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NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .

Saturday, February 28, 2015

Pseudogout differs from gout in that:

Pseudogout differs from gout in that:

a. Indomethacin is contraindicated.
b. The attack is more severe.
c. The crystals cannot be identified using microscopy.
d. The knee is the most commonly involved joint.
e. The typical patient is younger.

The answer is d. In a patient with pseudogout, the knee is the joint most commonly involved, followed by the wrist, ankle, and elbow. The average attack is not as severe as acute gout. In general, these patients are between the sixth and eighth decades that have a previous history of arthritic attacks. Joint fluid examination shows the weakly positive birefringent crystals of calcium pyrophosphate dihydrate. The crystals appear rhomboidal on regular light microscopy. Treatment for an acute attack is similar to the therapy for acute gout: NSAIDs or oral colchicine, although the latter is not as effective as with gout.

Acne conglobata

Acne conglobata in a 53-year-old man covered with open comedones and cysts on his back. He has the follicular occlusion triad including hidradenitis, dissecting cellulitis of the scalp and acne conglobata.

Thursday, February 26, 2015

Pott disease from tuberculosis

Pott disease from tuberculosis infection of the spine resulting in a severe kyphoscoliosis. 
Note to continue skin ulceration on the right and a severe deformity caused by this disease.

Tuesday, February 24, 2015


Impetigo is a superficial bacterial infection that presents with honey crusts or bullae.
Good hygiene can prevent impetigo and therefore is not surprising that many cases of impetigo will be seen in countries that lack access to soap and clean water. Impetigo is often secondary to other skin diseases such as scabies or fungal infections that create breaks in the skin barrier function.

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IMAGE :Impetigo caused by a bacterial infection on the buttocks of this child . Impetigo is more prevalent when there is inadequate hygiene and lack of access to healthcare.

Monday, February 23, 2015

Wide Complex Tachycardia in a Young Adult

Wide Complex Tachycardia in a Young Adult
Case presentation: 
A 24 - year - old female patient with no medical history of significance, transported to the emergency department via paramedics, had been complaining of sudden weakness and palpitations. All her symptoms had resolved prior to the paramedics ’ arrival at the scene. In the emergency department, the patient noted a recurrence of her symptoms; examination at that time demonstrated an alert patient with minimal distress.

The vital signs were: blood pressure 100/70 mmHg, pulse 240 beats/minute, and respiration 38 per minute. The monitor revealed a rapid, wide complex rhythm (pictured).  was undertaken with a return of a normal mental status and the second ECG noted here.

The remainder of the examination normalized as well.
Question: Of the listed interventions, the most appropriate initial intervention is:

A. Intravenous diltiazem
B. Oral metoprolol
C. Intravenous procainamide
D. Oral amiodarone
E. Intravenous potassium

Answer: C
Diagnosis: Antidromic tachycardia in Wolff – Parkinson –White syndrome

Discussion: The case rhythm strip demonstrates a wide complex tachycardia (WCT). The electrocardiogram reveals the classic electrocardiographic triad of Wolff – Parkinson – White (WPW) syndrome, including a shortened PR interval, widened QRS complex, and delta wave.
WPW syndrome is a form of ventricular pre - excitation involving an accessory conduction pathway. This accessory conduction pathway bypasses the atrioventricular (AV) node, creating a direct electrical connection between the atria and ventricles – in essence, removing the protective,
rate - limiting effect of the AV node and subjecting the ventricles to excessive rates when the patient experiences a dysrhythmia. The ventricles are “ pre - excited ” with atrial impulse conduction over the accessory pathway (AP), which arrives at the ventricular myocardium sooner than the same impulse conducted through the AV node. The electrocardiographic defi nition of WPW (Figure) relies on the following electrocardiographic features: (1) a PR interval less than 0.12 seconds; (2) slurring of the initial segment of the QRS complex (delta wave); (3) a widened QRS complex; and (4) secondary repolarization changes refl ected in ST segment and T wave changes. The
PR interval is shortened because the impulse progressing down the AP is not subjected to the physiologic slowing that occurs in the AV node. Thus, the ventricular myocardium is activated by two separate pathways (the AP and the AV node), resulting in a fused – or widened – QRS complex. The initial part of the complex, the delta wave, represents aberrant activation of the ventricular myocardium through the AP, while the terminal portion of the QRS represents normal activation through the His – Purkinje system from impulses that have traveled through both the AV node and the AP. This classic triad of electrocardiographic fi ndings, when encountered in the setting
of a symptomatic dysrhythmia, represents WPW  syndrome. These dysrhythmias include paroxysmal
supraventricular tachycardia (also known as atrioventricular reciprocating tachycardia [AVRT]),
A. Normal sinus rhythm with PR interval shortening, a delta wave (arrow), and a widened QRS complex. B. Normal sinus rhythm with PR interval shortening, a delta wave (arrow), and a widened QRS complex. Note that the delta wave has a negative polarity. C. Antidromic tachycardia with wide QRS complexes. Note the initial slurring of the QRS complex, which is termed the delta wave (arrow).

