ECG REVIEW

I found this souce interesting and helpful for my ECG Review.

http://ecg.utah.edu/tests

Enjoy.

Reading about Pneumonia

Atypical pathogens for Pneumonia
Chlamydophila
Mycoplasma
Legionella

IM as an student in charge

I dont know that  much. I felt that  my knowledge is inadequate for me to become a PA to an IM resident. Read read....

Internal medicine rotation

It seems that I'm quite nervous for my IM rotation this Wednesday because I feel that I dont know that much. 

Lessons from my Orthopedics Internship

Orthopedics- One of the surgical rotations I've enjoyed because of its mechanical and physical aspect. 

sunburst appearance

sunburst appearance associated with osteosarcoma

Patient on leg traction

wound opening sec to boil 

femoral head displaced

Internship: Lessons from Neurosurgery Rotation

Brain mass possibly obstructing the CSF  flow towards to the fourth ventriclesagittal view)

Coronal view

watching the OR...

T12 intradural mass(Xray)

Chest Xray

This is a PA view
CTR: >1
Cardiomegaly

Orthopedics: Fracture or Not?

Fracture GCI, incomplete, displaced,located at middle to distal third of the Fibula Right

Internship in OBGYNE: endometrium with cervical extension

This is  for academic purposes only...

 After getting the specimen we tried to measure its dimensions and then documentation

OBGYNE: Actual image of Dermoid Cyst

 Figure 1. Dermoid cyst

 Dermoid cyst at a closer look-it contains hair, teeth and sebum(yellowish) secretion.

   Normal ovary

Posterior side of the uterus

International Journal Publication: Large-scale production and evaluation of marker-free indica rice IR64 expressing phytoferritin genes

For those interested to read our latest publication about iron transporter genes in Rice variety IR64 Oryza sativa  entitled: Large-scale production and evaluation of marker-free indica rice IR64 expressing phytoferritin genes.Please click the link and download the pdf file Iron transporter genes. My contribution to this research publication was mainly on gene expression.Thank you for reading.

Endometrial Cancer in a Hypothetical Patient

Hypothetical Patient is XY
54 yo G4P3 (3013)
Pre-op Diagnosis: Endometrial adenocarcinoma secretory type with cervical extension IIA
Operative Findings:
Uterus measures 11x6.5x 3cm
cervix 3.5x3.5x2.5
Right ovary 2x1.5x0.5
Left ovary 2x1x0.5
Right Fallopian tube 8x0.5
Left Fallopian tube 8x0.5
Endocervical canal 2.5cm
UC 8.5
myometrium 2cm
endometrium 0.5cm
obturator nerve (L) 3.5x4x1.0
omentum 10x 8x3cm

Post Operative Diagnosis: Endometrial adenocarcinoma secretory type intraoperative stage  IIIC1
Management; Chemotherapy+ Pelvic EBRT+ Brachytherapy

Surgery done: Exploratory laparotomy,Peritoneal fluid cytology, Extrafascial hesterectomy with bilateral salpingooophorectomy, Random peritoneal biopsy,bilateral lymph node dissection, infracolic omentectomy,paraaortic lymph node sampling/CLEA

Infracolic omentectomy was done:
1.) poor histologic type *
2.) ovarian metastasis
3.) serosal extension*( yellowish at the back)
Plan:
Chemotherapy: Carboplatin-Paclitaxel

Notes:
Women who are at high risk for endometrial cancer are those known to carry HNPCC associated
mutations(pedigree showed 3 generations).

"Kadar and associates and Lurain and colleagues noted that positive peritoneal cytology was associated primarily with adverse features such as extrauterine disease and that therapy  for positive peritoneal cytology as an isolated finding did not appear to improve survival"-Compre Gyne

International Publication on Springer

I cant believe that in the next few months my international  publication about Rice iron transporter genes will be out. Im so  happy  and proud about it. 

Routine Labs and Basis

Liver Function test-  AST and ALT are ordered

Renal Function Test-BUN and Crea

Thyroid Function Test- FT4, FT3 and TSH

Chest Xray
Why it is usually done?
1.to check for the presence of pulmonary infiltrates in the lung especially in patients living in the Asia Pacific Region
when apica infiltrates-pertain to Tuberculosis
2. to check for pulmonary mass or nodules in the case of metastasis/spread is via hematogeneous/ blood route -such as  the case of lung cancer and patient with probable Gestational Trophoblastic Neoplasia
; this might warrant Chest CT scan to determine the extent of the mass and its distribution

3. to check for cardiomegaly, atherosclerotic aorta


The rationale for each will be discussed in detail  in  the next update.

