Hello Jessica,
The most common management options for osteoarthritis include:
1. Nonpharmacologic treatment - patient education and support, exercise, weight loss, joint protection
2. Pharmacological therapy - Paracetamol (Acetaminophen) up to 4g per day for pain relief, NSAIDs if more pain relief is necessary.
3. Surgical management - Osteotomy or joint replacement.

Now, in the context of emphysema, only two of the above options are of some concern:
1. Weight loss - Shortness of breath may limit the exercise tolerance
2. NSAIDs - as they are known to induce bronchospasm, especially in patients with chronic obstructive pulmonary disease, emphysema being one such condition.

To add to this, as you have mentioned, increased anesthetic risk is another concern, but can be overcome to some extent by utilizing non-general anesthesia - like spinal block etc.

Let me know if this information is useful, or you need any further help.

Regards

Hello,

Acute coronary syndromes (ACS) are divided into:
1. STEMI - ST Elevation MI - the classical MI
2. NSTEMI - Non-ST Elevation MI.\
3. UA - Unstable Angina

STEMI is when there is a transmural infartion of the myocardium - which just means that the entire thickness of the myocardium has undergone necrosis - resulting in ST elevation. Usually due to a complete block of a coronary artery (occlusive thrombus). This requires the use of thrombolytics like Streptokinase to lyse the thrombus. Evidence has proven that it is very effective and not as risky (Benefits > Risk)

UA or NSTEMI is when there is a partial dynamic block to coronary arteries (non-occlusive thrombus). There will be no ST elevation or Q waves on ECG, as transmural infarction is not seen. The main difference between NSTEMI and unstable angina is that in NSTEMI the severity of ischemia is sufficient to cause cardiac enzyme elevation.

Why is streptokinase not used in treating UA/ NSTEMI?
In patients with UA/NSTEMI, plaque stabilization to prevent progression of the disease is required. While fibrinolytics like Streptokinase benefit patients with STEMI, they may increase risk of bleeding complications for those with NSTEMI. This is also based on evidence - no benefit, more risk.

Summary/Keywords
1. STEMI - occlusive thrombus - ST elevation (and Q waves) - Cardiac Enzyme elevation - Fibrinolytics beneficial
2. NSTEMI - non-occlusive thrombus - NO ST/Q - Cardiac Enzyme elevation present - Fibrinolytics not beneficial
3. UA - non-occlusive thrombus - NO ST/Q - Cardiac Enzyme elevation absent - Fibrinolytics not beneficial

Hope this is clear.

Ask further if you need any details...

Shashikiran

Hello Amy,

Mechanism of photophobia is explained here: Photophobia in meningitis. The mechanism is similar in subarachnoid hemorrhage too.

As for neck stiffness, it is related to irritation of meningeal layers by the blood present in the CSF after hemorrhage in the subarachnoid space.

Shashikiran

Hello David,

This combination is good too. You can, as you have mentioned rightly, take computer related education away from your formal education (This reminds me of Mark Twain's famous "I never let schooling interfere with my education" ).

Role of Computers in Medicine

It's good that you are already adept at comfortably using computers.

In the very near future, most Hospitals will be paperless, where most of the documentation is digitalized (Digital prescriptions have been shown be less error prone than hand-written prescriptions).

In addition, imaging studies, laparoscopic surgeries and other procedures done in hospitals are heavily dependent on technology. These are already widely used and they are going to be more widely available with more advanced technology. Though they are made to be very userfriendly, it is always better to know a bit about their backend (they use sophisticated software) to effectively use them.

Knowledge of little programming can help a medical student have options of going in the direction of medical informatics, biomedical engineering and other fields.

Anyway, since you have already chosen English Literature, I feel you should go ahead with it and learn the others on your own.

Congratulations! Wow, that's very good news, and we are very happy for you

As far as the subjects are concerned, I feel that you should go for a combination of these:

• Biology
• Chemistry
• Mathematics
• ICT / Computing
• Philosophy

You can replace Mathematics by Physics based on your interest and other issues.
Knowledge of Computing sciences is becoming important (critical?) day by day in Medicine and that would be a great advantage for you.
As Medicine is a life science, some amount of Philosophy will take you a long way into understanding human nature, behavior and also help you personally to cope with many situations.
With these, you must be on a firm ground.

Anyway, please do keep us posted on your advancements.
Wish you the very best
Shashikiran

Hello David,

I am replying quite late and I think by now your your result should have been announced. Curious to know your result and your future plans. Hope you have got a good score that facilitates your plans for the future.

Regards
shashikiran

Hello Jessica,

Photophobia is a term used to describe light sensitivity or abnormal intolerance to light. Patients with photophobia avoid light because of pain or discomfort. It is generally seen in diseases affecting the iris and anterior segment of the eye. However, photophobia may also be seen in patients with completely normal appearing anterior segments (including blepharospasm, sub-arachnoid hemorrhage and head injury apart from migraine and meningitis that you have mentioned).

The mechanism of photophobia is not very well understood, but is thought to involve the trigeminal pathway with possible input from the occipital lobe and thalamus. Irritation to any region supplied by the trigeminal nerve can result in photophobia. This is all that is currently know about the mechanism of photophobia.

Hope this helps...
Sorry for the delay in replying,
shashikiran

The simple answer to your first question is "Yes, it is safe".

