DigiNerve Buzz (Monthly Newsletter – September 2024, Vol -2)
28 Oct 2024
DigiNerve Buzz (Monthly Newsletter – September 2024, Vol -2)

DigiNerve is constantly evolving to enhance the user experience while you’re on their journey to becoming a Top Doc. We are excited to bring the latest updates with our commitment to ensure a seamless journey on the go.

Read our monthly newsletter’s September edition (Vol – 2) for the latest updates.

 

 

CONTENT UPDATES

PostGrad Course Updates

Dermatology MD:-

1. Chat show on “Scabies and Pediculosis” by Dr. Ragunatha Shivanna, Dr. Priyanka Hemrajani, and Dr. Mariya Babu M. has been added to the course:

Learning Outcomes of the chat show are:

  • Understand nature and burden of disease.
  • Describe clinical types and clinical features of disease.
  • Understand relevance and significance of life cycle of mite and louse in treatment.
  • Describe efficacy and safety of therapeutic drugs.

 

Ophthalmology MD:-

1. Chat show on “Presbyopia Correcting IOLs” by Dr. N. Venkatesh Prajna and Dr. Haripriya Aravind has been added to the course:

Learning Outcomes of the chat show are:

  • Indications and contraindications of implanting toric.
  • Indications and contraindications of EDOF.
  • Indications and contraindications of MFIOLs.
  • Factors related to preoperative evaluation, intraoperative pearls and post operative assessment.

 

Professional Course Updates

Critical Care Simplified:-

1. The panel discussion on “Controversies and Advances in Sepsis” has been added to the module name Sepsis.

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NEET PG 2024 Exam Results Out
7 Nov 2024
NEET PG 2024 Exam Results Out

NEET-PG 2024 was conducted on 11th August,2024 in two shifts for admission to MD/MS/DNB/Diploma Courses of 2024-25 admission session.

The result of NEET PG 2024 has been declared and can be seen at NBEMS websites: https://natboard.edu.in/viewNotice.php?NBE=WFVQMUZiVWVUWkhwUlZoYXR3TjhZdz09

In accordance with the minimum qualifying/eligibility criteria for admission to MD/MS/DNB/Diploma Courses as mentioned in the Information Bulletin for NEET PG 2024, the cut-off percentile for various categories are as follows:

CategoryMinimum Qualification/Eligibility Criteria
General / EWS50th Percentile
General-PwBD45th Percentile
SC/ST/ OBC (Including PwBD of SC/ST/OBC)40th Percentile

 

The merit position for All India 50% quota seats shall be declared separately. The final merit list/category wise merit list for State quota seats shall be generated by the States/UT as per their qualifying/eligibility criteria, applicable guidelines/regulations & reservation policy.

Individual scorecard of the candidates who appeared in NEET-PG 2024 can be downloaded from the website https://nbe.edu.in/ on after 30th August 2024.

Candidature is purely provisional subject to fulfillment of eligibility criteria as mentioned in the NEET-PG 2024 Information Bulletin and verification of their Face ID/Biometric wherever required.

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Schizophrenia: Classification, Diagnosis & Treatments
4 Nov 2024
Schizophrenia: Classification, Diagnosis & Treatments

 

Schizophrenia is a serious mental illness that impacts about 1% of the global population. It is characterized by symptoms such as hallucinations, delusions, disorganized speech, and severely disorganized behavior. Additionally, individuals may experience negative symptoms, including diminished emotional expression, lack of motivation (avolition), and cognitive impairments.

Excessive dopamine is found in schizophrenics. Drugs that increase or decrease dopamine are known to worsen or make schizophrenia better.

https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.webmd.com/eye-health/good-eyesight&ved=2ahUKEwiDxqfvncWJAxXy9zgGHdVWCXwQFnoECFUQAQ&usg=AOvVaw00TFT4xJFYq-WYAA6iPZii

 

 

Schizophrenia Pathophysiology

Schizophrenia’s pathophysiology involves multiple molecular and neural circuit changes, though it’s unclear whether these are direct causes or adaptations to underlying dysfunctions. No current model fully explains all observed changes.

