oral intake of lipid soluble vitamins. There are well documented cases of acute vitamin toxicity, which developed after the consumption of certain food items. As you all know liver of any animal is responsible for detoxification of toxins and the storage of vitamins. This mechanism is really important for the storage of vitamin A and due to this most of the animal livers contain high amount of Vitamin A. But this amount in many animals is not adequate to cause acute vitamin A toxicity. But, polar bear liver, whale liver, shark liver and the lowly tuna liver may contain very high amount of vitamin A . This amount of Vitamin A may be adequate to cause acute vitamin A toxicity. First case of Vitamin A toxicity has described in 1597 by Gerrit ge Veer in the arctic. He is a carpenter and the crew of the ship he worked developed serious symptoms after eating a polar bear liver. Symptoms of acute vitamin A toxicity are headache, dizziness, vomiting, stupor and blurred vision.
Next time when you eat a polar bear liver, even though it is a great delicacy, keep in mind to eat in moderation. If you develop above symptoms after that better to seek medical attention immediately.

CPK blood test

CPK blood test


CPK blood test is very widely used for the detection of myocardial infarctions. But despite the popularity of CPK blood test for the detection of myocardial infarction it can be very effectively used to investigate and diagnose many other conditions associated with skeletal muscles. CPK-MM isoform of the CPK enzyme is predominantly found in skeletal muscle. These diseases of the skeletal muscles range from simple traumatic muscle damage to more advance muscle dystrophies. More common conditions are myositis, post electromyography, recent surgery, and strenuous exercise.
When we talk about the isoform CPK-MB it is predominantely found in cardiac myosites. When there is damage to cardiac muscle cell this isoform of CPK enzyme is released. This is another very common situation in which CPK blood test is performed. When someone is admitted to the hospital with a chest pain a CPK blood test may be performed to diagnose whether he is having a heart attack.

Importance of plants in human life?

Importance of plants in human life?
In every way humans are dependent on plants. For food, medicines, air purification, carbon cycle, nitrogen cycle and etc. But in addition to these now this has a much higher importance. It is in global warming. When the humans started burning fossil fuels carbon dioxide concentration in the atmosphere started increasing.Importance of plants in human life Carbon dioxide is a green house gas and it keeps infrared rays within the earth atmosphere and help increasing the temperature. In the upcoming years this will become more and more important in human life.
Another importance in human life is for medicines. As you all know quinine, a very potent antimalarial drug discovered from the plant cinchona. (Actually it was first discovered by an African tribe) Not humans are facing more and more challenges from emerging and re-emerging diseases. For an example HIV the most dangerous and devastating disease in the word I may say up to now does not have an effective cure. But plants may have a good answer for with. People in the Indian subcontinent and Sri Lanka have used plant extracts as very effective remedies for many conditions.

CPK Enzyme

CPK enzyme ( also known as creatine phosphokinase and creatine kinase) is the enzyme which is responsible for the conversion of creatine to creatine phosphate. CPK enzyme plays a very important in skeletal muscle since it creatine phosphate system is important for the sudden energy requirements in the skeletal muscle. CPK enzyme is also abandontely found in brain and smooth muscle. During the conversion of 1 mol of creatine to creatine phosphate CPK enzyme converts 1mol of ATP to ADP. CPK Enzyme has several isoforms. Those isoforms are CPK-BB, CPK-MB, CPK-MM. The CPK-MM type is known as the skeletal muscle type of the CPK enzyme. CPK-BB type is known as the Brain type of the CPK enzyme.Only within the myocardial cells more than 5% of CPK-MB activity can be observed. Due to this fact CPK-MB isoform of the CPK Enzyme is used to diagnose myocardial cell damage and CPk enzyme palys a major role in the diagnosis of myocardial infarctions-heart attacks. This enzyme is also important in the diagnosis of various myopathies. Usually in muscle dystrophies plasma level of CPK enzyme is elevated. To differentiate the source of CPK enzyme isoform speific enzyme assays of other markers should be used.
Eg: CPK enzyme and Troponin I in myocardial infarctions.
CPK enzyme and myoglobin in muscle damage.
Fot more information about this read CPK Test and CPK Blood Test