figure :A. Normal sinus rhythm with PR interval shortening, a delta wave (arrow), and a widened QRS complex. B. Normal sinus rhythm with PR interval shortening, a delta wave (arrow), and a widened QRS complex. Note that the delta wave has a negative polarity. C. Antidromic tachycardia with wide QRS complexes. Note the initial slurring of the QRS complex, which is termed the delta
wave (arrow). 

 atrial fibrillation, and ventricular fibrillation (Figure ). The most frequently encountered rhythm disturbance is AVRT, with two subtypes described; these two subtypes are classified based upon the direction of conduction through the AP (antegrade versus retrograde) and the resultant QRS complex width. Activation of the ventricular myocardium and impulse propagation occurs through either the AV node or the AP. With antegrade conduction through the AV node with impulse return to the atria via the AP, the AVRT is referred to as orthodromic. Orthodromic AVRT, the most common form of AVRT, presents electrocardiographically with a narrow QRS complex – and is indistinguishable from typical AV nodal  reciprocating tachycardia, i.e., persistent supraventricular tachycardia (PSVT).

The least common form of AVRT is antidromic tachycardia, which is seen in approximately 10% of WPW PSVT patients. In this rhythm presentation, the AP conducts the impulse from the atria to the ventricles in antegrade fashion. The impulse returns to the atria via the bundle branches, His – Purkinje fi bers, and the AV node.

In this form of AVRT, the QRS complex is wide due to inefficient conduction of the impulse through the ventricular myocardium – i.e., the His–Purkinje system is not used. The QRS complexes appear wide (essentially, an exaggeration of the delta wave), and the ECG displays a very rapid, wide complex tachycardia that is indistinguishable from that of ventricular tachycardia. The ventricular
rates are rapid, with a range of 180–240 beats per minute. This form of AVRT places the patient at risk for arrhythmic decompensation due to the loss of AV node protection of the ventricle from rapid rates. The initial treatment of the antidromic AVRT, i.e., the wide complex tachycardia, focuses on interrupting the re-entrant circuit. Electrical cardioversion should be applied to all patients with hemodynamic instability. Additionally, tachycardias with ventricular rates approaching 300 per minute are at an increased risk for ventricular fibrillation, resulting from myocardial ischemia due to reduced perfusion of the heart as well as subsequent depolarizations falling on the electrically vulnerable repolarization phase. In the hemodynamically stable patient, the agent of first choice would be either procainamide or amiodarone. Agents such as calcium channel antagonists, beta-adrenergic blocking agents, or digoxin, which act primarily on the AV node, are contraindicated
since they will facilitate conduction down the AP and could potentially lead to an increased ventricular rate with ventricular fibrillation.

Sunday, February 22, 2015

The age group experiencing the highest incidence of rotavirus-induced diarrhea is:

The age group experiencing the highest incidence of rotavirus-induced diarrhea is:

a. Neonates.
b. Infants.
c. School-age children.
d. Adults.
e. Elderly.

The answer is b. rotavirus predominantly affects infants between ages 3 and 15 months. The peak incidence is in the winter months, and rotavirus accounts for as much as 50% acute diarrhea in winter. Enteric adenoviruses are the second most common viral pathogen in infants. Bacteria, including Escherichia coli, Salmonella, and Shigella, cause most cases of diarrhea in summer.