Neurotransmitter imbalances, particularly involving dopamine, serotonin, glutamate, and GABA, are central to schizophrenia. The connection between dopamine and schizophrenia was highlighted by the discovery that D2 receptor blockers can alleviate psychotic symptoms. Four key dopamine pathways—mesolimbic, mesocortical, tuberoinfundibular, and nigrostriatal—play distinct roles. Excessive dopamine in the mesolimbic pathway is linked to positive symptoms, while reduced dopamine in the mesocortical pathway may lead to negative symptoms and cognitive deficits. The nigrostriatal pathway is associated with motor side effects of antipsychotics, and the tuberoinfundibular pathway relates to hyperprolactinemia.

Recent research in cognitive neuroscience has shown that mesostriatal dopamine neurons respond to “reward prediction error,” helping assign significance to stimuli. In schizophrenia, dysregulated firing of these neurons can lead to misattribution of importance to irrelevant stimuli, contributing to delusions and hallucinations.

The relationship between dopamine and schizophrenia is complex, as evidenced by the delay between D2 receptor blockade and clinical response to antipsychotics, suggesting secondary neurochemical mechanisms are also at play. Additionally, the interplay among dopamine, glutamate, and GABA is critical for regulating cortical circuits, with postmortem studies indicating alterations in these microcircuits. This has prompted exploration of targeting glutamate and GABA pathways for improved treatment options.

 

Stages of Schizophrenia

Phase 1: Initial diagnosis for the earliest signs of schizophrenia.

Phase 2: These are the periods between exacerbations of symptoms, which are relatively calm, but may be deteriorating.

Phase 3: Exacerbation or relapse with increased use of resources.

 

Major Types of Schizophrenic Disorders

  1. Disorganized Schizophrenia: Personality is severely disorganized, which includes hallucinations, inappropriate behavior and regression.
  2. Catatonic Schizophrenia: Acute stupor and sudden loss of animation that alternates with periods of excitement and over activity.
  3. Paranoid Schizophrenia: Suspicious of everyone and ideas of persecution or grandeur.
  4. Undifferentiated Schizophrenia: Prominence of psychotic symptoms from more than one subtype or that does not meet the criteria for any subtype.
  5. Residual Schizophrenia: Absence of prominent psychotic symptoms but continued evidence of symptoms of symptoms such as peculiar behavior and blunted affect.

 

(Hebephrenic) Disorganized Schizophrenia Type

Individual has facial tics and grimaces, characteristic rises sardonic smile, flat affect with no emotion or strong feeling and in between blunt affect, Volitional affect, and labile affect. Almost all affects are oriented to time place and person.

Pathognomonic are very characteristic:

  • Clanging- Rhyming ‘Go to hell, bell’ (pathognomonic).
  • Echolalia- Repeating phrase- repeats back “When did you come?”
  • Neologisms- Uttering new words without any meaning.
  • Pathognomonic are schizophrenics until rules out.

 

Catatonic Schizophrenia Disorder

Presence of psychomotor retardation, thought process is slow, walking slowly and flexibility is slow. Tendency to talk as though the other person isn’t there! Its tendency is very harmful.

Sometimes rage is combined with anger catatonic excitement and grand blow up can come out with insensitivity to staff.

Increased stress is like increased catatonic excitement.

 

Paranoid Schizophrenia

The individuals are intelligent with inflated ego (think they are someone special).

Basically, they have severe auditory hallucinations and fear of persecution. They have such fears about safety such as CBI is after them, they being controlled by special messages through electronic media. All delusions start with a kernel of truth.

 

Undifferentiated Type

The individual has a lot of symptoms. They may have symptoms of all other types so that it is difficult to differentiate.

 

Kinesics Nonverbal Behaviors

Bizarre behaviors which are outlandish, ridiculous and abnormal but not for drawing attention like shaving of one side of moustache, rose on one side of cheeks, etc.

