Endocrinology Made Simple : Treatment of Large Macroadenomas

Treatment of Large Macroadenomas                          

Large macroadenomas first line of treatment includes Dopamine Receptor Agonists such as Cabergoline and Bromocriptine.

With this treatment,the size of the tumor  decreases rapidly over a course of few days.

The patient”s vision also improves significantly.

After the treatment has been initiated with Dopamine receptor agonists,the patients should be closely monitored by assessing the following:

Visual fields Evaluation

Clinical symptoms

Prolactin levels

MRI of pituitary gland.

Clinical features of Macroadenoma includes:

Visual field defects due to compression of optic chiasm and visual pathways

Hypogonadism and Hypopituitarism

Computer Studies Made Simple : Metropolitan Area Network

Metropolitan Area Network

This computer network is designed to cover and maintain communication in a city.

It usually consists of one or more than one Local Area Networks

It is smaller than a Wide Area Network but larger than a Local Area Network.

A common application of Metropolitan Area Network is carrying out communications of Mobile Networks.

Endocrinology Made Simple : Cushing” Syndrome Secondary to Adrenal Etiology:

Clinical Features:

These are same as clinical features of Cushing”s Syndrome

These include

Weight gain

Lethargy

Weakness

Proximal myopathy

Hypertension

Thin extremities as compared to trunk

Increased fat distribution in the trunk region

Round face also called Moon face

Thin skin with striae

“Buffalo hump”

Biochemical Features:

Significantly Increased Urinary Free Cortisol Levels

Non-suppressible High Dose Dexamethasone suppresion Test

Undetectable ACTH Levels

Radiological Investigations

These include Imaging of the adrenal glands by MRI or CT Scan

Difference with other forms of Cushing Syndrome

In pituitary dependent Cushings Disease,Plasma ACTH levels are normal or increased.

Patients with Ectopic ACTH syndrome have high plasma ACTH levels.

Computer Studies Made Simple : Wide Area Netwrok / WAN

Wide Area Netwrok / WAN

This network covers a large area of communication such as connecting computers in different countries.

The computers in a WAN are connected by telephone lines or satellite communication.

The computers in WAN network are accessed by terminals.

The PC needs to be connected to a larger computer also called as a Host computer.

File transfer data is used to transfer the information between the personal computer or PC and the larger computer or Host computer.

Transfer of data from PC to host computer is called uploading while transfer of data from host computer to PC is called downloading.

WAN can cover greater distances than LAN and can connect computers anywhere in the world.

Data transfer speed is slower than LAN in WAN and WAN also has greater possibility of data transmission error 

Endocrinology Made Simple : Hyponatremia,Causes and Management

Hyponatremia

Hyponatremia is defined as relative excess of water in relation to sodium in the body.

Causes and Classification:

Increased water Intake:

Primary Polydipsia

Endocrine Disorders:

Adrenal Insufficiency

Hypothyroidism

Impaired water excretion

Advanced Renal Failure

Increased Anti diuretic Hormone ADH Release.

Causes Of Increased ADH Relaese:

Decreased effective circulating volume:

Volume depletion

Congestive Heart Failure

Cirrhosis

Diuretics Overuse

SIADH : Syndrome Of inappropriate ADH Secretion

Causes Of SIADH:

Central Nervous System Disorders

Cancer/Tumors : (Ususally small cell lung ca)

Medications and Drugs:

Carbamazepine

Cyclophosphamide

SSRIS : Selective Serotonin Reuptake Inhibitors

Lung Diseases

Postoperative patients.

Increased use of hypotonic fluids postoperatively

Symptoms Of hyponatremia:

These are mainly neurological and occur due to cerebral oedema caused by movement of water into the brain cells.

Earliest symptoms are nausea,malaise followed by headache.

In severe hyponatremia when serum sodium falls below 115 meq / L seizures,coma and respiratory arrest can occur.

Treatment Of Hyponatremia/Key Points

It depends upon th cause of hyponatremia,the severity of symptoms and plasma concentration of sodium.

