Histology Slides Database: February 2018

Wednesday, February 28, 2018

Respiratory system examination

Austin Flint Murmur is a mid diastolic Murmur audible at Apex in mautic regurgitation.
It occurs due to movement of anterior mitral leaflet between two streams of blood that is one from the left Atrium and other from aorta.
It resembles Murmur of mitral stenosis but S1 is not loud and opening snap is not present.

Graham steell Murmur is an early diastolic murmur of functional pulmonary regurgitation due to pulmonary hypertension

Carey coombs Murmur is a diastolic murmur audible at the apex in acute rheumatic carditis

Pistol shot femorals are heard over femoral arteries in Aortic regurgitation.
These may be heard over any artery.

A to and from murmur maybe audible over femoral arteries when stethoscope is pressed , this is called Duroziez's murmur.

Additional murmurs

Graham steell Murmur is an early diastolic murmur of functional pulmonary regurgitation due to pulmonary hypertension

Carey coombs Murmur is a diastolic murmur audible at the apex in acute rheumatic carditis

Pistol shot femorals are heard over femoral arteries in Aortic regurgitation.
These may be heard over any artery.

A to and from murmur maybe audible over femoral arteries when stethoscope is pressed , this is called Duroziez's murmur.

Tuesday, February 27, 2018

The 10 characteristics of innocent murmurs/ insignificant-functional murmurs

Innocent insignificant or functional memories have the following characteristics

Symptom free
Systolic
Short
Soft
Heard over a small area
Split second sound
Variation with posture
Sternal depression maybe there
No other abnormal clinical signs
ECG and chest x ray a normal

The detailed functions and roles of Vitamin C in human body

The details of functions of vitamin C in human body are discussed below

It helps in the synthesis of collagen

It helps in the conversion of dopamine to norepinephrine

It is required for the conversion of tryptophan to serotonin

It is required for conversion of cholesterol to steroid hormones

It is required for conversion of cholesterol to bile acids

For the synthesis of carnitine

It maintains iron and copper cofactors in reduced States

It acts as an antioxidant that is electron donor

It enhances non heme iron absorption

It enhances the transfer of iron from transferrin to ferritin

It is required in the synthesis of tetrahydrofolic acid

the normal angle between femur head and the shaft of femur

The normal angle between femur head and shaft of femur ranges between 126 to 139 degrees

In coxa Valga the angle is more than 140 degrees between the femur head and the shaft

In coxa Vara the angle between femur head and shaft is less than 125 degrees

The simplified biochemistry of Vitamin D metabolism

The very simplified biochemistry of vitamin D metabolism in human body is discussed below

Ultraviolet light when strikes the skin it helps in the formation of Vitamin D3 or cholecalciferol

This to liver where it is converted into 25 hydroxy cholecalciferol

In the Kidneys it is then converted by 1 Alpha hydroxylase into 125 dihydroxycholecalciferol which is also called calcitriol

1 Alpha hydroxylase is inhibited by rising serum calcium levels and it is stimulated by parathyroid hormone and decreased phosphate levels

125 dihydroxycholecalciferol also called calcitriol stimulates absorption of Calcium from intestine kidney and it causes bone resorption

One Alpha drops or Alpha Leo

One Alpha drops are available in Pakistan

1 Alpha contains 1 Alpha hydroxylase D3

It does not need kidney for its activation rather it is activated in the liver to calcitriol

The price in Pakistan for 20 ml tracking is rupees 1300

It contains 2 microgram per ml

.1 microgram per drop

Vitamin D3 in oral drop forms cholecalciferol

Vitamin D3 is also called cholecalciferol

This is the type of vitamin D that is produced from skin

Cholecalciferol is available in oral drop formulations with the name of all d and d Max drops

It is also available in injectable formulation which is given intramuscularly and never given intravenously

What is calcitriol what is its biochemistry

Calcitriol is 125 dihydroxy Vitamin D

It is produced in the Kidneys from 25 hydroxy vitamin D by activation through enzyme 1 Alpha hydroxylase

Also it may be produced from 1 Alpha hydroxy D3 which are available in drops form as one Alpha drops

1 Alpha hydroxy D3 is activated in liver to 125 hydroxyvitamin d

So it is noteworthy here that in case there is chronic kidney disease with functioning liver we can give one Alpha drops and Vitamin D requirements may be fulfilled in the patient

Calcitriol is available commercially in capsule forms and in injections

Vi cap is a soft capsule that is 25 micrograms calcitriol

Phosphate Binder in Pakistan

Sevelamer is a phosphate Binder available in Pakistan it is available with the brand name of reniwal the tablet is 400 milligram and the cost is rupees 30.

The detailed functions of vitamin D

Functions of vitamin D related to calcium and phosphate metabolism are as following

It promotes intestinal absorption of calcium and phosphate

Vitamin D directly suppresses parathyroid hormone release

Vitamin D has a permissive role for parathormone to cause bone resorption

Vitamin D promotes Calcium reabsorption from distal Renal tubule in Kidneys

It may be noted that the reabsorption of calcium through proximal renal tubule is passive

Functions of parathyroid hormone

When serum calcium levels are low it stimulates the production and release of parathyroid hormone from parathyroid glands which are 4 in number. the parathyroid hormone acts on bones and Kidneys. when it acts on bone the parathyroid hormone increases the bone resorption. bone resorption means that bone is broken down to release calcium. the effects of parathormone on kidney are such that it increases the formation of Vitamin D. it increases calcium reabsorption and it increases phosphate excretion. the vitamin D production is stimulated by induced if effects on 1 Alpha hydroxylase .so we can conclude that the conditions in which parathyroid hormone is in excess there will be too much excretion of phosphate from body and hence hypophosphatemia.

PCB way gml file issue

Pcbway is a renowned custom PCB manufacturing website from China. they do not accept gm1 format gerber files rather the dot gm1 should be renamed to dot gml.

Gml files tell the PCB making machine what are the controls of the PCB

To make gerber files easily fritzing is a very easy to use software .the printed circuit board designed in fritzing may be exported to gerber files and sent for manufacturing to any PCB company. other manufacturing companies such as easy pcb or the companies with .PCB file format do not give u gerber files.

I have tried many dot PCB 2.0 file conversion softwares and online websites but none of them work and I therefore concluded that fritzing is a good piece of free software to create gerber files.

Potassium for peritoneal dialysis isotonic fluid

Isotonic fluid for peritoneal dialysis does not have potassium . while doing the peritoneal dialysis of a child we do not add potassium to the dialysis fluid on day 1 . from second day onwards of dialysis we add 4 Milli equivalent per litre of potassium if serum Potassium is less than 3.5 Milli equivalent per litre. we do serum electrolytes daily. on day 1 of peritoneal dialysis restart 100% maintenance Fluids after few cycles of peritoneal dialysis .we had previously restricted Fluids because of absent urine output and fluid overload .in case of no urine output Fluids are restricted to 400 ml per metre square per day + urine output.