Drbeen has more than half million friend and followers now!

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Two years ago. I sat at my desk checking other successful brands in the field of medical education. I was awestruck by how many friends, fans, and followers they had. I felt that this was your way of saying thank you to those who were helping you. At this moment, I thought, I will never be able to do this. This recognition is reserved only for the best.

Then I got to work – as you know, I always do. I wrote down my philosophy. When I die I hope people say, “he worked tirelessly to improve patient care.” I didn’t care if drbeen was small, or we practically had no fans or followers, or that we were a brand not even worth noticing.

Two years later, we’ve just crossed half a million fans and followers this month. I am sitting at my desk, with eyes welling up. Overwhelmed with your love and support.

I have no words to say you thank you, jump into my melting heart, feel it and know that it is my thanks to you. 💕🌹

Thank you for your love and support. We will continue to offer our services and make them even better because you are worth it. Because YOU ARE IMPORTANT to us. Because we are nothing without you. Thank you again. 💕💕💕

Love you

Dr. Mobeen




Confusion are always a part of medical student’s life. We are confused starting from the first day of medical school till the end of our degree and thereafter too. Confusion are more for a medical students during the time of examination and most, at the examination hall. I have listed few confusion that can help a medical student to gain confidence level while presenting the topic or answering the question.

Alport syndrome and Apert syndrome

Alport syndrome: X linked disorder, Type IV collagen defect.

Apert syndrome: Triad of craniosynostosis, mid face hypoplasia and Symmetrical syndactyly.

Acrophobia and Agoraphobia

Acrophobia: Fear of height.

Agoraphobia: Fear of public places.

Chancre and  Chancroid

Chancre is painless ulcer seen in Syphilis.

Chancroid is painful ulcer seen in H. ducreyi infection.

Note: Chancre is Short in length, seen in Syphilis. Chancroid is also known as soft chancre.

Proptosis and Ptosis

Proptosis: Anterior buldging of the eye ball.

Ptosis: Drooping of the upper eye lid.

Reet and Tourette syndrome

Reet syndrome: Post natal genetic neurological disorder affecting gray matter of the brain.

Tourette syndrome: Neuropsychiatric disorder, onset in childhood associated with tics.

Rosacea and Rosea

Chronic dermatological vascular disorder predominantly affecting face and is characterized by flushing, telangiectasia, papules and pustules.

Pityriasis rosea: Characterized by scaly herald patch in the trunk followed by pink body rash. Does not appear to be contagious.

Conns disease and Addison’s disease

Conns disease: Increased aldosterone release.

Addison’s disease: Decreased aldosterone and cortisol.

Diabetes Insipidus

Central Diabetes Insipidus related to damage hypothalamus and pituitary.

Nephrogenic diabetes Insipidus related to kidney (ADH produced but it’s action on kidney tubules is impaired).

Hyperkalemia and Hypokalemia

Hyperkalemia: ECG, Tall tented T waves and small P waves.

Hypokalemia: ECG, Inverted T wave and presence of U wave.

Anisocytosis and Poikilocytosis

Anisocytosis: Abnormal sized RBCs.

Poikilocytosis: Abnormal shaped RBCs.

Have great time, until next 10 random confusions for medical students.

Dr Bivek Singh

Academic coordinator (MBBS)

Author “A journey into the human body”

Author “Pharmacology simplified”

Board of Directors (Medical Outreach Nepal, USA)



Morphology & Anatomy of Frog (at a glance)


  • ovoid, slightly flattened body, generally 10-15 cm long, bilateral symmetry.
  • skin is naked, smooth, moist and slippery (due to mucus secreted by the cutaneous glands present in skin).
  • dorsal surface of skin is generally olive green and pigmented while ventral surface is uniformly pale yellow.
  • neck and tail are absent
  • body = head + trunk
  • Head = mouth + external nares + eyes + brow spot + ear-drums + throat
  • mouth = located below the snout (blunt apex, helps in digging the earth), extends from one ear drum to the other, upper jaw is armed with small, conical teeth while the lower jaw is toothless.
  • external nares = pair of small apertures, the nostrils or external nares, helps in breathing, situated dorsally at the tip of the snout.
  • eyes = pair of eyes one on either side of the median line, almost on the top of the head, position of the eyes enables to see in all directions, round and protected by three eye-lids (upper + lower + third), third eyelid is also called nictitating membrane. Nictitating membrane is thin transparent and freely movable eyelid that protect the eyes under water and on dry lands.
  • brow spot = represents a reduced third eye, sensitive to light of the lower wavelength, producing colour changes in the skin.
  • ear-drums = also called tympanic membrane or tympanum or ear-drum, receives sound waves.
  • Trunk = forelimbs + hindlimbs
  • forelimbs = brachium (upper arm) + antebrachium (fore arm) + manus (hand)
  • hands = wrist (carpal) + palm (metacarpal) + four, short, tapering fingers (digits)
  • the first digit (thumb or pollex) is rudimentary and invisible externally
  • nuptial or amplexusory or copulatory pads = present in males only at inner finger of each, become specially enlarged during the breeding season.
  • hind limbs = thigh + shank (crus) + foot (pes)
  • foot = ankle (tarsal) + instep (metatarsal) + five, long toes (digits)
  • toes are joined together by thin folds of skin called webs
  • Sexual dimorphism = separate sexes
  • male possess vocal sacs placed ventrolaterally on either side of the head behind the mouth, used to produce croaking sounds to call the females.


  • skin (naked) = epidermis + dermis
  • epidermis = outer thin, derived from ectoderm, keratinized, stratified squamous epithelium.
  • dermis = inner thick, developed from mesoderm, contain sac-like mucous glands and chromatophore.
  • true coelom = pericardial cavity (around the heart & very small) + pleuroperitoneal cavity (very large)
  • skeleton = axial skeleton (skull + vertebral column) + appendicular skeleton (limb-bones + girdles)

Digestive System

mouth –> buccopharyngeal cavity –> pharynx –> oesophagus –> stomach –> intestine (duodenum –> ileum –> rectum –> cloaca).

