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Monday, October 30, 2006

Osmolal Gap

Osmolal Gap is the difference between measured serum osmolality and calculated serum osmolality.

It is typically calculated as: OG = measured serum osmolality - (2 X serum sodium + serum glucose + serum urea)

Where:

* 2 X serum sodium + serum glucose + serum urea = the calculated serum osmolality and all measures are in mmol/L.
* OG = osmolal gap

In US customary units the calculated osmolarity is: ( 2 x sodium ) + glucose/18 + BUN/2.8.

A normal osmolal gap is < 12 mmol/L.

Causes of an elevated osmolal gap are numerous. Several causes are:

* ethanol intoxication
* methanol ingestion
* isopropanol ingestion
* ethylene glycol ingestion


Anion Gap Increases in Ethylene Glycol Poisoning (as the unmeasured ion is Anion)
Anion Gap Decreases in Lithium Toxicity (as the unmeasured ion is cation)

What will happen to Osmolal Gap in both Conditions

Suppose a person has BOTH Etylene Glycol Poisoning and Lithium Toxicity (Hypothetical - say a person with MDP attempted suicide), his anion gap may even be normal (depending on the degree of the toxicities)

But the Osmolal gap will be very high

More about Private Banks

See the following posts

http://deepakvasudevan.blogspot.com/2006/09/nationalized-banks-truly-caring-for.html

http://www.iba.org.in/

http://www.arjunprabhu.com/blog/archives/2005/04/27/icici-bank-a-bad-experience-for-many/

This is in follow up to my previous post on Banks

You may find these interesting
http://www.ask4safety.com/banksafety/

The following page is written by some one who knows nothing about economy
http://doctorbruno.blogspot.com/2006/09/how-private-banks-are-killing-village.html
please point out the mistakes

http://doctorbruno.blogspot.com/2006/09/one-more-private-bank-steals-public.html

Sunday, October 29, 2006

Tough Entrance Exams

Entrance Exams are not pass/fail exams. They are rank exams. So whether the paper is tough or easy is not that important.

Advantages of Tough Questions

  • There will be less clustering of ranks and hence you will not miss the bus by one mistake. If it is a easy paper, you will go back by 150 ranks per mistake (for ranks 100 to 3000)

Disadvantage of Tough Questions

  • Your brain has been tuned to get an instant depression when you see a question for which you don't know the answer. (this is due to the faulty school system in india) hence you are likely to make mistakes in other easy questions

Saturday, October 28, 2006

Links for Statisticians

http://clinresearch.blogspot.com/

BMJ

Statistics at Square One
http://bmj.bmjjournals.com/collections/statsbk/index.shtml

Journal of Physiology and Pharmacology
http://www.jpp.krakow.pl

Applied Clinical Trials
to know click on the link below
http://www.actmagazine.com/appliedclinicaltrials/

Indian Journal of Pharmacology . To go on the journal site click on the link below
http://www.ijp-online.com/

The New England Journal of Medicine. Click on the link below
http://content.nejm.org

Friday, October 27, 2006

படித்ததில் புடித்தது

http://kuzhali.blogspot.com/2006/10/blog-post_27.html

நமக்கு பிடிக்காதவர்கள் பாதிக்கப்படுகிறார்கள் என்பதற்காக அரசாங்க அத்துமீறல்களை நாம் கைதட்டி வரவேற்றால், அரசாங்கத்திற்கு பிடிக்காத அரசாங்கத்தால் சமாளிக்க முடியாத நபர்களின் நியாயமான பிரச்சினைகளுக்காக போராடுபவர்களை நோக்கி(அது நீங்களாக கூட இருக்கலாம்) அதே முறையற்ற அரசாங்க அத்து மீறல்கள் திரும்பும்போது நம்மால் ஒன்றும் செய்ய இயலாது.

A preview of Fire Fox 2

http://www.vkpedia.com/2006/08/06/firefox-2-a-preview/

Comment on Rahul Dravids inefficient captaincy

http://www.vkpedia.com/2006/10/26/i-lose/

The only thing Rahul Dravid did not do today when India took to the field was to walk up to the umpires and say, “I’m handing the Windies a walkover.” Dravid seems to be the timidest (or is it, the most timid?) captain in recent memory. Not that captains can wave their hands and watch the wickets tumble, but our man is the least inspiring — one look at his sorry face, and you know India are going down.

I’m no fan of Sourav Ganguly, but he used to be a bit more optimistic, and not afraid to experiment. Dravid looks like he is always rehearsing his post-match speech — trying to find the most acceptable excuse.

