Tomorrow isn't fine- poem

  

Tomorrow is a wonderful day, 
Tomorrow will be fine, 
There are so many wonders
Waiting to be revealed, 
All the good times and
Rainbows are yet to come, 
Tomorrow shall be mine. 
Tomorrow, tomorrow, 
God given tomorrow, 
Will put an end to all
My treacherous sorrow. 

Yeh, but....... 
What about the day after? 
The week end, The next month, 
The new year, a decade later?
What if it wouldn't turn out 
Like I want it to? 
May be a nightmare, a blood splatter, 
Insignificant like a mindless chatter. 
Or even catch a flu? 

Is tomorrow ever fine? 
May be, the optimistic halo 
"Happily ever after", 
Is a overrated lie, 
And painfully shallow, 
The ignorant hope, 
We unquestionably muster, 
In reality 
Will leave us flustered. 

May be, 
Every Heart break, 
And love, 
Pain and pleasure, 
Every loss and gain 
Are not evil nor good, 
Rather flavors ushered, 
In proportional measures, 
For life to have a blissful taste, 
And distinct leisures. 

Give me something to boast about- poetry

Give me something to boast about,
Can't you see that's what I want, Something to clear off insecurities,
Walk with head held high, Something to proudly talk about in gettogethers,
Make them gasp,
Something that stops me from looking down every time I meet an eye,
Let them look up,
Something that convinces me there is meaning to all this charade called life,
So that I want to wake up next time,
Something materialistic, something superficial, something shiny, something that shouts hierarchy.
Heck, I will even take moral superiority,
Something that throws spotlight at me.
So my optimistic human side, gains power over the rebellious cynic with the crown called pride.
Let it run over any question unanswerable, unfavorable.
Let pride blind me, let pride spoil me, let pride save me.
Let it cloak me with deluded self importance and self love.
Give me something to boast about.

Vyapam scam- all you need to know

"Vyapam" ( Vyavsayik Pa riksha Mandal), is a autonomous body garnered with the  responsibility of conducting entrance exams in Madhya Pradesh.

The exams are held for admissions in to colleges in the state and recruitment for government jobs.

The Vyapam scam is irregularities in the admission procedures in a number of entrances examinations conducted by the Vyapam.

Undeserving candidates bribe politicians and officials through middlemen to get high ranks.

The scam involved 13 different exams conducted for selection to various colleges and jobs.

Impersonation, Copying, manipulation of records and answer sheets, leaking the answer key were the methods employed.

Though many complaints of foul play have been reported since the mid-1990s, the first FIR was filed only in 2000.

In 2009 when police were tipped off about irregularities in a premedical entrance.

They realized cases were not singular but were part of a organized crime racquet. 

A committee was formed to investigate the crime, which led to imprisonment of 100's by 2011.

On 13 July 2013, Jagdish Sagar the leader of the scam was arrested in Mumbai.

Later the involvement of former MPPEB  (Madhya Pradesh Professional Examination) board chairman Pankaj Trivedi was found.

Along with former BJP minister Laxmikant Sharma 1000's of parents, students and impersonators were arrested.

Questions have also been raised over the involvement of the Madhya Pradesh Governor Ram Naresh Yadav.

Suspicious deaths have further complicated the investigation, since 42 people involved in the scam have died.   

With the scam pointing out the corruption within the highest bodies of the government

It becomes yet another example as to why common people can't trust politicians and officials.

Bhutan- carbon negative

Kingdom of bhutan, is a landlocked country in south Asia at the eastern end of the Himalayas.

It is sandwiched between two political giants and rivals India and China.

Since it's small and non controversial, it is often overlooked by the international community. 

But the country of about 750,000 keeps making the world take notice of it again and again.

Bhutan is South Asia's happiest country.

Which is not surprising since its the one country that uses Gross Happiness Index to measure its growth.

But now Bhutan is in the news for different reasons, it became the world's first carbon negative country.

This means the country’s  forests and trees absorb more carbon dioxide each year than it produces.

According to numbers the country emits around 1.5 million tonnes of carbon annually, while its forests absorb over 6 million tonnes.

The achievement is due to  Bhutan's strong environment protection policies.

72% of the country is still forested, and it's constitution guarantees at least 60% will remain that way.

Last June, a team of 100 volunteers  for planting 49,672 trees in just one hour setting a new world record.

Even this march 82,000 households planted a tree to celebrate the birth of Queen's first child.