 

Symptoms of Schizophrenia

Here are some of the symptoms associated with schizophrenia:

 

Primary Symptoms of Schizophrenia

  • Delusions: False beliefs maintained against logic and contrary evidence.
  • Loosening of Associations: Ideas skip from one thought to another in unrelated way.
  • Hallucinations: False sensory perceptions in the absence of actual external stimuli.
  • Positive Symptoms reflect the presence of unusual behavior and related distortions in form and content of thought.

 

Secondary Symptoms of Schizophrenia

  • Disturbances in affect often blunt or flat.
  • Disturbances in volition inability to initiate goal-directed activity.
  • Disturbances/interpersonal functioning often withdrawn from others (in the extreme autism).
  • Increases psychomotor activity or decreased psychomotor activity.
  • Negative symptoms reflect the absence of normally expected behavior.

 

Diagnosis of Schizophrenia

The diagnosis of schizophrenia relies on two primary systems: the DSM-5-TR and the ICD-10, each with slight variations.

 

1. DSM-5-TR

The DSM-5-TR, published by the American Psychiatric Association (APA) in 2022, outlines the following criteria for diagnosing schizophrenia:

  • Symptom Presence: The patient must exhibit two (or more) of the following symptoms for a significant portion of time during a 1-month period (or less if successfully treated). At least one symptom must be one of the first three:
    • Delusions
    • Hallucinations
    • Disorganized speech (e.g., frequent derailment or incoherence)
    • Grossly disorganized or catatonic behavior
    • Negative symptoms (e.g., diminished emotional expression or avolition)
  • Functional Decline: There must be a noticeable decline in functioning in areas such as work or relationships since the onset of symptoms.
  • Duration: Continuous signs must persist for at least 6 months, including at least 1 month of active-phase symptoms, which may be shorter if treated. Symptoms can also be prodromal or residual, including negative or attenuated active-phase symptoms.
  • Exclusion Criteria: Schizoaffective, depressive, or bipolar disorders with psychotic features must be excluded. Symptoms should not be attributed to substance use, medication, or another medical condition. If a developmental disorder is present, the diagnosis requires at least 1 month of prominent delusions or hallucinations.

 

2. ICD-10

The ICD-10 specifies that the patient must demonstrate at least one of the following symptoms for a duration of 1 month or more:

  • Thought echo, thought insertion or withdrawal, thought broadcasting
  • Delusions of control, influence, or passivity; delusional perceptions
  • Hallucinatory voices providing a running commentary on the patient or discussing the patient among themselves
  • Persistent delusions that are culturally inappropriate or implausible

Alternatively, the patient may exhibit at least two of the following symptoms for 1 month or more:

  • Persistent hallucinations in any modality, accompanied by fleeting or half-formed delusions
  • Breaks or interruptions in thought leading to incoherence, irrelevant speech, or neologisms
  • Catatonic behavior
  • Negative symptoms
  • Significant changes in overall behavior, such as loss of interest and social withdrawal

In contrast to the DSM-5-TR, the ICD-10 categorizes schizophrenia based on key presenting symptoms into various types, including:

  • Paranoid schizophrenia
  • Hebephrenic schizophrenia
  • Catatonic schizophrenia
  • Undifferentiated schizophrenia
  • Post-schizophrenic depression
  • Residual schizophrenia
  • Simple schizophrenia
  • Schizophrenia, other
  • Schizophrenia, unspecified

 

Evaluation of Schizophrenia

Schizophrenia is primarily a Clinical diagnosis, but specific radiographic and laboratory tests are necessary to rule out other potential causes. The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia recommends the following evaluations during an initial assessment:

 

1. Hematology

A complete blood count (CBC) should be performed to check for anemia or signs of infection that may mimic schizophrenia symptoms. If the patient is being considered for treatment with clozapine, an absolute neutrophil count (ANC) should also be obtained.

 

2. Blood Chemistry Panel

This should include tests for electrolytes, renal function, liver function, and thyroid-stimulating hormone (TSH). Hypothyroidism can present with psychiatric symptoms such as depression and cognitive impairment.

 

3. Pregnancy Test

A pregnancy test is recommended for women of childbearing age.

 

4. Electroencephalogram (EEG)

An EEG may be warranted based on the neurological examination or patient medical history to rule out seizure disorders.