Anion Gap HAGMA LAGMA and NAGMA !!!

  • Blood has a lot of Cations
  • Blood has a lot of Anions

Total charge of Anions = Total Charge of Cations

So

Na + K + Unmeasured Cations = HCO3 + Cl + unmeasured Anions
Rearranging
Na + K - (HCO3 + Cl) = Unmeasured Anions - Unmeasured Cations
Anion Gap = Unmeasured Anions - Unmeasured Cations

Anion Gap = (Na + K) - (HCO3 + Cl)

Note that some books ignore the value of Calcium and calculate Anion Gap as Na - (HCO3+Cl)
  • Unmeasured Anions: Means all anions other than HCO3 and Cl ----> lactate, phosphate, ketoacids , Albumin, Ethylene Glycol etc
  • Unmeasured Cations: Means Ca, Lithium, Globulin
So
Anion Gap is Increased in

  • Conditions with Increased Unmeasured Anions
    1. Diabetic Ketoacidosis
    2. Uremia
    3. Lactic Acidosis
  • Conditions with Decreased Unmeasured Cations
    1. Hypocalcemia
Anion Gap is decreased in
  • Conditions with Decreased Unmeasured Anions
    1. Hypoalbuminaemia (theoritically)
  • Conditions with Increased Unmeasured Cations
    1. Increase in Globulin (multiple Myeloma)
    2. Lithium Toxicity

Easy way to solve MCQs

1. Check what is decreased / Increased

If that is Na / K / HCO3 / Cl it is Normal Anion Gap Metabolic Acidosis (also called NAGMA). The matter is settled. No doubt about that. Vomitting, Diarrhoea, Renal Tubular Acidosis etc come here

2. If there is an increase in Unmeasured Anions (lactate etc)
It is High Anion Gap Metabolic Acidosis (HAGMA)

3. If there is a decrease in Unmeasured Cations (Globulin etc)
It is High Anion Gap Metabolic Acidosis (HAGMA)

4. If there is an increase in Unmeasured Cations (lactate etc)
It is Low Anion Gap Metabolic Acidosis (LAGMA)

5. If there is a decrease in Unmeasured Anions
It is Low Anion Gap Metabolic Acidosis (LAGMA)

Any doubts !!!
Post in the comments section

OSAMA'S LETTER TO BUSH

After numerous rounds of: "We don't even know if Osama is still alive," Osama himself decided to send George Bush a letter in English, in his own handwriting to let him know he was still in the game. Bush opened the letter and it appeared to contain a real strange, perhaps coded message: *370HSSV-0773H*

Bush was baffled, so he emailed it to Condi Rice. Condi and her aides had no clue either, so they sent it to the FBI. No one could solve it so it went to the CIA, then to NASA. With no clue as to its meaning, they eventually sent it to New Delhi asked the RAW for help. RAW cabled the White House: "Tell the President he's holding the message upside down."

Whose Votes did Vijayakanth get

http://kuzhali.blogspot.com/2006/10/blog-post_25.html

I was expecting exactly this only. The reason is simple

People vote for DMK because of the following reasons
1. They like Kalaignar personally
2. They are government Servants (with exceptions)
3. They like one of the alliance
4. They don’t like Jayalalitha

People vote for ADMK because of the following reasons
1. They like MGR
2. They belong to / like one of the alliance
3. They belong to Sasikala’s community (with exceptions)
4. They belong to Jayalalitha’s community (with exceptions)
5. They don’t like Kalignar’s “Dravidian” Policies (but they will tell family politics or sarkaria commission as reason) (This is similar to Category 4)
6. They don’t like DMK’s other policies

Now When Vijayakanth has started the party, he is likely to get
1. Category 4 from the DMK Voters
2. Category 6 from the ADMK Voters (not 4 or 5 !!!)

But what happened is Vijayakanth was openly against DMK and very rarely did he question ADMK

So what happened was that All those who don’t like DMK voted for him . He got only Category 6 from ADMK Voters. He got very little support from the Category 4 of DMK Voters because he was more anti-DMK than anti-ADMK

This he eroded the ADMK vote bank more than the DMK Vote Bank in the Assembly elections. In the present Local body polls the erosion of DMK vote bank was very minimal but ADMK lost considerably.

