Saturday 30 September 2017

Metabolic Medicine Made Simple : Features of Salicyte Overdose


Mechanism of Salicylate / Aspirin Toxicity:

Acute Aspirin Toxicity stimulates the central respiratory centre and leads to respiratory alkalosis by causing tachypnea.


Aspirin causes an anion gap metabolic acidosis by 3 main mechanisms:

1. Salicylate toxicity causes uncoupling of oxidative phosphorylation thereby causing an increase in rate of oxygen consumption in peripheral tissues .This uncoupling is also the cause of hyperpyrexia seen in aspirin toxicity.

2.Salicylate toxicity causes inhibition of enzymes involved in carbohydrate and lipid metabolism leading to accumulation of  organic acids such as pyruvate,lactic acid and acetoacetic acid.

3.Salicylates impair renal function causing accumulation of inorganic acids such as sulfuric acid and phosphoric acids.

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Biochemical presentation:

Salicylate toxicity can present with a mixed respiratory alkalosis and metabolic acidosis which is characterized by a near normal pH , a decrease in PaCO2 and a concurrent decrease in HCO3-.

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Image result for Salicylate overdose images

Clinical Features include :

Tinnitus
Fever
Tachypneasis.
Vomiting
Respiratory Alkalosis
Anion Gap Metabolic Acid


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Tuesday 26 September 2017

Cardiovascular Medicine Made Simple : Anti Hypertensives of choice in Diabetic Patients

Which Antihypertension treatment options should be avoided in Diabetes Mellitus :

Beta - Adrenergic Blockers

Beta adrenergic blockers blunt or mask the premonitory signs and symptoms of acute episodes of hypoglycemia which include these symptoms :

Tachycardia
Blood  Pressure changes

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Non selective beta blockers such as propranolol may even potentiate insulin induced hypoglycemia.

Although this effect is less likely with cardioselective agents,the use of either cardioselective or non-selective beta-blockers in diabetes is not recommended due to their masking effect of the normal warning signs and symptoms of hypoglycemia.

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Angiotensin converting enzyme inhibitors such as captopril are treatment of choice for hypertension in Diabetics as well as Angiotensin receptor blockers such as Losartan.

Calcium channel blockers 
such as Diltiazem are also considered to be safe and effective for treatment of hypertension in Diabetic patients.

Centrally acting alpha-adrenergic agonist such as Methyldopa  &

Alpha 1 adrenergic antagonist such asPrazosin canbe safely used to treat hypertension in Diabetics but due to their side effects they are used only in diabetic patients who are unresponsive to ACE inhibitors and calcium channel blockers.


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Monday 25 September 2017

Dermatology Made Simple : Prognostics factors in Malignant Melanoma

Melanomas Prognostic Criteria : 

Melanomas are skin tumors that can develop either de novo or in an existing mole.

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Sunlight exposure is a significant risk factor and fair skinned persons are at an increased risk of developing melanomas.

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Depth of the lesion : 

The major significant factor for long term prognosis is depth of the lesion since the superficial dermis lies about 1 mm under the skin surface and penetration to this depth is associated with a much higher incidence of metastasis than is with a more superficial location.

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The circumference of the lesion :

The circumference of the lesion is much less important than the depth since one form of melanoma ( superficial spreading ) can still have a good prognosis despite large size ,if it has not extended to the depth of the superficial dermal lymphatic bed.

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The darkness or degreee of variation in color :

The darkness or degreee of variation in color do not have prognostic significance once melanoma is diagnosed.
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Irregularity or fuzziness at the border of a mole like lesion

Irregularity or fuzziness at the border of a mole like lesion is a good clue to potential malignancy but does not affect prognosis once a melanoma is confirmed.

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Sunday 17 September 2017

Physics Made Simple : Transistor Amplifiers

Transistor Amplifiers:

For some applications,  transistors maybe used instead of electron tubes for amplification purposes.

A transistor is completely different from tube and operates on an entirely different principle.

A transistor is a semiconductor device used to amplify or switch electronic signals and electrical power. It is composed of semiconductor material usually with at least three terminals for connection to an external circuit. 