Management of Severe Symptomatic Hyponatremia / sodium below 115 meq/L

Sodium should be corrected at rate of 1.5 – 2 meq/L / hour for the first 3 – 4 hours.

Hypertonic saline should be used in this perios eg 3 % Normal saline.

Plasma sodium levels should be monitored frequently during this initial correction.

Sodium levels should not be raised more than 12 meq/L in first 24 hours.

Computer Studies Made Simple : Different Components Of Local Area Networks:

Different Components Of Local Area Networks

Following are various components of a Local Area Network

Gateway

Router

Bridge

Network Interface Card

Communication Medium

Gateway:

This device connects networks together and converts the data according to the type of protocol

And thus can connect multiple networks with different types of protocol together.

Router:

This device connects multiple networks with various types of protocols together and can also be used if networs are operating in various countries

Bridge:

This device is used to connect similar types of networks

Network Interface Card:

This type of device physically connects a computer to a network and controls flow of information between computer and network.

Communication Medium:

This refers to medium that are used to connect different computers for the purpose of data transfer.

The major types of this medium include:

Co-axial cables

Fibreoptic cables

Endocrinology Made Simple : Causes Of Hypercalcemia

Causes Of Hypercalcemia

The causes of Hypercalcemia can be broadly divided into following two types :

1.Parathyroid Dependent

2.Parathyroid Independent

1.Parathyroid Dependent Hypercalcemia:

These may be.      

          

      a      Primary Hyperparathyroidsim

      b.      Tertiary Hyperparathyroidism

   

      c.       Lithium Induced Hypercalcemia

     

      d.      Familial Hypocalciuric Hypercalcemia

2 . Parathyroid Independent Hypercalcemia:

The causes of these are as follows:

       a.Malignancies

       b.Vitamin D Toxicity

       c.Granulomatous Disease

       d.Milk Alkali Syndrome

Malignancy Induced Hypercalcemia:

This occurs due to secretion of PTHrP and other haematological malignancies

It is important to measure serum PTH levels in order to classify if hypercalcemia is PTH Dependent or PTH 

Independent.

Dermatology Made Simple : Skin lesions caused by Medications 3:

Contact Dermatitis:

This usually occurs at areas of contact with medications/ointments etc to the skin

It occurs after months of exposure to the medication.

Usually the medication is in form of ointment,gel or topical patch.

Some of the medications that can cause this include:

Oestradiol

Clonidine

Nitroglycerin

Allergic contact Dermatitis

Management:

Avoidance of causative agent.

Topical steroids

Fixed Drug Eruption:

These are skin lesions that occur at the same site of skin repeatedly whenever an individual gets exposed to a medications to which he has developed allergy.

These maybe single or multiple lesions.

Common medications that cause this lesion include:

Fluconazole

Ciprofloxacin

Doxycycline

Clarithromycin

NSAIDs

Trimethoprim

Cotrimoxazole

Phenytoin

Cetirizine

Management:

Identifications and Avoidance of the causative agent

Topical steroid application at site of the lesion

Computer studies Made Simple : Local Area Network / LAN

Local Area Network / LAN

Local Area Network are used to connect computers in a single building or group of buildings.

Types of LAN/Local Area Networks

There are many types of LANs

The most common type is Ehernet.

Composition of LAN :

A Local Area Network consists of  a central node which is alos called as network Hub.

The computers in LAN are connected to the central node in a star topology.

These links between the hub and computers is made with UTP cables/Unsheilded Twisted Pair Cables.

The maximum recommended length for a UTP cable in LAN is 100 meters.

The computers in a LAN communicate with each other at a high speed.

The speed of communication between 2 devices in a LAN varies between 2 to 1000 million bits/second
Mbps.

No computer in a LAN should be more than 100 meters from the central hub,hence,LAN can transmit data
only in a limited distance.

That is why LAN are mostly used to connect computers in a single building or room etc.








UTP Cables


 Local Area Network

Advantages  and Applications of LAN:

1.Data is shared by all users in the network  

2.The data transfer is very secure from getting copied and there are lesser chances of it getting destroyed or
corrupted.