  • buccopharyngeal cavity contains numerous maxillary teeth arranged along the margin of the upper jaw and vomerine teeth, lower jaw is toothless
  • salivary glands are absent
  • muscular tongue = bilobed at the tip and free from behind, used to capture the prey.
  • small intestine = long coiled ileum + short straight duodenum
  • digestive glands = gastric glands + intestinal glands + liver + pancreas + gall bladder
  • gastric glands + intestinal glands = present in the walls of stomach and small intestine respectively, produce gastric juices
  • gastric juice = thin, strongly acidic (pH varying from 1 to 3), almost colorless liquid, essential constituents are the digestive enzymes pepsin, hydrochloric acid, and mucus.
  • gall bladder = stores bile secreted by liver, bile emulsifies fats, changes pH of food from acidic to alkaline and checks growth of bacteria.
  • pancreas = secretes pancreatic juice containing digestive enzymes (trypsin, amylase, lipases etc)
  • villi + microvilli = digested food is absorbed by the numerous finger-like folds in the inner wall of intestines called villi and microvilli.

Respiratory System

cutaneous + buccopharyngeal + pulmonary

  • cutaneous respiration = occurs through naked skin, takes place in water as well as on land. During hibernation and aestivation frogs respires through this method only.
  • buccopharyngeal respiration = occurs only on land through moist lining of buccopharyngeal cavity.
  • pulmonary respiration = lungs are a pair of oval, pinkish, sacs located in the thorax, pulmonary respiration has a maximum frequency of 20/minutes. Occurs only when more energy is required.

Nervous System

  • Central nervous system + Peripheral nervous system + Autonomic nervous system.
  • CNS = brain + spinal cord.
  • Brain is contained in a bony structure known as brain box or cranium and protects it from the external shocks. Brain of frog consists of a pair of occipital condyles.
  • Brain = Fore-brain + Mid-brain + Hind-brain
  • Fore-brain = olfactory lobes + a pair of cerebral hemispheres + unpaired diencephalon.
  • Cerebrum = response to environment
  • Olfactory lobe = controls the sense of smell.
  • diencephalon = relays sensory information between brain regions and controls many autonomic functions of the peripheral nervous system.
  • Mid-brain = consists of a pair of optic lobes, involved in the frog’s vision.
  • Hind-brain = cerebellum + medulla oblongata
  • cerebellum = helps to maintain the balance and equilibrium of the frog, also controls the muscular coordination and posture.
  • medulla oblongata = passes out via the foramen magnum and continues into the spinal cord of the frog up to the tip of its trunk, which is contained in the vertebral column, helps in the regulation of respiration, digestion, and other automatic functions.
  • Peripheral nervous system = cranial + spinal nerves
  • Ten pair of cranial nerves are present in the frog (as compared to twelve pairs present in human) and it arises from the brain and innervate to the different parts of body. Cranial nerves are involved in passing the information from outside to the brain.
  • Frog contains 10 pairs of spinal nerves (as compared to 30 pairs present in humans) that rise from the spinal cord and gets distributed to the different parts of body. Spinal nerves of frog appear as white in color and are thread-like structures that emerge between the vertebrae and are located along the dorsal wall of body cavity. Spinal nerves functions in passing information from the extremities to brain through spinal cord.
  • Autonomic nervous system = the part of the nervous system responsible for control of the bodily functions not consciously directed, such as breathing, the heartbeat, and digestive processes.



How to Manage Stress When You’re a Medical Student

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Studies show that the high level of stress endured by medical students may actually hinder one’s cognitive function and learning ability. Not to mention, research reveals that 27 percent of all medical students are depressed, with 11 percent having suicidal thoughts. If the stress and depression are not managed early on, it’s likely that it will carry on into their professional careers, which can potentially lead to early burnout. No matter how many research papers you have to write or exams to study for, the number one thing on your list should be taking care of your mental health so you don’t start exhibiting self-destructive behavior.

Avoid Falling Into a Substance Abuse Trap

Between the pressures of studies and a pile of debt from tuition, it’s not uncommon for a medical student to turn to drugs and alcohol as a coping method. Nearly a third of students report alcohol abuse, with burnout and exhaustion being the main driving factors. There’s also a correlation between the type of abuse with the field of study. For example, resident surgeons tend to abuse alcohol, while those in emergency medicine also abuse benzodiazepines, cocaine, and marijuana. While the following mental health tips can help prevent an addiction, should you find yourself hooked on a substance, it’s a good idea to get treated at a facility that specifically caters to medical professionals—even if you’re still a student. Aside from the obvious reasons, it’s important to immediately address your addiction. If it continues into your professional practice, you run the risk of having your license revoked.

Take Regular Breathers

Chaining yourself to your desk isn’t going to do anything for your mental health. Schedule regular breaks throughout the day/night. Even a 30-second micro-break can increase your productivity by 13 percent, and a 15-second break from staring at your computer screen can reduce fatigue by 50 percent.


Plan Healthy Meals

Going down a junk food spiral is only going to decrease your energy and make you feel irritable, especially if you start to put on unnecessary weight. It takes little effort to open a bag of pre-washed greens and top it with a piece of lean, pre-cooked meat (think a rotisserie chicken) or can/pouch of tuna. Keep regular snacks like fruit, veggie sticks and hummus, nuts, string cheese, etc., to help curb hunger (or nerve) pangs without intaking a lot of calories.


Get Enough Sleep

While it’s going to be necessary from time to time, don’t make a regular habit of burning the midnight oil to squeeze in some extra study time because it’s only apt to hurt you in the long run. It’s been proven that lack of sleep can affect short-term and long-term memory and cause mood swings, weight gain, high blood pressure, and a risk for diabetes and heart disease. Institute time management and organizational skills like placing timed tasks in your iPhone with reminders to keep you on track.


Give Yourself a Confidence Boost

Don’t get so caught up in your studies that you forget to give yourself some props for all the hard work you’re doing. Institute confidence-boosting techniques, such as keeping a gratitude journal, being prepared as often as possible, turning a negative thought into a positive one, changing your body language, and staying away from negative people and situations.

Don’t Forget About Other Aspects of Your Life

Keep up with hobbies and personal relationships as best as you can. Retaining some semblance of balance in your life is liable to have a positive effect on your mental health, plus it can be helpful to get support from someone who’s not in your world.

Being in the medical field is a rewarding career, but in order to enjoy it to its fullest, you’ve got to make sure you’re taking care of yourself along the way. Try to see the forest through the trees in the most stressful of situations. Remember that in order to take care of others, you have to make sure you’re in good physical and mental health, too.




Insult to liver on long run can cause fibrosis of the liver and formation of nodules ,which is termed as liver cirrhosis. Liver cirrhosis is a chronic condition of the liver in which there is fibrosis and formation of nodules. The normal architecture of the liver gets distorted and patient presents with number of clinical feature.

