Role of iodine in nuclear disasters

The amount of radioactive iodine uptake by thyroid is inversely proportional to concentration of iodide in blood. That is why iodide salts were given during nuclear disaster to prevent the chances of hypothyroidism & radiation induced thyroid cancer.Following the Chernobyl nuclear reactor accident in 1986, approximately 10 million children and adults in Poland were given stable iodine to prevent the development of thyroid cancers

Management of gestational diabetes

Counselling before pregnancy (for example, about preventive folic acid supplements) and multidisciplinary management are important for good pregnancy outcomes.
Most women can manage their GDM with dietary changes and exercise. Self monitoring of blood glucose levels can guide therapy.
Some women will need antidiabetic drugs, most commonly insulin therapy.
The goal of treatment is to reduce the risks of GDM for mother and child.
Scientific evidence is beginning to show that controlling glucose levels can result in less serious fetal complications (such as macrosomia) and increased maternal quality of life
Metformin has shown promising results. Treatment of polycystic ovarian syndrome with metformin during pregnancy has been noted to decrease GDM levels

Test for gestational diabetes

Fasting blood glucose
Random blood glucose
Oral glucose tolerance test

Pathophysiology of gestational diabetes

The hallmark of GDM is increased insulin resistance. Pregnancy hormones and other factors are thought to interfere with the action of insulin as it binds to the insulin receptor.Placental hormones, and to a lesser extent increased fat deposits during pregnancy, seem to mediate insulin resistance during pregnancy. Cortisol and progesterone are the main culprits, but human placental lactogen, prolactin and estradiol contribute too.

Risk factors for gestational diabetes

* a previous diagnosis of gestational diabetes or prediabetes, impaired glucose tolerance, or impaired fasting glycaemia
* a family history revealing a first degree relative with type 2 diabetes
* maternal age - a woman's risk factor increases as she gets older (especially for women over 35 years of age)
* ethnic background
* being overweight, obese or severely obese increases the risk by a factor
* a previous pregnancy which resulted in a child with a high birth weight
* previous poor obstetric history

Geastational diabetes

Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy.
Babies born to mothers with gestational diabetes are at increased risk of problems typically such as being large for gestational age (which may lead to delivery complications), low blood sugar, and jaundice. Gestational diabetes is a treatable condition and women who have adequate control of glucose levels can effectively decrease these risks

Treatment of diabetic retinopathy

Regular, comprehensive eye examinations are essential for all individuals with DM. Most diabetic eye disease can be successfully treated if detected early. Routine, nondilated eye examinations by the primary care provider or diabetes specialist are inadequate to detect diabetic eye disease, which requires an ophthalmologist for optimal care of these disorders. Laser photocoagulation is very successful in preserving vision. Proliferative retinopathy is usually treated with panretinal laser photocoagulation, whereas macular edema is treated with focal laser photocoagulation

Monoamine oxidase Inhibitors

Monoamine oxidase enzyme is present in liver, intestines & MA releasing neurons
Inactivates monoamines
Inactivates dietary tyramine in liver
Foods rich in tyramine: cheese & red wine
Nonselective MAOI: e.g. Phenelzine & tranylcypromine, not used now a days because of frequent side effects & drug interactions
Selective MAOAI: Moclobemide, Clorgiline: used in depression
Selective MAOBI: Selegiline, used in parkinsonism

Other therapies of depression

Psychotherapy or talk therapy
Electroconvulsive therapy (ECT)
Light therapy for winter depression
Vagous nerve stimulation therapy
Transcranial magnetic stimulation

Other uses of SSRI

Obsessive compulsive disorder (OCD)
Panic disorder
Social phobias
Eating disorders
Premenstrual dysphoria
Post traumatic stress disorders
Anxiety disorders
Body dysmorphic disorders
Kleptomania

Examples of SSRI

Fluoxetine
Fluvoxamine
Sertraline
Citalopram

Selective serotonin reuptake inhibitors (SSRI)

Block only serotonin (not NE) reuptake
Elevate serotonin levels
Fewer side effects than TCA
No hypotension
No anticholinergic effects
No cardiotoxicity
Most common side effect
Nausea, insomnia, sexual dysfunction

Uses of Tricyclic antidepressant

Endogenous or major depression
Neuropathic pain like diabetic & postherpetic neuralgias
Attention deficit hyperactivity disorders in children
Nocturnal enuresis
Migraine
Pruritus e.g. atopic dermatitis, lichen planus

