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Tubotympanic Chronic Suppurative Otitis Media

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We discussed about CSOM or Chronic Suppurative Otitis Media in general in our previous section. Let’s take a deeper look into its first type, i.e, Tubotympanic CSOM, also called safe CSOM or benign CSOM. Click to jump to Atticoantral CSOM.

Etiology

The Etiology of Tubotympanic CSOM is as follows:

  1. Sequela of Acute Otits Media following exanthematous (eruptive) fever and leaving behind a large central perforation which becomes permanent and permits repeated infections from external ear.
  2. Ascending infections via Eustachian tube like from tonsils, adenoids and infected sinuses.
  3. Persistent mucoid otorrhoea is sometimes result of allergy to ingestants such as milk,eggs,fish etc.

Pathology

Pathology of CSOM Chronic Suppurative Otits Media
Pathology of CSOM Chronic Suppurative Otits Media

It remains localized to mucosa and mostly to anteroinferior part of middle ear. Pathological changes seen in Tubotympanic CSOM is as follows:are:

  1. Perforation of pars tensa- Central perforation
  2. Middle ear mucosa- Normal when disease is inactive but oedematous and velvety when active
  3. Polyp- Pale
  4. Ossicular chain- usually intact and mobile but may show some degree of necrosis, especially of long process of incus.
  5. Tympanosclerosis- It is hyalinisation and subsequent calcification of subepithelial connective tissue. It is seen as white chalky deposits on promontory, ossicles, joints, tendons, oval and round windows. It interferes with mobility of these structures, hence, causing conductive deafness.
  6. Fibrosis and adhesion- They are result of healing process and may further impair mobility of ossicular chain or block eustachian tube.

Bacteriology

The bacteriology of Tubotympanic CSOM is as follows:

  1. Aerobic
  2. Pseudomonas aeruginosa, proteus, E.coli, Staph aureus
  3. Anaerobic
  4. Bacteriodes fragilis and anaerobic streptococci

Clinical features

The Clinical Features of Tubotympanic CSOM are as follows:

  1. Ear discharge- Non-offensive, mucoid or mucopurulent, constant or intermittent. Discharge appears mostly at time of upper respiratory tract infection or accidental entry of water into ear.
  2. Hearing loss- Conductive type and rarely exceeds 50dB. Sometimes, patient reports of paradoxical effect, i.e, hears better in presence of discharge than when ear is dry. This is due to ’round window shielding effect’ produced by discharge which helps to maintain phase differential. In dry ear with perforation, sound waves strike both oval and round windows simultaneously, thus, cancelling each others effect.

    Shielding effect in CSOM Chronic Suppurative Otitis Media
    Shielding effect in CSOM Chronic Suppurative Otitis Media
  3. Perforation- Always central which is anterior,posterior or inferior to handle of malleus or subtotal/extending upto annulus.

    Perforation in Tubotympanic CSOM Chronic Suppurative Otitis Media
    Perforation in Tubotympanic CSOM Chronic Suppurative Otitis Media
  4. Middle ear mucosa- Pale pink and moist on normal but when inflamed, it looks red, oedematous and swollen and occasionally with polyps.

Investigations

Investigations done in Tubotympanic CSOM are as follows:

  1. Examination under microscope- can reveal granulation, ingrowth of squamous epithelium, status of ossicular chain, tympanosclerosis and adhesion.
  2. Audiogram- Conductive deafness but sensorineural deafness element may be present.
  3. Culture and sensitivity of ear discharges- may help to select proper antibiotic ear drugs.
  4. Mastoid Xrays/CT scan temporal bone- Mastoid is usually sclerotic but may be pneumatized with clouding of air cells. There’s no evidence of bone destruction (which is a feature of atticoantral csom)

Treatment

The aim of treatment is to control the infection and eliminate ear discharge and at a later stage, surgery may be done to assist hearing loss. Following are treatment regimes for Tubotympanic CSOM:

  1. Aural toilet- All discharge and debris from is ear is removed to enhance effect of topical antibiotics.
  2. Ear drops- Neomycin, Polymysin and gentamycin are used.
  3. Systemic antibiotics- Only in acute cases.
  4. Precautions- Avoiding hair washing, water in ears or blowing nose hard can be helpful.
  5. Surgical treatment- Polyps in ear or granulation is removed to facilitate ear toilet though avulsion is strictly avoided.
  6. Treatment of contributory causes- Corrects of infection of adenoids, maxillary antra and nasal allergy.
  7. Reconstructive surgery- Once ear is dry, myringoplasty with/without ossicular reconstruction and closure of perforation can stop recurrent infections.

Chronic Suppurative Otitis Media | CSOM

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Chronic Suppurative Otitis Media or CSOM is a long standing infection of a part or whole of the middle ear cleft characterized by Ear discharge and a permanent Perforation. A perforation becomes permanent when it’s edges are covered by squamous epithelium and it does not heal spontaneously. A permanent perforation can be likened to an epithelium-lined fistulous track.

Word wise Meaning of CSOM:

  • Chronic- Long standing
  • Suppurative- Related with pus (containing or discharging pus)
  • Otitis- Inflammation of ear
  • Media- Middle ear

Types of CSOM

Clinically, it can be divided into two types:-

Tubotympanic

  • Also called the safe or benign type.
  • It involves anteroinferior part of middle ear cleft ,i.e, eustachian tube and mesotympanum.
  • It is associated with central perforation.
  • There is no risk of serious complication.

Atticoantral

  • Also called unsafe or dangerous type.
  • It involves posterosuperior part of middle ear cleft, i.e, attic, antrum and mastoid.
  • It is associated with an attic or marginal perforation.
  • This disease is often associated with a bone-eroding process such as cholesteatoma, granulation or osteitis and risk of complication is very high.

Difference between Atticoantral and Tubotympanic CSOM

tubotympanic vs atticoantral csom
Difference between Tubotympanic and Atticoantral CSOM
Features Tubotympanic Atticoantral
Discharge Profuse Mucoid

Odorless

Scanty

Purulent

Foul Smelling

Perforation Central Attic/Marginal
Granulation Uncommon Common
Polyp Pale Red and fleshy
Cholesteatoma Absent Present
Complications Rare Common
Audiogram Mild to moderate conductive deafness Conductive deafness or mixed deafness
polyp in ear canal csom
Polyp in Ear Canal in CSOM

This was general about Chronic Suppurative Otitis Media. There are its two types- Tubotympanic and Atticoantral CSOM.

Basics of Reading Chest X ray

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Xray is a type of radiography and most widely used investigation. It first appears too complicated to read the chest xrays because we barely know what lies where and what to make out of it. But the basics of Chest Xray here will guide you through various aspects, including Counting ribs, PA vs AP view, Inspiratory vs Expiratory Xray, Erect vs Supine, Lucency and Opacity and some common terms like Consolidation and Pleural Effusion.

Part 1: Basics First

Best Chest Xray

PA vs AP view

AP vs PA view of Chest Xray

  • AP or Anteroposterior view- The view is from front to back.
  • PA or Posteroanterior view- The view is from back to front

Difference between PA vs AP view Chest Xray

PA vs AP view Chest Xray

Features PA view AP view
Position of clavicle Oblique Horizontal
Scapula Away from lung field Over the lung field
Spirolamina angle Inverted ‘V’ Not significant

PA is most common X-Ray done where AP is usually done when patient cannot stand and XRay machine is brought to him on bed and view taken from anterior to posterior.

The point to add is that there is apparent Cardiomegaly in AP view as compared to PA view because there is slight magnification of heart since heart is away from view capturing film.

This can be well understood by the following:-

The approach to cardiomegaly on Chest Xray is as follows:

Chest xray cardiomegaly

  • A/B x 100 = cardio ratio
  • In PA view, Cardiomegaly when ratio is more than 50%
  • In AP view, Cardiomegaly when ratio is more than 60%

Erect vs Supine position

erect vs supine cxrThere is fundal view in erect position because all the air in stomach comes in fundus when the patient is standing.

Inspiratory vs Expiratory

inspiratory vs expiratory chest xrayinspiratory vs expiratory chest xray 2If anterior end of 6th or 7th rib reaches mid-clavicular line of diaphragm, it is Inspiratory Xray.

Counting Ribs in Chest Xray

Counting ribs CXRTwo points can just help you quickly count ribs from top to bottom:

  • The front opaque appearing side of ribs is actually it’s posterior side.
  • Ribs are counted from anterior sides.

Counting ribs chest xrayBefore we proceed, let us see what structures lie in a normal Chest Xray:

Best Chest XrayThe Chest Xray is usually divided into three zones as:

Zones in Chest xray

  • Upto 2nd rib- First zone
  • 2nd to 4th rib- Second zone
  • 4th to 6th rib- Third zone

Now let’s proceed to start studying the Xray.

Lucency and Opacity in Chest Xray

Lucency

Anything that appears dark or black on chest xray is said to be lucent.

  • This is because of less density.
  • Black color appears because of AIR.

Opacity

Anything that appears light or white on chest xray is said to be Opaque.

  • This is because of high density.
  • White color appears because of Bones and soft tissues.

Therefore, we can conclude the following easily:-

Increase in lucency:

  • Increase in air
  • Decrease in soft tissues or absence of bone

Increase in Opacity:

  • Increase in soft tissue or abnormal bone
  • Decrease in air

The basic approach when seeing a chest xray always sequentially as:-

  1. Define whether xray is normal or abnormal
  2. If xray is abnormal, where is this abnormality
  3. Extent of abnormality
  4. What is the final diagnosis

Before we proceed to pathological approaches to Chest X-Rays, let’s see what layers the xrays hit when they enter the body. Note this strengthens further basics:-

Muscle> Ribs> Pleura> Lung

Talking about when Hyperlucency (increase in blackness) or Hyperopacity (increase in whiteness) occurs:-

Unilateral Lung Hyperopacity

Hyperopaque lung

  1. Consolidation- Replacement of air by something abnormal
  2. Atelectasis- Collapse of lung resulting in loss of air

Also seen in Plethora, i.e, increase i vascularity.

The differential diagnosis of three important causes if unilateral (one side) opaque thorax are:-

1. Atelectasis- collapse of lung

  • Displacement of interlobar fissure: because the lobes of lung collapse, the fissures in between the lobes move up or down because of hyperinflation of normal lobe against collapsed lobe. This is the most reliable direct sign of Collapse.
  • Mediastinal shift: The structures on mediastinum shift to side of collapsed lung
  • Crowding of ribs
  • Elevation of hemidiaphragm
  • Sharp defined margins of opacity

2. Consolidation- replacement of air

Consolidation

  • No mediastinal shift
  • Ill defined margins of opacity
  • Airbronchogram sign: visualization of air in bronchus sorrunded by alveolar opacity

Positive Airbronchogram sign is seen in:

  • All except interstitial (viral) pneumonia
  • Pulmonary oedema (water replace air)
  • ARDS (Acute respiratory distress syndrome)
  • Goodpasture syndrome (blood)
  • HMD (Hyaline membrane disease)
  • Pulmonary alveolar proteinosis (macrophages congested in alveoli making crazy paving pattern)

Airbronchogram sign is NOT seen in:

  • Lung abscess
  • All except bronchoalveolar carcinoma

3. Pleural effusion-accumulation of fluid

Normally, there is no air in pleura. But effusion in pleura can occur.

  • Mediastinal shift: which is on opposite side, i.e, structures shift to opposite side of pleural effusion.

Note: Pleural effusion and Haemothorax cannot be differentiated because soft tissue cannot be differentiated on Chest Xray.

Unilateral Lung Hyperlucency

hyperlucent lung

  • Rotation: apparent increase in air gap
  • Scoliosis
  • Masectomy
  • Poland syndrome (absent pectoralis major muscle)
  • Airway obstruction
  • Large pulmonary embolus
  • Pneumothorax

A small mnemonic to quickly grab the names:

POEMS

  • P- Poland syndrome/Pneumothorax
  • O- Oligemia/Obstruction (like Pulmonary embolism)
  • E- Emphysema
  • M- Mastectomy/Mucous plug
  • S- Swyer’s james syndrome

Enjoyed reading? In our upcoming blog of Chest xray, we will be explaining Silhoutte sign (where exactly the abnormality is in the lung relating with intervening border of an organ or its part) and some pathological diseases observed on chest xrays like pulmonary embolism, left ventricular failure, bronchogenic carcinoma, bronchiectasis, and lots more. Stay tuned.

Part 2: ABCDEF Approach to Reading Chest X-Ray

Before Analyzing

Before Analyzing Chest Xray, ABCDEF approach for preliminary check can be used as:

A: AP or PA view

B: Body Position

C: Confirm Name of patient on film

D: Date of Xray

E: Exposure adequate?

F: Films for comparison

Analysis of Chest XRay

Again, an ABCDEFGHI approach can be used to recall the steps of Analysis of Chest Xray. It can be related as:

A: Airways- Initially check tracheal deviation, and then check for hilar adenopathy or enlargement

B: Bones / Breast Shadows- Check for fracture of ribs, scapula or clavicle)

C: Cardiac Silhouette- Cardiac Enlargement/ Costophrenic Angles- Check for sharp angles, if blunt could be pleural effusion

D: Diaphragm- Check for free air, could mean perforation peritonitis/ Digestive tract

E: Extra-thoracic tissues / Edges- Apices for fibrosis, pneumothorax, pleural thickening or plaques)

F: Fields- Check for alveolar filling in lung fields / Failure- Alveolar air space disease with prominent vascularity with or without pleural effusions

G: Gastric Bubble- Visible at left upper abdomen

H: Hilum- Check for lymph node enlargement

I: Insertion / Artefacts: Check for any external object appearing in xray film

Types of Headache

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Headache is indeed the most common symptom everyone suffers in his day to day life. But rather than going all type approaches for headache, we will be explaining today what are the types of headaches and what possible information a medico should have about headache.

Headache is a symptom which appears as pain occurring anywhere in the region of head and neck. Cutting off the causes of headache, we will just discuss types of headaches as shall be learn by a medical officer.

Types of Headache

There are basically 5 types of headaches that we will be dealing about in this blog. These are:

  1. Migraine
  2. Tension headache
  3. Cluster headache
  4. Hypnic headache
  5. Pseudotumour cerebri

Let’s have a closer look on all the types we just pin pointed:-

MIGRAINE

Migraine is basically a female predominant type of headache. Most common age in which females face migraine has been found to be 10-25 years of age.

Features

  1. It is commonly unilateral (meaning one sided)
  2. Throbbing pain in nature
  3. Severe in intensity
  4. Starts and peaks at 3-4 hours
  5. Associated with photophobia and phonophobia (fear of light and sound)
  6. Associated with nausea and vomiting
  7. Associated with aura

Just to explain, Aura is feeling before migraine actually starts. Visual disturbances are more common in the contralateral eye.

Migraine, again can be of two types, depending whether the aura was present or not.

  • Headache with Aura- 25% – also known as classical migraine.
  • Headache without aura- 75% – common migraine

 

Diagnosis

Clinical/ diagnosis of exclusion is done to find out migraine following the symptoms. Other features of migraine include:

  • Xray PNS (paranasal sinus) – normal
  • MRI Brain – normal
  • Fundus examination – normal

 

Treatment

Depends whether the migraine is acute migraine or chronic migraine:

1. Acute migraine

  • First drug- NSAID (Non steroidal anti inflammatory drug)
  • Best drug- sumatriptan ( sumatriptan,though, has 10-13% chances of sudden cardiac death)
  • Other drug- ergotamine

2. Chronic migraine

  • Propanolol
  • Valproate
  • Flunarizine
  • Caramazepine
  • Topirimate
  • TCA (Tricyclic antidepressants)
  • cGRP antagonist which is calcitonin related peptide, eg. OLCAGEPENT
  • PIEZOTIFEN which causes vasoconstriciton and is 5HT2 antagonist

 

Tension headache

There is constant gripping sensation on forehead. Moreover, there is no anxiety and stress. This headache is less severe in intensity and thus mild headache. Therefore, it usually doesn’t interfere with normal life.

The tension headache is further divided into two types as acute and chronic.

  • Acute Tension Headache- less than 15 episodes per month
  • Chronic Tesnion Headache- more than 15 episodes per month

 

Treatment

  • Acute Tension Headache- Nsaids
  • Chronic Tesnion Headache- TCA like amitryptiline

 

Cluster headache

It is a male predominant type of headache and commonly occurs at age of 30-40 years.
Features of cluster headache include:

  1. Rhinnorrhoea- unilateral
  2. Lacrimation- unilateral
  3. Intake of alcohol- on/off effect which is pathognomic of cluster (patient complains of increased intensify and frequency of headache with 3 episodes per day for 1-2 months and then a gap of 1 year)
  4. Tearing type of headache which hampers normal life
  5. Unilateral type
  6. Very severe in intensity
  7. Chemosis which is unilateral
  8. Nasal congestion which is unilateral
  9. Peaks in 10-15 minutes and remains for 45-60 minutes

 

Diagnosis

The diagnosis is again made on clinical basis.

Treatment

1. For acute cluster headache:

  • O2 inhalation
  • Application of lignocaine to base of inferior nasal turbinate which blocks pterygopalatine ganglion

2. For chronic cluster headache:

  • DOC,namely verapamil
  • lithium
  • steroids
  • ergotamine

 

Hypnic headache

It is more prominent in elderly females where the mean age is 60 years. The headache occurs within 1-2 hours of sleep and remains for more than 15 minutes. Pathophysiology of  hypnic headache is yet unknown but hypertension may be related since hypothalamic nucleus may have a role.

Features

  1. Occurs 1-2 hrs after sleep
  2. Very severe- patient awakes of headache
  3. Lasts more than or equal to 15 minutes (upto 1 hour)
  4. Frequency should be more episodes per month
  5. Associated with hypertension
  6. Associated with hypothalamic inflammation which gives circadian rhythmic type of headache
  7. MRI of brain is normal
  8. EEG explains REM sleep onset

 

Treatment

  • For acute attacks- NSAID like indomethacin
  • For chronic attacks- Lithium is used

 

PseudoTumour cerebri

It is also known as benign intracranial hemorrhage. It is more predominant in females than males. Common age is 35-50 years of age. The pseudo tumour cerebri is more common in obese patients.

Risk factors of pseudotumour cerebri

  • Addison’s disease
  • Hypoparathyroidism
  • Oral contraceptive pills
  • Hypervitaminosis A

 

Features

  1. Incidentally mild headache which doesn’t hamper daily activity
  2. Maybe unilateral or bilateral
  3. No focal neurological deficit (FND)
  4. Fundus- pappiloedema
  5. MRI brain is normal
  6. CSF examination reveals pressure increased and cells,protein and sugar are normal

 

Treatment

  • For chronic pseudotumour, the approach is either medical or surgical.
  • Medically, we give acetazolamide or sterouds like prednisolone.
  • Surgically, in order to reduce CSF pressure, we perform either optic nerve fenestration or Ventriculo peritoneal shunt is performed.

So that was all about the five types of headache from the medical point of view.

Medical Trade Fair Pragati Maidan 2015

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Medical Fair-India led many visitors to enjoy the exquisite opportunities of learning about the new medical technology around the globe.

Though the statement about the visits to medical fair was like:

Only for business visitors

This statement was indeed, upsetting for medical students and other aspirants who had wish to visit the medical fair without actually buying or dealing with the exhibitionist.

But later on, it was observed that the students and other visitors are allowed to visit. All that was required was an identification proof. And the entry was ABSOLUTELY FREE!

Featured Exhibitions

After visits to Hall 11,12 & 12A of pragati maidan fair, some of the wonderful and eye-catching exhibition were:

Aerocom

Aerocom
Aerocom
Aerocom

This is one technology that helps in transferring medical equipment,cash and other important things from one place to another with secured and wonderful speed. It can be used in hospitals to deliver medical equipment and others to patients and doctors.

Student-friendly Surgical models

Surgical Models

These models actually help students aspiring for surgery or orthopedics.

Wound Hub

Wound Hub
Wound Hub

This technology helps heal the wounds by spraying medic over the burns or wounds. Since you are not touching the wound, pain and chances of infection are very less.

Sliding Stair Chair

Sliding Stair Chair
Sliding Stair Chair

This can be set up at home for people who cannot walk the stairs or those are unable to walk to top floors with no access to lift or any other reason.

Wrist bands

Wrist bands

These wrist band can be used in hospitals on patients. This will easily identify the patient important details like blood group, sensitivity to penicillin, etc. without need of carrying files of individual patients.

Medical fair 2015 Pragati maidan was indeed fun, let’s see what they have planned for 2016 Mumbai!

And like the theme said:
Hope to see you soon in Medical Fair,Mumbai,2016.

What After MBBS? All Courses and Careers options

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After this blog, you will never ask the same questions again! Are you an aspiring MBBS student who is worried about career option after MBBS? Or have you considered questions like “pg courses after mbbs”, “options after mbbs” or even “jobs after mbbs”? There are a lot of approaches and ways one you may go after mbbs in India, but what is best, that comes with wisdom.

Important Update: Check your NEET PG 2019 Result here!

We will guide you through very basics of choices after MBBS you can opt and where, when and how. We will help you at our best towards all courses and career options after MBBS :

The first question, is of course, what after MBBS? Following are choices of courses that will make career after mbbs:

  • Post-graduation
  • Research
  • Hospital management
  • Foreign studies
  • Clinical practice

With these keeping as key points, we will get answers of all our questions regarding after MBBS.

Post-Graduation after MBBS

There are 3 main Post Graduation courses you can opt after MBBS. PG career after MBBS is indeed what everyone’s parents ask for. These are as follows:

  • PG- Specialty
  • PG- Diploma
  • DNB

PG- Specialty

Post graduation courses after mbbs in India are the most pronounced MD (Doctor of Medicine) and MS (Master of Surgery). These are some of the toughest PG exams in India and even after a lot of tries, many mbbs graduates fail to get success.

The simple reason behind this is very limited number of seats. Even after you get the college of your choice, you may not get the course of choice or vice-versa. Although many private colleges provide pg seats, but the price of private institutions outweighs that of merit quota.

Nevertheless, you will be having great career options after MBBS after completing Post graduation.