A 60-year-old woman complains of diarrhea and weight loss for the past several weeks

A 60-year-old woman complains of diarrhea and weight loss for the past several weeks. She also complains of “hot flashes” similar to what she underwent 10 years ago during menopause. You notice several “spider veins” on her nose and cheeks.

On physical examination, you hear a heart murmur, which gets louder when she takes a deep breath.

The most helpful test you can order to confirm your suspected diagnosis is:
a. Serum serotonin level.
b. Liver ultrasound.
c. Serum sodium bicarbonate level.
d. Plasma chromogranin A (CgA) level.
e. Stool for Clostridium difficile.

The answer is d. The syndrome strongly suggests a carcinoid tumor, which accounts for up to one-third of small intestine tumors. Carcinoid involvement of the heart resulting in right-sided valvular lesions is a late manifestation of metastatic disease. The most sensitive screening test for small intestine carcinoids is a CgA level, which is elevated in almost 90% of patients with advanced small bowel carcinoid. Urinary 5-HIAA or platelet serotonin levels are also elevated in patients with metastatic carcinoid, but are less sensitive than CgA.

Saturday, February 21, 2015

post kala azar dermal leishmanoid (PKDL)

PKLD in chinese patient who waa cured by chemotherapy
dermal leishmanoid which vary in size and contains many amastigote form of parasites under microscope

भुलेर पनि नगर्नुस् १० काम, मृगौला खत्तम हुन्छ है !

भुलेर पनि नगर्नुस् १० काम, मृगौला खत्तम हुन्छ है !

 यहाँ हामीले दैनिक जीवनमा गर्ने १० गल्तीको चर्चा गरिएको छ जसले मृगौलालाई हानी पुर्‍याउँछ ।यी १० कुरा सँधै ख्याल गर्नुस् ...

१ पानी कम पिउने---- यदि तपाइँ नियमित पानी पिउने गर्नु हुन्न भने यसको सबै भन्दा पहिलो र खराव प्रभाव मृगौलामा पर्छ । पानीको अभावले गर्दा मृगौलाले रगत सफा गरेर फोहोर फ्याँक्न कठिन हुन्छ । यसले उल्टो परिणाम दिन्छ शरीरमा टक्सिन जम्मा हुन्छ ।

२ नून बढी---- खानामा चर्को नून खाने बानी छ भने यसले रक्त चाप बढाउँछ । यसले मृगौलामा दवाव पैदा गर्छ । तपाँइले दिनमा ५ ग्राम भन्दा बढी नून खानु हानिकारक छ ।

३ पिसाव रोक्ने--- यदि पिसाव आउँदा पनि पछि जाउँला भनेर बस्ने बानी छ भने आजै देखि बानी सुधार्नुस् । पिसाव रोक्ने बानीले मृगौलामा पत्थरी हुने र मृगौला फेल नै हुने खतरा समेत पैदा गर्छ ।
४ गुलियो खाने बानी--- यदि गुलिया खानेकुरा धेरै बानी छ भने आजै देखि छोड्नुस् । गुलियो बढी खाँदा यसले शरीरमा प्रोटीनको मात्रा बढी भएर मृगौलामा समस्या हुन्छ ।

५ पोषणको अभाव--- शरीरमा पोषक तत्वको अभाव भो भने मृगौला खराव हुन्छ । भिटामिन-6 र म्याग्नेशियम भरपुर खानाले मृगौलामा पत्थरी हुन दिँदैन ।

६ मासु बढी खाने-- मासुको पारखी हुनुहुन्छ र बढी नै मासु खाने बानी छ भने पनि तपाइँको मृगौला समस्यामा छ । मांसाहारले शरीरको पाचन प्रक्रियालाई प्रभावित पार्छ जसले मृगौलामा सोझै असर गर्छ ।

७ अनिद्रा--- रातिमा निद्रा नलाग्ने वा धेरै जागा बस्ने बानी पनि मृगौलाका लागि घातक छ । यसले मृगौला सम्बन्धि विभिन्न रोग ल्याउन सक्छ । निद्राले मृगौलालाई स्वस्थ राख्न सघाउँछ ।

८ चिया कफी बढी सेवन चिया कफी अत्याधिक मात्रामा पिउँदा पनि मृगौलामा समस्या हुन्छ । चिया कफीले शरीरमा क्याफिनको मात्रा बढाउँछ जसले मृगौलामा भार पर्छ ।

