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< X-Bar

Can we be raw for a minute, here? Life is fucking hard, man. If I don't put forward the amount of effort society deems necessary, then society scolds me. And rightfully so. Those who work hard deliver results. We can fight about it all we want; we can bitch about how much society demands from us as humans, but we know the truth. It's not that we are lazy--I'm not sure I believe in lazy--it's that we don't have a strong enough "why". Meaning is such a powerful concept that I lost along the way, or maybe I didn't have it to begin with.   So, you're wondering: who the hell is this dude and why do I care? Well, you probably don't care, and I support your decision to not care, because this is 80% for me and 20% for someone else--whomever that may be. Anywho, my name is Dan, and I'm a recent graduate from Trent University in Peterborough, Ontario with a Bachelor of Science Honours in Computing Systems (Software Engineering). My cGPA was ~2.97. First year was a 3.5, and it tumbled year over year until graduation day. I don't know why it tumbled. Maybe I didn't love the courses or the teachers or the homework? Or, maybe I had no reason to perform better? Maybe I had no why? Yes, I suspect my lack of motivation was a combination of disorientation and an absent overarching reason to be there. It was like that in high school, where my average was 66%!   The point of these posts is to give me a space for self-reflection and expression. It's also to call myself out on some things, though. I titled this post "< X-bar", because I truly believe that, at the present moment, I am performing less than average. By average, I mean the performance of an average student admitted to medical school. High standards to live up to, but I'm tired of being this person that I am, and this blog is my "coming out"--so to speak--to you, world. This blog is me saying "I have not lived up to society's and my own expectations. I have not failed, but I have not succeeded." These posts are also a plea to you, world, to hold me accountable, to give me strength, and to call me out when I have taken more than I have given. The greatest doctors, I must assume, are also some of the greatest givers.   The seed of wanting to become a doctor was planted in me long ago. Well over 10 years ago, when I was in high school. But, I was not serious back then, and I was not mature in the ways I ought to have been. After high school, I tried college 5+ times--dropping out each time. I burned 10s of thousands of dollars on a fruitless pursuit. To this day, it is my largest regret. Perhaps I will forgive myself for these actions some day; perhaps not. To add jet fuel to the fire, I jumped from job to job, burning bridges as I went. I quit jobs without notice--I simply didn't show up one day--and I quit the military 2 weeks into basic training because it was too hard. I told my section sergeant it was for moral reasons, which at the time I felt it was, but looking back, it's clear I quit because that's what I do when things get hard.   Then, I met my girlfriend (now fiance), who pushed me to do well in first year of university. I am so thankful for this. This was the greatest thing that could have happened to me, but I retreated back to my comfortable zone of slacking by, and I don't blame her for not being on my ass all the way through university, because that's on me. I was the student. Not her. Still, she's an amazing person, and if something terrible were to happen or the love were to fizzle, I doubt I would pursue love again. I told that to a counselor once, and he didn't believe me. Ah, well.   I think that's all I have to say for now. You know who I am and where I've been. This post was a background and introduction, and I welcome all comments--not just the good ones. If you want to say "Dan, you sound like a low life piece of shit, and you will never become a doctor, because there are people out there far better than you...", then I accept that. I thank you for your openness and expression and wish peace and goodness upon you. I also accept positive posts or shared stories of your own. Silence is also accepted, for it's unlikely anyone will even read this.   Until next time.   -Dan

dannyboy

dannyboy

 

