Friday, July 13, 2012

Collodion Baby

             Lamellar ichthyosis (LI) is an autosomal recessive disorder that is apparent at birth and is present throughout life. The newborn is born encased in a collodion membrane that sheds within 10-14 days. The shedding of the membrane reveals generalized scaling with variable redness of the skin. The scaling may be fine or platelike, resembling fish skin. Although the disorder is not life threatening, it is quite disfiguring and causes considerable psychological stress to affected patients. Ectropion will be present. There will be macroglossia.

       Patients with lamellar ichthyosis have accelerated epidermal turnover with proliferative hyperkeratosis, in contrast to retention hyperkeratosis. This involves a mutation in the gene for transglutaminase 1 (TGM1). The transglutaminase 1 enzyme is involved in the formation of the cornified cell envelope. The formation of the cornified cell envelope is an essential scaffold upon which normal intercellular lipid layer formation in the stratum corneum occurs. Thus, mutations in the TGM1 secondarily cause defects in the intercellular lipid layers in the stratum corneum, leading to defective barrier function of the stratum corneum and to the ichthyotic phenotype seen in lamellar ichthyosis patients and in transglutaminase 1 knockout mice. How much a defective cornified cell envelope alone contributes to the barrier abnormality in ichthyoses remains unclear.[1]

To date, 6 genes for lamellar ichthyosis have been localized and 5 of them identified, as follows[2] :

  • TGM1 (14q11)

  • ABCA12 (2q34)

  • 19p12-q12

  • 19p13

  • ALOXE3-ALOX12B (17p13)

  • ichthyin (5q33) 

In the neonatal period, following the shedding of the collodion membrane, the newborn is at risk for secondary sepsis and hypernatremic dehydration.

As the child ages, the hyperkeratosis can interfere with normal sweat gland function, which can predispose to heat intolerance and possible heat shock. Ectropion may result in the inability to fully close the eyelids and can cause exposure keratitis.

  Recently , a case was reported in ESI Post Graduate Institute of Medical Sciences and Research,  Rajajinagar,Bangalore.

collodion babay

collodion baby

Picture Courtesy : Dr.Tejaswini Hiremath  MS OBG(std) ESIPGIMSR,Bangalore, India

Ref: 1. http://emedicine.medscape.com/article/1111300-overview

      2. http://indianpediatrics.net/dec2001/dec-1428.htm

Tuesday, July 10, 2012

The Amazing Spider Surgery!

      how-does-spider-work       As the Amazing Spiderman hits the theatres all over the world, the amazing ‘spider surgery technology’ is all set to create buzz in the Asia Pacific minimal access surgical field. Dr Pradeep Chowbey, who heads the Max Institute of Minimal Access, Metabolic and Bariatric Surgery, be at the helm of spider surgery in Asia pacific region for the first time on 10th July 2012.

           In the conventional laparoscopic surgery there are at least 4 to 5 ports/small incisions around the umbilicus for the insertion of various instruments including a camera.

lap1

       But in Spider surgical system,the surgeon inserts the SPIDER Surgical System through a single incision usually located near the patient's belly button. The system opens up umbrella-like within the abdomen, providing the surgeon with two flexible channels for right- and left-hand instruments with 360-degree range of motion, and two rigid channels for small cameras and other instruments. Once the procedure is completed, the SPIDER Surgical System closes up and is removed through the same incision.

spide

    The spider surgical system is presently used for appendectomy, gall bladder surgeries and mainly bariatric surgeries. With the periodic transition in the field of abdominal surgeries this Spider tech is said to be a giant leap..

Source: http://www.transenterix.com/spider-surgical-system.php 

Monday, July 9, 2012

Electronic Resources in Medicine (ERMED) Consortium

       inner_head        ERMED-India Consortium , is an effort in India by Director General of Heath Services (DGHS) of Govt. of India to develop nation wide electronic information resources in the field of medicine in India. The authorities provide financial support for the Govt. Medical colleges to purchase electronic journals. The ERMED is coordinated through National Medical Library situated in New Delhi.The Govt. Medical colleges can join this initiative free of charge. The leading E journals provided by ERMED are

1. American Academy of Pediatrics
2. BMJ Publishing
3. Cambridge University Press
4. Cengage Learning
5. IOS Press
6. Lippincott William Wilkins
7. Oxford University Press

8. Royal Society of Medicine Press

  To join ERMED the following application is to be filled

http://nmlermed.in/Application.pdf

The applications should be sent to the address below


National Medical Library
Ansari Nagar,
Ring Road,
New Delhi-110029.
Ph: 011-26589085,26589128,26589489
e-mail: nationalmedicallibrary66@yahoo.in

http://nmlermed.in/howToJoin.htm

            Most of  the Govt. Medical colleges in India are lagging behind in Research and recent advances in the world of medicine because of various reasons. ERMED is an effort to help the medical colleges and students to update themselves with newer things.

