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Read our monthly newsletter’s September edition (Vol – 2) for the latest updates.
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:
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:
1. The panel discussion on “Controversies and Advances in Sepsis” has been added to the module name Sepsis.
Radiology is a study of medical technology, it is a important discipline included in the MBBS typically introduced in the later years of medical training. It covers various imaging techniques used to diagnose and manage diseases, including X-ray, ultrasound, computed tomography, positron emission tomography, nuclear medicine and magnetic resonance imaging.
Radiology serves as a critical link between clinical medicine and diagnostic image technology helping medical professionals to visualize internal structures and identify pathological conditions.
A strong grip in radiology for medical students is important, as it aids in accurate diagnosis, treatment/management planning and monitoring of diseases progression with stages.
The radiology curriculum in MBBS covers topics like principles of imaging modalities, anatomy in imaging, interpretation of radiographs, advanced imaging techniques, radiation safety, and the role of radiology in various clinical scenarios, including trauma, oncology, and pediatric care.
In the NEET-PG examination 10- 15 questions are asked, while in the INI-CET there are about 15-20 questions that are based on the Radiology Subject.
These competitive exams mainly cover the extent of the candidates’ knowledge about medical imaging procedures, diagnosis diagnostic accuracy principles and role of radiology in clinical practice.
Acquaintance of subject weightage, typical examination formats, areas of significant potential for high yield and general study strategies can greatly help to improve conceptual understanding of Radiology exam.
Concepts of Kilovolt Peak (KVP) and Milliampere-Seconds (MAS)
Important X-ray Views
Radiation Interactions
Mammography Technique
Hysterosalpingography Images
IVP Images
Types of CT Imaging
CT Anatomy
Coronary Calcium Scoring
CT Angiography
Radiation Protection
1. Teletherapy
2. Brachytherapy
3. Systemic Radiotherapy
4. Law of Bergonie and Tribondeau
5. Radiosensitivity of Tissues and Tumors
6. Different Iodine Isotopes
7. Half-Lives of Important Radioisotopes
Chronic sinusitis is a chronic inflammation of mucous membranes of paranasal sinuses by which irreversible degenerative changes have occurred. Almost invariably succeeds acute sinusitis which did not receive adequate treatment, or it can also develop following a cold or tooth infection.
It occurs when the self-cleansing mechanism of nose and paranasal sinuses gets impaired. Most involved sinusitis is maxillary sinus with duration of symptoms is more than 3 months.
Causes of chronic sinusitis are:
1. Atrophic Sinusitis
Main changes take place in afferent vessels leading to cellular response at and around the arterioles and arteries, later the vessel wall itself becomes thickened and contracted causing endarteritis and thrombosis. In this condition, there is much less edema present as this is primarily a condition that affects the horse’s lower jaw. Hypertrophic and atrophic coexist in the same sinus, the condition causing atrophy at one location and polypoidal hypertrophy at the other place.
2. Hypertrophic Sinusitis
It is characterised mainly by the fact that inflammation is chiefly of the efferent vessels and of the lymphatics. Recurrent stresses take place, which result in changes of the venous and lymphatic flow and organization lead to the formation of oedema and polypoidal mucus membranes, polyps, oedema of periosteum and osteoporosis.
3. Papillary Sinusitis
Occurs when metaplasia of ciliated columnar epithelium to stratified squamous type and throughout the papillary hyperplastic epithelial cells or stroma may be seen inflammatory cells. It is a viral infection.
4. Follicular Sinusitis
Small follicles are seen in the mucous membranes of the sinuses.
5. Glandular Sinusitis
Increase markedly in the submucosal tissue lining of sinuses.
What Kind of Surgery is Done for Chronic Sinusitis?
There are different types of surgery including minimally invasive techniques using endoscopes to remove blockages such as polyps or infected tissue, or to improve drainage in the sinuses. Here are some surgical procedures for chronic sinusitis:
Functional endoscopic surgery is a procedure to re-establish the drainage of the natural ostia and to restore ventilation and mucociliary clearance.
It is based on the principle that clearing the blocked ostium will restore the mucociliary clearance and the diseased mucosa normalizes.
Equipment Used for FESS
Indications for Endoscopic Sinus Surgery
Procedure
Ballon Sinuplasty is a minimally invasive procedure used to treat chronic sinusitis. It includes use o a ballon catheter to dilate the sinus openings, improving drainage and airflow.
Balloon sinuplasty is a medical treatment that is employed by ear, nose, and throat surgeons to open blocked sinus, especially the sinusitis patients who do not respond to drugs.
The United States Food and Drug Administration approved this endoscopic, catheter-based procedure for chronic sinusitis in 2005. It employs the use of a balloon inflated over a wire catheter in order to open up the sinuses passages. It therefore helps to regain normal drainage because when filled the balloon stretches the sinus opening and therefore the walls of the passageway.
Indications:
Procedure:
Frequent Asked Questions (FAQs)
Ans. Here are some different types of sinus surgery:
Ans. Chronic sinusitis with polyps should be treated with topical nasal steroids. If severe or unresponsive to therapy after 12 weeks, a short course of oral steroids can be considered. Leukotriene antagonists can be considered.
Ans. FESS is a more traditional approach that involves the endoscopic removal of obstructive tissue and polyps to restore sinus drainage. In contrast, balloon sinuplasty is a less invasive technique that utilizes a balloon to dilate the sinus openings without extensive tissue removal. Both techniques aim to improve sinus drainage, but their applications may vary based on the severity and anatomy of the sinus disease.
Ans. Potential complications include bleeding, infection, and cerebrospinal fluid leaks, although these are relatively rare. Post-operative care involves monitoring for signs of complications, managing pain, and ensuring proper nasal hygiene. Medical students should be aware of the importance of follow-up evaluations to assess healing and address any complications early. Educating patients on signs of complications is also a vital part of post-operative care.
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.
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.
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.
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:
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.
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.
The individual has a lot of symptoms. They may have symptoms of all other types so that it is difficult to differentiate.
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.
Here are some of the symptoms associated with schizophrenia:
The diagnosis of schizophrenia relies on two primary systems: the DSM-5-TR and the ICD-10, each with slight variations.
The DSM-5-TR, published by the American Psychiatric Association (APA) in 2022, outlines the following criteria for diagnosing schizophrenia:
The ICD-10 specifies that the patient must demonstrate at least one of the following symptoms for a duration of 1 month or more:
Alternatively, the patient may exhibit at least two of the following symptoms for 1 month or more:
In contrast to the DSM-5-TR, the ICD-10 categorizes schizophrenia based on key presenting symptoms into various types, including:
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:
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.
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.
A pregnancy test is recommended for women of childbearing age.
An EEG may be warranted based on the neurological examination or patient medical history to rule out seizure disorders.
Brain imaging tests, either a CT or MRI (with MRI being preferred), may be indicated based on neurological findings or patient medical history.
Chromosomal testing is suggested if indicated by the physical examination or developmental clinical history.
This screen may be necessary to identify substance use that could lead to psychotic symptoms.
The treatment of schizophrenia typically involves a comprehensive approach that combines medication, psychotherapy, and supportive services. Here are the key components: