THE CREATIVE SPARK

N   ecrotising enterocolitis is the most common gastro-intestinal disorder and is a surgical emergency in neonates. Mortality rates exceedingly more than 50% in premature babies or those whose weight is less than 1500 grams. NEC (Necrotising Enterocolitis) occurs in three groups of babies – 1.     Term babies with risk factors 2.     Preterm babies (immaturity of the gut) 3.     Babies with IUGR (Intra-Uterine-Growth-Retardation) 4.     Any other food given other than breast milk for the baby 5.     Ischaemia to the gut Basically, what happens in NEC is, due to ischaemia, there occurs a decrease in blood supply to the gut, this leads to necrosis and increase in air accumulation inside the gut. This causes excessive filling of the gut with the air leading to bloating of the gut. This condition is called as Pneumatosis intestinalis. This leads to distention of the abdomen an...

C   ongenital Adrenal Hyperplasia or CAH, is a disorder which is characterised by defects in enzyme that lead to various effects.  The most common enzyme affected in CAH is 21 hydroxylases enzyme. The second most common enzyme to be affected is 11-β-hydroxylase enzyme. The gene CYP 21A 2 is affected, this is the same gene that codes for 21 hydroxylases. The following image shows the steroid pathway that takes place in the adrenal glands, where cholesterol is the basic material used for synthesis.  Here 21 OH stands for 21 Hydroxylase, 11 beta signifies 11-β-hydroxylase. As the normal physiological process, 21 hydroxylase enzyme acts as an important enzyme for synthesis of corticosteroids and mineralocorticoids. As there is 21 hydroxylase deficiency there will be reduction in the production of corticosteroids and mineralocorticoids. Due to deficiency of mineralocorticoids, there will be salt and water wasting. As the levels of corticoste...

A   n ECG is electrical recording of the heart’s conduction system.  This is recorded on an ECG paper which has the following things – 1.     Patient’s name 2.     Time of recording 3.     Place of recording 4.     Date of recording 5.     Age of the patient The ECG paper is basically a graph paper where a single large square is divided into 25 smaller squares thus, making the larger square of size 5mm x 5mm. The horizontal line represents time period and the vertical line represents the voltage of the heart or the voltage of the conducting system of the heart to be precise. Each small square is of 1mm x 1mm size. The speed of ECG is 25mm/sec, i.e. it travels though the entire 25 smaller boxes in 1 second or in other words, it can be also said that 5 large square per seconds. Close up view of the squares. 1mm corresponds to 0.04 seconds and 1 large box (5mm x ...

S   urgical incision is a cut made into the body so as to facilitate an operation or procedure. The 3 essential things should be achieved while doing so – Accessibility, extensibility and a reliable closure. The incision should be long enough for good exposure with keeping in mind the vessels and nerves are not damaged and a good closure is achieved by the end of the procedure. Splitting of the area is more appreciated rather than the cutting of the tissue. Transverse incisions are always better than vertical incisions and retraction of the muscles or other tissues should be done in the direction where there is neurovascular bundle. The choice of incision depends upon the – 1.     Type of surgery (elective/emergency) 2.     Target organ 3.     Previous surgeries 4.     Surgeons preference and experience. An ideal incision is the incision which allows easy access to the desired organs o...

I   njuries that result from direct contact or exposure to any physical, thermal, chemical, electrical, or radiational source are termed as Burns.   Ambroise pare (1510 – 1590) showed the technique for early excision of burns wound. 1607 – G. F. Hildanus: showed the pathophysiology of burns. 1842 – Curling showed the Gastric and Duodenal ulcers. It is estimated that almost 2,65,000 deaths are occurring every year because of burns. In India, approximately 70 lakh burns cases occur annually out of which 1.4 lakh people die. 4/5 th are women and children and 80% of the cases reported are because of domestic accidents (usually in the kitchen). Burns are classified: On the basis of Cause – 1.     Thermal (scalding and flaming) 2.     Electrical (electric wires, power transmission lines and lightning) 3.     Chemical (acids and alkali) 4.     Radiational (alpha, beta, and gamma r...