3.It can help sharing of utility devices such as Printer easier between users in the network.

4.A single software canbe used by all users in the network.

5.Data is stored in a central computer and hence can be esily used by all users in the network.

Dermatology Made Simple : Skin lesions caused by Drugs

Skin lesions caused by Drugs

Drug Induced Vasculitis

Vasculitis is inflammation of blood vessels that can cause their complete occlusion or lead to leakage of blood components through the vessel wall.

The inflammation can affect any of the vessels in the skin including capillaries, venules, arterioles and lymphatics.

The chief drugs involved in causing vasculitis are as follows:

Thiazide diuretics

Thiouracil

Antibiotics

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Oral anticoagulants ( warfarin and coumarin).

 skin vasculitis

Mechanism of Drug Induced Vasculitis :

Both  cell mediated and humoral immunity are thought to play a role.

The most common encountered skin rash is non blanching purpura on the limbs.

Treatment involves:

Withdrawing the offending drug

Administration of systemic steroids

Erythema Multiforme:

Erythema multiforme (EM) is an acute, self-limited, and sometimes recurring skin condition that is considered to be a type IV hypersensitivity reaction associated with certain infections, medications, and other various triggers

The characterstic rash is called as  target lesions that involve elbows,face and palms.

These lesions have a central vesicle and are erythematous.

There may or may not be some systemic features associated with this rash  

  Erythema multiforme

Precipitating factors include 

Herpes simplex virus (HSV) 

Epstein-Barr virus (EBV)

Histoplasmosis

Mycoplasma

Erythema multiforme represents mild end of spectrum of skin conditons with Steven Johnson”s syndrome the severest.

Following is a list of medications that cause Erythema multiforme:

Barbiturates

Non-steroidal anti-inflammatory drugs

Penicillins

Sulphonamides

Phenothiazines  

Anticonvulsants.

Diagnosis

This is usually clinical but in case of doubt,skin biopsy is diagnostic that show on histology necrotic 

keratinocytes,lymphocytic infiltrate and blister formation

Management:

This is usually achieved by stopping the causative medication and applications of topical steroids

Erythema Multiforme  major may require hospital admission for supportive care

Oral antihistamines and/or topical corticosteroids may help relieve itching.

Following treatments t have been reported to help suppress recurrent Erythema Multiforme:

Antimalarial drugs eg hydroxychloroquine

Dapsone 100-150mg/d

Azathioprine 100-150 mg/d

Miscellaneous Drugs in Resistant cases:

Ciclosporin,

Mycophenolate mofetil

Photochemotherapy (PUVA)

Thalidomide

Computer Studies Made Simple : Devices used for connecting Computer Networks

Gateway:

A gateway is a device that connects two or more networks with different types of protocols.

This device converts data according to the protocol.

The computer on a Local Area Network   require gateway access to internet

Bridges

A bridge is a device that connects two network segments.

It connects similar types of networks.

On receiving a signal,the bridge decides which segment the signal should be sent to.

It reads the address of sending and reciving computers

Advantages

It increases network performance

It reduces network traffic

Dermatology Made Simple : Skin lesions caused by Drugs

Skin lesions caused by Drugs

Toxic Epidermal Necrolysis :

This is an extensive and life threatening skin muco-cutaneous skin disorder that usually occurs in response to a use of medication.

It causes extensive necrosis of skin and formation of blisters and large part of skin becomes denuded.

Patients become unwell clinically and can lead to dehydration and death rapidly if not treated in time.

Mucous membranes of eyes,mouth and genitalia can become involved.

It shoud be treated in HDU prompltly.

The causative medications should be withdrawn.


Toxic Epidermal Necrolysis

Steven Johnson”s Syndrome

This is a immune complex mediated hypersensitivity reaction to drugs that involves mucous membranes of mouth eyes and genitals .

Patients are clinically unwell with fever,headache,and malaise.

The skin lesions consist of erythema,pustules papules and erosions.

Treatment consists of stopping the offending drugs,fluid balance and skin dressings.