Duration of course: 3 years

Complete list of PG degree courses after MBBS in India include 78 recognized courses:

  • DM – Infectious Diseases
  • DM – Organ Transplant Anesthesia & Critical Care
  • DM – Critical Care Medicine
  • MD – Thoracic Medicine
  • MD – Sports Medicine
  • MD – Family Medicine
  • MD – Radio Diagnosis/Radiology
  • MD – Aviation Medicine/Aerospace Medicine
  • MD – Tuberculosis & Respiratory Diseases / Pulmonary Medicine
  • Anesthesia. & Critical Care Med.
  • MD – Medical Genetics
  • MD – Rheumatology
  • Master of Family Medicine
  • MD – Palliative Medicine
  • Master of Public Health (Epidemiology)
  • MD – Blood Banking & Immuno. Haem./Imm. Haem. & Blood Trans.
  • MD – Tropical Medicine
  • MD – Maternity & Child Health
  • MD – Pulmonary Medicine
  • MD – CCM
  • MD – P.S.M
  • MD – TB & Chest
  • MD – Skin & VD & Lepxsy
  • MD – MD- Skin & VD
  • MD-Transfusion Medicine
  • MD – Immuno Hematology & Blood Transfusion
  • MD – Medicine
  • Doctor of Medicine
  • M.D.
  • Master’s of Physician
  • MD – Pharmacology and Therapeutics
  • MD – Pathology & Microbiology
  • MD – Emergency Medicine
  • MD – R & D
  • MD – Anesthesiology
  • MD – Anatomy
  • MD – Aviation Medicine
  • MD – Bio-Chemistry
  • MD – Bio-Physics
  • MD – Community Medicine
  • MD – Dermatology
  • MD – Forensic Medicine/Forensic Medicine & Toxicology
  • MD – General Medicine
  • MD – Community Health Administration
  • MD – Geriatrics
  • MD – Hospital Administration
  • MD – Health Administration
  • MD – Lab Medicine
  • MD – Microbiology
  • MD – Nuclear Medicine
  • MD – Obstetrics & Gynecology
  • MD – Ophthalmology
  • MD – Pediatrics
  • MD – Pathology
  • MD – Dermatology , Venereology & Leprosy
  • MD – Pharmacology
  • MD – Physiology
  • MD – Physical Medicine & Rehabilitation
  • MD – Psychiatry
  • MD – Radio Diagnosis
  • MD – Radiology
  • MD – Radiotherapy
  • MD – Social & Preventive Medicine / Community Medicine
  • MD – Tuberculosis & Respiratory Diseases/Medicine
  • MD – Venereology
  • MS – Obstetrics and Gynecology
  • MS – Orthopedics
  • MS – Anatomy
  • MS – ENT
  • MS – General Surgery
  • MS – Ophthalmology
  • MS – Anesthesia
  • MS. – MS. Medicine
  • MS – Neuro Surgery
  • MS – Traumatology and Surgery
  • MD/MS – Anatomy
  • MD/MS – Ophthalmology
  • MD/MS – Obstetrics & Gynecology

MD or MS? This is another tricky question, however, the choice mainly depends on one’s skills and wish. We will soon write a blog for this topic too.

PG- Diploma

Pg diploma courses after mbbs include total of 61 courses according to MCI in India. These are as follows:

Duration of course: 2 year

Following is the list of Diploma Courses after MBBS:

  • Diploma in Anesthesia
  • Diploma in Child Health
  • Diploma in Community Medicine
  • Diploma in Clinical Pathology
  • Diploma in Dermatology
  • Diploma in Diabetology
  • Diploma in Forensic Medicine
  • Diploma in Health Administration
  • Diploma in Hospital Administration
  • Diploma in Health Education
  • Diploma in Bacteriology
  • Diploma in Obstetrics & Gynaecology
  • Diploma in Industrial Hygiene
  • Diploma in Immuno-Haematology and Blood Transfusion
  • Diploma in Leprosy
  • Diploma in Oto-Rhino-Laryngology
  • Diploma in Radio-Diagnosis
  • Diploma in Radio Therapy
  • Diploma in Medical Virology
  • Diploma in Occupational Health
  • Diploma in Ophthalmology
  • Diploma in Orthopaedics
  • Diploma in Public Health
  • Diploma in Physical Medicine & Rehabilitation
  • Diploma in Psychological Medicine
  • Diploma in Radiation Medicine
  • Diploma in Sports Medicine
  • Diploma in Tuberculosis & Chest Diseases
  • Diploma in Tropical Medicine Health
  • Diploma in Dermatology, Venereology and Leprosy
  • Diploma in Venereology
  • Diploma in Paediatrics
  • Diploma – Aviation Medicine
  • Diploma in Cardiology
  • Diploma in Basic Medical Sciences (Anatomy)
  • Diploma in Basic Medical Sciences (Physiology)
  • Diploma in Basic Medical Sciences (Pharmacology)
  • Diploma in Maternity & Child Welfare
  • DGO -PREVENTIRE & SOCIAL MEDICINE
  • DGO
  • FMT
  • PSM
  • Diplom -Diploma V & D
  • Diploma – Diploma – OLO – Rhino-Laryngology
  • Diploma – Diploma in Medical Radio-Diagnosis
  • Diploma in Medicine Radiology and Electrology
  • Diploma – Diploma in Pathology & Bacteriology
  • Diploma- Plastic Surgery
  • Diploma- Urology
  • Diploma-Diplomate N.B.(Gen.Surg.)
  • Diploma in Microbiology
  • Dip. in Path.& Bact.
  • Diploma in Industrial Health
  • Diploma in Medical Radio Electrology
  • Diploma (Marine Medicine)
  • Diploma in Nutrition
  • Diploma in ENT
  • Diploma in Psychiatry
  • Diploma in Radiological Physics
  • Diploma in Neuro-pathology
  • Diploma in Allergy & Clinical Immunology

DNB (Diplomate of National Board) after MBBS

DNB stands for Diplomate of National board and is another diploma equivalent to MD. You can find more about DNB in the link given below.




This is another perfect career option after MBBS apart from Post-graduation.

Duration of course: – 3 years

Link to DNB CET

Research after MBBS

Clinical research options for MBBS students rely on your will to learn and to invent. The most renowned research institute in India is the ICMR (Indian council for medical research) which is also renowned for its studentship to graduating mbbs students, though the 5000 INR is too low for 2 months, but the experience adds wonders to your resume.

Duration of course: – 3 years

Following 45 PhD courses after MBBS have been recognized by MCI in India:

  • Ph. D – Bio- Chemistry
  • Ph. D – Microbiology
  • Ph. D – Pathology
  • Ph. D – Forensic Medicine
  • Ph. D – Anaesthesia
  • Ph. D – Bio-Statistics
  • Ph. D – Bio-Technology
  • Ph. D – Cardiology
  • Ph. D – Community Medicine
  • Ph. D – Cardio Thoracic & Vascular Surgery
  • Ph. D – Dermatology & Venereology
  • Ph. D – Endocrinology & Metabolism
  • Ph. D – ENT
  • Ph. D – Gastro & Human Nutrition Unit
  • Ph. D – Gastrointestinal Surgery
  • Ph. D – Hospital Administration
  • Ph. D – Haematology
  • Ph. D – Histo Compatibility & Immunogenetics
  • Ph. D – Lab Medicine
  • Ph. D – Medical Oncology
  • Ph. D – Medical Physics
  • Ph. D – Medicine
  • Ph. D – Nephrology
  • Ph. D – Neurology
  • Ph. D – Neuro Surgery
  • Ph. D – Neuro Magnetic Resonance
  • Ph. D – Nuclear Medicine
  • Ph. D – Obst. & Gynae
  • Ph. D – Ocular Bio Chemistry
  • Ph. D – Ocular Microbiology
  • Ph. D – Ocular Phramacology
  • Ph. D – Orthopaedics
  • Ph. D – Paediatric Surgery
  • Ph. D – Paediatric
  • Ph. D – Physical Medicine & Rehabilitation
  • Ph. D – Psychiatry
  • Ph. D – Radiotherapy
  • Ph. D – Radio Diagnosis
  • Ph. D – Surgery
  • Ph. D – Urology
  • Ph. D – Medical Biochemistry
  • Doctor of Phylosophy
  • Ph. D-Pharmacology
  • Ph. D – Anatomy
  • Ph. D – Physiology

Hospital Management after MBBS

Hospital management is another very fast developing sector which is one trending career option available for MBBS students. IIM (Indian institute of Management) is one worthy but toughest choice. But you should be prepared to face the competition for this course.

