Hb Bart syndrome

It is the most severe form of alpha thalassaemia. Caused by mutation or deletion of all 4 alpha globin alleles (copies of the alpha globin genes) causing a lack of production of alpha hemoglobin.

Anion gap

In plasma

Cations Na+136 mEq/L K+ 4.5 mEq/L Ca++ 5 mEq/L Mg++ 1.5 mEq/L

Anions Cl- 100 mEq/L HCO3- 24 mEq/L Proteins 15 mEq/L PO4--- 2 mEq/L SO4-- 1 mEq/L Organic acid 5 mEq/L

The normal range of anion gap is 8 to 16.

The anion gap is increased in Lactic acidosis DKA Hyperosmolar acidosis Salicylate poisoning Ethylene glycol poisoning Paraldehyde poisoning Hypokalaemia Hypocalcaemia Hypomagnesaemia.

Anion gap reduced in Bromide poisoning Myeloma.

Classification of Data

1. Quantitive or contunuous
eg. age, height, weight, Blood pressure

2. Ordinal
eg. mild, moderate, severe symptoms

3. Categorical
eg. hair color, ethnic group

4. Binary
eg. male or female

5. Time dependent
eg. Classification of subject whether dead or alive depending on the length of follow-up

How to calculate confidence interval for the mean

95%CI = mean ± (1.96 * SEM )
99%CI = mean ± (2.58 * SEM )
90%CI = mean ± (1.65 * SEM )
SEM = standard error of the mean

Branches of lumbar plexus

The lumbar plexus involves the anterior primary rami of L1 to L5. This plexus forms in the substance of psoas major muscle. The branches are
Iliohypogastric L1
Ilioinguinal L1
Lateral cutaneous nerve of thigh L2 L3
Femoral L2L3L4

Genitofemoral L1L2

Obturator L2L3L4
Lumbosacral trunk L4L5

All the branches emerge from the lateral border of psoas major except genitofemoral (anterior), Obturator (medial) and Lumbosacral (medial).

The Obturator nerve

Arises from the ventral primary rami of the 2nd, 3rd, 4th lumbar nerves.
Emerges from the medial side of psoas major muscle.
Reaches the thigh by passing through obturator canal.
Provides cutaneous branches to medial aspect of thigh and
Muscular branches to gracilics, Obturator externus and adductor muscles (longus, magnus and brevis).
Articular branches to hip and knee joints.

The fallopian tube

The fallopian tube is developed from the cranial portion of paramesonephric duct. It is narrower at its medial than lateral end. The most lateral part is called fimbrial. The fimbria ovarica attaches the tube to the lateral pole of the ovary and presumed to aid in ovum transport into the tube. From medial to lateral the tube has parts namely interstitial, isthmus, ampulla, infundibulum and fimbria.
The tube is lined by single layered columnar epithelium with 4 types of cells; ciliated, secretory, peg and basal. Ciliated cells are more numerous in infundibulum and ampullary regions, with secretory cells more often seen in isthmus.
The epithelium shows cyclical changes.

Fallopian tube

The fallopian tube is developed from the cranial portion of paramesonephric duct. It is narrower at its medial than lateral end. The most lateral part is called fimbrial. The fimbria ovarica attaches the tube to the lateral pole of the ovary and presumed to aid in ovum transport into the tube. From medial to lateral the tube has parts namely interstitial, isthmus, ampulla, infundibulum and fimbria.
The tube is lined by single layered columnar epithelium with 4 types of cells; ciliated, secretory, peg and basal. Ciliated cells are more numerous in infundibulum and ampullary regions, with secretory cells more often seen in isthmus.
The epithelium shows cyclical changes.

Cardiac output in normal pregnancy

In normal pregnancy, cardiac output starts to rise from early pregnancy and peak at around 20 weeks which is about 1.5litre per minutes (40% above the non pregnant level). This rise is maintained through the rest of pregnancy.
The increase in CO is caused by increased heart rate (15beat/min) and stroke volume (from 65 to 70ml).

What is Ferguson reflex?

The neuronal stimuli caused by distension of the cervix by the presenting part of the fetus increase the secretion of oxytocin more frequently during labour.
This is called as Ferguson Reflex.