Abnormal cpk levels


Abnormal cpk levels
can be due to various reasons. CPK levels are comparatively high in the skeletal muscle, heart and the brain. So any damage to skeletal muscle heart or brain can give rise to abnormal cpk levels. But in the clinical setting the most important aspects are the skeletal muscles and the heart. In the case of abnormal cpk levels in the clinical setting the term “Abnormal cpk levels” is synonymous with elevated cpk levels. (See also - elevated cpk levels) when we talk about the skeletal muscle conditions direct trauma, exercise, polymyositis, dermatomyositis, Duchenne muscular dystrophy and etc can give rise to very high cpk values. In Duchenne muscular dystrophy cpk values can be abnormal (very high) even before the actual clinical manifestation.
After a myocardial infarction damaged myocardial cells release cpk-mb isoform of the CPK enzyme. This can give rise to abnormal CPK levels in the blood. But significance of this decreases after two days. But in addition to these many other conditions can give rise to abnormal cpk levels. So before coming to a conclusion all the differential diagnosis of a particular clinical scenario should be taken into account.

CPK blood test range

If you have undergone the CPK blood test the laboratory may have provided you with a set of values. Any decent laboratory should provide the range of normal values with it. But sometimes they may not. Then you may be wondering before going to a doctor “what is the CPK blood test range? “ For you reference herewith I am providing you with the CPK blood test range. Blood please remember CPK normal values are always laboratory specific so there can be a slight deviation of the normal values I have provided here from the normal values of your laboratory.

Creatine kinase (CPK)

  • Female 24-170 U/L
  • Male 20-260 U/L
  • CK-MB fraction

There is another thing. Any value outside the normal range is not necessarily abnormal. Any value outside this range has a higher probability to be abnormal. So some values outside the normal range can be perfectly normal for some people.

Orthopedic Supplies to change your life

The term orthopedics is derived from the Greek words “orthos” and “paideion”. Orthos means “correct or straight” and “paideion means “child”. The original meaning of the word orthopedics is “to make crooked child straight”. Nowadays orthopedics is far from this original state and it has become a field where people do wonders.  In this century orthopedics doesn’t mean surgery. It covers a vast array and includes numerous methods of conservative treatment. If a joint is aching due to wear and tear it doesn’t mean always you have to go for an artificial joint replacement.  There are fascinating supports, braces and various other gadgets in the market to relieve your pain.

In Earlier days you can remember we had plaster-of-Paris back slabs we used to splint fractured limbs. Those were heavy, ugly and difficult to manipulate. Nowadays we have nice good looking material made up of fiber comes in various colors and those are light weight. These Orthopedic Supplies are developed by scientists after numerous years of research. Now we know how mechanical forces act on our body and our joins and how we should support these joints without damaging a different part of the body. Actually these new orthopedic supplies are the ones which have actually changed the field of orthopedics.
If your heel is aching due to plantar fasciitis, a soft insole for you footwear can solve the problem. Or if you are suffering from knee osteoarthritis a specifically designed knee support can help your condition. To relieve back and abdominal pain during pregnancy a maternity support belt can do a great job. How many of you are suffering from lower back pain due to mechanical problems? Most of these symptoms can be relieved by using a proper lumbosacral belt or a lumbar support. Even you can have a heat moldable insert to support the lower back spine. These plastic inserts molds directly to the skin. Conditions like cervical spondylosis are really troublesome to the patient and the amount of suffering is huge. Using a proper cervical collar for few months can reduce the symptoms to a great extent.
  
But the most important thing is when you choose Orthopedic Supplies you should find high quality products those can actually support you. Even though you have a large array of Orthopedic Supplies in the market choosing high quality products from great suppliers matters. Only high quality products can provide the actual service required from them or the products may wear out before the expected lifetime. Some of the companies provide extremely high quality products.

Endless possibilities with Chinese GPS


Recently I bought a Chinese GPS unit which has 7 inch display, a 600 MHz processor, 128 MB RAM and running Windows CE operating system. First I thought it as a simple GPS unit. But after going through various forums I realised that we can modify the GPS unit to do various functions. Actually manufacturers of the GPS units lock their Windows operating environment to do several defined tasks. Like GPS, calculator, movie player and MP3 player. But there is actually an Windows environment running beneath what you see. You can actually unlock it to get the maximum out of your unit. After unlocking your unit you can install software of your choice.