Causes of Liver cirrhosis include:
1. Infection: Hepatitis B, C, D
2. Toxins: Alcohol
3. Cholestasis
4. Vascular
5. Metabolic
6. Genetic
7. Cryptogenic





  1 2 3
BILIRUBIN (mg/dl) <2 2-3 >3
ALBUMIN (g/dl) > 3.5 2.8-3.5 <2.8
INR <1.7 1.7- 2.3 >2.3




The rough diagram provided below will helps us memorizing all the major features of hepatic cirrhosis.
17887437_10154737177749585_120343564_o (1)
1. Hepatic encephalopathy
2. Jaundice
3. Epistaxis
4. Fetor hepaticus
5. Pigmentation
6. Purpura
7. Clubbing
8. Hepatomegaly
9. Splenomegaly
10. Ascites
11. Loss of libido
12. Impotence
13. Testis atrophy
14. Collateral vessels
15. Menstrual irregularities
16. Amenorrhea
17. Menorrhagia
18. Palmar erythema
19. Gynaecomastia
20. Breast atrophy
21. Spider telangiectasia
22. Cyanosis
23. Hair loss
24. Fever



Dr Bivek Singh

Academic coordinator (MBBS)

Author “A journey into the human body”

Author “Pharmacology Simplified”

Board of Directors (Medical Outreach Nepal, USA)


Natural Selection


In the mid 19th century, Charles Darwin (1809 – 1882), formulated the scientific theory of evolution by natural selection, published in his book “On the origin of species” in 1859.

Darwin’s idea were inspired by the observations that he had made during a sea voyage in a sail ship called H.M.S Beagle round the world, from 1831 to 1836.

Natural selection is the process whereby organisms better adapted to their environment tend to survive and produce more offspring. It is a key mechanism of evolution which involves the change in heritable traits of a population over time.

The concept of fitness is central to natural selection i.e., individuals that are more “fit” have better potentials for survival. Herbert Spencer (1820 –  1903) coined the phrase “survival of the fittest”, in his book “Principles of biology” in 1864, after reading Darwin’s book “On the origin of species”.

Alfred Russel Wallace (1823 – 1913) best known for independently conceiving the theory of evolution through natural selection by working in Malay Archepelago. The concept of natural selection was published by Darwin and Wallace in a “Joint presentation of papers” (1858).


Five basic concepts of Darwinism

  1. Rapid multiplication or overproduction
  2. Limited resources
  3. Variations
  4. Natural selection
  5. Speciation (new species formation)


Types of selections

  1. Stabilizing or balancing selection: It reduces the variations and maintains the mean value in a population, thereby preventing the evolutionary change. For example, selection against homozygous sickle-cell sufferers, and the selection against the standard HgbA homozygotes by malaria.
  2.  Directional or progressive selection: Population changes towards a particular direction, thereby disturbing the mean value in a population. For example, evolution of DDT resistant mosquitoes and industrial melanism (described below).
  3. Disruptive or diversifying selection: Favors both extremes in a population thereby eliminating most individuals of mean values. It leads to development of two different populations. For example, sexual dimorphism.


Classical example of natural selection: Industrial melanism

The classical example of natural selection is provided by the response of a peppered moth Biston betularia, which is found in all parts of England.

Industrial melanism is an adaptation where the moths living in the industrial areas developed melanin pigment to hide themselves from their predators.

Before the industrial revolution, most of the peppered moths in the UK were white and very few were melanic (black). After their habitats become polluted with soot from the coal-fired industries, the white moths were selectively picked up predators.

On the other hand, dark-colored moths were camouflaged very well by the blackened trees and in turn their population rapidly increased.

Evidence from biogeographical distribution

Darwin studied the climatic conditions, flora and fauna of Galapagos islands, during his voyage around the world.

He noticed nearly 20 related varieties of small birds in these islands which differed mainly in the shape and size of their beaks. These birds are now called Darwin’s finches.

The first clear explanation for these different varieties is allopatric speciation or geographical speciation. It occurs when biological populations of the same species become isolated from each other to an extent that creates hindrance in genetic interchange.


Other observations of natural selection

  1. Resistance of insects to pesticides.
  2. Antibiotic resistance in bacteria.
  3. Heavy metal resistance in plants.
  4. Transient genetic polymorphism.
  5. Production of new varieties through artificial selection.


Limitations of natural selection

  1. Small variations which are not essential also inherited.
  2. According to this theory, vestigial organs should not be present.
  3. Evolution of complex internal structures and organs are not explained.
  4. No clear explanation for the causes and origin of variations.
  5. No explanation for evolution of terrestrial animals from aquatic animals.


There are different hormones related to gastrointestinal system which plays important role in digestion of the food. These hormones are related to each other and in different pathological condition, their production may increase or decrease leading to derangement of digestive process. Some important hormones are Gastrin, Cholecystokinin (CCK), Secretin, Somatostatin, and Motilin.


Gastrin is peptide hormone produced by G cells (flask shaped cells), from the antrum of the stomach.  Also found in duodenum and jejunum.

Gastrin secretion is stimulated by


Gastrin secretion is inhibited by


Calcium (blood borne) GIP/VIP


Amino acids
Peptides Acidic environment
Epinephrine (blood borne)
Distension (Gastric)/ Discharge (vagal) Secretin/Somatostatin
Action of gastrin on parietal cells

  1. Gastrin causes insertion of K+/H+ ATPase pump into apical membrane of parietal cells.
  2. Stimulates the secretion of HCI

Action of gastrin on ECL (Entero Chromaffin Like) cells

  1. Stimulates the release of histamine by acting on CCK-B receptors on ECL cells.
Bivek014 (1)


Cholecystokinin (CCK) – Pancreozymin (PZ)  is peptide hormone produced by I cells of the small intestine (duodenum > jejunum, ileum) and stimulates the digestion of protein and fats.

Action: (@GRID)

  1. Gall bladder contraction
  2.  Relaxation of sphincter of Oddi
  3. Increased pancreatic enzyme secretion
  4. Decreased gastric emptying

CCK receptors are of two types mainly, CCK- A and CCK- B, CCK- A primarily located in GIT, and CCK- B primarily located in CNS. CCK also acts in hypothalamus inducing satiety and it augments effect of secretin for production of alkaline pancreatic juice. It also exerts tropic effect on pancreas.

CCK secretion in enhanced by lipid >>> peptones, amino acids, CCK releasing factors.


Secretin is peptide hormone (27 amino acids) produced by S cells of duodenum and jejunum. It is stored as prosecretin. It stimulates secretion of fluid and bicarbonate from the pancreas. It acts through cAMP causing increase secretion of watery alkaline pancreatic juice.