Incase of serious /extensive involvement,the patient should be nursed in HDU  

Computer Studies Made Simple : Devices used to connect networks of computer

Devices used to connect networks of computer

Different devices used to connect networks of computer are as follows

Routers

Gateway

Bridges

Router:

This device connects multiple networks that use similar or different protocols.

It manages the best and most appropriate route between any two communication networks.

It consists of both software and hardware.

The hardware can be a network server or a separate computer.

The software includes operating system and routing protocol.

Advantages

Routers are used when several networks are connected together.

They can connect networks between different countries

They can transfer data in less time.

Dermatology Made Simple : Rashes caused by Drugs

Dermatology Made Simple : Rashes caused by Drugs :

Many medications have the potential to cause rashes on the skin as side effect.

Majority of these lesions are not severe and simple measures can treat them such as simple emollients.

However some lesions can be life threatening such as Steven Johnson”s syndrome and Toxic Epidermal 

Necrolysis

Some commonly encountered drug reactions are as follows:

Erythema nodosum

Toxic Epidermal Necrolysis

Steven Johnson”s Syndrome

Vasculitis

Photosensitivity

Urticaria

Angio-oedema

Pigmentary changes

Patterns Of Involvement of Drug Induced Skin Rashes :

Drug induced skin rashes maybe geenralized meaning they can affect the skin of entire body or they may be 

localized 

Computer Studies Made Simple : Mesh Topology:

Mesh Topology:

In this network,every device in the nwtwork is connected to every other device.

A message can be sent from source along different possible pathways to the destination.

This topology has enhanced performance and is very reliable.

They are usually used in wide area networks.

Advantages:

This system doesnot slow down in cases of heavy data flow.

It is easy to truble shoot

The system continues to function even if one link becomes non-functional.

Disadvantages:

It is very expensive

It has difficult configuration and installation.  

Dermatology Made Simple : Terms used in Dermatology Part 3

Terms used in Dermatology Part 3

Nummular lesions:

This means con like lesions.

They are usually seen in eczematous lesions of the skin.

Annular lesions:

This term is used to describe ring shaped lesions of the skin.

Excoriation:

This refers to partial or complete loss of epidermis.

Reticulate lesions:

This refrs to lesions who are shaped like a net.

They are seen in Autoimmune conditions usually.

Desquamation:

This refers to peeling off of superficial layers of the skin.

Fissures:

These are slits through whole thickness of the skin.





Plaque



Bullae




Pustule on skin

Computer Studies Made Simple : Tree Topology

Tree Topology

This type of topology has combined features of both bus and star topologies.

It consists of a group of computers configured in a star topology.

These groups are then connected to a backbone bus cable.

Advantages:

It is used for expansion of an existing network.

Disadvantages:

If the bus cable/backbone cable breaks,the entire network fails.

It is more difficult to configure than other topologies.

Dermatology Made Simple : Terminology used for describing lesions of the skin:

Terminology used for describing lesions of the skin:

Ulceration:

This means loss of surface of skin.

This includes the epidermis and dermis.

Pustules:

These are skin lesions that contain pus.

This can be due to bacterial infection or sterile in case of pustular psoriasis.

Atrophy:

This means thinning of the skin.

It occurs due to loss of tissue in epidermis,dermis and subcutaneous fat.

Lichenification

This means thickening of the skin.

It occurs due to long term rubbing on the skin and pressure.   

Computer Studies Made Simple : Ring Topology

Ring Topology

In this network,each computer is connected to the next one forming a ring of computers.

Each computer transmits the data it receices from the previous one.

The flow of data thus is in one direction which is forward from the previous computer.

The data/information passes around the ring till it reaches the correcr destination folder.

Advantages:

1.It is less expensive than star topology.

2.Each computer has equal access to the network.

Disadvantages:

1.Failure of one computer in the ring can affect the entire network.

2.It is more difficult to troubleshoot.

3.Adding or removing computers can affect the entire network.

Ring Topology

Dermatology Made Simple: Changes in Nails Part 2

Changes in Nails  Part 2

Beau Line:

This refers to a partial thickness transverse break in nail plate.

