Human papilloma virus vaccination is considered as a breakthrough in prevention of human cervical cancer. Human papilloma virus is able to cause malignant transformation of cervical epithelium. Harald zur Hausen was given the Nobel Prize in 2008 for this discovery. Vaccination is given to adolescent girls prior to onset of sexual intercourse. It has a 98 to 100% efficacy and is recommended at 11 to 12 years of age. It may benefit older girls as well, but is not recommended after the age of 26 years. 

Hepatic encepahalopathy is a neuropsychiatric syndrome with multiple manifestations. It is caused by liver failure and / or portosystemic shunting of blood. It is potentially reversible.
Loss of function / or mass of hepatocytes can cause hepatic encephalopathy. The former occurs in acute fatty liver of pregnancy.
Pathogenesis of hepatic encephalopathy
Various agents are implicated in the pathogenesis of hepatic encephalopathy:
Direct ammonia toxicity
Mercaptan, short chain fatty acids
Aromatic amino acids
GABA
Types of hepatic encephalopathy
1. Acute liver failure
2. Major portosystemic shunt without cirrhosis as in non-cirrhotic portal hypertension
3. Chronic liver disease
Overt vs minimal hepatic encephalopathy
Overt hepatic …

DMPS – Dimercaptopropane sulfonate. Used as a chelating agent for treatment of heavy metal poisoning.

Radiograph showing mastectomy of left breast. The breast shadow is visible on the right side, whereas it is not seen on the left side.

PASH – Pseuodangiomatous Stromal Hyperplasia

“Metabolic memory” is the name given to the situation of diabetic vascular stresses persisting after normalization of glucose values. The emergence of metabolic memory in diabetes mellitus emphasises the need for early aggressive treatment and normalization of glucose levels. The mechanism of the memory appears to be due to non enzymatic glycation of cellular proteins and lipids as well as due to an excess of cellular reactive oxygen and nitrogen species. These reactive species originate at the level of glycated mitochondrial proteins and may maintain stress signaling independant of glucose …

 Diabetic maculopathy – most common cause of visual loss.
IRMA: Intra retinal microvascular abnormalities.
NPDR: Non proliferative diabetic retinopathy.
PDR: Proliferative diabetic retinopathy.
PRP: Panretinal photocoagulation.
Neovascular glaucoma is a complication of proliferative diabetic retinopathy.

American Diabetes Association (ADA) target levels for lipoproteins in diabetic dyslipidemia are as follows:
Low density lipoprotein (LDL ) < 100 mg /dl
High density lipoprotein (HDL) > 45 mg / dl
Triglyceride (TG) <150 mg /dl

Insulin secretion in the body follows and inverted U pattern, during the natural history of type 2 diabetes mellitus, which is termed the ‘Starling’s curve of the pancreas’. Insulin concentration in blood initially increases as the sensitivity to insulin decreases as a consequence of situations like obesity. But when the glucose tolerance deteriorates as in impaired glucose tolerance or overt type 2 diabetes mellitus, the insulin levels come down.

 Normal blood glucose: Fasting 70-100 mg dl; Following glucose load: <140 mg/dl
Pre-diabetes
Hyperglycemia not sufficient to meet the diagnostic criteria of diabetes mellitus
Impaired fasting glucose (IFG) 100 – 125 mg/dl
Impaired glucose tolerance (IGT) 140 -199 mg/dl (after 75 gm glucose load)
Both basal hyperglycemia and postprandial hyperglycemia can increase HbA1c and cardiovascular complications
Types of diabetes mellitus
Type 1 Diabetes Mellitus: beta cell deficiency
Type 2 Diabetes Mellitus: beta cell defect + insulin resistance
Gestational Diabetes Mellitus (GDM)
ADA 1997, WHO 1999 – Diagnostic criteria for diabetes mellitus
Symptoms of hyperglycemia (polyuria, polydipsia and unexplained weight loss) and …