For more details visit

http://nmlermed.in/main.htm

Sunday, July 8, 2012

Steve Jobs’ speech @ Stanford Versity

Stay Hungry, Stay Foolish.

iPhone apps for Doctors

           Since ages it’s a general perception that doctors are considered to be weak in technical things and poor in gadget using. Now the time has changed with , whole of the medical profession is being dependent on gadgets.The days of bedside teaching , learning and being proud of ones clinical skills will become like test cricket in years to come. Change is the principle of nature and in the struggle for existence the most adaptable will survive. Its becoming mandatory to use medical applications in our smart phones for quick response during emergencies.. Here are few medical applications for iPhone. The first one in the review series of the medical apps.

1. Heart pro

3D4Medical in collaboration with Stanford University School of Medicine present the Heart Pro III. As featured in the WWDC 2012 Keynote Speech. This app was developed in partnership with Dr. Lacy E Harville III, MD, FACS.
In this upgrade 3D4Medical have added in several new features and several new animations all for free.
Built in Animations:
-Anterior Beating Heart - Aortic Stenosis - Conduction Heart Beat - Heart Catheterization-Ischemic Stroke - Myocardial Heart Attack - Patent Ductus Arteriosus (PDA) - Ventricular Fibrillation - Ventricular Septal Defect - Blood Flow (slow speed) - Blood Flow in Beating Heart - Coronal Cut (Ant.) Beating Heart - Lateral Beating Heart - Posterior Beating Heart - Right Lateral Beating Heart - Sagittal Cut (Lat) Beating Heart - Transverse Cut (Ant) Beating Heart - Aortic Valve - Left Atrium - Left Ventricle - Mitral Valve - Pulmonary Valve - Right Atrium - RightVentricle Tricuspid Valve.

 heart proheart pro 1

heart pro 4heart pro 5

hear pro 2

To buy the app visit 

http://itunes.apple.com/us/app/heart-pro-iii/id393231526?mt=8

Tuesday, July 3, 2012

Stay Hungry, Stay Foolish….

Steve-JobsAs my mind wanders through the uncertainties of life, i found this inspiring speech by Steve Jobs.

Steve Jobs' 2005 commencement address at Stanford University.

      I am honoured to be with you today at your commencement from one of the finest universities in the world. I never graduated from college. Truth be told, this is the closest I've ever gotten into a college graduation. Today I want to tell you three stories from my life. That's it. No big deal. Just three stories.The first story is about connecting the dots.I dropped out of Reed College after the first 6 months, but then stayed around as a drop-in for another 18 months or so before I really quit. So why did I drop out?It started before I was born. My biological mother was a young, unwed college graduate student, and she decided to put me up for adoption. She felt very strongly that I should be adopted by college graduates, so everything was all set for me to be adopted at birth by a   lawyer and his wife. Except that when I popped out they decided at the last minute that they  really wanted a girl. So my parents, who were on a waiting list, got a call in the middle of the  night asking: "We have an unexpected baby boy; do you want him?" They said: "Of course."My biological mother later found out that my mother had never graduated from college and that my father had never graduated from high school. She refused to sign the final adoption papers. She only relented a few months later when my parents promised that I would someday go to college.And 17 years later I did go to college. But I naively chose a college that was almost as expensive as Stanford, and all of my working-class parents' savings were being spent on my college tuition. After six months, I couldn't see the value in it. I had no idea what I wanted to  do with my life and no idea how college was going to help me figure it out. And here I was spending all of the money my parents had saved their entire life. So I decided to drop out and trust that it would all work out OK. It was pretty scary at the time, but looking back it was one  of the best decisions I ever made. The minute I dropped out I could stop taking the required classes that didn't interest me, and begin dropping in on the ones that looked interesting.It wasn't all romantic. I didn't have a dorm room, so I slept on the floor in friends' rooms,  I returned coke bottles for the 5¢ deposits to buy food with, and I would walk the 7 miles across town every Sunday night to get one good meal a week at the Hare Krishna temple. I loved it.And much of what I stumbled into by following my curiosity and intuition turned out to be priceless later on. Let me give you one example:Reed College at that time offered perhaps the best calligraphy instruction in the country.Throughout the campus every poster, every label on every drawer, was beautifully hand calligraphed. Because I had dropped out and didn't have to take the normal classes, I decided to take a calligraphy class to learn how to do this. I learned about serif and san serif typefaces, about varying the amount of space between different letter combinations, about what makes great typography great. It was beautiful, historical, artistically subtle in a way that science can't capture, and I found it fascinating.None of this had even a hope of any practical application in my life. But ten years later, when we were designing the first Macintosh computer, it all came back to me. And we designed it all into the Mac. It was the first computer with beautiful typography. If I had never dropped in on  that single course in college, the Mac would have never had multiple typefaces or proportionally spaced fonts. And since Windows just copied the Mac, it's likely that no personal computer would have them. If I had never dropped out, I would have never dropped in on this calligraphy class, and personal computers might not have the wonderful typography that they do. Of course it was impossible to connect the dots looking forward when I was in college. But it was very, very clear looking backwards ten years later.Again, you can't connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something — your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life.