This represents a temporary arrest in nail matrix development process.

It may affect a number of nails.

It can happen during times of illness as well as in association with nail diseases such as eczema and psoriasis.






Longitudinal nail splits:

These may be sinle or multiple.

An single split on nail usually represents an area of focal nail damage.

This canbe due to one of the following causes:

Acute trauma or injury to the nail.

Repeated trauma from external object.

In case there are multiple longitudinal aplits,they canbe due to a generalized inflammatory or degenerative process.

The casues for these include:

Lichen planus

Aging

Darier”s Diseases

Darier"s Disease

Darier"s Disease is characterized by dark crusty patches on the skin, sometimes containing pus. The crusty patches are also known as keratotic papules.

Mild forms of the disease are the most common, consisting solely of skin rashes that flare-up under certain conditions such as high humidity, high stress or tight-fitting clothes. 

Even in mild forms, short stature combined with poorly formed fingernails containing vertical striations are diagnostic.

 

Skin Lesions in Darier"s Disease

Computer Studies Made Simple : Star Network / Topology

Star Network / Topology

In this type of network,all computers are connected with central device which is called as hub.

This type of topology is mostly used in Client Server Models.

In order for a computer to share its data with other computers in the network,it first sends its data to  the hub.

The hub will then subsequently send the data to the other computers/receiving computers.

Thus the hub acts as a central connection point and each computer in a star topology communicates with the central hub.

Advantages:

1.It is easy to find and troubleshoot faults and errors incase one arises in this type of network.

2.Failure of one computer will not cause the entire network to collapse.

3.It Is easy to add or remove computers without disturbing the network.

Disadvantages:

1.If the central hub fails,the entire network will fail.

2.Overall it is  an expensive network.

3.A large amount of cable is neee for connecting the computers.

Dermatology Made Simple : Structure and Function of the Skin

Structure and functions of the skin

Skin structure

The skin is the largest organ of the body. It has three main layers, the epidermis, the dermis and the subcutaneous layer.

The epidermis is an elastic layer on the outside that is continually being regenerated. It includes the following:

• Keratinocytes - the main cells of the epidermis formed by cell division at its base. New cells continually move towards the surface. As they move they gradually die and become flattened.

• Corneocytes - the flattened dead keratinocytes that together make up the very outer layer of the epidermis is called the stratum corneum or horny layer. This protective layer is continually worn away or shed.

• Melanocytes – produce the pigment melanin that protects against UV radiation and gives skin its colour.

• Sweat glands – produce sweat that travels via sweat ducts to openings in the epidermis called pores. They play a role in temperature regulation.

• Hair follicles – are pits in which hairs grow. Hairs also play a role in temperature regulation.

• Sebaceous glands – produce sebum (an oil) to keep hairs free from dust and bacteria. Sebum and sweat make up the ‘surface film’.

The dermis is the inner layer that includes the following:

The subcutaneous layer under the dermis is made up of connective tissue and fat (a good insulator).

Functions of the skin :

• Provides a protective barrier against mechanical, thermal and physical injury and hazardous substances.

• Prevents loss of moisture.

• Reduces harmful effects of UV radiation.

• Acts as a sensory organ (touch, detects temperature).

• Helps regulate temperature.

• An immune organ to detect infections etc.

• Production of vitamin D.

Dermatology Made Simple : Introduction to blistering disorders of the skin

Introduction to blistering disorders of the skin

Blisters arise due to separation of epidermal cells as a result of one of the following phenomenon:

Allergic  reaction

Trauma or injury

Infection

Oedema

Inflammation

Vasculitis

In addition,allergy causes immune reactions that ocuur at junction of epidermis and dermis aand cause blister formation.

Predisposing Factors:

There is a high chance of blister formation in indivduals with predisposition to allergy and there is an element of genetic susceptibility as well.

Most common blistering disorders of the skin (also known as immunobullous disorders are as follows:

Pemphigoid

Pemphigus

Dermatitis Herpetiformis

Linear IgA

General Principles Of Management :

Avoid precipitans

Topical treatment

Systemic Therapy including immunosuppressive drugs

Skin Blister

Computer Studies Made Simple : Network Topology

Network Topology

This term refers to the physical layout of connected devices in  a computer network .

