This is default featured slide 1 title

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 DRUGS DIRECTORY

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 DRUGS DIRECTORY

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 DRUGS DIRECTORY

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 DRUGS DIRECTORY

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 .

Thursday, August 20, 2015

13 Reasons Why Doctors Can Never be the Ideal Boyfriend

13 Reasons Why Doctors Can Never be the Ideal Boyfriend






Women have so many images about the ideal boyfriend. Sweet, caring and fun are just some of those. But your dream-boyfriend image will probably shatter if you end up dating a doctor. Well not all, but most doctors can never be any girl's dream boyfriend. These reasons below will just prove our point better.

1. He will never have any free time, ever!

2. He will always have another woman in his life, apart from his mother. The nurse, of course.

3. Being in a profession that is anti-emotions, do not expect long and emotional conversations.

4. He will never, willingly, take you out for lunches. Obviously, he never recommends unhealthy food.

5. It is possible that his romantic lines will also talk about pills, x-rays, and tests.

6. He is already committed to his work, so commitment with you would be a...?

7. He will have more mood swings than you can never have or even imagine. Obviously, getting good and bad news on the same day can do that to him.

8. Not all your jokes will make him laugh. Come on, they are doctors, hence very intelligent!

9. It is possible that you might have to get an appointment to go on a date with him.

10. It is also possible that he will leave you in between the act, if he gets an emergency call from the hospital.

11. He can never be that oh-so-cool guy you ever wished.

12. It is possible that your room will be filled with files, folders and all those medical books.

13. His favourite accessory is probably his stethoscope and not that ring you gifted him.

<script type="text/javascript">
    google_ad_client = "ca-pub-9828764142595208";
    google_ad_slot = "9645153375";
    google_ad_width = 728;
    google_ad_height = 90;
</script>
<!-- FOOT LONG -->
<script type="text/javascript"
src="//pagead2.googlesyndication.com/pagead/show_ads.js">
</script>

Thursday, August 6, 2015

A “Blue Hue” Following Endoscopy -DrSudeepKC

A “Blue Hue” Following Endoscopy


A 39-year-old previously healthy female presents to the emergency department as a transfer
from an outpatient endoscopy clinic. She had been in her usual state of health until 45 minutes into her esophagogastroduodenoscopy when she was noted to have a  gradual decrease in her oxygen saturations and dyspnea. 

On arrival, her vital signs were as follows: pulse 125 beats per minute, blood pressure 96/43 mmHg, respiration 36 breaths per minute, and temperature 37.3° C. Her examination is unremarkable except for the skin findings pictured here (the patient’s hand is on the right, and the nurse’s hand on the left). Her lungs are clear, and her pulses are strong.

Question: Which of the following is the appropriate antidote for this toxicity?

A. Prussian blue
B. Physostigmine
C. Deferoxamine
D. Methylene blue
E. Naloxone


Answer: D
Diagnosis: Methemoglobinemia
Discussion: Methemoglobinemia occurs when the iron atom within the hemoglobin molecule is oxidized from the ferrous (Fe 2 + ) to the ferric (Fe 3 + ) form. This results in an impaired oxygen and carbon dioxide - carrying capacity  that can lead to a functional anemia and tissue hypoxia. It most commonly occurs as the result of exposure to oxidizing compounds or their metabolites (such as in this case, where the patient received benzocaine during endoscopy), but can also result from genetic, dietary, or idiopathic causes. Methemoglobin (MHb) renders the blood a chocolate color, which is pathognomonic at the bedside. Nonanemic healthy patients can tolerate MHb levels up to 15% without symptoms. Levels between 20% and 30% may result in anxiety, tachycardia, changes in
mental status, and headache. MHb levels  above 50% may cause coma, seizures, dysrhythmias, and death. However, reports of patients with levels greater than 70% have been reported with minimal symptoms. 

The most important mechanism for prevention of methemoglobinemia in humans is the nicotinamide
adenine dinucleotide (NADH) dependent methemoglobin reductase system (Figure 67.1 ). This enzyme is responsible for the removal of the majority of MHb that is produced in normal circumstances. The other enzyme, nicotinamide adenine dinucleotide phosphate (NADPH)
methemoglobin reductase, is a minor pathway for the removal of MHb under normal conditions. However, when high concentrations of MHb are present, the NADH enzyme pathway becomes saturated and the NADPH enzyme system becomes dominant. Cyanosis occurs in patients when as little as 1.5 g/dL hemoglobin is in the MHb form, whereas 5 g/dL deoxyhemoglobin is required to produce cyanosis. Pulse oximetry is misleading when MHb is present. 


Pulse oximetry only measures the relative absorbance of two wavelengths of light, thereby only differentiating oxyhemoglobin from deoxyhemoglobin. At high levels of MHb, the pulse oximeter reads a saturation of approximately 85%, which corresponds to equal absorbance of both wavelengths. The partial pressure of oxygen on the arterial blood gas refl ects plasma oxygen content and does not correspond to the oxygen - carrying capacity of hemoglobin. Therefore,in patients with MHb, their partial pressure of oxygen remains within the normal reference range. Co-oximetry should be requested to measure the MHb level. Cooximetry can measure the relative absorbance of four different wavelengths of light and can thereby differentiate MHb from carboxyhemoglobin, oxyhemoglobin, and deoxyhemoglobin.
Once the diagnosis has been made, treatment is supportive for patients with minimal signs or symptoms. For symptomatic patients, methylene blue is the treatment of choice. Methylene blue is an oxidizing agent that is reduced to leukomethylene blue via the NADPH methemoglobin reductase enzyme. Leukomethylene blue then reduces methemoglobin to hemoglobin through conversion
of iron from the ferric (Fe3+) to the ferrous (Fe2+) state. 

Methylene blue is dosed at 1–2 mg/kg of a 1% solution, infused intravenously over 3–5 minutes. If there is no improvement in symptoms, this dose can be repeated at 30-minute intervals up to a maximum dose of 7 mg/kg. Methylene blue, when infused, can cause burning at the site of injection. The intravenous line should be flushed promptly after injection. Rapid administration or higher doses of methylene blue can result in thoracic pain, dyspnea, hypertension, and diaphoresis. 


Doses above 15 mg/kg can cause direct damage to the erythrocyte and hemolysis with Heinz bodies. Dosing should be monitored  carefully in patients with renal failure, as the kidneys excrete both methylene blue and  eukomethylene blue. 

Methylene blue may also result in a false lowering of the pulse oximetry saturation readings.

Wednesday, August 5, 2015

Allopurinol is used in the treatment of

Allopurinol is used in the treatment of




A. Osteoarthritis

B. Gout

C. Rheumatoid Arthritis
D. Ankylosing spondylitis


ANS IS C : GOUT
Gout (also known as podagra when it involves the big toe) is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected (approximately 50% of cases). It may also present as tophikidney stones, or urate nephropathy. It is caused by elevated levels of uric acid in the blood. The uric acid crystallizes, and the crystals deposit in joints, tendons, and surroundingtissues.
Clinical diagnosis may be confirmed by seeing the characteristic crystals in joint fluid. Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, or colchicine improves symptoms. Once the acute attack subsides, levels of uric acid are usually lowered via lifestyle changes, and in those with frequent attacks, allopurinol or probenecid provides long-term prevention.
Gout has become more common in recent decades, affecting about 1 to 2% of the Western population at some point in their lives. The increase is believed to be due to increasing risk factors in the population, such as metabolic syndrome, longer life expectancy, and changes in diet. Gout was historically known as "the disease of kings" or "rich man's disease."