Another factor is that Vijayakanth’s Fan Clubs are always seen in the villages where you see MDMK Flag. (It is very easy to guess which fan club will be there based on the flag or statue in our villages – If it is MDMK Flag , it is Vijayakanth – If it is the statue of Kamarajar, it will be Sarath kumar or Ramarajan along with Athithanar NaRpani manRam– if it is the statue of Pasumpon Thevar it will be Karthik Fan Club)

Thus Vijayakanth eroded both ADMK votes as well as MDMK’s (Telugu) votes

Wednesday, October 25, 2006

Madurai Medicos 1973

http://www.maduraimedicos1973.netfirms.com/index.htm

Lie-Clocks

A man died and went to heaven. As he stood in front of St. Peter at the Pearly Gates, he saw a huge wall of clocks behind him. He asked, "What are all those clocks?"
St. Peter answered, "Those are Lie-Clocks. Everyone on Earth has a Lie-Clock. Every time you lie the hands on your clock will move."
"Oh," said the man, "whose clock is that?"
"That's Mother Teresa's. The hands have never moved, indicating that she never told a lie."
"Incredible," said the man. "And whose clock is that one?"
St. Peter responded, "That's Abraham Lincoln's clock. The hands have moved twice, telling us that Abe told only two lies in his entire life."
"Where's Bush's clock?" asked the man.
"Bush's clock is in Jesus' office. He's using it as a ceiling fan."

Jigzaw puzzle

I got a a funny one:

Cheney gets a call from his "boss", George W Bush.
"I've got a problem," says Bush.
"What's the matter?" asks Cheney.
"Well, you told me to keep busy in the Oval Office, so, I got a jigsaw puzzle, but it's too hard. None of the pieces fit together and I can't find any edges."
"What's it a picture of?" asks Cheney.
"A big rooster," replies Bush.
"All right," sighs Cheney, "I'll come over and have a look."
So he leaves his office and heads over to the Oval Office. Bush points at the jigsaw on his desk.
Cheney looks at the desk and then turns to Bush and says, "For crying out loud, Georgie - put the corn flakes back in the box."

Sunday, October 22, 2006

Chickungunya in Tamil Nadu

சிக்-குன்-குனியா (சிக்குன்குனியா) சில பதில்கள்
No one has died due to this disease. I am very sure of that. Chickungunya is not a fatal disease. Even the Central Government says that only. WHy should Dr.Anbumani who says that Dengue is fatal say chickungunya is not fatal. Any answers for this.... The only answer is that Chickunguny is non fatal

Tamil Nadu government says AIDS is fatal, Hepatitis B is fatal, TB is fatal, Dengue is fatal, Cholera is Fatal etc. Why should is say Chickungunya is non fatal

Epidemics like Malaria, Cholera etc can be prevented by the Government, but for Chickungunya, government ALONE can do nothing

The reason for this epidemic spreading in our state is because we have a lot of CLEAN Waters.

  • Malaria is transmitted by Anopheles mosquito which grows in farms
  • Japanese encephalitis (மூளை காய்ச்சல்) is transmitted by Culex mosquito which grows in Sewage. It is government's responsibility to clean the sewage
  • Chickungunya is transmitted by Aedes mosquito which breeds in CLEAN water found in

1. ஆட்டு உரல்
2. Tyres
3. Buckets
4. சிரட்டை
5. நுங்கு கூந்தல்
6. Coolers7. Improperly made rain water harvesting structures

The responsibility of cleaning all this lies in the common man.

If every one keeps his house clean (Unused ஆட்டு உரல் should be turned upside down), there would be no Aedes mosquito and no transmission

Have you done this

Do you expect your collector and Tahsildhar to come to each home and turn the ஆட்டு உரல் and see whether there is block in the rain water harvesting structure.
பக்கத்து மாநிலத்தில் உள்ள அரசு என்ன செய்து கொண்டிருக்கறது
They have woken up 6 months later and telling false figures with no shame

It is given in all text books of medicine that Chickungunya is not fatal. WHO also says that. WHy should Harrison and WHO who say that Ebola and Dengue are fatal tell that Chickungunya is non fatal

Do you think that the Chief Ministers of Kerala and Former Chief minister of Tamil Nadu know more about this disease than those who are at WHO and those who have written textbooks
இந்த நோயினால் யாரும் சாகவில்லை
This is the fact.

I can give proof. The list given by politicians is full of guys who are over 75 years old.

Also they have given those who had kidney disease for more than 15 years in the list.
ஒரு epidemic தமிழகத்திலை உலுக்கிறது,
Yes...