९ पेनकिलर सेवन-- टाउको दुख्ने वित्तिकै वा सामान्य दुखाइ कम गर्न पनि गोली खाने बानी छ भने आजै देखि छोड्नुस् । धेरै पेनकिलरको सेवनले तपाइँको मृगौलामा प्रभाव पार्छ ।

१० जाँड रक्सी--- अल्कोहल अर्थात जाँड रक्सीको अत्याधिक सेवनले पनि मृगौला समस्यामा पर्छ । यसले मृगौला फेल हुने अत्याधिक सम्भावना हुन्छ ।

Thursday, February 19, 2015

Most patients with appendicitis have:

Most patients with appendicitis have:

a. Pyuria.
b. Nausea and vomiting, but not diarrhea.
c. A temperature greater than 39.4◦C (102.9◦F).
d. Leukocytosis above 20,000 WBC/mm3.
e. Appendicolith on plain abdominal radiographs.

The answer is b. Patients with appendicitis frequently run a low-grade fever, between 37.7◦C and 38.3◦C (100◦F and 101◦F), but fever may be absent in more than half the patients with peritoneal signs. Plain abdominal radiographs lack the sensitivity and specificity to be helpful in making the diagnosis, although some experts consider the finding of an appendicolith to be pathognomonic. While many patients with appendicitis complain of constipation, a few do have one or two diarrheal stools, although far from a majority. Pyuria is an infrequent finding.

Monday, February 16, 2015

Arsenic toxicity

Answer: A
Diagnosis: Arsenic toxicity
Discussion: Numerous reports of acute intoxication following criminal poisoning have been published (in the case presented, the patient ’ s wife was placing it into his food). Clinical effects may appear minutes, hours, or days after exposure depending on the dose and type of arsenic
consumed. The earliest manifestations of acute poisoning are severe gastrointestinal symptoms of nausea, vomiting, abdominal pain, and diarrhea. The diarrhea may resemble that seen with cholera and can appear as “ rice water. ” These symptoms occur within minutes to several hours after ingestion. The patient often complains of muscle cramps and thirst. Cardiovascular and respiratory symptoms include hypotension, shock, pulmonary edema, acute respiratory distress syndrome, and heart failure. Prolonged or additional symptoms may occur for days to weeks after an acute exposure. Neurologic symptoms  such as headache, confusion, personality change, irritability, hallucinations, delirium, and seizures may develop or persist. Peripheral neuropathy commonly occurs 1 – 3 weeks after an acute poisoning. The peripheral neuropathy may last for years. Progressive neuropathy
may be misdiagnosed as Guillain – Barr é syndrome. Sensory symptoms may include numbness, tingling, lightheadedness, delirium, encephalopathy, muscle weakness, and severe pain following superfi cial touch of the limbs. An accumulation of arsenic in the skin, hair, and nails causes clinical effects such as hyperpigmentation, keratoses of the palms and soles, melanosis, and hair loss.
Mees ’ lines (Figure )may be seen and correspond with signifi cant poisonings that have occurred previously. A metallic taste and garlic odor of the breath and sweat may  be noted. Defi nitive diagnosis is made by an elevated urinary arsenic level.

Saturday, February 7, 2015

pelvic inflammatory disease (PID)

A 23-year-old woman presents with fever and bilateral lower quadrant abdominal pain for two
days. She complains of the onset of a mucopurulent vaginal discharge with her menses, which she states is yellowish in color. She has a new sexual partner and uses a nonbarrier method of contraception.

Her temperature is 103.2°F. She has bilateral lower quadrant tenderness with palpation, and pelvic examination reveals cervical and adnexal motion tenderness.

anatomy of female pelvis

A mass is palpable in the left adnexa. Which of the following is the most likely diagnosis?

a. Fitz-Hugh-Curtis syndrome
b. Pelvic inflammatory diseasec. Perihepatitis
d. Acute inflammation of Bartholin’s gland
e. Chancroid

The answer is b The patient most likely has pelvic inflammatory disease (PID) due to Neisseria gonorrhoeae. Infections typically occur during menstruation, and patients complain of abdominal pain and yellow mucopurulent vaginal discharge. 