Antidepressant drugs

Depression ,in psychiatry, a symptom of mood disorder characterized by intense feeling of loss, sadness, hopelessness, failure and rejection.
Types :
1.Reactive : 60%
2.Endogenous 20-25%
3.Bipolar 15-20%
Pathophysiology
Amine hypothesis
Due to decrease functional amine dependent synaptic transmission
Medical evidence suggest that depressive states may be connected to deficiencies in the neurotransmitters norepinephrine and Serotonin. Serotonin is often referred to as the body’s natural mood altering drug & changes in serotonin levels can quickly alter mood
Classification of antidepressant drugs
Tricyclic antidepressant
Monoamine oxidase inhibitors (MAO-AI)
Selective serotonin reuptake inhibitors (SSRI)
Atypical antidepressant

Leukotriene Inhibitors- Zileuton, Montelukast, Zafirlukast

The formation of leukotrienes depends on lipoxygenation of arachidonic acid by 5-lipoxygenase.
Zileuton is a potent and selective inhibitor of 5-lipoxygenase activity and thus inhibits the formation of all 5-lipoxygenase products.
Thus, in addition to inhibiting the formation of the cys-LTs,
zileuton also inhibits the formation of leukotriene B4 (LTB4), a potent chemotactic autacoid
They are used only for prophylactic purpose in mild to moderate asthma

Triggers for bronchospasm in bronchial asthma

Antigens
Nonantigenic stimuli
• exercise
• cold air
• irritants (sulfur dioxide, smoke)
• sleep
• viruses
• Pharmacologic Stimuli: aspirin,coloring agents like tartrazine,Beta-blockers, & sufiting agents.

Ten Misconceptions about weight loss

1. High-protein/low-carbohydrate diets are a healthy way to lose weight
2. Starches are fattening and should be limited
3. Fad diets work for permanent weight loss
4. Herbal weight-loss products and slimming pills are safe and effective
5. Low-fat or fat-free means no calories:
6. Skipping meals is a good way to lose weight:
7. Eating after 8 p.m. causes weight gain:
8. Cutting out all snacks can help you lose weight:
9. Drinking water helps you lose weight
10.You burn more fat if you exercise on an empty stomach

Breast cancer- Prevention tips

1. Exercise regularly
2. Eat a healthy well- balanced diet: little or no red meat, and lots of fresh fruits and vegetables.
3. Stop Cigarette smoking
4. Maintain regular gynecological examinations: including Pap smears and Mammograms. 5. Perform monthly breast self exams

Breast cancer- Detection

Early detection of breast cancer, through monthly breast self-exam and particularly yearly mammography after age 40, offers the best chance for survival

Risk factors for breast cancer

Family history,
Atypical hyperplasia,
Delaying pregnancy until after age 30 or never becoming pregnant
Early menstruation (before age 12)
Late menopause (after age 55)
Current use or use in the last ten years of oral contraceptives
Daily consumption of alcohol

Routes of transmission of HIV

HIV is transmitted by both homosexual and heterosexual contact; by blood and blood products; and by infected mothers to infants either intrapartum, perinatally, or via breast milk
There is no evidence that HIV is transmitted by casual contact or that the virus can be spread by insects, such as by a mosquito bite

Breast cancer- Incidence & Prevalence

It is a scary statistic: one in every 30 Mumbai women stands the risk of developing breast cancer in her lifetime.Breast cancer, which has replaced cervical cancer as the leading cancer among women living in urban centres, is increasingly being viewed as a lifestyle disease.Its incidence is increasing because of late marriages, later age of bearing children, fewer children, shorter lactation period and lack of physical exercise.Availability of gene-based therapy has been the biggest change in the field of breast cancer. Monoclonal antibodies like Trastuzumab are used for treatment of breast cancer.The healthy lifestyle should be followed to prevent Ca breast like cutting down obesity, early motherhood and breast-feeding for a year.

Is depression causes weight gain ?

Weight gain can also occur as a side effect of antidepressant drugs.
Stress may be a cause of weight gain. Due to stress more stress hormones like cortisol releases, which increase appetite.
Depression and weight gain frequently co-occur. It becomes a vicious cycle when you eat out of boredom, loneliness, isolation or any number of emotional reasons and you gain weight

Parkinsons disease

Progressive degenerative disorder
Extrapyramidal dysorder charecterized by rigidity, tremor & hypokinesia with secondary manifestations like defective posture & gait, mask like face & sialorrhoea, dementia may occur
First described by James Parkinson in 1817

Etiology of Parkinsons disease

Primary or idiopathic
Secondary :
Environmental – toxins like MPTP, carbon monooxide, manganese
Repeated head injuries as in boxers
Free Radicals – there is a increase level of free radicals in post-mortem brain sections
Aging – age related decline in dopamine production
Genetic – possible, no single gene identified, mutation in the gene coding synuclein protein leading to formation of lewy bodies
Drug induced like antipsychotic drugs, reserpine, metoclopramide etc