Action include (@CIDS)

  1. Contraction of pyloric sphincter.
  2. Increased secretion of pancreatic enzymes along with CCK.
  3. Decreased secretion of gastric acid.
  4. Stimulate pancreatic growth (exocrine portion) along with CCK.

Secretin secretion is enhanced by amino acids, bile acid, fats, increased duodenal acidity and it is inhibited by Somatostatin.


Somatostatin /Growth hormone inhibitory hormone

There are two forms of Somatostatin ( 14 and 18). Somatostatin 14 is primarily located in hypothalamus and Somatostatin 18 in GIT. Secretion is more in gastric lumen as compared to circulation and it acts through G protein coupled receptor. In GIT , it is secreted by D cells present in stomach, duodenum and pancreatic islet and is released in response to acid in stomach.

It decreases:

  1. Gall bladder contraction /Bile flow
  2. Pancreatic secretion ( both endocrine and exocrine)
  3. Intestinal secretion
  4. Gastric acid secretion
  5. Motility
  6. Absorption of glucose amino acids, triglycerides.

It increases:

  1. Fluid absorption.

It inhibits secretion from:

  1. Gastrin /Secretin
  2. VIP/GIP
  3. Insulin/Glucagon
  4. Motilin/Growth hormone


  • Motilin is 22 amino acids polypeptide secreted by enterochromaffin cells and Mo cells in the stomach, small intestine, and colon.
  • Produces contraction of smooth muscle in the stomach and intestines in injection.
  • Major regulator of the migrating motor complexes (MMCs) that control gastrointestinal motility between meals.

Note: Keep updates on schematic diagrams in next 72 hours and other gastrointestinal hormones.

Dr Bivek Singh

Academic coordinator” MBBS”

Author ” A Journey into the human body”

Author ” Pharmacology Simplified” 



Chromosomal Mutations

The process that produces an alteration in DNA or chromosome’s structure or number is known as mutation.

The term ‘mutation’ was coined by Hugo Marie de Vries in 1901.

Any agent that cause mutation or increase the rate of mutation is known as mutagen.

Chromosomal Mutation

Chromosomal mutation is a missing, extra, or irregular portion of chromosome. It is also known as chromosomal anomaly, chromosomal abnormality, chromosomal aberration or chromosomal disorder.

It can be classified into following three categories:

  1. Polyploidy
  2. Aneuploidy
  3. Chromosomal translocation 

1. Polyploidy

‘Ploidy’ is the number of set of chromosomes in the nucleus of a cell.

When an organism or a cell contains more than two paired sets of chromosomes (>2n), then the condition is known as polyploidy. It may be tripolidy (3n), tetraploidy (4n), pentaploidy (5n) and so on.

This condition is mostly observe in plants.

Autopolyploids = Polyploids with chromosomes sets, derived from single species.

Allopolyploids = Polyploids with chromosome sets, derived from different species.

2. Aneuploidy

When an organism or a cell contains more than two paired sets of chromosomes, but not a complete set, then the condition is known as aneuploidy

Aneuploidy originates during anaphase of meiosis when the chromosome(s) do not separate properly between the two daughter cells, a condition known as non-disjunction.

Few examples of aneuploidy are given below:

Nullisomy (2n-2) The loss of both pairs of homologous chromosomes.

Monosomy (2n-1) – The loss of a single chromosome.

Example – Monosomy of sex chromosome (45, X) causes Turner syndrome or gonadal dysgenesis.

Trisomy (2n+1) – The gain of an extra copy of chromosome. 

Example – The presence of an extra chromosome 21 which is found in Down syndrome is called trisomy 21.

Tetrasomy (2n+2) – The gain of an extra pair of homologous chromosomes.

Example – Tetrasomy 9p is caused by the the presence of two extra copies of the short arm of chromosome 9.

3. Chromosomal Translocation

It is caused by rearrangement of parts between non-homologous chromosomes.

Example – Chronic Myelogenous Leukemia (CML) 



Chromosome Abnormality: Down Syndrome

  • A chromosome abnormality or a chromosomal disorder is a missing or irregular or extra portion of chromosomal DNA.
  • usually occur when there is an error in cell division following meiosis or mitosis.
  • are generally not inherited but occur as random events during the formation of reproductive cell.
  • an error in cell division called non-disjunction results in the reproductive cells with an abnormal number of chromosome.
  • Non-disjunction – the failure of one or more pairs of homologous chromosomes or sister chromatids to separate normally during anaphase (meiosis), usually resulting in  abnormal distribution of chromosomes in the daughter nuclei.
  • examples of chromosomal disorders = Down syndrome, Edwards syndrome, Patau syndrome, Cri du Chat syndrome, Turner syndrome etc

Fig: Non-disjunction (wikipedia)

Down Syndrome:

  • also called trisomy 21 or 47, + 21 or DS or DNS
  • chromosomal disorder caused by the presence of whole or a part of third copy of chromosome 21.
  • first characterized by English physician John Langdon Down in 1862.
  • occurs in about one per 1000 babies born each year.
  • sign & symptoms = mental illness, stunted growth, shortened hands, slanted eyes, abnormal teeth, short neck, flat head, large and protruding tongue, poor muscle tone (hypotonia), extra space between big toe and second toe etc
  • prone to respiratory disease, heart malformation, keratoconus and leukemia.
  • most individuals with Down syndrome have mild IQ (50-70) or moderate IQ (35-50).
  • characteristic cause = non-disjunction of chromosome 21 during meiosis – paired homologous chromosome failed to disjoin either during anaphase – I or II that may lead to gametes with n +1 chromosome composition.
  • main source (about 95%) of trisomy 21 is the ovum.
  • other cause = chances dramatically increase as the age of mother increases.

