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Thursday, November 9, 2006

How Rasputin treated Tsarevich Alexei's Hemophilia

The background information

Tsesarevich Alexei Nikolaevich Romanov was Tsesarevich - the heir apparent - of Russia, being the youngest child and the only son of Tsar Nicholas II of Russia and Alexandra Fyodorovna.

Alexei is presumed to have died on July 17, 1918, but as his body has never been found this is impossible to definitively confirm.

He inherited haemophilia from his mother Alexandra, a condition which could be traced back to her maternal grandmother Queen Victoria. His haemophilia led to controversy, on the grounds that it was believed that his mother was having an affair with the Russian starets, Grigori Rasputin. Rasputin claimed to be able to 'heal' Alexei when he was on the brink of death after spells of haemophilia-related complications.

Rasputin was wandering as a pilgrim in Siberia when he heard reports of Tsarevich Alexei's haemophilia in 1904. The disease had been inherited from his great-grandmother (Queen Victoria). When the young Tsarevich got a bruise after he fell off of a horse, he suffered from internal bleeding for days while vacationing with his family. The Tsaritsa, looking everywhere for help, asked her best friend Anna Vyrubova to secure the help of the charismatic peasant healer in 1905. He was said to possess the ability to heal through prayer, and he was indeed able to give the boy some relief. Skeptics have claimed that he did so by hypnosis, though during a particularly grave crisis, Rasputin, from his home in Siberia, was believed to have eased the suffering of the tsarevich (in Saint Petersburg) through prayer. His practical advice, such as "Don't let the doctors bother him too much, let him rest," may also have been of great assistance in allowing Alexei and his worried mother to relax, so that the child's own natural healing process might take place. Others believe he used leeches to stop the boy's bleeding for the moment; however, this is unlikely to have been successful, as leech saliva contains hirudin and other natural anticoagulants. Every time the boy had an injury causing internal or external bleeding, the Tsaritsa contacted Rasputin, whereupon the Tsarevich subsequently got better, and this made it seem as if Rasputin was effectively healing him.

Now coming to one interesting theory
The medical treatment which was halted due to Rasputin's intervention included aspirin, then a newly-available (1910) "wonder drug" for treatment of pain. Because the poor (poor in terms of life and not money) boy had joint pain, some doctor would have given aspirin. Since aspirin is an anticoagulant (the anticoagulant property was only discovered in 1971), this would have increased the bleeing into joints which was causing Alexei's joint swelling and pain. So Aspirin was infact increasing the pain (by causing more hemorrhage into the joints) rather than decreasing it. When Aspirin was stopped, the boy became better

Monday, November 6, 2006

Chikungunya declared a `notifiable disease'

Hospitals and laboratories must report new cases
From http://www.hindu.com/2006/11/06/stories/2006110613020600.htm

MADURAI: The State Government has declared Chikungunya a `notifiable disease' under the Tamil Nadu Public Health Act, 1939.

"This is a milestone in the Chikungunya control programme," S. Elango, Joint Director of Public Health, told The Hindu here on Sunday. A Government Order issued on October 26 under Section 52 listed chikungunya along with other notifiable diseases such as dengue, cholera, malaria, typhoid, chickenpox and HIV/AIDS, said Dr. Elango who was here to attend a Continuing Medical Education Programme said.

The Act makes it mandatory for all private hospitals and laboratories to report chikungunya cases to the Health department.

Action could be initiated if the institutions failed to report to the Government, he added.

The notification would help the Directorate of Public Health to get enough data on the incidence of the vector-borne disease and enable the Government to take early preventive measures, he said.

Decision hailed

According to Dr. Elango, the Government decision was hailed at the national level and experts involved in the national vector-borne diseases control programme urged other States to follow the Tamil Nadu model.

Sunday, November 5, 2006

How Indicators Work

The inspiration of this post is http://vivekspace.wordpress.com/2006/09/28/iits-in-news/

When I was in school, our Chemistry teacher told us a story about the phrase “caught red-handed”. He said that the police actually puts a chemical (some sort of mild acid in powdered form) on the currency notes which are handed over in an anti-corruption operation. Clearly, the term “sting operation” hadn’t caught on in those days. Later, when they wash the hands of the culprit with a chemical they turn red.


So what is the powder that is applied in the notes and is the other chemical

If the initial powder is an acid, the indicator would be
Thymol Blue (which is actually red in Acid and Yellow in Base)
Methyl Orange
Methyl Red

If it (the powder on the note) is a base, the indicator would have been phenophthalein

Or the powder can be an indicator and the second chemical acid / base.