A voltage or current applied to one pair of the transistor's terminals controls the current through another pair of terminals. Because the controlled (output) power can be higher than the controlling (input) power, a transistor can amplify a signal. 

A small change in voltage (Vin) changes the small current through the base of the transistor; the transistor's current amplification combined with the properties of the circuit means that small swings in Vin produce large changes in Vout.

Various configurations of single transistor amplifier are possible, with some providing current gain, some voltage gain, and some both.

From mobile phones to televisions, vast numbers of products include amplifiers for sound reproduction, radio transmission, and signal processing. 

The first discrete-transistor audio amplifiers barely supplied a few hundred milliwatts, but power and audio fidelity gradually increased as better transistors became available and amplifier architecture evolved.


Modern transistor audio amplifiers of up to a few hundred watts are common and relatively inexpensive.


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The major advantages of this amplifier are :


1.Small size

2.Low power consumption.

3.More durability

4 . No cathode heater (which produces the characteristic orange glow of tubes), reducing power consumption, eliminating delay as tube heaters warm up, and immune from cathode poisoning and depletion

5.Very small size and weight, reducing equipment size.

6. Large numbers of extremely small transistors can be manufactured as a single integrated circuit.

7. Low operating voltages compatible with batteries of only a few cells.

8. Circuits with greater energy efficiency are usually possible. For low-power applications (e.g., voltage amplification) in particular, energy consumption can be very much less than for tubes.

9. Inherent reliability and very long life; tubes always degrade and fail over time. Some transistorized devices have been in service for more than 60 years[citation needed] .

10. Complementary devices available, providing design flexibility including complementary-symmetry circuits, not possible with vacuum tubes.

11.Very low sensitivity to mechanical shock and vibration, providing physical ruggedness and virtually eliminating shock-induced spurious signals (e.g., microphonics in audio applications);
Not susceptible to breakage of a glass envelope, leakage, outgassing, and other physical damage.

Disadvantages:

They have a tendency to pick up unwanted signals as compared to vacuum tubes.

This is particularly disavantageous in cases of  high fidelity amplifiers.


Friday 15 September 2017

Physics Made Simple : Cascade Amplifiers

Cascade Amplifiers:

For a large number f applications, the amplification produced by a single triode is not sufficient.

In order to overcome this difficulty,several amplification stages may be coupled or connected by feeding the output from the plate circuit of one tube into the grid of a second tube.

To make a cascade amplifier,two or more tubes are coupled by means of resistors,transformers or other components.

A cascade amplifier is any two-port network constructed from a series of amplifiers, where each amplifier sends its output to the input of the next amplifier in a daisy chain.

The complication in calculating the gain of cascaded stages is the non-ideal coupling between stages due to loading.

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Sunday 10 September 2017

Physics Made Simple : Amplifiers

Amplifier

Amplifier is a device that increases the strength of an electric signal by the use of power from a source other than the signal.

An amplifier increases the amplitude of an electric wave while preserving the form and length of the wave. Amplifiers are widely used in radio and television broadcasting and receiving.

 Mechanism of operation: 

 The basic electron tube amplifier consists of a triode in a circuit with other components. A triode is an electron tube that contains 3 electrodes : the cathode,the grid,and the anode or plate. In a diode amplifier, the signal to be amplified is fed to the grid of the tube.

In addition,the grid is given a small negative voltage called the grid bias relative to the cathode by means of a battery or other methods.

The total grid voltage that is the sum of the signal voltage and the grid bias controls the number of electrons that flow from the cathode to the plate.

This electron flow determines the current that is set up in the plate current.

A small change in the grid voltage produces a large change in the plate current.


Image result for simplified triode amplifier circuit


Image result for simplified triode amplifier circuit


The current in the plate circuit flows through the load resistor R and the output is voltage is developed across this resistor.

The output voltage is equal to the product of the plate current and the value of load resistor.
Thus a small change in input voltage produces a large change in the output voltage.

Gain of the Amplifier 

The ratio of the output voltage to the input voltage fed to the grid is called the voltage gain of the amplifier.