MBA or MHA? Where MBA stands for Masters of Business Administration, MHA stands for Masters in Hospital Administration. Both are choices for getting into the hospital management, but which to go for? You can read our review on MBA vs MHA.

Duration of course: 2 years

Foreign Studies after MBBS

And then you wanted to study abroad, but here we will discuss education after MBBS in USA and UK. USMLE is for US while PLAB is for UK.




USMLE stands for United States Medical Licensing Examination and is one of most fortunes giving choice. Yet many Indians fail to achieve a success even after appropriate tries. This is because USMLE is a 3 step procedure. Further, the costs are too high and even after you complete these three steps, it still doesn’t guarantee until you have secured US residency. But if you get it, you will make fortunes after MBBS.

You can find more info on USMLE here or apply to USMLE.

PLAB is an alternative to USMLE who want to study in UK after MBBS. PLAB stands for Professional and Linguistic Assessments Board. It is an option after MBBS in UK.

You can find more info on PLAB here.

Please note, there are other master degrees and PhD course in other countries like US too, but we have missed them since we are focusing on more appropriate choices for an Indian MBBS student.

Clinical Practice after MBBS

While some believe practicing at clinic refreshes what you study and hence help in preparing for PG exams, some give preference to getting as much time for books.

An MBBS graduate student may plan to study while going for job after mbbs, or start clinical practice immediately after completing MBBS. It can be done in following ways:

  • Government hospitals: You can either go for Full time job or even do contract basis part time job.
  • Private Hospitals- Corporate sectors always welcome worthy students.
  • Owned clinic- Owned clinic, nursing home or hospitals are always the best choice for some.

References:
MCI (Medical Council of India)

So, we hope we delivered you the best of courses and career options that you can go for after MBBS. If you still have doubts, let us know in the comments.

Online Histology Made Easy Slides Atlas

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We have prepared an online atlas of histology that has following histology slides terming it as Histology made easy. These histology slides can be used for practical exams in First Year MBBS while others may find it useful in their ways. Hope the following slides help you in exams and learning it better, though you will have to refer a histology atlas book.

Appendix Histology slide

Appendix Histology slide
Appendix Histology slide

Bone Histology slide

Bone Histology slide
Bone Histology slide

Cardiac muscle Histology slide

Cardiac muscle Histology slide
Cardiac muscle Histology slide

Cerebellum Histology slide

Cerbellum Histology slide
Cerbellum Histology slide

Cerebrum Histology slide

Cerebrum Histology slide
Cerebrum Histology slide

Cornea Histology slide

Cornea Histology slide
Cornea Histology slide

Dorsal root ganglia Histology slide

Dorsal root ganglia Histology slide
Dorsal root ganglia Histology slide

Duodenum Histology slide

Duodenum Histology slide
Duodenum Histology slide

Elastic artery Histology slide

Elastic artery Histology slide
Elastic artery Histology slide

Epididymis Histology slide

Epididymis Histology slide
Epididymis Histology slide

Fallopian tube Histology slide

Fallopian tube Histology slide
Fallopian tube Histology slide

Fundus stomach Histology slide

Fundus stomach Histology slide
Fundus stomach Histology slide

Gall bladder Histology slide

Gall blader Histology slide
Gall blader Histology slide

Hyaline Cartilage Histology slide

Hyaline Histology slide
Hyaline Histology slide

Ileum Histology slide

Ileum Histology slide
Ileum Histology slide

IVC Histology slide

IVC Histology slide
IVC Histology slide

Jejunum Histology slide

Jejunum Histology slide
Jejunum Histology slide

Large intestine colon Histology slide

Large Intestine colon Histology slide
Large Intestine colon Histology slide

Large intestine Histology slide

Large Intestine Histology slide
Large Intestine Histology slide

Liver Histology slide

Liver Histology slide
Liver Histology slide

LS of thin skin Histology slide

Ls of thin skin Histology slide
Ls of thin skin Histology slide

Lungs Histology slide

Lungs Histology slide
Lungs Histology slide

Lymph node Histology slide

Lymph Node Histology slide
Lymph Node Histology slide

Mixed gland Histology slide

Mixed Gland Histology slide
Mixed Gland Histology slide

Mucus glands Histology slide

Mucus Glands Histology slide
Mucus Glands Histology slide

Muscular artery Histology slide

Muscular Artery Histology slide
Muscular Artery Histology slide

Esophagus Histology slide

Esophagus Histology slide
Esophagus Histology slide

Ovary Histology slide

Ovary Histology slide
Ovary Histology slide

Palatine tonsil Histology slide

Palatine tonsil Histology slide
Palatine tonsil Histology slide

Pituitary gland Histology slide

Pituitary gland Histology slide
Pituitary gland Histology slide

Prostate Histology slide

Prostate Histology slide
Prostate Histology slide

Pylorus Histology slide

Pylorus Histology slide
Pylorus Histology slide

Retina Histology slide

Retina Histology slide
Retina Histology slide

Serous gland Histology slide

Serous gland histology slide
Serous gland histology slide

Simple Columnar Histology slide

Simple Columnar Histology slide
Simple Columnar Histology slide

Skeletal muscle Histology slide

Skeletal muscle Histolog slide
Skeletal muscle Histolog slide

Smooth muscle Histology slide

Smooth muscle Histology slide
Smooth muscle Histology slide

Spleen Histology slide

Spleen Histology slide
Spleen Histology slide

Sub-mandibular gland Histology slide

Submandibular gland Histology slide
Submandibular gland Histology slide

Supra-renal gland Histology slide

Suprarenal gland Histology slide
Suprarenal gland Histology slide

Sympathetic ganglia Histology slide

Sympathetic ganglia Histology slide
Sympathetic ganglia Histology slide

Testis Histology slide

Testis Histology slide
Testis Histology slide

Thick skin Histology slide

Thick skin Histology slide
Thick skin Histology slide

Thymus Histology slide

Thymus Histology slide
Thymus Histology slide

Thyroid Histology slide

Thyroid Histology slide
Thyroid Histology slide

Tongue Histology slide

Tongue Histology slide
Tongue Histology slide

Trachea Histology slide

Trachea Histology slide
Trachea Histology slide

TS of skin Histology slide

TS of skin Histology slide
TS of skin Histology slide

Ureter Histology slide

Ureter Histology slide
Ureter Histology slide

Urinary bladder Histology slide

Urinary bladder Histology slide
Urinary bladder Histology slide

Uterus Histology slide

Uterus Histology slide
Uterus Histology slide

Vas Deferens Histology slide

Vas Deferens Histology slide
Vas Deferens Histology slide

This was our online atlas of histology for first year mbbs students. If you want to download the atlas in PDF format or if you want these histology slides in High Image Quality, then please contact us through Facebook page or through mailing us at given address.

Intravenous Cannula Insertion | IV Cannulation: Common Veins Sites

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Intravenous Cannula Insertion is one important clinical procedure that requires skills and practice. But you can always get some tips and info from sources. With the below guide, you will learn what is Intravenous (IV) Cannula Insertion, Indications, Procedure, Common vein sites for cannula insertion, When to avoid it, Complications and some bonus tips.