Virus

General categories of viruses include: skin (rash) viruses, respiratory viruses, skin (worts) viruses, CNS viruses, GI viruses   There are different types of rashes: vesicle, bulla, mascule, pustule. Viruses that cause a mascular red rash include measles or rubeolla, rubella, B19, HHV6 and HHV7. Measles is where the patient gets a rash behind the ear that spreads to the neck, conjunctivitis, children with vitA deficiency get keratitis, kloptic spots at the buccal mucosa. Pathogenesis is that the virus causes syncytia to form via CD46 where the syncytia ruptures and the virus is spread to the lymphatic vessels and eventually to blood. Measles is not latent. Patients particularly at risk for measles include men, pregnant women and the immunocompromised. Measles during pregnancy can lead to abortion and babies born with measles will get congenital measles. Measles is transmitted vertically and it is airborne, which is why it is so infectious. People who had measles can get SSPE 6-8 years later, which has a 100% mortality rate. It is diagnosed clinically like all rash viruses. Live attenuated vaccine is available for measles. Rubella infection during the first trimester will almost certainly lead to deafness, heart and CNS problems in the fetus. After the 1st trimester, the risk drops significantly. So it is transmitted vertically and through droplet. It is diagnosed clinically. B19 is also called 5th disease, erythema infectuosum and slapped cheeks. It infects pre-erythrocyte cells and causes TAC transient aplastic crisis. In pregnant women it leads to abortion. In other patients it causes anemia. It is biphasic and is at first a fever and then progresses to a rash. It can be diagnosed clinically.   Respiratory viruses include rhinovirus, adenovirus, coronavirus, RSV, parainfluenza virus and influenza virus. They all have flu-like symptoms. Rhinovirus infects the upper respiratory tract because it can only live at room temperature. It causes otitis media, respiratory problems and sinusitis. It is transmitted via droplets and fomites play a big role. Kissing does not lead to transmission. Stress only worsens symptoms not trigger it. IgA is important for rhinovirus recovery most likely because it is in the mucus in the respiratory tract. Adenovirus is both upper and lower respiratory tract. It causes conjunctivitis. It is transmitted via droplet and can be latent. It tends to affect kids and military personnel. Coronavirus is transmitted via droplet. RSV has a tropism for bronchial epithelium and it causes syncytia in there. This means that in young children it can constrict the airways and kill them. In adults and older children it doesn't do much. It causes croup, bronchiolitis and pneumonia. You diagnose RSV via DFA or EIA and treat with synagis antibodies. There are 2 types of parainfluenza virus that cause respiratory infections, PSV1 and PSV3. PSV1 causes croup (like RSV and B.pertussis). PSV3 causes bronchiolitis (like RSV). It is transmitted via droplet like all respiratory viruses. It is diagnosed via DFA and EIA (like RSV).   There are different types of worts: deep plantar, common worts, plane worts or flat worts. Viruses that cause worts include papilloma virus HPV, molluscum and orf. HPV causes epidermodysplasia verruciformis. This is where flat worts are on the skin and the worts tend to appear where there is more sunlight exposure. HPV can cause anogenital worts on the penis or labia (condylomas). It will cause worts on the vagina and cervix. It can cause malignancy or cancer and it is the cause for the vast majority of cervical cancer, specifically HPV16 and HPV18. Its E6 protein binds to p53 and E7 binds to p107, which induces malignancy. It can be diagnosed clinically and in the clinic you can do the acetic acid test. It is treated via liquid nitrogen (cosmetic), interferon, podophyllin or Gardrasil vaccine. Molluscum is a pox virus and it is mostly seen in children and is contracted usually from swimming pools. Molluscum is painless and self limiting, so it usually disappears after a few years. Molluscum causes hypopigmentation or hyperpigmentation Orf is a parapox virus and known as milker's nodule. It is an occupational disease seen in farmers who are in contact with cows and sheep.   Meningitis symptoms include headaches, photophobia, nausea, vomiting, bulging frontanelle (children). Encephalitis symptoms include personality changes, irritability, drowsiness, swelling of the brain. CNS viruses include: herpesvirus HSV, enterovirus, adenovirus, rabies virus, measles virus, polio virus. Enterovirus causes meningitis, it's common in children, it is transmitted via contact and it is diagnosed via PCR (like HSV). HSV2 causes meningitis and it accounts for the vast majority of meningitis. It is diagnosed via PCR and it is treated with acyclovir. HSV1 causes encephalitis and those who get it will likely die or get a disability. Rabes virus and polio virus cause chronic problems. Adenovirus is prevalent in SE Asia and it's transmitted through aedes mosquitoes. Adenovirus includes flavivirus, west nile virus and yellow fever virus. Flavivirus causes dengue fever, which can manifest into dengue hemorrhagic fever and dengue shock syndrome. Flavivirus Dengue fever will be a flu-like symptom and it will not cause death but it will cause a severe headache and severe pain in the joints and muscles (called breakbone fever). It can progress into dengue hemorrhagic fever which progresses to dengue shock syndrome, both of which are more likely to happen in children but malnourished people get less severe symptoms. Dengue hemorrhagic fever is where plasma from capillaries flow into the interstitial space, causing low blood volume, hypotension, hypoxia and hemorrhage. Dengue shock syndrome happens when the hemorrhagic fever gets really bad and it's when you're blood volume is so low you get shock. Dengue hemorrhagic fever causes a fever, thrombopenia low platelets and hypotension. This is unlike dengue fever, which is flu-like, has no change in platelets and does not change blood pressure. Diagnose clinically and treat symptomatically via replenishing water. West nile virus is mostly asymptomatic and usually only affects old and immunocompromised people. It causes low grade infection, encephalitis and meningitis. Diagnose west nile via antibody tests and PCR and treat symptomatically. Yellow fever causes hemorrhage, which leads to damage to the liver, heart and kidneys. In serious cases it can cause hypotension and jaundice. These patients have a high chance of dying. There is a live attenuated vaccine for this unlike with the other adnoviruses.   GI viruses include mumps virus, polio virus, rotavirus and norovirus. Mumps virus infects the parotid salivary glands and reaches the lymph nodes, leading to viremia. It causes diarrhea, vomiting, asceptic meningitis, pancreatitis, oophritis, orchitis and gastroenteritis. It is highly contagious and is transmitted via droplet. It is diagnosed clinically and it is treated symptomatically with water. There is an attenuated vaccine for it. Polio virus is mostly asymptomatic, but it can cause asceptic meningitis, minor fever, abdominal pain, diarrhea and vomiting. It infects M cells in the Peyer's patch and migrate to the lymphatic vessels. In children it tends to be consumed and infects the gut. Types of polio virus include abortive minor flu, non-paralytic polio (but still CNS) minor flu and asceptic meningitis, paralytic polio bulba or spinal. It causes paralysis mainly because it has a tropism for ANS and motor neurons. It also causes post polio syndrome PPS which is when there is muscle weakness where the polio virus once infected. It is transmitted via droplet via fecal oral route. It is diagnosed via throat rectal swab and a culture or serology. Polio virus has 2 vaccines available: live attenuated sabin and inactivated salk. Sabin is more effective since it will cause IgA to be produced but it can revert to wildtype. Rotavirus is the biggest cause of gastroenteritis in children. Enters enterocytes in the intestine and interfere with ion exchange. This leads to diarrhea and vomiting. Treat symptomatically via rehydration. Rotavirus has 2 oral vaccines Rotateq and Rotarix. Norovirus is also called norowalk or noravirus. It has no prodrome and tends to be asymptomatic. It has no envelope and mutates rapidly so immunity cannot be had and it is very infectious. It is treated symptomaticaly via rehydration. has no prodrome.