Table of Indicators

Common Name

pH Range transition change

Color in Acid

Color in Base

Picric Acid

0.1 to 0.8

Colorless

Yellow

Thymol Blue

1.2 to 2.8

Red

Yellow

Congo Red

3.0 tp 5.0

Blue

Red

Methyl Orange

3.1 to 4.4

Red

Yellow

Methyl Red

4.2 to 6.3

Red

Yellow

Neutral Red

6.8 to 8.0

Red

Yellowish Orange

Phenolphthalein

8.0 to 9.6

Colorless

Pink

Alizarin Yellow

10.1 to 12.0

Colorless

Violet

Monday, October 30, 2006

Osmolal Gap

Osmolal Gap is the difference between measured serum osmolality and calculated serum osmolality.

It is typically calculated as: OG = measured serum osmolality - (2 X serum sodium + serum glucose + serum urea)

Where:

* 2 X serum sodium + serum glucose + serum urea = the calculated serum osmolality and all measures are in mmol/L.
* OG = osmolal gap

In US customary units the calculated osmolarity is: ( 2 x sodium ) + glucose/18 + BUN/2.8.

A normal osmolal gap is < 12 mmol/L.

Causes of an elevated osmolal gap are numerous. Several causes are:

* ethanol intoxication
* methanol ingestion
* isopropanol ingestion
* ethylene glycol ingestion


Anion Gap Increases in Ethylene Glycol Poisoning (as the unmeasured ion is Anion)
Anion Gap Decreases in Lithium Toxicity (as the unmeasured ion is cation)

What will happen to Osmolal Gap in both Conditions

Suppose a person has BOTH Etylene Glycol Poisoning and Lithium Toxicity (Hypothetical - say a person with MDP attempted suicide), his anion gap may even be normal (depending on the degree of the toxicities)

But the Osmolal gap will be very high

Sunday, October 29, 2006

Tough Entrance Exams

Entrance Exams are not pass/fail exams. They are rank exams. So whether the paper is tough or easy is not that important.

Advantages of Tough Questions

  • There will be less clustering of ranks and hence you will not miss the bus by one mistake. If it is a easy paper, you will go back by 150 ranks per mistake (for ranks 100 to 3000)

Disadvantage of Tough Questions

  • Your brain has been tuned to get an instant depression when you see a question for which you don't know the answer. (this is due to the faulty school system in india) hence you are likely to make mistakes in other easy questions

Saturday, October 28, 2006

Links for Statisticians

http://clinresearch.blogspot.com/

BMJ

Statistics at Square One
http://bmj.bmjjournals.com/collections/statsbk/index.shtml

Journal of Physiology and Pharmacology
http://www.jpp.krakow.pl

Applied Clinical Trials
to know click on the link below
http://www.actmagazine.com/appliedclinicaltrials/

Indian Journal of Pharmacology . To go on the journal site click on the link below
http://www.ijp-online.com/

The New England Journal of Medicine. Click on the link below
http://content.nejm.org

Friday, October 27, 2006

Anion Gap HAGMA LAGMA and NAGMA !!!

  • Blood has a lot of Cations
  • Blood has a lot of Anions

Total charge of Anions = Total Charge of Cations

So

Na + K + Unmeasured Cations = HCO3 + Cl + unmeasured Anions
Rearranging
Na + K - (HCO3 + Cl) = Unmeasured Anions - Unmeasured Cations
Anion Gap = Unmeasured Anions - Unmeasured Cations

Anion Gap = (Na + K) - (HCO3 + Cl)

Note that some books ignore the value of Calcium and calculate Anion Gap as Na - (HCO3+Cl)
  • Unmeasured Anions: Means all anions other than HCO3 and Cl ----> lactate, phosphate, ketoacids , Albumin, Ethylene Glycol etc
  • Unmeasured Cations: Means Ca, Lithium, Globulin
So
Anion Gap is Increased in

  • Conditions with Increased Unmeasured Anions
    1. Diabetic Ketoacidosis
    2. Uremia
    3. Lactic Acidosis
  • Conditions with Decreased Unmeasured Cations
    1. Hypocalcemia
Anion Gap is decreased in
  • Conditions with Decreased Unmeasured Anions
    1. Hypoalbuminaemia (theoritically)
  • Conditions with Increased Unmeasured Cations
    1. Increase in Globulin (multiple Myeloma)
    2. Lithium Toxicity

Easy way to solve MCQs

1. Check what is decreased / Increased

If that is Na / K / HCO3 / Cl it is Normal Anion Gap Metabolic Acidosis (also called NAGMA). The matter is settled. No doubt about that. Vomitting, Diarrhoea, Renal Tubular Acidosis etc come here

2. If there is an increase in Unmeasured Anions (lactate etc)
It is High Anion Gap Metabolic Acidosis (HAGMA)

3. If there is a decrease in Unmeasured Cations (Globulin etc)
It is High Anion Gap Metabolic Acidosis (HAGMA)

4. If there is an increase in Unmeasured Cations (lactate etc)
It is Low Anion Gap Metabolic Acidosis (LAGMA)

5. If there is a decrease in Unmeasured Anions
It is Low Anion Gap Metabolic Acidosis (LAGMA)

Any doubts !!!
Post in the comments section

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