Definition

Intravenous Cannula Insertion is a procedure of inserting intravenous cannula or IV cannula into the vein to provide easy access to vein and hence reduce IV injection repetitions.

Indications

  1. Repeated blood sampling
  2. Intravenous fluid administration
  3. Intravenous medications administration
  4. Intravenous chemotherapy administration
  5. Intravenous nutritional support
  6. Intravenous blood or blood products administration
  7. Intravenous administration of radiological contrast agents for computed tomography, magnetic resonance imaging, or nuclear imaging

Procedure

The procedure involves the following steps:

A. Introduce yourself to the patient and ask for his consent to perform the Intravenous Cannula Insertion. Usually this is avoided in hospitals but it is an important step.

B. Prepare the equipment

The equipment required for IV Cannulation should be ready. The equipment required for iv cannula insertion include:

  1. Hand sanitizer
  2. Gloves
  3. Cotton
  4. Disposable tourniquet
  5. IV cannula
  6. Suitable plaster
  7. Syringe
  8. Saline

C. Wash your hands with a hand sanitizer.

D. Identify the vein in which venous cannula is to be inserted. The preferable site includes median vein in arm.

E. Click Sites of Intravenous Cannula Insertion to know more about sites of choice for IV cannula insertion.

F. Apply the tourniquet above the insertion point and make sure it is tight but make sure it is comfortable for patient.

G. Wear the gloves and clean the patient’s skin.

H. Prepare the cannula for insertion and avoid touching it.

I. Stretch the skin distally and tell the patient to expect a sharp scratch.

J. Insert the needle, bevel upwards at about 30 degrees. Advance the needle until you observe blood at the back of the cannula.

K. Once bloods appear, progress the entire cannula a further 2mm, and then fix the needle, advancing the rest of the cannula into the vein.

L. Release the tourniquet, apply pressure to the vein at the tip of the cannula and remove the needle fully. Remove the cap from the needle and put this on the end of the cannula.

M. Dispose off the needle used to ensure clinical safety.

N. Apply the dressing to the cannula to fix it in place.

O. Fill the syringe with saline and flush it through the cannula to check for patency. If there is any resistance, if it causes any pain, or you notice any localized tissue swelling; immediately stop flushing, remove the cannula and start again.

P. Dispose off your gloves and equipment in the clinical waste bin.

Common Veins Sites

Sites for Intravenous cannula insertion include common veins for IV cannula- Cephalic vein, Basilica vein, Median vein and Metacarpal veins.

Common sites of veins for Intravenous Cannulation
Common sites of veins for Intravenous Cannulation

While Median vein remains the choice of vein, each vein has its own advantages and disadvantages.

These are as follows:

1. Cephalic vein

Advantages:

  • Readily receives a large cannula and is therefore a  good site for blood administration.
  • Splinted by the forearm bones
  • Cannula is easily secured

Disadvantages:

  • Can be more difficult to cannulate than the metacarpal veins.
  • May be confused with an aberrant radial artery.

2. Basilic vein

Advantages:

  • A large vein that is frequently overlooked while searching for other veins.

Disadvantages:

  • Requires awkward positioning of the limb to gain access to the vein.
  • The vein tends to roll away when you attempt to cannulate  it.
  • Site prone to phlebitis.
  • Cannula port gets caught on sheets.

3. Median vein

Advantages”

  • Large veins and so they will readily accept a large cannula.
  • Do not “shut down” as quickly as the more peripheral veins.
  • First choice in emergency situation.

Disadvantages:

  • Can be very positional due to elbow flexion/extension.
  • Can be very uncomfortable for the patient due to elbow flexion/extension.
  • Care must be taken not to cannulate the brachial artery.

4. Metacarpal veins

Advantages:

  • Easy to see and palpate veins.
  • Splinted by metacarpal bones
  • Allows use of more proximal veins in the same limb should the cannula need to be re-sited.
  • Cannula is easily accessible in the theater environment.

Disadvantages:

  • Active patients may dislodge easily.
  • Dressing may be compromised by hand-washing.
  • May be more difficult if the skin is thin and friable.
  • Flow can be affected by wrist flexion or extension i.e. A POSITIONAL VENFLON.

Contraindications

There is no absolute contraindication for Intravenous cannula insertion, but some key points may always be recalled:

  1. When peripheral venous access is an injured, infected, or burned extremity, Cannulation should be avoided if possible.
  2. Some vesicant and irritant solutions (pH < 5, pH >9, or osmolarity >600m Osm/L) can cause blistering and tissue necrosis if they leak into the tissue, including sclerosing solutions, some chemotherapeutic agents, and vasopressors. These solutions are more safely infused into a central vein. They should only be given through a peripheral vein in emergency situations or when a central venous access is not readily available.

Complications

  1. Hematoma: a collection of blood, which can result from failure to puncture the vein when the cannula is inserted or when the cannula is removed. Selection of an appropriate vein and gently applying pressure slightly above the insertion point on removal of the cannula may prevent this.
  2. Infiltration: when infusate enters the subcutaneous tissue instead of the vein. To prevent this, a cannula with accurate trim distances may be used. It is essential to fix the cannula in place firmly.
  3. Embolism: this can be caused by air, a thrombus, or fragment of a catheter breaking off and entering the venous system. It can cause a pulmonary embolism. Air emboli can be avoided by making sure that there is no air in the system. A thromboembolism can be avoided by using a smaller cannula.
  4. Phelebitis: an inflammation of the vein resulting from mechanical or chemical irritation or from an infection. Phlebitis can be avoided by carefully choosing the site for cannulation and by checking the type of infusate used.

Bonus tips

  1. Always apply tourniquet first. This makes the vein show up easily.
  2. With patient having cold arms or arms at room temperature, veins do not tend to show up easily.
  3. Wrist sites are highly prone to infiltration, pain, and positional flowing of the IV solution. Select something mid-arm or in the hand for the best results, and always start distal and work your way proximal unless there is a clinical reason for a larger vein.

But the best learning comes with practice, so go and try it out.

What is Endotracheal Intubation: Procedure, Steps, Complications

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Endotracheal Intubation is an emergency procedure of introducing ET or Endotracheal Tube Insertion. It is one of the widely performed medical procedure in casualty to establish respiration to those who are unable to breath. Our guide below will help you with its indications, procedure, complications and a video of course.

What is Endotracheal Tube Insertion?

Endotracheal Tube Insertion or Endotracheal Intubation (EI) is an emergency procedure most often performed in patients who are unconscious or who cannot breathe on their own. EI helps to prevent suffocation or obstruction of the passage of air.

In a typical EI, a patient is first given a heavy anesthetic. Then, a flexible plastic tube is placed into the trachea (windpipe) through the mouth or sometimes the nose to help the patient with breathing.

The trachea, also known as the windpipe, is a cylindrical tube that is about four inches long and one inch in diameter. It begins just under the voice box, descends behind the breastbone, and then divides into two smaller tubes. Each tube connects to one of your lungs.

The windpipe is made from discs of tough cartilage, muscle, and connective tissue. Its lining is composed of smooth tissue. Each time you breathe in, the windpipe gets slightly longer and wider—then returns to its normal size as you breathe out.

Indications

Basically, Endotracheal Tube Insertion is used for:

  • Provide airway for mechanical ventilatory support.Administration of surfactants or other medications directly into the lungs.
  • Relieve critical upper airway obstruction.
  • Provide route for selective bronchial ventilation.
  • Assist in pulmonary hygiene when secretions cannot be otherwise cleared.
  • Obtain direct tracheal cultures.