At 30 –> 1 in 1000
At 40 –> 1 in 100
At 45 –> 1 in 5o

  • parental diagnosis = Amniocentesis (AFT) or Chorionic Villus Sampling (CVS)
  • therapeutic abortion is one option currently available to parents with number of religious and ethical issues.
Fig: Karyotype – Down Syndrome




Principles of One-Gene Inheritance

  • The study and analysis of inheritance as a result of monohybrid crosses is called one-gene inheritance.
  • The cross between true-breeding pea plants with tall stems and dwarf stems is represent Mendel’s monohybrid crosses.
  • When Mendel crossed true breeding tall plants with dwarf plants, the resulting F1 generation consisted of only tall plants.
  • When members of the F1 generation were selfed cross, Mendel observed that 787 0f 1064 F2 plants were tall while 277 of 1064 were dwarf – a ratio of about 3:1.
  • Mendel made similar crosses between pea plants, exhibiting each of the other pairs of contrasting traits. In every case, the outcome was similar to the tall/dwarf cross.
  • Mendel proposed the existence of what he called ‘unit factors’ for each trait. He suggested that these factors serve as the basic unit of heredity and are passed unchanged from generation to generation.
  • Using the results of monohybrid crosses, Mendel derived the following three postulates, also known as ‘Principles of Inheritance’:
  1. Principle of paired factor:- Genetic characters are controlled by unit factors that exist in pairs in individual organisms.
  2. Principle of Dominance:- Out of the two contrasting traits, only one is able to express its effect in the individual. It is called dominant factor while the other is called recessive factor which does not show its effect.
  3. Principle of Segregation:- During the formation of gametes, the paired unit factors separate or segregate randomly so that each gamete receives one or the other with equal possibility.


mendel monohybrid cross


Liver: At a glance


  • It is the heaviest internal organ and largest gland in the body, weighing about 1.2 – 1.5 kg in an adult human.
  • It is located in the upper right side of the abdominal cavity and is reddish brown in colour.
  • It has two main lobes (larger right lobe & smaller left lobe) and two small lobes (quadrate lobe & caudate lobe) present behind the main lobes.
  • The two main right and left lobes are separated by the falciform ligament.
  • The liver consists of small structural and functional units called hepatic lobules.
  • The lobules are roughly hexagonal, and consist millions of glycogen-rich cells, the hepatocytes (hepatic cells).
  • Each lobule is covered by a thin connective tissue sheath known as Glisson’s capsule.
  • The mammalian liver also contains phagocytic cells known as Kupffer cells. They engulf dead WBCs, RBCs and pathogens.
  • A thin-walled, sac like structure, the gall bladder, lies in the lower surface of the right lobe. It stores and concentrates bile secreted by the liver cells.
  • The duct of gall bladder is called cystic duct.
  • The cystic duct is connected with common hepatic duct to form bile duct which passes downward and is joined by the pancreatic duct to form hepatopancreatic duct.
  • The hepatopancreatic duct is connected with duodenum through a hepatopancreatic ampulla which is guarded by a sphincter called the sphincter of Oddi.
  • There are two distinct sources that supply blood to the liver: oxygenated blood flows in, from the hepatic artery and nutrient-rich (deoxygenated) blood flows in, from the hepatic portal vein.


Fig: Liver and pancreas with their ducts.

Vital Functions

  • Filtration of blood coming from the digestive tract, before passing it to the rest of the body.
  • Regulation of blood sugar level through glycogenesis (conversion of excess glucose into glycogen) and glycogenolysis (conversion of glycogen into glucose).
  • Performs gluconeogenesis (formation of glucose from non-carbohydrate source).
  • Controls lipogenesis (conversion of excess glucose and amino acids into fats).
  • Acts as haemolytic organ (breaks old RBCs).
  • Secretes angiotensinogen, that later forms angiotensin – a peptide hormone and a potent dipsogen (agent that causes thirst). Angiotensin is also a part of renin-angiotensin system (a hormone system that regulates blood pressure and fluid balance).
  • Detoxifies chemicals and metabolizes drugs.
  • Secretes bile – an alkaline fluid having several organic and inorganic salts that helps in the emulsification of fats.
  • Storage of glucose in the form of glycogen, mineral like copper, iron etc as well storage of vitamins like vitamin A, D, E, K and B12.



Prescription Writing (Latin Terms)

This series has been presented in a webinar as well. 
Please go here to watch it: Drbeen Webinars


As much as I am not a fan of Latin terms for prescription writing, I understand that following holds true:

  • These are globally taught terms. This allows almost a universal understanding and administration of a prescriptions.
  • Our books, software, infrastructure, processes, and other existing systems already use these terms.

Clearly learning important terms and using them effectively is important for anyone who is part of the chain of drug administration (see first article in this series.)


In this article we will learn following categories of terms:

  • Count/quantity of drug
  • Administration
  • Formulation
  • Frequency


Count of a drug for example, 2 tablets at one time, or 2 capsules at one time, etc. were written originally as roman numerals. For example i for 1, ii for 2, and iii for 3. This then changed into T (which can be thought of the capital roman letter I) with a dot on it.

T with a dot


For example to prescribe Amoxicillin 250 mg tablets, taken 2 tablets orally three times a day for 7 days you will write (note the T with dots in red):

amoxicillin 250 mg two tablets 3 times a day for 7 days

You can write the Ts or ii. Don’t, however, put one T with two dots on it. It is error prone.

So what are some examples of the count/quantity?

  • ii tablets (two tablets)
  • i capsule or i cap (1 capsule)
  • 4 mL (suspension). See notes about the suspension below.

Suspension Administration

Administering table/tea spoons is error prone due to spilling and inaccuracy in filling. Putting quantity in measurable units is preferred. However, for the patient there has to be a way to measure this exact quantity and use. Syringes can be used. Problem with the syringes is the availability, and more importantly choking hazard by the syringe cap for small children.

My opinion is that metric units can be used where the administration is in expert staff’s hand. For a patient table spoon and tea spoon are still the most easy method for compliance.

Route of Administration

A drug can be administered by many routes or exactly only one route depending upon its chemical formulation and the intent of administration. Common routes of administration and their terms are following:

  • p.o. (per os) mouth
  • p.r. (per rectum)
  • SubQ (subcutaneous)
  • IV (intravenous)
  • IM (intramuscular)
  • IN (intranasal)
  • IT (intrathecal)
  • SL (sublingual)
  • Vag (vaginally)

In the Amoxicillin example above the p.o. is for oral administration.


There can be various formulations of the same drug. This is to allow administration of a drug to patients of various ages and state of health. Scope of a drug’s distribution also dictates the formulation. Some common formulations are following:

  • Tab (tablet)
  • Cap. (capsule)
  • Bolus (discrete amount)
  • Susp. (suspension)
  • Syr. (syrup)
  • fl. (fluid)
  • Cr. (cream)
  • Ung. (unguentum) ointment

In the Amoxicillin example above we used tablets, we could have used tab as well with the same clarity.

Frequency of Administration

Writing frequency is possibly the most commonly bothersome area. My approach is to teach the terms that make up the frequency. For example cibum in Latin is for meal, and anti is for before. So anything before meal will be said to be anti cibum and written as a.c.