Bhutan has already shown us a way on how to halt global warming, but are we ready to listen?

Surgery notes- breast diseases

Breast

Cystic swellings of the breast
Inflammatory
Acute bacterial mastitis

Neoplastic
Benign- phylloides tumor
Malignant- Intracystic carcinoma

Non neoplastic
Fibroadenosis
Simple cyst of breast

Retention cyst of breast- galactocele

Others
Tuberculous mastitis
Lymphatic cyst of breast
Hydratid cyst of breast
Haemotoma of breast.

Fibroadenoma

Benign tumor of the breast.
Epithelium in a fibrous stroma.
It is an aberration in the normal breast.

Types
Intracanalicular (less fibrous, deep)
Pericanalicular (nor fibrous, superficial)

1 cm or smaller -normal
1-3 cm - large
More than 3- giant

Clinical features
- peak age 20 yrs
- Usually a single lobe
- Painless
- well defined, capsule
- freely moves throughout the breast (breast mouse) -not in elderly.

Treatment -
Excision- Pericanalicular is by Peri areolar incision
Intracanalicular is by sub mamillar incision.

Complication - breast ca.

Phylloides tumor

Fibroepithelial tumors
Also called cystosarcoma fibroid

Capable of attaining massive sizes.

Types- benign, borderline, malignant.

Clinical features
30-40 yrs age
Rapid growth
Stretched skin
Engorged veins
Bosselated appearance

Diagnosis
Clinical, ultrasound, trucut biopsy

Treatment
Excision
Malignant- mastectomy may be necessary

Difference from carcinoma-

Is not attached to skin or pectorals
Can cause multiple cysts due to necrosis
No nipple retraction
Histology- blanching pattern (leaf like)

Breast abscess

Acute bacterial mastitis
Antibioma
Retro maxillary abscess
Sub areolar  abscess
Tuberculous abscess

Acute bacterial mastitis

Etiology
Lactational mastitis
Cracks or fissures in the nipple

Haematoma-
Bacteria like staphylococci can infect haemotoma, can also proliferate intraductally and clot milk.

Non lactational- anaerobic bacterial causes. Occurs in patients with ductal ectasia and subareolar mastitis.

Other factors- diabetes, HIV.

Clinical features

Stage of cellulitis- Inflamed, tender, tense, warm breast.

Stage of Abscess- fever, chills - cystic swelling develops untreated- rupture- necrosis- ulcer+ discharge.

Signs- fluctuations may be positive.

Treatment-
Stage of cellulitis
Cloxicillin, NSAIDs - ibuprofen

Stage of abscess
Incision and drainage with antibiotic cover, if both breasts are affected- boil the milk and use.
Complication- abscess, necrosis and
Antibioma- when I and C is done without antibiotic cover, it is replaced by fibrous tissue leading to a firm/hard lump, its treated by excision.

Discharge per nipple

Classification
Types of discharge
Serous- fibrocystic disease, duct ectasia.
Milk- lactation, hyper prolactinoma
Blood- duct ectasia, papiloma
Green- duct ectasia
Yellow- abscess

Site
Unilateral- duct ectasia, fibrocystic - bilateral

With mensuration- fibrocystic

With mass- tender- fibrocystic, non tender- carcinoma

Spontaneous discharge- papiloma.

Investigation and management
Ultrasound, mammogram
TSH, prolactin
Examination of discharge.
- rule out carcinoma, antibiotics, core excision.

Galactorrhea

Discharge of milk from nipples other than breast feeding

Physiological Causes- stimulation during sex

Drugs-
Oral contraceptives
Anti hypertensives

Galactocele
-sub areolar retention cyst
- due to accumulation of milk
- blocked lactiniferous ducts by epithelial debris
- rarely undergoes calcification
-treatment -multiple aspirations.
Or lastly excision

gynecomastia

Unphysiological enlargement of male breast
(Physiological- obesity, adolescence)

Causes

M- malignancy
A-anorchism- absence of testis
S-sex chromosomal anomaly klinefelter's
T-tablets- cimentidine, stibesterol
I-idiopathy
A- atrophied testis(polio, liver failure)

Clinical features- enlarged tender breast, unilateral or bilateral
Examination of testis and liver function.

Treatment- lumpectomy or mastectomy with preserved nipples.