medici

medici

 

Sign Language For Babies

I recently read in one of the foreign sites: Adults often difficult to reach an agreement, let alone when we apply this concept to the world of a child, a small child. Inability to communicate makes that we can not find a common language and a common contact (verbal or non-verbal) is broken. When the family of the young man appears, parents instinctively surrounded by care and love. With the eagerly expect when their child will be big enough to alone could communicate, or verbalize their needs. Crying baby often causes the parents feeling of helplessness and frustration when they can not read his cause. In the 90s, scientists have developed a system called bobomigami characters that rely on sign language and are used for communication with the baby. The method developed by Joseph Garcia is effective in communicating with infants both deaf and hearing. It can be used from the eighth-ninth month of life, when it can no longer consciously use known characters. They allow you to express needs and feelings of the child. Sample messages are: eat, drink, sleep, mother, hurt, bear, dad. In the beginning, choose a few words and repeat them several times. It is important that learning takes place through play. The use of sign language for babies brings a lot of advantages: helps the child to communicate with the environment, and parents - take care of a baby
contributes to the development of speech stimulates the development of coordination of visual - spatial
develops imagination and manual skills
facilitates storing, preparing for later literacy
improves concentration comments
affect the intellectual development
strengthens the emotional bond between parents and their comfort
Joseph Garcia method known as "SIGN2BABY" into Polish adapted Danuta Mikulska, the inspiration became Polish Sign Language signs. Currently in the country, more and more clubs, where you can learn the secrets of "bobomigania". origin: http://portalmedycznofarmaceutyczny.pl/jezyk-migowy-dla-niemowlat/

Anna

Anna

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