Microfractures and Objective Questions (MCQs)

Microfracture is a surgical procedure aimed at cartilage regeneration.

The arthroscopic technique involves clearing damaged tissue from the knee joint and creating tiny holes ("microfractures") in the bone area where the cartilage is defective.

The underlying bone marrow seeps out through the holes and becomes part of a blood clot that forms over the area.

The marrow contains stem cells, which have the ability to form replacement cartilage between the bare-bone surfaces of the knee. Appropriate rehabilitation of the knee after surgery is critical to the success of the operation.

Continuous Passive Motion (CPM), where the knee is moved gently by a machine for 5-8 hours a day for several weeks, keeping weight off of the joint for a period of 6-8 weeks, and strict adherence to an aggressive physical therapy program following surgery all appear to enhance the success of the procedure.

AIIMS NOV 2003 question
microfracture is done for?
1) delayed union femur
2) non union of tibia
3) loose bodies of ankle joint
4) osteochondral defect of femur

Answer is 4) Osteochondral defect of femur

Isolated articular cartilage lesions in the knee are common and are difficult to treat. A number of treatment modalities have been utilized in an effort to promote the regeneration of articular cartilage, including microfracture (MFX) and autologous chondrocyte Implantation (ACI).
Management of focal chondral defects
Isolated superficial cartilage injuries that do not penetrate the vascular subchondral bone do not heal and may enlarge for several years following the initial injury, potentially leading to overt degenerative arthritis. Full-thickness cartilage injuries that penetrate the more vascular subchondral bone permit local access to an undifferentiated cell pool (primitive mesenchymal stem cells) capable of forming fibrocartilage or "scar cartilage." Fibrocartilage is composed predominantly of type I collagen and is biochemically and mechanically inferior to normal hyaline articular cartilage, which is composed predominantly of type II collagen. Fibrocartilage formation is the biological basis for the MSTs commonly used to treat symptomatic full-thickness cartilage defects.

Abnormal shear and blunt forces are manifested at the junction of the uncalcified and calcified cartilage layers, potentially creating isolated cartilage injury extending to the subchondral bone. This is otherwise known as a focal or full-thickness cartilage defect. Typically, femoral lesions result from shear stress due to a twisting injury; patellofemoral joint lesions result from direct trauma to the front of the knee. The natural history of an asymptomatic full-thickness cartilage defect and its relationship to the development of secondary degenerative changes typically seen in osteoarthritis is poorly understood. However, lesions that become symptomatic inexorably progress, leading to reciprocal degenerative changes at the opposing articular surface.

The goals of any surgical option used to treat articular cartilage defects are to restore the joint surface, leading to full, painless range of motion; and halting cartilage degeneration. Surgical options can be palliative (ie, arthroscopic debridement and lavage), reparative (ie, MSTs), or restorative (ie, ACI and osteochonral grafts). Osteochondral grafts can be obtained from the patient (ie, autografts) or from cadaveric donors (ie, allografts). Arthroscopic debridement and lavage was discussed previously. Most studies reflect outcomes following the treatment of established osteoarthritis, not of isolated focal chondral defects.

Determining the appropriate surgical option is a complex process.24 Decision-making is affected by the following variables: the size of the defect (ie, smaller or larger than 2 cm2), the number and type of previous surgeries (ie, primary or secondary), location of the defect (ie, femoral condyle, trochlea, or patella), patient demands and expectations, and coexisting pathologic lesions (ie, ligament tears, malalignment)

Source: Steadman J, Rodkey W, Singleton S, et al. Microfracture technique for full-thickness chondral defects. Op Tech Ortho 1997;7(4):300-4

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UPSC Combined Medical Services Examination, 2005

See here for the results
UPSC Results for CMS 2005

Books for Physiology

What to read for Physiology After MBBS

The best way to be prepared in Physiology is by reading Ganong and Guyton thoroughly, but it is impossible. So we will go for an optimum strategy. Your plans should be decided on what you have read during your undergraduate classes
1. If you had read Ganong during your Undergraduate classes, you can read Ganong ONCE again
2. If you had read Guyton during your Undergraduate classes, go for a rapid revision of Guyton and Read the following from Ganong

1. All Tables
2. All Diagrams
3. Foot Notes under each diagram and Table
4. The MCQs given at the end of Ganong
5. Chapter on Kidneys
6. First Chapter from Ganong

3. If you have read some other book in your Undergraduate, you have to

1. Read Consice Medical Physiology by Sujit. K. Chaudhuri and
2. The topics from Ganong Enumerated above

Hepatitis B and sex ratio

Taken from http://slate.com/id/2119402/


What is economics, anyway? It's not so much a subject matter as a sort of tool kit—one that, when set loose on a thicket of information, can determine the effect of any given factor. "The economy" is the thicket that concerns jobs and real estate and banking and investment. But the economist's tool kit can just as easily be put to more creative use.

Consider, for instance, an incendiary argument made by the economist Amartya Sen in 1990. In an Essay in the New York Review of Books, Sen claimed that there were some 100 million "missing women" in Asia. While the ratio of men to women in the West was nearly even, in countries like China, India, and Pakistan, there were far more men than women. Sen charged these cultures with gravely mistreating their young girls—perhaps by starving their daughters at the expense of their sons or not taking the girls to doctors when they should have. Although Sen didn't say so, there were other sinister possibilities. Were the missing women a result of selective abortions? Female infanticide? A forced export of prostitutes?