Spread of the gonococci (or, in some cases, Chlamydia) into the upper abdomen may cause a perihepatitis or Fitz-Hugh-Curtis syndrome, and patients will complain of upper abdominal pain. Acute inflammation of Bartholin’s gland (an infected duct) would be visible in the labium majus. Chancroid is due to Haemophilus ducreyi; patients typically present with a painful ulcer that bleeds easily.

Thursday, February 5, 2015

e. Hepatic adenoma

Which of the following neoplasms has been associated with the use of oral contraceptives?

nilokan chakki

a. Breast cancer
b. Ovarian cancer
c. Endometrial cancer
d. Hepatic cancer
e. Hepatic adenoma

The answer is e. Beginning with high dose combination contraceptive pills used over 20 years ago, pills have    been studied extensively for a possible association with neoplasia. There is only scant evidence from this experience that use of oral contraceptives increases the risk of any type of cancer. Actually, the progestational component of combination pills (or progestin-only minipills) may confer a protective effect against carcinoma of the breast and endometrium, and avoiding ovulation may decrease the risk of developing ovarian carcinoma.

A slightly higher risk of cervical carcinoma was observed in some studies of users of oral contraceptives. These studies were not controlled, however, for confounding variables such as multiple partners or age at onset of sexual intercourse, and it is generally believed now that any increased risk in contraceptive pill users would be attributable to these other factors and not
the steroids themselves. Although the risk of developing benign liver adenomas is increased somewhat in users of oral contraceptives, the risk of hepatic carcinoma is not increased.

Wednesday, February 4, 2015

Ipratropium (or tiotropium)

A patient with chronic obstructive pulmonary disease (COPD, eg, emphysema , chronic bronchitis ) i s receiving an orally inhaled muscarinic receptor-blocking drug to maintain bronchodilation. 

What drug belongs to that class ?

a . Albuterol
b. Diphenhydra mi ne
c. Ipratropium (or tiotropium)
d. Piloca rpi ne
e. Vecuronium

The answer is c.  Ipra tropium, a quaternary (and so poorly absorbed) a nicotimuscarinic
drug, i s FDA-a pproved for use as aninhaled bronchodilator for COPD. Its action involves blocka de/a ntagoni s m of ACh-medi a ted bronchocons tri cti on, a nd i t i s often us ed a djuncti vel y wi th a l buterol or other β2 agonist bronchodilators . A related drug is tiotropium.

Al buterol (a ) i s a n i nha l ed bronchodi l a tor for a s thma or COPD, but i t works , of cours e, a s a β2-a drenergi c a goni s t. Di phenhydra mi ne (b) ha s bronchodi l a tor a cti vi ty (by bl ocki ng both hi s ta mi ne H1 a nd mus ca ri ni c receptors ), but i t i s not gi ven by i nha l a ti on; moreover, for a mbul a tory pa ti ents wi th a s thma the mucus -thi ckeni ng effects of mus ca ri ni c receptor bl ocka de ca n do more ha rm tha n good. Vecuroni um (e) i s a cura re-l i ke s kel eta l neuromus cul a r bl ocker (competi ti ve a nta goni s t of ACh a t NM receptors ) a nd i s us ed ma i nl y for ca us i ng i ntenti ona l s kel eta l mus cl e pa ra l ys i s duri ng s urgry to s uppres s s ponta neous venti l a ti on i n s ome ICU pa ti ents on a venti l a tor. Pi l oca rpi ne (d) i s a mus ca ri ni c a goni s t, us ed
ma i nl y for ca us i ng mi os i s (cons tri cti ng the pupi l [s ] of the eye[s ]) i n s ome pa ti ents wi th a ngl e-cl os ure gl a ucoma . Pi l oca rpi ne wi l l ca us e bronchocons tri cti on—a n effect tha t ma y be ha rmful , i f not fa ta l , for pa ti ents wi th COPD or a s thma .

Tuesday, February 3, 2015

Today World Cancer Day: 4th February 2015 , Why is this day important ?- DrSudeep KC

World Cancer Day: 4th February 2015

-DrSudeep KC
Dr.Sudeep KC 


Put simply, because the global cancer epidemic is huge and is set to rise. Currently, 8.2 million people die from cancer worldwide every year, out of which, 4 million people die prematurely (aged 30 to 69 years).