 

5. Imaging

Brain imaging tests, either a CT or MRI (with MRI being preferred), may be indicated based on neurological findings or patient medical history.

 

6. Genetic Testing

Chromosomal testing is suggested if indicated by the physical examination or developmental clinical history.

 

7. Drug Toxicology Screen

This screen may be necessary to identify substance use that could lead to psychotic symptoms.

 

Treatment of Schizophrenia

The treatment of schizophrenia typically involves a comprehensive approach that combines medication, psychotherapy, and supportive services. Here are the key components:

 

1. Medications

  • Antipsychotics: These are the cornerstone of schizophrenia treatment. They can help manage symptoms such as delusions, hallucinations, and disorganized thinking. There are two main categories:
    • Typical (First-Generation) Antipsychotics: Examples include haloperidol and chlorpromazine. These primarily target dopamine receptors but may have more side effects, such as extrapyramidal symptoms.
    • Atypical (Second-Generation) Antipsychotics: Examples include risperidone, olanzapine, and aripiprazole. These tend to have a lower risk of motor side effects and can also address negative symptoms.

 

2. Psychotherapy

  • Cognitive Behavioral Therapy (CBT): This can help patients manage symptoms and improve functioning by challenging distorted thoughts and developing coping strategies.
  • Supportive Therapy: Providing emotional support, practical assistance, and education about the mental disorders can be beneficial.
  • Family Therapy: Involving family members can enhance support and improve communication.

 

3. Rehabilitation and Support Services

  • Psychosocial Rehabilitation: Programs focused on social skills training, vocational rehabilitation, and community support can help individuals reintegrate into society and improve quality of life.
  • Case Management: Coordinated care by case managers can assist patients in accessing services and navigating the healthcare system.
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A Comprehensive Guide to Surgical Instruments and Their Uses
28 Oct 2024
A Comprehensive Guide to Surgical Instruments and Their Uses

The surgical instrument is a medical device for performing particular actions or achieving desired effects during surgery procedures or operations such as providing access for viewing or modifying biological tissue.

Over time, various surgical instruments and tools have been invented for different surgical procedures. Some common surgical instruments are designed for general use in all kinds of surgeries, while others are designed for specific specialties or medical procedures.

These instruments are essential tools enabling surgeons to access soft tissue, remove bone, dissect and isolate lesions, and treat or eliminate abnormal structures.

Larger/basic medical instruments for surgery are used for the initial exposure, while finer instruments are utilized for navigating delicate structures encountered during procedures.

 

Surgical Instruments List is Classified According to their Functional Use into the Various Categories

1. Cutting and Dissecting Instruments

These types of surgical instruments are used for cutting skin, dissecting tissues, soft tissues, and even bones through anatomical planes.

 

2. Grasping and Handling Instruments

Surgeons use these instruments to grasp or hold delicate tissues to help a closer view of their surgical field, one of the most common instruments used for this purpose is forceps including tissue forceps.

 

3. Clamping and Occluding Instruments

These surgical instruments are used for clamping blood vessels or other tough tissue to keep them away from the area during surgical procedures.

 

4. Retracting and Exposing

Surgeons used retractors to have a better view of the surgical area. It is used to retract heavy tissues while minimizing trauma during the procedure.

 

5. An Instrument for Improvement Visualization

Special surgical instruments are designed to visualize internal structures that are not visible externally such as speculums, endoscopes, anoscopes, and proctoscopes.

 

6. Suturing and Stapling Instruments

These instruments help in crafting to bring together the edges of skin or soft tissue nearby.

 

7. Suctioning and Aspiration Instrument

In surgical and dental settings, the presence of blood and fluids can obscure underlying structures. Surgeons utilize specialized instruments to clear these fluids from the surgical field, such as the Poole abdominal tip for laparotomy, the Frazier tip for brain and orthopedic surgery, and the Yankauer suction tip for oropharyngeal procedures.

 

8. Dilating and Probing Instruments

Dilating instruments are used to enlarge orifices like urethra or cervical os. These instruments come in various sizes, from small to large, with surgeons typically beginning with smaller sizes and incrementally, are inserted into natural openings such as the urethra, vagina, or common bile ducts to explore these body cavities.