Back to the GPS functionality of my unit, it is actually very sensitive and has a good signal reception, it runs on SIRF 5 GPS processor. One of the best processes in the current market. My GPS is made by the company called ERODA. Their unit appeared actually very good.

Constipation and hemorrhoids

Constipation and hemorrhoids
Large number of people in the world is suffer from hemorrhoids. And most of the people think constipation is a major risk factor for hemorrhoids. Today we will talk more about this subject. According to Baily and love’s “short practice of surgery-25th edition” when stools are harder it requires more straining and more time sitting on the lavatory with relaxed perineum. This causes the venous plexus around the anus to get engorged and it could also obstruct the venous return. From this we can expect to have some association between hemorrhoids and constipation. But it is also mentioned in the same paragraph the epidemiological pattern of constipation differs from that of the hemorrhoids. So it means no association between hemorrhoids and constipation. But the current view about the hemorrhoids is that hemorrhoids are caused by shearing forces acting on the anus due to variety of reasons. But the most important thing is if a patient is suffering even from 1st degree hemorrhoids relieving constipation in that patient is a must. If the patient is having both constipation and hemorrhoids, constipation can really aggravate the symptoms of hemorrhoids. Actually patients with hemorrhoids are always advised by doctors to take more dietary fiber to normalize their bowel habits. As far as I believe according to the current view association between Constipation and hemorrhoids is a yes and a no.

HbA1c Test

If you are a diabetic probably by now you should know something about the HbA1c test. This test actually measures the percentage of glycosylated hemoglobin(HbA1c) in the blood of a person. In any person since there is a normal blood sugar level glucose molecules get attached to hemoglobin molecules without the aid of an enzyme. This is called the non-enzymatic glycosylation of hemoglobin. This percentage is usually in a non-diabetic less than 5.5%. In a diabetic since the blood sugar levels are high this rate of glycosylation is high. So this HbA1c value is higher. HbA1c test measures this HbA1c value. Since this is a long term process and life cycle of red blood cell is nearly 120 days this Hba1c value gives an idea about the blood sugar control in past 2-3 months. And the other important thing is a single heavy meal doesn’t affect the HbA1c test value much. So If the HbA1c value is high it means that your blood sugar control has been bad during past 2-3 months. Doctors recommend keeping HbA1c value below 7% for the diabetics.

Troponin T test TnT test

As I previously mentioned about Troponin I test or the TnI test, Troponin T is also a cardiac specific bio-marker. So during a heart attack blood troponin T levels are also elevated and physician can measure this value to get an idea about the condition. Actually when we talk about the Troponin T test basically there are two types. Troponin T titre, where the laboratory provides the actual serum value of troponin T, and the plain troponin T test, Where laboratory gives the test result only as positive or negative. For the clinical management of the patient Troponin T titre has an added benefit over simple troponin T test. Same to troponin I Troponin T also takes some time to rise so it may be necessary to repeat the test.

Troponin I test TnI test

Troponin I test
When a patient comes to the emergency room with a chest pain doctors tend to request a Troponin I test. This test is also known as TnI test. So lest talk bit more about this Troponin I test. Troponin I is a highly specific cardiac marker which is released to the blood when cardiac myocytes suffer injury. In a heart attack heart muscle cell die and after that troponin I within the muscle cells are released to the blood. By doing a Troponin I test (TnI test) doctors can get an idea whether there is an underlying cardiac muscle damage. As you can already see any injury to cardiac myocytes can cause increased levels of Troponin I. So conditions like acute or chronic conditions such as myocarditis (heart inflammation), congestive heart failure Can give rise to a positive troponin I test. The other important thing is conditions which affect the other muscles does not give rise to a positive Troponin I test. TnI test sometimes performed with other test such as CPK test or myoglobin. The other important thing is blood Troponin I levels may remain elevated even for 1-2 weeks. So even after a one week of a myocardial infarction TnI test can be positive. This is very important in diagnosing a previous heart attack.