            My second story is about love and loss.I was lucky — I found what I loved to do early in life. Woz and I started Apple in my parents garage when I was 20. We worked hard, and in 10 years Apple had grown from just the two of us in a garage into a $2 billion company with over 4000 employees. We had just released our finest creation — the Macintosh — a year earlier, and I had just turned 30. And then I got  fired. How can you get fired from a company you started? Well, as Apple grew we hired someone who I thought was very talented to run the company with me, and for the first year or so things went well. But then our visions of the future began to diverge and eventually we had a falling out. When we did, our Board of Directors sided with him. So at 30 I was out. And very publicly out. What had been the focus of my entire adult life was gone, and it was devastating.I really didn't know what to do for a few months. I felt that I had let the previous generation of entrepreneurs down - that I had dropped the baton as it was being passed to me. I met with David Packard and Bob Noyce and tried to apologize for screwing up so badly. I was a very public failure, and I even thought about running away from the valley. But something slowly began to dawn on me — I still loved what I did. The turn of events at Apple had not changed that one bit. I had been rejected, but I was still in love. And so I decided to start over.I didn't see it then, but it turned out that getting fired from Apple was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.

     During the next five years, I started a company named NeXT, another company named Pixar,and fell in love with an amazing woman who would become my wife. Pixar went on to create the worlds first computer animated feature film, Toy Story  , and is now the most successful animation studio in the world. In a remarkable turn of events, Apple bought NeXT, I returned to Apple, and the technology we developed at NeXT is at the heart of Apple's current renaissance. And Laurene and I have a wonderful family together.I'm pretty sure none of this would have happened if I hadn't been fired from Apple. It was awful tasting medicine, but I guess the patient needed it. Sometimes life hits you in the head with a brick. Don't lose faith. I'm convinced that the only thing that kept me going was that I loved what I did. You've got to find what you love. And that is as true for your work as it is for your lovers. Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love  what you do. If you haven't found it yet, keep looking. Don't settle. As with all matters of the heart, you'll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don't settle.

    My third story is about death.When I was 17, I read a quote that went something like: "If you live each day as if it was your  last, someday you'll most certainly be right." It made an impression on me, and since then,for the past 33 years, I have looked in the mirror every morning and asked myself: "If today were the last day of my life, would I want to do what I am about to do today?" And whenever the answer has been "No" for too many days in a row, I know I need to change something.Remembering that I'll be dead soon is the most important tool I've ever encountered to help me make the big choices in life. Because almost everything — all external expectations, all pride, all fear of embarrassment or failure - these things just fall away in the face of death,leaving only what is truly important. Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart.About a year ago I was diagnosed with cancer. I had a scan at 7:30 in the morning, and it clearly showed a tumour on my pancreas. I didn't even know what a pancreas was. The doctors told me this was almost certainly a type of cancer that is incurable, and that I should expect to live no longer than three to six months. My doctor advised me to go home and get my affairs in order, which is doctor's code for prepare to die. It means to try to tell your kids everything you thought you'd have the next 10 years to tell them in just a few months. It means to make sure everything is buttoned up so that it will be as easy as possible for your family. It means to say your goodbyes.I lived with that diagnosis all day. Later that evening I had a biopsy, where they stuck an endoscope down my throat, through my stomach and into my intestines, put a needle into my  pancreas and got a few cells from the tumor. I was sedated, but my wife, who was there, told me that when they viewed the cells under a microscope the doctors started crying because it turned out to be a very rare form of pancreatic cancer that is curable with surgery. I had the surgery and I'm fine now.This was the closest I've been to facing death, and I hope it's the closest I get for a few more decades. Having lived through it, I can now say this to you with a bit more certainty than when death was a useful but purely intellectual concept:No one wants to die. Even people who want to go to heaven don't want to die to get there.And yet death is the destination we   all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. It is Life's change  agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it is quite true.Your time is limited, so don't waste it living someone else's life. Don't be trapped by dogma —which is living with the results of other people's thinking. Don't let the noise of others' opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.When I was young, there was an amazing publication called The Whole Earth Catalogue, which was one of the bibles of my generation. It was created by a fellow named Stewart Brand not far from here in Menlo Park, and he brought it to life with his poetic touch. This was in the late1960's, before personal computers and desktop publishing, so it was all made with typewriters, scissors, and polaroid cameras. It was sort of like Google in paperback form, 35years before Google came along: it was idealistic, and overflowing with neat tools and great notions.Stewart and his team put out several issues of The Whole Earth Catalog, and then when it had run its course, they put out a final issue. It was the mid-1970s, and I was your age. On the back cover of their final issue was a photograph of an early morning country road, the kind you might find yourself hitchhiking on if you were so adventurous. Beneath it were the words:"Stay Hungry. Stay Foolish." It was their farewell message as they signed off. Stay Hungry.Stay Foolish. And I have always wished that for myself. And now, as you graduate to begin a new, I wish that for you.

Stay Hungry. Stay Foolish.

Thank you all very much