Here are some terms for Frequency to keep in mind

  • Cibum: meal
    • a.c. (ante-cibum) before meal.
    • p.c. (post cibum) after meal.
  • Meridian (noon)
    • a.m. (ante meridian) in the morning.
    • p.m. (post meridian) in the evening.
  • Die: day
  • Hora: hour
  • Somni: sleep
  • Quque: every
    • qh: every hour
  • Sumendus (take)
  • p.r.n. (pro re nata) as needed

Frequency involving Days

  • o.d. (once a day). Note: this should be replaced with the word daily.
  • q.d. a.m. (quaque die ante meridien) every day after morning
  • b.i.d. (bis in die) two in a day. bds (bis die sumendus. Two in a day take).
  • t.i.d. (ter in die) three in a day. tds (tre die sumendus. Three in a day take)
  • q.i.d. (quarter in die) four in a day. qds (quarter die sumendus. Four in a day take.)
  • q.a.d. (quaque altera die) every alternate day
  • (bis in 7 d) every 7 days. Weekly.

Frequency involving Hours

  • q.i.d. a.m. a.c. (quque in diem ante meridien ante cibum). Once daily before meal. Again the preferred writing method will be to once daily before meal.
  • q.i.d. p.c. (once daily after meal). See above point.
  • h.s. (hora somni) at sleeping time.
  • hor. alt (hora alternis) every other hour.
  • q.h. (every hour).
  • q.1.h. (every hour) q1h.
  • q.2.h. (every two hour) q2h.

Hope these terms provide enough data to help you write prescriptions.



This article series has not covered the following:

  • How to prescribe injections/infusions?
  • How to prescribe Insulin/Steroids?
  • How to perform dosage calculation?

Let me know if you will like me to write about these as well?

When I get a chance I will add some example prescriptions.


Drbeen's Favorite Books Uncategorized USMLE Step 1 Books

USMLE Step 1 Books

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Very often students ask me about the books they should use for the steps’ preparation. Here are a few principles and book names that I have gathered over the years from our students that prepare and take tests with various results.


  1. Every book is valuable, however, everyone has a different taste and different ways to understand. Hence, you will have to choose your own set by reading various books.
  2. Read a topic for example pathology of asthma from all candidate books and see which one helps you the most in terms of style of writing, diagrams, distractions, and recall. Mind it, when you will read the same topic from each book, you will become better from one to the next book. You might incorrectly conclude that the last book you read the topic from is better. To counter this bias, read another topic in the reverse order. Mix it up for a few topics and choose your favorite writer.
  3. Each book has some great points and some points that are missing. If this was not the case then all of them will be the same one book. Furthermore, some books are textbooks, some are review books, some are notes, and so on. Don’t compare a textbook to a notes book.
  4. It is not necessary to choose a set that is by one company e.g. all Kaplan’s books, or all Becker’s books or all DrBeen’s topics, etc.
  5. Once you have a set chosen then stick to it. As each book is written differently, they all have different deficiencies. Accept this instead of running after every book and ending up with a pile of books that you cannot review in a timely fashion.

With these principles in mind, here is my favorite set to study and teach from. Apply the rules and tests mentioned above and select what you like.

  1. Foundational Book

    1. First Aid for USMLE. It will not help you ace the exam, it will make sure that you know the essential topics and can guarantee that you will pass if you know it cold from the beginning to the end.
  2. Biostats

    1. First Aid is sufficient. Add some questions that you attempt with a piece of paper and a calculator.
  3. Biochemistry, molecular biology, and genetics

    1. Hands down Kaplan. Don’t touch anything else.
  4. Behavioral Sciences

    1. High yield behavioral sciences with First Aid is sufficient.
    2. We have a set of psychiatry videos by Dr. Adam Jones that also covers high yield aspects. These are short (10-15 minutes) and to the point for the Steps.
  5. Microbiology and Immunology

    1. Immunology from Lange’s microbiology or my lectures.
    2. Microbiology from Microbiology made ridiculously simple with First Aid. Use sketchy videos if you like mnemonics and visual aids.
    3. I have done (DrBeen) a number of important microbiology lectures that are very valuable for Step 1 and Step 2 both.
  6. Pharmacology

    1. Kaplan’s pharma is great.
    2. Lange’s Ketzung and Trevor’s pharmacology is great too.
    3. One of the above not both.
  7. Physiology

    1. I love Kaplan’s physiology. Becker’s physiology is second.
    2. Board review series is great too.
    3. My own lectures for neuro, cardiovascular system, respiratory system, and renal are valuable as well.
    4. Choose one book to add to First Aid. Not all.
  8. Pathology

    1. I love Goljan’s pathology audio. I am not a super big fan of Goljan’s book. Its style of writing is less appealing to me. But, that’s just me.
    2. Pathoma is great for Steps, however, not that great to understand. Combine Goljan’s audio with Pathoma book and video.
    3. I am not a big fan of board review pathology. It turns me off. Test it for yourself.
    4. My lectures on CVS, Neuro, Respiratory, Immunology, and EKG are very valuable as well.
    5. Dr. Najeeb is great if you have time to listen for four hours to extract 15 minutes of solid understanding. If you don’t have this time and if you have already not used his videos during school then stay away. Same philosophy for my lectures too.
    6. Robbins is great, however, too long. Use mini robbins, but again, this book is not geared for the steps prep. Read some topics, compare with other books and then decide.
    7. I think Osmosis has some value, however, I have heard that it is too superficial for the exam prep. My point of view is that it is a good overview of the topics to allow you to consult better resources and grasp them easily. I will not bank on osmosis for the exam prep.
  9. Anatomy

    1. High yield anatomy with First Aid is sufficient.
    2. High yield neuroanatomy and clinical neuroanatomy are sufficient for the neuro part.
    3. I have heard that Dr. Najeeb’s head and neck and neuro videos are great. However, these are very lengthy as well. Maybe listen to the topics that you are finding difficult.
    4. My neurology videos are also one of the better resources, these are shorter than Dr. Najeeb but longer than I will like for review material. The same principle as for Dr. Najeeb applies here, if a topic is difficult, study it from my videos.

I will go over this list and add links in another day or so.

Happy studying.


CVS Questions Uncategorized

CVS Question

What disease/condition doubles the risk of CVS diseases?

  • A. Diabetes
  • B. Smoking
  • C. Hypertension
  • D. Alcoholism
  • E. Liver cirrhosis
Nervous System Questions Uncategorized

CNS Question (Huntington’s Disease)

A 32 years old male patient has recently stopped going to his job and is complaining of depression. He is having difficulty remembering things and focusing on tasks. He mentions that he has noticed involuntary ticks in his fingers. He is very worried for his health.