Sen had used the measurement tools of economics to uncover a jarring mystery and to accuse a culprit—misogyny. But now another economist has reached a startlingly different conclusion. Emily Oster is an economics graduate student at Harvard who started running regression analyses when she was 10 (both her parents are economists) and is particularly interested in studying disease. She first learned of the "missing women" theory while she was an undergraduate. Then one day last summer, while doing some poolside reading in Las Vegas—the book was Baruch Blumberg's Hepatitis B: The Hunt for a Killer Virus—she discovered a strange fact. In a series of small-scale medical studies in Greece, Greenland, and elsewhere, researchers had found that a pregnant woman with hepatitis B is far more likely to have a baby boy than a baby girl. It wasn't clear why—it may be that a female fetus is more likely to be miscarried when exposed to the virus.

Oster was suitably intrigued. She set out first to see if she could use data to confirm Blumberg's thesis. A vaccine for hepatitis B, she learned, had been available since the late 1970s. She found good data on a U.S. government vaccination program in Alaska. Before the vaccinations began, Alaskan natives had a historically high incidence of hepatitis B as well as a high birth ratio of boys to girls. White Alaskans, meanwhile, had a low incidence of hepatitis B and gave birth to the standard ratio of boys to girls. But after a universal vaccination program was carried out in Alaska, the Native Alaskans' boy-girl ratio fell almost immediately to the normal range, while the white Alaskans' ratio was unchanged. A vaccination program in Taiwan revealed similar results.

Convinced now of the relationship between hepatitis B and birth gender, Oster set out on a vast data mission to determine the magnitude of that relationship. She measured the incidence of hepatitis B in the populations of China, India, Pakistan, Egypt, Bangladesh, and other countries where mothers gave birth to an unnaturally high number of boys. Sure enough, the regions with the most hepatitis B were the regions with the most "missing" women. Except the women weren't really missing at all, for they had never been born.

If you believe Oster's numbers—and as they are presented in a soon-to-be-published paper, they are extremely compelling—then her detective work has established the fate of roughly 50 million of Amartya Sen's missing women. Her discovery hardly means that Sen was wrong to cry misogyny, at least in some parts of the world: While Oster found, for instance, that Hepatitis B can account for roughly 75 percent of the missing women in China, it can account for less than 20 percent of the boy-girl gap in Sen's native India. The culprits behind the disappearance of the 50 million women whom Oster did not find are likely the horrible ones that Sen and others have suggested. But Oster's analysis does show that economics is particularly useful for challenging a received wisdom—in this case, one that was originally put forth by another economist.

The key to Oster's research was the availability of large and reliable sets of data. This is an advantage in economics that is not always conferred on the other social sciences. Consider now a different piece of groundbreaking research in developmental psychology.

In the early 1980s, a group of psychologists and linguists banded together to write Narratives From the Crib, a study of how children acquire linguistic skills. Narratives was built around the speech patterns of one child, a 2-year-old girl. Her parents had noticed that she often talked to herself in the crib after they said good night and left her room. They were curious to know what she was saying, so they began to record her chatter. They turned on the tape recorder while they were tucking her in and then left it running. Eventually they gave the tapes to a psychologist friend, who shared it with her colleagues. The big surprise to these experts was that the girl's speech was far more sophisticated when she was alone than when she was speaking with her parents. This finding, as Malcolm Gladwell would later write in The Tipping Point, "was critical in changing the views of many child experts."

The 2-year-old girl in question was referred to as Baby Emily. Her full name? Emily Oster. In retrospect, it would appear that Narratives From the Crib suffers what researchers call an "n of 1" problem, with "n" representing the size of the sample set—a problem that is gravely exacerbated when the one subject turns out to be … well, a good bit brighter than average. Studying how children learn to talk by observing Baby Emily may be a bit like studying how children learn to play golf by studying Tiger Woods. Now that she's an economist, Emily Oster has at least assured herself that she will never contribute to another "n of 1" problem. The challenge in her field—and so far she has met it well—is quite the opposite: to take a mass of disparate numbers and somehow wring from it one thing that is true.

MS ENT or MD Path - What to choose

MS ENT or MD Path - What to choose

If you are a male and married to a non medico - MS ENT
If you are a male and married to a medico who prefers and is interested in Non Clinical side - MS ENT
If you are a male and married to a medico who prefers and is interested in Clinical side - MD Path

If you are a female and married to a Non Medico - MD Path
If you are a female and married to a Medico who prefers clinical side - MD Path
If you are a female and married to a Medico who prefers non clinical side -- MS ENT

Note that the choice of Clinical and non clinical differs for a male and a female when you are married to a non medico

DMER- Directorate of Medical Education and Research

DMER- Directorate of Medical Education and Research



No.DMER/PGM-CET-2005/AIEE-2004/Joining/Notification/2-A, Date : 6/5/2005



NOTIFICATION



As per the orders passed by the Hon'ble High Court, Mumbai in Writ Petition No.1129/2005 and in Review Petition (L) No.34/2005, the students selected through AIEE-2004 for admission to Medical Postgraduate courses at Government / BMC Medical Colleges in Maharashtra were not permitted to join the course / Residency from 2/5/2005. The Special Leave Petition was filed at the Hon'ble Supreme Court by this Directorate against the orders of the Hon'ble High Court, Mumbai. The said SLP was heard on 4/5/2005. The orders of the Hon'ble High Court, Mumbai has been stayed by the Hon'ble Supreme Court.



Therefore the candidates selected through AIEE-2004 and reported in the year 2004 should note that they must report to the concerned office of the Dean of Government / BMC Medical Colleges for admission and to join the Medical Postgraduate (MD/MS/Diploma) course on or before 9th May, 2005 failing which their selection will be treated as cancelled.



sd/-

(Dr. W. B. Tayade)

Competent Authority & Director

Medical Education & Research, Mumbai