It explains the locations of various computers in a network.

Types of Network Topologies:

Bus topology

Mesh Topology

Star Topology

Tree topology

Ring Topology


Bus Topology:

This is most simplest type of network

Its Is good for a network with small number of computers.

All computers in this network are connected to one common communication medium.

This medium Is called as BUS and is usally a central wire

Terminators are used at end of the BUS to absorb signals.

If two computers transmit data at the same time,a collision can take place.

This type of topology is mostly used in Peer to Peer Networks.

If a  computer  wants to send data to another computer in the network,it will do so via the bus.

The data and address move from one computer to another.

Each computer will check the address.If this matches with address of the computer,the computer will keep
the data.If not,the data will move on to the next computer.

Advantages:

1.It is simple to use

2.It is economical in terms of its costs.

3.Even if there is failure of one node,it will not affect working of rest of the network.

4.It is easy to add more computers to this network by extending the bus.

5.The amount of cable use is not much and thus is very cheap and easy to use.

Disadvantages:

1.Only a small number of computers are supported bythis network.

2.In case of an error in network,it is difficult to trouble shoot.

3.If more computers are added to this network,the network speed and efficiency will decrease.

Dermatology Made Simple : Benign Skin Tumors

Benign Skin Tumors

Seborrhoeic Warts:

They are usually found on face,trunk and neck.

Their size varies from as small as 0.3 cm to upto 4 cm.

They may have variable color varying from light brown to dark brown.

They may or may not have a peduncle (pedunculated or non-pedunculated respectively).

Dermatofibroma:

These are small nodules that arise in the dermis.

Their colour varies from red to light brown.

They are usually seen in women.

They are usually found on legs

Predisposing Factor:

It is believed they are mostly seen in areas of skin that are exposed to trauma.

  Dermatofibroma

Skin Tags:

They are usually seen at places where skin can get rubbed by skin or clothing.

They are found in axillae,neck,groin and under breasts.

They may be pigmented and color varies from light brown to dark brown.

Computer Studies Made Simple : Computer Network Standards

Network Standards:

These refer to the rules and regulations that reflect the technical and physical specifications about a computer network.

Types of Network Standards:

There are two main types of network standards:

1.De Facto

2.De Jure

1.De facto:

These standards have developed over course of time with historical developments and are based on research and experience.

These are mostly used by organizations.

2.De Jure:

These standards have been devised by governing bodies in networks.

These are a set of protocols devised by major organizations.

Some of organizations that design these regulations are as follows:

IEEE : Institute of Electrical and Electronics Engineers

IEA : The Electronic Industries Association

ANSI : American National Standard Institute

Computer Studies Made Simple : Peer to Peer Model

Peer to Peer Model

In this type of computer model,all computers operate individually and have equal status

There is no computer that acts as server.

Each computer has got access to files and data on other computers in the network.

This model  has the disadvantage of being less secure as the data is stored on more than one computer in the network and hence is prone to damage or loss.

Also it is slower than the client server network.

Hybrid Models:

These models include both Client Server Models and Peer to Peer models and hence have properties and advantages of both these models.

Dermatology Made Simple : Changes in Nails in Systemic Disease 2

Onycholysis:

This term is used to describe detachment of nail from its nail bed.

Causes:

Mechanical causes

Manual trauma

Systemic Diseases:

Thyrotoxicosis

Psoriasis

 Onycholysis

Pitting:

This refers to small pits or depressions on nail surface

Causes

It is usually associated with several systemic disease such as:

Psoriaisis

Alopecia areata

Lichen planus

 Nail Pitting

Thickening of Nails:

These can occur in a variety of conditions:

Chronic nail trauma

Fungal infections

Psoriasis

Leuconychia:

This means the color of nails is white.

It is seen with low protein states such as Hypoalbuminemia and 

Liver diseases causing cirrhosis of Liver

 Leuconychia of nails