Detailed Steps on Primer Design

I list here the steps on how to design a good working primer.

1.       Get the sequence of your gene  from published literature for example OsNAS3.

2.       Using the TIGR Blast/ NCBI Blast, check the whole sequence if it specifies the gene of interest. It is important that the gene sequence is 100% homologous to the plant where the sequence is derived and the most important is that the whole sequence specifies only one distinct gene.

3.       Put your sequence inside the box of   Primer 3 online software. Specify in the software what are the parameters of the primer you want to have. Click generate. You would get something like this.

Important Notes:

When designing primers take note of the following:

GC content, melting temp (Tm) of primer, 3’ ends of the primer

PCR product size- It depends on what your purpose is. If your going to used the conventional PCR you can create a primer with a product size of 400bp and up. If you’re going to use the primer for real time PCR design a primers with 100-350 size only.  

4.       To be extra sure if your primer is really  specific,  Blast them again with NCBI blast. This would look like this. With the use of Vector NTI/Bioedit you can check the size of your PCR product.

5.       You are now ready to order your primers at SBS and proligo.

Erythrocyte Sedimentation Rate

Erythrocyte sedimentation rate (ESR) AKA  sedimentation rate or Westergren ESR, is the rate at which red blood cells sediment/precipitate in a duartion of one hour. It is a very common blood test, and is a NON-specific measure of inflammation. In order to conduct this test, anticoagulated blood is placed in an upright tube, known as a Westergren tube, and the rate at which the red blood cells fall is measured and reported in mm/h. 

Diagnostic Use: 
 ESR increased can be triggered  by any cause or focus of inflammation.It may be increased in pregnancy, inflammation, anemia or rheumatoid arthritis. However it may  be  decreased in polycythemia, sickle cell anemia, hereditary spherocytosis, and congestive heart failure. Studies reiterated that it may be increased in kidney cancer.It should be taken note that basal ESR is slightly higher in females(Medline).

Commonly Use:
 useful in diagnosing some diseases such as:
 multiple myeloma, 
temporal arteritis,
 polymyalgia rheumatica,
 systemic lupus erythematosus, 
rheumatoid arthritis,
chronic kidney diseases.

 In many of such cases, the ESR may exceed 100 mm/hour.

.

Blood Works: Absolute Neutrophil Count

How to compute for absolute neutrophil count?

ANC= (% bands + % neutrophils) X WBC

             --------------------------------

                          100

          = (0+ .0078)X 9.36 X 10E6/mm3

          = 7,300

How to interpret?

NCI Risk Category ANC

0 Within normal limits

1 ≥1500 - <2000 mm3="">

2 ≥1000 - <1500 mm3="">

3 ≥500 - <1000 mm3="">

4 <500/mm³

OBGYne Diagnostics

Transvaginal Vaginal-UTZ in Gestational Trophoblast


Transabdominal UTZ


Beta HCG in GTN
Levels indicative of

Pediatrics in focus

Neoplasia in Pediatrics
Wiskott aldrich syndrome- X -inked recessive eczema thrombocytopenia immunodeficiuncy syndrome
Hodgkin disease-malignant lymph node disorder of unknown etiology
Nonhodgkin lymphoma-heterogenous group of lymphoid  tumors
                             Causes: Viral infxn and immunodeficiency
What is tumor lysis syndrome? overload of lysed tumor material in the blooidstream leading to hyperuricemia compromising kidney function   Tx: hydration is important, allopurinol and sodium bicarbonate
 What is Bloom syndrome? aka Bloom–Torre–Machacek syndrome, a rare autosomal recessive disorder characterized by short stature and predisposition to the development of cancer. Cells from a person with Bloom syndrome exhibit a striking genomic instability that includes excessive homologous recombination. 
 What is the most common leukemia in children? ALL (acute lymphoblastic leukemia)
In leukemia, what is induction? 4 to 6 weeks initial treatment phase for reduction of leukemic burden
Usual Rx: corticosteroid, vincristine, asparaginase with or without anthracycline
What constitutes remission? decreased of blast cells in bone marrow by 5%.
Commonly used maintenance drugs in ALL? methothrecate, 6-mercaptourine, corticosteroid, vincristine
What is Fanconi Anemia?
genetic defect in a cluster of proteins involved in DNA repair, most common in Ashkenazi Jews, frequently leds to  the development of acute myelogenous leukemia 
Treatment for AML? 
ARA-C-it kill cells by interfering DNA synthesis, used in the treatment of AML and nonHodgkin Lymphoma, aka as cytrabine or ARA-C Arabinofuranosyl cytidine 
Daunorubicin-