You suspect Huntington’s disease. What is the most probable neurotransmitter issue that is causing ticks?

A. Reduced dopamine release in the neostriatum.
B. Increased dopamine release in the neostriatum.
C. Reduced GABA release in the neostriatum.
D. Increased GABA release in the neostriatum.
E. Reduced acetylcholine release in the frontal cortex.
F. Increased acetylcholine release in the frontal cortex.



When scientists are looking for presence of water in some other planets, we doctors are trying our best to know as much details as possible about our own body. Starting from the days when dead bodies were stolen from the graveyard so that they can learn about the anatomy of various organs, we have come a long way with the invention of sophisticated devices and techniques like X- ray, echo, ultrasound, CT- Scan, MRI and so on. With such advancement in medical science we are still lacking behind in exploring the treatment of many diseases and their pathogenesis.

Going through more than five years long journey to become a doctor with good concept is not that easy, there are failures and frustrations that provide the reason to leave the course in between. Being most expensive and sophisticated course, it is not uncommon to find medical students undergoing depression and committing suicide in their career. Apart of teaching medical subjects and medical ethics it is high time for the medical schools of the world to come up with some motivating and interactive session time and again to make the course more ease and effective.

When we enter medical school, we are already loaded with pressure from family, neighbour and on top of that monetary crisis. Repeating the definition 10- 20 -30 times may not be sufficient to make it perfect and knowing the definition may not be perfect unless you can present it among the audience.

There are several reason why medical students are more prone for depression, some of them are:

  1. Lacking base concept

–          Some students do lack the base concept about the human body. Working as academic coordinator for MBBS students, I have encountered many times, when first year medical students believe that there are two liver/s and spleen is present inside the ear. They lack the basic concept that should be obtained before entering into medical school, mostly during the secondary schooling.

  1. Huge volume of books

–          There are large number of books that has to be covered in short span of time and often medical students gets confused finding way out to cover such voluminous text in short span of time.

  1. No idea  to prepare for the exams

–          Most of the time medical students have no idea on preparing for the exams, preparing for the exams in totally different and going through the entire text book just before the exams is not possible. Students don’t know the areas which they have to focus on for the exams.

  1. Time management

–          Managing time is most difficult task for all of us. We often make routine for time management but I wonder how many of us follow the routine. It is not possible to maintain the routine may be due to human habits or some other reasons.

  1. Personal issues

–          As the course is of longer duration, many times students has to struggle with personal issues like suffering from diseases, love, marriage, break-ups, illness in family members, death of family members and so on . Sometimes remaining far from the home and home sickness account for degradation of quality.

The next question is finding the solution for all the mentioned issues, and it may not be easy to implement the solution in practical life. There are ways to deal with each of the problems mentioned above.

Choose the profession you love, there are students joining medical school because of the pressure from their parents and that creates the worse doctors in our community. The dream of parents to see their children as doctors (who are not interested) is one of the reasons for production of worse doctors.

Do not study just to pass the exams, study to get good concept. Make study correlating every subject with human body and try to create concept when you study. Concept lasts longer than memorizing details.

Most of the time we try to complete different subjects in short period of time and we do not repeat or revise sufficiently. It is not possible to get good concept until you revise the text several times. To get the concept into long term memory, revision is must. Revising maximum times gives you confidence. I have seen medical students saying, they don’t have confidence to present any medical topics. And lack of confidence may be due to lack of revision. If someone ask my name for 100 times, I will answer my name perfectly even for the 100th time because it is in my long term memory and I have revised several times that my name is Mr …………….

Try to create notes for what you study and make habit of writing note in your own way, and do not forget to cross check whether your writing is correct or not. Try explaining every medical detail to mass/colleagues/friends. Explaining resolves the confusion and the more you explain the more perfect confidence you gain.

While preparing for the exams focus on exam pattern and write as per the marks. Sometimes we write long answers just because we know it which often irritates the examiner. Write what is asked, and try to make it technical. Do not try to explain medical terminologies as layman.

Make habit of reading daily, we are in profession where we are learning from books/patients throughout our lives. Habit of daily reading will help you to get updated on recent advancement and will make you confident.


  • Don’t take medical course as burden.
  • Don’t read more and revise less.
  • Don’t read only during the exams.
  • Don’t hesitate to learn from any one, junior, seniors, teachers, and patients.
  • Don’t hesitate to say “No” when you don’t know.
  • Don’t be over confidence.
  • Don’t forget, you are human being first and then a doctor.
  • Don’t hesitate to respect seniors and teachers. The know something important that you don’t know but you need to know.
  • Don’t read without concentration.
  • Don’t forget to revise as many times as possible.
  • Don’t choose more books for single subjects.
  • Don’t study just to pass the exams.
  • Don’t give up. I have found that 90 % losers are those people who give up on the way.
  • Don’t compare with others.
  • Don’t run after success. Run after excellence, success will follow you.

Photo courtesy:

Dr. Bivek Singh

Author “A Journey into the human body”

Author “Pharmacology Simplified”

Instructor (BPH/PCL/B Sc Nursing)

Academic coordinator (MBBS)

Board of Directors, Medical Outreach Nepal, San Francisco, United States

Anatomy Uncategorized

Kidney Anatomy – General Features


Kidney in the fresh state has reddish-brown.


  • 11 cm long
  • 6 cm wide
  • 3 cm thick


  • Males: 150 g
  • Females: 135 g

General Relations

  • Retroperitoneal organ
  • Lies on the ventral surface of the quadratus lumborum muscle.
  • Lateral to the psoas major, psoas minor, and the spinal column.
  • Middle parenchyma is called Medulla and the outer parenchyma Covering the medulla is called Cortex

Renal Capsules and Fasciae

True or renal capsule is a thin sheet of fascia that can be easily peeled in a healthy individual. In some pathologies this sheet can become scarred and firmly adherent to the kidney surface.


A vertical cleft on the concave medial side of the kidney. From anterior to posterior hilum contains renal vein, renal artery, and renal pelvis. Renal hilum continues inwards to contain renal vessels, lymphatics, renal pelvis, major and minor calyces, nerve plexus, and some fat.

Right Kidney (1.5 cm lower than the left kidney)

  • Upper pole at T12.
  • Right kidney’s hilum is 5cm from the median plane and below the transpyloric plane.
  • Below the spinous process of the L1 vertebra.
  • Related to rib 12.