Urgent action needs to be taken to raise awareness about the disease and to develop practical strategies to address the cancer burden. Disparities between people from different settings are growing, particularly in the access to prevention, treatment and palliative care.

Now, more than ever there is a need for a global commitment to help drive advancements in policy and encourage implementation of comprehensive National Cancer Control Plans. Furthermore, we have a collective responsibility to support low- and middle-income countries who are tackling a cancer epidemic with insufficient resources. World Cancer Day is the ideal opportunity to spread the word and raise the profile of cancer in people’s minds and in the world’s media.


img :Dr.SudeepKC working with Protein Pic And Slc23a 3
World Cancer Day is an initiative of the Union for International Cancer Control (UICC), a leading international non-governmental organisation that unites the cancer community to reduce the global cancer burden, to promote greater equity, and to integrate cancer control into the world health and development agenda. Founded in 1933 and based in Geneva, UICC’s growing membership of over 800 organisations across 155 countries, features the world’s major cancer societies, ministries of health, research institutes, treatment centres and patient groups. Additionally, the organisation is a founding member of the NCD Alliance, a global civil society network that now represents almost 2,000 organisations in 170 countries.

World Cancer Day 2015: ‘Not Beyond Us’ 

• Choosing healthy lives 

• Delivering early detection

 • Achieving treatment for all 

• Maximising quality of life

Cancer is a neoplastic disease of multifactorial origin; its development depends on the interaction of the organism’s genes with the environment. Although some cancers are hereditary, the majority of tumors is of the sporadic type, i.e., they originate de novo from somatic genetic changes that are  promoted by exposure to environmental carcinogens and/or infectious agents. Cancer caused by infectious agents such as bacteria, parasites, and viruses has been estimated to be 16.1%

virus HIV

Prevention is the best medicine; therefore, knowing the interaction between virus and host cell and the relationship of that interaction with cancer puts combating viral infection (e.g., the development of vaccines against oncoviruses) on the front lines of defense against cancer. When viral infection is established in the host, although the mechanism for triggering carcinogenesis is not strong, the viral infection affects several pathways, such as those of the cell cycle, apoptosis, senescence, DNA repair, or changes in metabolism, which increases not only the complexity of the disease,but also its prognosis, treatment alternatives, and preventive measures The majority of current treatments for cancer has been developed by employing targeted cell proteins rather than viral elements. However, viral factors are equally important, and their use may open new lines of cancer treatment. Because virus involvement in cancer-related events is very broad, viruses can be used as molecular tools to assess genes that are over- or under- expressed in the homeostatic cell to treat direct or indirect causal agents of diseases.

Peutz-Jeghers syndrome (PJS).

A 10-year-old girl presents with multiple pigmented macules on the vermilion border of her lower lip.

Melanosis of lips

The dark brown lesions are 2–5 mm in size and are arranged in a cluster. The patient’s older brother has similar lesions. The patient complains of recurrent bouts of abdominal pain.

Which of the following is the most likely diagnosis?
a. Gardner syndrome
b. Herpes simplex virus infection
c. Freckles
d. Peutz-Jeghers syndrome
e. Hand-foot-and-mouth disease

The answer is d.  The most likely diagnosis in this patient is Peutz-Jeghers syndrome (PJS). This is an autosomal dominant polyposis characterized by multiple small macules (lentigines)
on the lips and oral membranes. Abdominal symptoms occur because of multiple benign hamartomatous polyps in the small and large bowel and in the stomach. Freckles (ephelides) are lighter lesions due to increased epidermal pigment in the distribution of sun-exposed areas. Gardner’s syndrome is an autosomal dominant disease characterized by facial cysts and
adenomatous polyps in the small and large intestines. Herpes simplex virus
is characterized by painful vesicles, which are grouped and confluent.
Hand-foot-and-mouth disease is a highly contagious systemic infection
caused by coxsackievirus A16 and characterized by ulcerative oral lesions

and a vesicular exanthem on the distal extremities.

Sunday, February 1, 2015

Dr.Sudeep KC working in laboratory

rat heart
Dissecting the rats
lab rats
DrSudeep doing genetic study in cardiomyopathy induced from doxorubucin