 

Here Are Some Common Instruments for Surgical Procedures

1. Scalpel Blades

These instruments are used for initial incision and cutting tissue. It consists of a blade and handle. Surgeons refer to these instruments by their blade numbers.

#10 Blade: Used for making large skin incisions, e.g. in laparotomy.

Scalpel Blades 1

 

#11 Blade: Used for precise or sharply angled incisions.

Scalpel Blades 2

 

#15 Blade: This one is the smaller version of the #10 blade used for finer incisions.

Scalpel Blades 3

 

2. Surgical Forceps

Also called grasping forceps, thumb forceps, locking forceps, or pick-ups, are used for grasping objects or tissue. Can be non-toothed at the tip or toothed (serrated).

Tissue Forceps: It is non-toothed forceps used for traction during dissection and fine handling of tissue.

Tissue Forceps

 

Adson Forceps: These forceps are toothed at the tip and used for handling dense tissue such as skin closure.

Adson Forceps

 

Bonney Forceps: These are heavy forceps used for holding thick tissue e.g. fascial closure.

Bonney Forceps

 

DeBakey Forceps: This is used for atraumatic tissue grasping during dissection.

DeBakey Forceps

 

Russian Forceps: Used for grasping traumatic tissue during dissection.

Russian Forceps

 

3. Clamps

Also known as locking forceps, these are some ratcheted instruments used to hold objects or tissue or provide hemostasis. It can be traumatic or atraumatic.

Allis Tissue Forceps: These are straight along the long axis with a gap to accommodate the tissue between. Sharp teeth at the tip which interlock on closing with minimal crushing of tissues. Used to hold thin structures.

Allis Tissue Forceps

 

Babcock Tissue Forceps: Its non-traumatic type of forceps, fenestrated and curved blades allow a bulky amount of tissue to be held between. Used to hold soft and firm tissues like the appendix, fallopian tube, ureter, etc.

Babcock Tissue Forceps

 

Kocher’s Hemostatic Forceps: It has a single sharp tooth at the tip of one blade and a groove at the tip of the other blade. The blades are conical blunt with transverse serrations on the inner margins.

Kocher's Hemostatic Forceps-

 

Hemostatic Clamps: Is a non-toothed clamps used in blunt dissection and also used to grasp tissue or vessels that are tied off.

Hemostatic Clamps

 

Kelly Clamp: These are the larger size variations of hemostatic instruments with the same function for grasping larger tissues or vessels.

Kelly Clamp

 

4. Scissors

Used for cutting tissue, suture, or for dissection. Surgical scissors can be curved or straight and used for cutting finer and heavy structures.

Mayo Scissors: These are heavy scissors available in different varieties and also known as suture scissors. Straight scissors are used for suture cutting while curved scissors are used for cutting heavy tissue.

Mayo Scissors

 

Metzenbaum Scissors: These are lighter scissors used for cutting delicate tissue i.e. heart and for blunt dissection.

Metzenbaum Scissors

 

Pott’s Scissors: These are fine scissors used for creating precise incisions bein blood and vessels.

Pott's Scissors

 

Iris Scissors: Used for precise dissection and cutting fine sutures. It serves a multipurpose role for ophthalmic procedures.

Iris Scissors

 

5. Needles & Sutures

Needles come in various shapes and cutting edges for different applications. Sutures can be non-absorbable or absorbable and can be available in different sizes.

The shape and curvature of the needle allow use in specialized applications. Straight needles are used for skin and subcuticular suturing while curved needles are used in most general surgical procedures.

There are different types of needles which include:

Conventional Cutting Needle: It is triangular with sharp edges, and one edge faces the inside of the curved needle. This needle is used for tougher tissues such as skin.

Conventional Cutting Needle

 

Tapered Needle: It is round and tapers to a simple point. It is commonly used in softer tissue such as the intestine but may also be used in tougher tissue such as muscle.