Here is the detailed answer:

Monosodium glutamate is a commonly used flavour enhancer. Basically it is a sodium salt of the normally present amino acid - glutamate - found naturally in our bodies and in many protein-containing foods such as cheese, milk, meat, peas, and mushrooms. Part of the flavour-enhancing effect of tomatoes is attributed to their high content of glutamate. In its salt form MSG appears as a crystalline white powder. When dissolved in water or saliva it rapidly dissociates into free sodium and glutamate ions.

Did you know that the 'taste' induced by MSG is called "Umami"?

There are allegations that MSG is responsible for many adverse health conditions, including MSG intolerance, characterized by symptoms such as headache, nausea, digestive upsets, drowsiness, palpitations, bronchosapsm, anaphylactic shock etc. "Chinese restaurant syndrome" is often used as an example of the symptoms purported to be caused by MSG.
Neurotoxicity and excitotoxicity were also attributed to MSG. It was also demonstrated in newborn laboratory mice that MSG can induce adult obesity.

However, lets look at the scientific evidence. I will refer to these publications related to MSG available on PubMed:

• The safety evaluation of monosodium glutamate. J Nutr. 2000 Apr;130(4S Suppl):1049S-52S.
• Review of alleged reaction to monosodium glutamate and outcome of a multicenter double-blind placebo-controlled study. J Nutr. 2000 Apr;130(4S Suppl):1058S-62S.
• The monosodium glutamate symptom complex: assessment in a double-blind, placebo-controlled, randomized study. J Allergy Clin Immunol. 1997 Jun;99(6 Pt 1):757-62.

If you go through these resources, you will realize that none of the above allegations against MSG have been demonstrated in scientific studies.

Some important quotes:

Hope this information answers your queries.

As mentioned in the first post, one of the mechanisms is "Stimulates insulin secretion from the beta cells of pancreas when blood glucose is high" unlike sulfonylureas that stimulate insulin release irrespective of blood glucose levels. Hence, hypoglycemia is not common with Exenatide alone.

However, Exenatide is always used in type 2 DM in conjunction with either sulfonylureas or metformin. In combination with these drugs, hypoglycemia may be observed often. Check out this PubMed Search for Exenatide & hypoglycemia.

Relative incidence of hypoglycemia with Exenatide:
Exenatide with Sulfonylureas:
1. Placebo - 3%
2. 5mcg/dose Exenatide - 14%
3. 10mcg/dose Exenatide - 36%

Exenatide with Metformin & Sulfonylurea
1. Placebo - 13%
2. 5mcg/dose Exenatide - 19%
3. 10mcg/dose Exenatide - 28%

More important than hypoglycemia are gastrointestinal adverse effects. Though Exenatide is given subcutaneously, it causes significant GI adverse effects - nausea and vomiting. Most patients who discontinue this medication do so due to the GI adverse effects.

Why is Exenatide preferred over insulin?
1. Milder and less frequent hypoglycemia
2. Weight loss (as opposed to weight gain with insulin).

I do not think it is available for therapeutic use at present. However, some centers may be using it for research purposes.

In comparison to Insulin, advantages are that Exenatide cause significantly less hypoglycemia and and results in weight loss. On the other hand, it does cost more, but the patients saves on the incidences of hypoglycemia, which could be expensive at times.

However, it is far from being an alternative to insulin. It is approved for use in type 2 diabetes alone and insulin is still the drug of choice for type 1 diabetes.

You can try downloading the files from the download center again now. The links are working.

It is available in the Downloads area under Neurology.

You can also get it from here: UMN and LMN facial palsies. The explanations given in posts are useful in understanding the topic as well as slides.

Sorry for the delay in replying.

You might have as well finished your assignments by now. However, do you know the that the entire Gray's anatomy text book with all illustrations is available free on the Net? See it here: Gray's Anatomy.

Please don't generalize this beyond the face.

Remember that if the UMN "lesion" is below the pons, facial UMN fibres/nerve is NOT affected at all. Sometimes, even in "lesions" above the level of pons, due to the localized nature of some lesions, facial UMN fibres may not be affected...

As stated above, remember that "Upper face spared in upper motor neuron type of facial palsy", not all UMN palsies...

Features of UMN and LMN palsy elsewhere:

.	UMN palsy	LMN palsy
Power	Weakness	Weakness
Muscle Bulk	Normal*	Atrophy
Tone	Hypertonia	Hypotonia
Tendon Reflexes	Hyperreflexia	Hypo or Areflexia
Superficial Reflexes	Extensor plantar Absent superficial reflexes	Absent superficial reflexes

* In long standing UMN paralysis, however, there may be disuse atrophy.

Do you have a photograph of the lesions that you are referring to?

Can you also elaborate on these:

• Age, gender and other relevant data of the patient.
• Duration of this condition.
• Any known illnesses that the patient has, like diabetes.

Most dermatological conditions may have increased itching in airconditioned rooms and cold environments as the air is generally dry in such areas. Dryness results in itchiness. (One exception probably is a condition called Urticaria calorica in which pruritus is seen in hot environments and after exercise alone, and is relieved by cold.)

Apart from that, the on-off nature of the lesions suggest that they are probably related to exposure to some allergen, either food or otherwise.

How to confirm? Most dermatological conditions related to allergy are based on history and the sense of observation and association of the patient. If the patient can relate the lesions and symptoms to a particular exposure, the diagnosis can be easy. Otherwise a battery of not-so-informative "allergy tests" may be required.