Specifically, endotracheal tube insertion is used for the following conditions:

  • Respiratory arrest
  • Respiratory failure
  • Airway obstruction
  • Need for prolonged ventilatory support
  • Class III or IV hemorrhage with poor perfusion
  • Severe flail chest or pulmonary contusion
  • Multiple trauma, head injury and abnormal mental status
  • Inhalation injury with erythema/edema of the vocal cords
  • Protection from aspiration

Preparation

Endotracheal Intubation is an invasive procedure and can cause considerable discomfort. For this reason, general anesthesia and a muscle relaxing medication are usually administered so that you do not feel anything. However, if necessary, the procedure can be performed while the patient is awake, with local anesthesia or with no anesthesia at all.

Procedure Steps

To begin the procedure steps, an anesthesiologist opens the patient’s mouth by separating the lips and pulling on the upper jaw with the index finger. Holding a laryngoscope in the left hand, he or she inserts it into the mouth of the patient with the blade directed to the right tonsil. Once the right tonsil is reached, the laryngoscope is swept to the midline, keeping the tongue on the left to bring the epiglottis into view.

The laryngoscope blade is then advanced until it reaches the angle between the base of the tongue and the epiglottis. Next, the laryngoscope is lifted upwards towards the chest and away from the nose to bring the vocal cords into view. Often during endotracheal intubation, an assistant has to press on the trachea to provide a direct view of the larynx. The anesthesiologist then takes the endotracheal tube, made of flexible plastic, in the right hand and starts inserting it through the mouth opening.

The tube is inserted through the cords to the point that the cuff rests just below the cords. Finally, the cuff is inflated to provide a minimal leak when the bag is squeezed. Using a stethoscope, the anesthesiologist listens for breathing sounds to ensure correct placement of the tube.

Risks

Waking Up While Under Anesthesia

According to the Mayo Clinic, about one or two people in every 1,000 wake up briefly while under the effects of general anesthesia. If this happens, usually you will be aware of your surroundings but will feel no pain. On rare occasions of endotracheal intubation, people feel severe pain. This can lead to long-term psychological problems. Factors that may increase the risk of this happening include:

  • Emergency surgery
  • Heart or lung problems
  • Long-term use of opiates, tranquilizers, or cocaine
  • Daily alcohol use

Risks

There are some risks related to endotracheal intubation. To prevent these from occurring, you will be evaluated by the anesthesiologist (or ambulance personnel in an emergency situation) before the procedure and will be monitored throughout for potential complications such as:

  • Buildup of excess water in your tissues
  • Bleeding
  • Collapsed lung

Sleep Paralysis: Demon vs Medical | Sleep Apnoea

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Have you ever wake up to find you cannot move or speak but you can feel everything and hear everything near you? Have you ever felt that a ghost or something is trying to stop you from getting up? The phenomenon you just suffered is called Sleep Paralysis or Sleep Apnoea. This guide will explain the medical causes as well as uncover what are the mythological creatures supposed for Sleep Apnoea in different countries and culture.

Then certainly you are reading the right blog. We will be explaining what just happened with you. Read throughout what just caught you!

Two way approach

The two-way approach says either you will take it as medical condition or stick to the old theory-“A ghost struck me!” So, we are gonna explain everything according to the two-way approach for sleep apnoea or the sleep paralysis.

Where the medical approach defines parameters for sleep apnoea, the spiritual theory says you will call demons to this world if you recite the prayers backwards!

Sleep Paralysis: A Medical Approach

Sleep paralysis or Sleep Apnoea is a feeling of being conscious but unable to move. It occurs when a person passes between stages of wakefulness and sleep. During these transitions, you may be unable to move or speak for a few seconds up to a few minutes.

Some people may also feel pressure or a sense of choking. Sleep paralysis may accompany other sleep disorders such as narcolepsy. Narcolepsy is an overpowering need to sleep caused by a problem with the brain’s ability to regulate sleep.

When it occurs?

Sleep paralysis can occur either when you are asleep or when you are awake.

When asleep: If it occurs while you are falling asleep, it’s called hypnagogic or predormital sleep apnoea.

Mechanism: As you fall asleep, your body slowly relaxes. Usually you become less aware, so you do not notice the change. However, if you remain or become aware while falling asleep, you may notice that you cannot move or speak.

When awake: If it happens as you are waking up, it’s called hypnopompic or postdormital sleep paralysis.

Mechanism: During sleep, your body alternates between REM (rapid eye movement) and NREM (non-rapid eye movement) sleep. One cycle of REM and NREM sleep lasts about 90 minutes. NREM sleep occurs first and takes up to 75% of your overall sleep time. During NREM sleep, your body relaxes and restores itself. At the end of NREM, your sleep shifts to REM. Your eyes move quickly and dreams occur, but the rest of your body remains very relaxed. Your muscles are “turned off” during REM sleep. If you become aware before the REM cycle has finished, you may notice that you cannot move or speak.

Causes

Many theories have been put up for the causes like hormones or neurological, but the more casual approach just defines the simple causes:

  1. Teenage
  2. Lack of sleep
  3. Changing sleep schedule
  4. Sleeping on the back
  5. Other sleep problems like narcolepsy or nighttime leg cramps
  6. Use of meds like for ADHD
  7. Substance abuse

Diagnosis

If you find yourself unable to move or speak for a few seconds or minutes when falling asleep or waking up, then it is likely you have isolated recurrent sleep paralysis. Often, there is no need to treat this condition.

More symptoms include:

  1. Anxiety
  2. Tiredness
  3. Insomnia or sleepless at nights

Treatment

Most people need no treatment for sleep apnoea. Treating any underlying conditions such as narcolepsy may help if you are anxious or unable to sleep well. These treatments may include the following:

  • Improving sleep habits — such as making sure you get six to eight hours of sleep each night
  • Using antidepressant medication if it is prescribed to help regulate sleep cycles
  • Treating any mental health problems that may contribute to sleep paralysis
  • Treating any other sleep disorders, such as narcolepsy or leg cramps

The Demon- Paranormal Theories

Some people deny the fact of medical thing, because the feeling of demon is so strong, that they can actually feel like a ghost is sitting on the chest! They may also report like someone or something was preventing them from moving while they were trying to move from the bed.

In such a case, we have got a collection of cultural beliefs of different countries which define sleep paralysis with supernatural powers in their own languages. These are Cultural beliefs of sleep apnoea.

Scandinavian folklore

Mare, a supernatural creature which is related to incubi and succubi, is a cursed woman and her body is carried mysteriously during sleep and without her noticing. In this state, she visits villagers to sit on their rib cages while they are asleep, causing them to experience nightmares. Watch the movie Marianne for epic fun.

China

Pinyin: guǐ yā shēn is translated as “ghost pressing on body” or “ghost pressing on bed.”

Japan

Kanashibari, meaning Bound in metal (Kana: Metal, Shibari: To bind)

Korea

The term sleep paralysis is called gawi nulim, literally meaning “being pressed down by something scary in a dream.” It is often associated with a belief that a ghost or spirit is lying on top of or pressing down on the sufferer.

Mongolia

Nightmares in general as well as sleep apnoea is referred to by the verb-phrase khar darakh meaning “to be pressed by the Black” or “when the Dark presses.”

Tibet

Sleep paralysis is often known as dip-non or dip-phok which translates roughly as “oppressed/struck by dip”; dip, literally meaning shadow, refers to a kind of spiritual pollution.

Cambodia

Sleep paralysis is called phǐǐ am and khmout sukkhot. It is described as an event in which the person is sleeping and dreams that one or more ghostly figures are nearby or even holding him or her down. The sufferer is unable to move or make any noises. This is not to be confused with pee khao and khmout jool, ghost possession.