Reasons

1. The Common man does not clean up his house

2. Block in the rain water harvesting mechanism

3. TV Channels and Media who still say that this epidemic is due to Sewage

Few more reasons
கிட்டத்தட்ட மூன்று மாதங்கள் ஆன பிறகு கடந்த வாரத்தில் முதல் மருத்துவ முகாம் நடத்தப்பட்டது
Remember that the population of Tamil Nadu is 6 crores. There are 1415 Primary Health Centres. That means one PHC for 42000 population.

Every day a camp can cover only an area of 500 population.

So if a Primary Health Centre starts camp today in one area of their range, they can go to the last area on Day 84. (After 3 months).. SO one area will get the camp after 3 months only. How can one doctor, who has to look after 42000 population go to all areas on the first day itself. Isn' this plain common sense

More than 2500 doctor posts are vacant.
There are another 12000 vacancies in health department for paramedical staff, which were not filled up from 2001. Who is to be blamed for not filling up the posts from 2001. (1500 doctors were appointed in June 2006)

கேரள அரசு சிக்கன் குனியாவை சமாளிக்க WHO மற்றும் National Institutes of Communicable Diseases சாரந்த நிபுனர்களை வரவழைத்துள்ள செய்தியைப் பார்த்தேன்.

We did that in April Itself. We are ahead of them by 6 months.

With over 62,000 cases of chikungunya reported in Tamil Nadu, the four districts of Namakkal, Dharmapuri, Vellore and Tirunelveli have seen the highest number of cases being reported.

The first case of chikungunya in the southern districts was reported on April 22. அப்ப யாரு ஆட்சி செய்தாங்க. This disease does not know DMK or ADMK !!!
It peaked in July when 700 cases were reported in a week. Since September 3, no new cases have been reported.
இது கட்டுப்பாடு இல்லையா
Chikungunya being a viral disease, there is no known treatment till now.
உலகத்திலேயே மருந்து கிடையாது.
Each primary health centre that handles chikungunya cases has a doctor, a nurse, a pharmacist and a laboratory assistant.
this is for a population for 42000.
Apart from treating patients who come to the centres, this team also conducts mobile outreach camps in faraway villages.
11 மணி வரை hospital out patients treatment கூடுத்து விட்டு தான் முகாம் வர முடியும். இல்லையென்றால் Government Hospitalல Doctors இருக்க மாட்டார் என்று கூறுவீர்கள்.

Please know that there are no seperate doctors or nurses etc for conducting the camps. The same team has to treat patients coming to hospitals and then come for camp. Do you know that no vehicles were purchased from 2001. Most of the hospitals don't have any vehicles. The doctors and others have to come to the camp by town bus only.

Gopi's Encoding Converters for Tamil - Adhiyaman

http://www.higopi.com/adhiyaman/

Saturday, October 21, 2006

Epidemiology for the Uninitiated

This is free full text book uploaded on BMJ which can be had from te following site
http://bmj.bmjjournals.com/collections/epidem/epid.shtml

35 free full text medical journals

These are available on the follwing site
http://medind.nic.in/

Tuesday, October 10, 2006

Quacks plague Tuticorin

http://www.hindu.com/2006/10/10/stories/2006101002700500.htm


R.Vimal Kumar

People suspected to have contracted chikungunya are falling victims

TUTICORIN: Quacks operating across the dis

trict pose a threat to the `Operation Chikungunya-2006' campaign launched by the State Government.

The people suspected to have contracted chikungunya are falling victims to these quacks, especially in rural areas.

The latest victim was Ganesh Kumar (14), a resident of Ottapidaram, who died on October 3, after he was allegedly treated by a quack, who holds a diploma in pharmacy.

An investigation the Health Department conducted after the death revealed the boy had been administered an injection for symptoms of chikungunya, by Raju, a pharmacist, at his `clinic' on Ottapidaram-Kurukkusalai road.

"Soon after the injection was administered, the boy developed Gangrene as well as Septicaemia and died," Selva Kumari, Deputy Director of Health Services, told The Hindu . A notice had been served on Raju, she said.

Similar deaths were reported from other parts of the district. Medical sources said a physiotherapy graduate was prescribing internal medicines to patients at a clinic at Puthiamputhur using the name of a lady doctor. A Siddha practitioner was administering injection at his clinic near Puthiamputhur and an ex-laboratory technician was running a clinic at Ottapidaram, all against the Code of Medical Ethics, 2003, formulated by the Tamil Nadu Medical Council.

Collector R. Palaniyandi said cases would be registered against those who practised medicine without degrees.

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