Etiology of breast carcinoma
Sex- women (100:1)
Age- above 35
Race- white
Genes- BRCA1, BRCA2
Diet- obesity
Hormones- early puberty late menopause is a risk factors
More the lactational period lesser the risk.
Hormone replacement therapy
Chest wall radiation- multiple cheast wall

Pathogenesis of breast cell ca
Scirrhous carcinoma
60-75 percent.
Fibrous reaction.
Hard lump.
Retraction of nipple.
Fixidity to skin and chest wall.
While necrosis and calcification
Occurs.
Histology- round or polygon cells.
Sometimes causes atrophic infiltrating ca.

Medullary carcinoma breast
15% of the breast ca
Soft to firm, undifferentiated cells, lymphatic infiltration, good prognosis.

Inflammatory ca
Less than 1%,
Lymphatic infiltration is present.
Rapidly growing tumor comes under local advanced breast carcinoma.
During Lactation and pregnancy
Pain, redness and enlargement present,
different from abscess by lack of fever and presence of peau d' orange.
Worst prognosis.

Paget's disease of nipple
Misnomer.
Carcinoma of the ducts
Unilateral, affects elderly women.
Causes fissures, cracks, ulcers in the nipple, sometimes completely destroyed.
Hyperchromatic halo cell (mucopolysacchsrides or Paget's cell is present)

Colloid ca
Production of mucin
Good prognosis.

Clinical classification and grading of breast cell ca.

Clinical features

Investigations

Management

Advanced breast cell carcinoma

Mastectomy.

Medical notes (hypospadias)

Pic- en.wikipedia.org

Hypospadias

Due to improper development of urethra the opening is user the penis.

Types

Glandular- Milli meters away from the usual opening

Coronal - junction between the gland and body

Penile- shaft

Peno- Scrotal- between the two scrotum- urethra is not deve at all.

Clinical features

Micturition is normal but can we clothes especially in types 3 and 4.
Penis is bent (chordee)
Sexual intercourse is difficult.
Hooded prepuce

Treatment

One stage urethroplasty
Treatment of chordee
Urethra formation by tube

Two stage urethroplasty
-chordee is corrected in 6-12 months after birth. (Orthoplasty)
- reconstruction of urethra at 5-6 years (urethroplasty)

Medical notes (BPH)

Pic- urology.jhu.edu/prostate/bph.php
Urology

Benign prostatic hypertrophy

(Benign enlargement of prostate)

Etiology
Hormonal theory- decreased androgen and increased estrogen leads to hypertrophy.
Neoplatic theory- benign neoplasm of fibrous, muscular and grandular parts of prostate.

Pathogenesis
There is obstruction of urethra by the elongated prostate.
- Urethral changes- elongates, narrows.
- Bladder changes- hypertrophies with folds, I.e fasciculations and sacculation, the urine is caught up in them and may even cause diverticuli or stones due to stasis.
Kidney changes- hydronephrosis (enlargement due to stasis of urine).

Clinical features

Frequency- due to ineffective emptying of bladder.
Urgency
Hesitancy to pass urine because it is ineffective.
Acute and chronic retention of urine.
Hematuria.

Complications
Diverticuli
Stone
Hydronephrosis
UTI
Renal failure

Investigation

Urea, creatinine- rule out hydronephrosis and renal failure
Uroflowmetry- measures the flow of urine with a flow meter. If the flow is less than 10 ml/sec its peak obstruction.
Ultrasounds- prostate, bladder, kidney.
CT, MRI.

Staging
1- 1-2 cm on rectal exam
2- 2-3 exam on rectal exam
3- 3-4 cms on rectal exam
4- more than 4 cm mass.

Treatment.
If there is no obstruction and not much symptoms no medication, just advice them avoid alcohol.

Drugs-
Finastride acetate
Alpha adnenergic drugs.

Surgery

Indications- urinary retention
Frequency is unbearable, complication.

Transurethral resection a prostate

A resectoscope is sent via the ureter, constant irrigation is applied with water, prostate is cut into pieces.
Post op recovery is smooth, but water intoxication can happen.

Transvesical suprapubic prostectomy
If gland weighs more than 100 g
The prostate is accessed via the extra peritoneal approach, and ennucleated (removal of the entire organ without cutting) with fingers.
Malicot's catheter is used to drain the bladder.
Prostatic Urethra is dissected, but a new one develops along the foley's catheter by fibrosis.

Retro pubic prostectomy

Other method
YAG laser.