Thailand

Sleep paralysis is called phǐǐ am and khmout sukkhot. It is described as an event in which the person is sleeping and dreams that one or more ghostly figures are nearby or even holding him or her down. The sufferer is unable to move or make any noises.

Vietnam

Sleep paralysis is called ma đè, meaning “held down by a ghost,” or bóng đè, meaning “held down by a shadow.”

Philippine

Bangungut has traditionally been attributed to nightmares.

New Guinea

People refer to this phenomenon as Suk Ninmyo, believed to originate from sacred trees that use human essence to sustain its life. The trees are said to feed on human essence during night as to not disturb the human’s daily life, but sometimes people wake unnaturally during the feeding, resulting in the paralysis.

Malay Peninsula

Sleep paralysis is known as kena tindih (or ketindihan in Indonesia), which means “being pressed.” Incidents are commonly considered the work of a malign agency; occurring in what are explained as blind spots in the field of vision, they are reported as demonic figures.

India Kashmir

In Kashmiri mythology, sleep apnoea is caused by an invisible creature called a pasikdhar or a saayaa. Some people believe that a pasikdhar lives in every house and attacks somebody if the house has not been cleaned or if god is not being worshiped in the house. One also experiences this if one has been doing something evil or derives pleasure from the misfortunes of others.

India Tamil Nadu

The sleep paralysis phenomenon is referred to as Amuku Be or Amuku Pei meaning “the ghost that forces one down.”

Pakistan

Sleep paralysis is considered an encounter with Shaitan (Satan), evil jinns or demons who have taken over one’s body. Like Iran, this ghoul is known as bakhtak or ‘ifrit’. It is also assumed that it is caused by the black magic performed by enemies and jealous persons. People, especially children and young girls, wear Ta’wiz (Amulet) to ward off evil eye. Spells, incantations and curses could also result in ghouls haunting a person. Some homes and places are also believed to be haunted by evil ghosts, satanic or other supernatural beings and they could haunt people living there especially during the night. Muslim holy persons (Imams, Maulvis, Sufis, Mullahs, Faqirs) perform exorcism on individuals who are believed to be possessed. The homes, houses, buildings and grounds are blessed and consecrated by Mullahs or Imams by reciting Qur’an and Adhan, the Islamic call to prayer, recited by the muezzin.

Bangladesh

The phenomenon of sleep apnoea is referred to as boba (“speechless”).

Sri Lanka

This particular phenomenon is referred to as Amuku Be or Amuku Pei meaning “the ghost that forces one down.”

Nepal

Especially Newari culture,it is also known as Khyaak, after a ghost-like figure believed to reside in the darkness under the staircases of a house.

Arab

Sleep paralysis is often referred to as Ja-thoom, literally “What sits heavily on something”. In folklore across Arab countries, the Ja-thoom is believed to be a shayṭān or a ‘ifrīt sitting on top of the person or is also choking him. It is said that it can be prevented by sleeping on your right side and reading the Throne Verse of the Quran.

Turkey

Sleep apnoea is often referred to as karabasan (“the dark presser/assailer”). It is believed to be a creature that attacks people in their sleep, pressing on their chest and stealing their breath. However, folk legends do not provide a reason why the devil or ifrit does that.

Persia

It is known as bakhtak, which is a ghost-like creature that sits on the dreamer’s chest, making breathing hard for him/her.

Nigeria

Ogun Oru is a traditional explanation for nocturnal disturbances among the Yoruba of Southwest Nigeria; ogun oru (“nocturnal warfare”) involves an acute night-time disturbance that is culturally attributed to demonic infiltration of the body and psyche during dreaming.

Ogun oru is characterized by its occurrence, a female preponderance, the perception of an underlying feud between the sufferer’s earthly spouse and a “spiritual” spouse, and the event of bewitchment through eating while dreaming. The condition is believed to be treatable through Christian prayers or elaborate traditional rituals designed to exorcise the imbibed demonic elements.

Zimbabwe

The word Madzikirira is used to refer something strongly pressing one down. This mostly refers to the spiritual world in which some spirit—especially an evil one—tries to use its victim for some evil purpose. The people believe that witches can only be people of close relations to be effective, and hence a witches often try to use one’s spirit to bewitch one’s relatives.

Ethiopia

The word dukak (“depression”) is used, which is believed to be an evil spirit that possesses people during their sleep. Some people believe this experience is a symptom of withdrawal from the stimulant khat. The evil spirit dukak is an anthropomorphic personification of the depression that often results from the act of quitting chewing khat. ‘Dukak’ often appears in hallucinations of the quitters and metes out punishments to its victims for offending him by quitting. The punishments are often in the form of implausible physical punishments (e.g., the dukak puts the victim in a bottle and shakes the bottle vigorously) or outrageous tasks the victim must perform (e.g., swallow a bag of gravel).

Finland

Sleep paralysis is called unihalvaus (dream paralysis), but the Finnish word for nightmare, painajainen, is believed to originally have meant sleep apnoea, as it’s formed from the word painaja, which translates to pusher or presser, and the diminutive suffix -nen.

Hungary

Sleep paralysis is called lidércnyomás (lidérc pressing) and can be attributed to a number of supernatural entities like lidérc (wraith), boszorkány (witch), tündér (fairy) or ördögszerető (demon lover).[17] The word boszorkány itself stems from the Turkish root bas-, meaning “to press.”

Iceland

Sleep apnoea is generally called having a Mara. A goblin or a succubus (since it is generally female) believed to cause nightmares (the origin of the word ‘Nightmare’ itself is derived from an English cognate of her name). Other European cultures share variants of the same folklore, calling her under different names; Proto-Germanic: marōn; Old English: mære; German: Mahr; Dutch: nachtmerrie; Icelandic, Old Norse, Faroese, and Swedish: mara; Danish: mare; Norwegian: mare; Old Irish: morrigain; Croatian, Bosnian, Serbian, Slovene: môra; Bulgarian, Polish: mara; French: cauchemar; Romanian: moroi; Czech: můra; Slovak: mora. The origin of the belief itself is much older, back to the reconstructed Proto Indo-European root mora-, an incubus, from the root mer- “to rub away” or “to harm.”

Malta

Sleep apnoea attributes a sleep paralysis incident to an attack by the Haddiela, who is the wife of the Hares, an entity in Maltese folk culture that haunts the individual in ways similar to a poltergeist. As believed in folk culture, to get rid of the Haddiela, one must place a piece of silverware or a knife under the pillow prior to sleep.

Greece

It is believed that sleep paralysis occurs when a ghost-like creature or Demon named Mora, Vrahnas or Varypnas (Greek: Μόρα, Βραχνάς, Βαρυπνάς) tries to steal the victim’s speech or sits on the victim’s chest causing asphyxiation.

America:

Salem witch trials

During the Salem witch trials several people reported night-time attacks by various alleged witches, including Bridget Bishop, that may have been caused by sleep paralysis.

Mexico

It is believed that this is caused by the spirit of a dead person. This ghost lies down upon the body of the sleeper, rendering him unable to move. People refer to this as “subirse el muerto” (dead person on you).

Newfoundland

Sleep apnoea is known as the ‘Old Hag’. In island folklore, the Hag can be summoned to attack a third party, like a curse.

Brazil

There is a legend about a mythological being called the pisadeira (“she who steps”). She is described as a tall, skinny old woman, with long dirty nails in dried toes, white tangled hair, a long nose, staring red eyes, and greenish teeth on her evil laugh. She lives over the roofs, waiting to step on the chest of those who sleep with a full stomach.

Alien abduction

Some people also report that alien took them away and did experiments on them and returned them back.

This was all about Sleep Apnoea- The way you think is the one which will decide what it does to you. The best solution to get rid of it is SLEEP!

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