Tapered Needle

 

6. Sutures

There are different types of sutures, their classification, and common uses, along with the suture sizes:

AbsorbableNon-Absorbable
BraidedMonofilamentBraidedMonofilament
Vicryl®
Polysorb®
Monocryl®
Maxon®
PDS®
Chromic Gut
SilkProlene®
Surgipro®
Monosof®
Nylon
Internal AnastomosisFascial Closure
Subcuticular Skin Closure
Vessel LigationSkin Closure
Reapproximate Lacerations

 

The number associated with surgical sutures denotes the size or diameter of the suture material. Here’s what these numbers typically mean in the context of sutures:

  • Lower numbers before the dash (#5, #4) indicate thicker sutures.
  • Higher numbers before the dash (#3, #2) indicate thinner sutures.
  • More zeros after the dash (#4-0, #3-0) indicate finer sutures.

 

7. Retractors

It varies in different forms, retractor are used to hold an incision open, hold back tissues or other objects to maintain a clear surgical site, or reach other structures. They can either be hand-held or self-retaining retractors via a ratcheting mechanism.

Retractors can be used in various forms in surgery, such as holding incisions open, and retracting tissues or objects to ensure a clear surgical field, or reaching deeper structures. They come in handheld retractor versions or self-retaining types with a ratcheting mechanism for stability.

Deaver Retractor: These are large retractors with broad S-shaped blades. The long handle ends in the form of a hook for better grip. It helps in retracting intra-abdominal cavity viscera like the spleen, and liver during surgeries.

Deaver Retractor

 

Army-Navy Retractor: It is used to gain exposure to skin layers.

Army-Navy Retractor

 

Weitlaner Retractor: Self-retaining retractors for exposing smaller or deep surgical sites. Also known as “Wheaty”.

Weitlaner Retractor

 

Richardson Retractor: It can be used to hold back deep tissue structures.

Richardson Retractor

 

Bookwalter Retractor: Self-retaining retractor system helps in anchoring to the operating table.

Bookwalter Retractor

 

Malleable Retractor: Can be customized and bent. Also helps protect the intestines during abdominal closure.

Malleable Retractor

 

Rake Retractor: Hand-held retractor equipped with sharp teeth used to hold back surface structures.

Rake Retractor

 

8. Special Surgical Consideration

Surgical subspecialties typically utilize specialized equipment tailored to their specific procedures. This guide provides a concise introduction to some of these equipments for better familiarity:

Laparoscopic Instruments: These instruments are similar to those used in open surgery, which fit through narrow ports placed through the skin, it work via conducted ports.

Laparoscopic Instruments

 

Camera & Lens: Camera is a held-hand component, which connects to various lenses. Lenses available with multiple view angles to get better visualization of anatomical structures.

Camera & Lens

 

Light Source: It is a fiber optic cable that connects with the lens to illuminate the field of vision.

Light source

 

Insufflator: Used for injecting carbon dioxide into the abdominal cavity which creates space for trocar placement and surgical procedures.

Insufflator

 

Veress Needle: A technique for creating pneumoperitoneum involves blindly inserting a needle into the abdomen and then injecting gas.

Veress Needle

 

Trocars: Transabdominal ports are used for inserting laparoscopic instruments, as well as for insufflating or extracting specimens. They are available in various sizes such as 5mm, 10mm, and 12mm.

Trocars

 

Frequently Asked Questions (FAQs)

Q1. What are some essential instruments for delicate tissue manipulation in microsurgery?

Ans. Instruments used for microsurgery, such as fine forceps for tissue reflection or specialized needle holders like mayo-hear needle holders, are important. These instruments allow precise handling of connective tissue to ensure optimal surgical outcomes.

 

Q2. How are deep wounds in the abdominal wall managed during surgery?

Ans. Surgical instrumentation for deep wounds includes precise suturing with needle holders, and suction tubes for maintaining a clear field, and these key instruments are designed for delicate tissue manipulation. These tools help surgeons achieve effective closure and enhance surgical outcomes.

 

Q3. What is the grade of surgical instruments?

Ans. Various types of stainless steels are used to produce surgical instruments; however, there are two main types: 300 series and 400 series. The 400 series stainless steel is hard and used for instruments that require a cutting surface.

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