Structures anterior to the right kidney

  •     Right suprarenal gland
  •     Right colic flexure
  •     Small intestine
  •     Part of the descending duodenum
  •     Liver

Structures posterior to the right kidney

  •     12th rib
  •     Transverse process of L1 vertebra
  •     Diaphragm
  •     Psoas Major
  •     Quadratus Lumborum
  •     Tendon of Transverse Abdominis muscle

Left Kidney (1.5 cm higher than the right kidney)

  • Upper pole at T11
  • Hilum of the left kidney is 5cm from the median plane at the lower border of the spinous process of the L1 vertebra.
  • Transpyloric plane passes through the hilum of the left kidney and L1. (Remember L for Left).
  • Related to ribs 11 and 12

Structures anterior to the left kidney

  •     Left suprarenal gland
  •     Stomach
  •     Jejunum
  •     Left colic flexure
  •     Pancreas
  •     Spleen

Structures posterior to the left kidney

  •     11th and 12th ribs
  •     Transverse process of L1 vertebra
  •     Diaphragm
  •     Psoas Major
  •     Quadratus Lumborum
  •     Tendon of Transverse Abdominis muscle

Histology of Human Gut

The wall of the human alimentary canal consists of four distinct layers: the mucosa, sub-mucosa, muscularis and serosa.


Fig: Transverse section of gut (diagrammatic representation)

Mucosa The mucosa is the innermost layer of the gastrointestinal tract that is surrounding the lumen (open space within the tube). This layer comes in direct contact with digested food. This layer forms rugae in the stomach and villi in the small intestine. The mucosa is made up of epithelium – innermost layer, responsible for most digestive, absorptive and secretory processes. Mucosa also contains goblet cells which produces mucus that protects the epithelial surface.

Sub-mucosa The sub-mucosa consists of a dense irregular layer of connective tissue with large blood vessels, lymph vessels and nerves. In duodenum, glands are also present in it. Sub-mucosa supports the mucosa.

Muscularis/Muscular layer – Muscularis is a thin layer of smooth muscles arranged into an outer longitudinal layer and an inner circular layer. The circular layer prevents food from traveling backward and the longitudinal layer shortens the tract. The coordinated contraction of these layers is called peristalsis (alternate contraction and relaxation, which pushes ingested food). At a number of points along the gut the circular muscle thickens into structures called sphincters.

Serosa Serosa is the outermost layer of the human alimentary canal. It is made up of a thin layer of secretory epithelial cells, with some connective tissues underneath. The epithelial layer, produce the lubricating serous fluid. This fluid has a consistency similar to thin mucus. These cells are bound tightly to the underlying connective tissue. The connective tissue layer provides the blood vessels and nerves for the overlying secretory cells, and also serves as the binding layer which allows the serosa to adhere to organs and other structures.


MAGNESIUM: Unexplored Mineral

Most of us in our life encounter muscle spasm, back pain and various grades of musculoskeletal pain. We often suffer from number of pain related diseases especially during the old age due to derangement of number of minerals within the body.

There are number of minerals in our body and they have diverse role inside the body. Some people prefer taking carbohydrates, proteins and fats enough to make their diet complete but they fail to maintain sufficient vitamins and minerals to metabolize those food products. It is the food adulteration, less knowledge of way of cooking food and sedentary life style that is shifting the diseases pattern to a unusual paradigm.

Being in a medical profession we often find many youth as well as adults who are taking calcium on regular basis to cure their back pain, muscle spasm, bone pain etc. Still they are fighting against their painful condition. It was during my medical schools when I suffered from severe muscle spasm that gave me the reason to look upon recent advances on any other minerals which shares the job of calcium. During medical school we go through many texts and many times describing the importance of calcium in the human body and maybe we remember it by heart as these are the questions often asked during the exams. Even with lot more emphasis on calcium, we should never forget the role of magnesium in human body. Recent research to explore the role of magnesium in human body gives us clear view of the larger boundary magnesium has created for a healthy life.

Magnesium, atomic number 12, is often designated as Mg. The Linus Pauling Institute supports the latest RDA for magnesium intake (400-420 mg/day for men and 310-320 mg/day for women). During my medical schools, I have encountered the several occasions where magnesium was used to treat several medical conditions. Epsom salt (Magnesium Sulfate) is used as anti inflammatory. Epsom can also be used in faster healing of the wound and it prevents infections. Eclampsia in among the clinical conditions which reveals the medicinal property of magnesium. Within the human body, magnesium plays major role in maintaining cardiovascular system, nervous system, immune system, musculoskeletal system, body metabolism, energy generation and as neurotransmitter precursor. It has role for effective blood circulation and maintains skin integrity. With immense role of magnesium we can still read text books and researches saying 80 % of the Americans are suffering from magnesium deficiency. It is also important to maintain the ration of calcium and magnesium which was initially described by French researcher to be 2: 1 but this ration was varied in later research conducted by award winner medical/ naturopathic doctor, Dr Carolyn Dean. She was working on role of magnesium for more than 15 years and the role of magnesium is yet to get revealed. Magnesium in often used by homeopathic physicians to treat number of health ailments and is commonly used by number of acupuncture specialist. The most absorbable form of magnesium in citrate. It has role in number of chemical reactions within the human body cells.

With the role of magnesium in number of medical conditions like fibromyalgia, heart diseases, migraine, osteoporosis, eclampsia, wound healing, heart failure, high blood pressure, insomnia, mental illness, PMS, hearing problems, stress, insulin resistance diabetes mellitus, vascular pathology and many more, it is high time to give the emphasis on importance of magnesium for maintaining good health. This miracle mineral should not be titled as “hidden mineral” in days to come.

Photo credit:



Dr. Bivek Singh

Author “A Journey into the human body”

Author “Pharmacology Simplified”

Instructor (BPH/PCL/B Sc Nursing)

Academic coordinator (MBBS)

Board of Directors, Medical Outreach Nepal, San Francisco, United States




The Harshest Critic

We all know who the harshest critic is. And no, it’s not your mom or your dad. It’s you. Expectations are useful as a driving force as you strive to achieve the goals of your life, but when they take a turn to the dark side, they can be your worst nightmare.

Growing up, I wanted to be a musician (to quote my dad in an Egyptian accent, “over my dead body”), a physician, an athlete (I stopped growing = game over), and for a few of my formative years, a ninja.


It’s a good thing the whole ninja thing worked out.


I was never in a “gifted and talented” class in elementary school.  Early on, I was in academic classes simply because that’s where I initially was placed. After my parents realized I could do better, I moved up to advanced. It would have been easy to coast through like that, but when middle school reared its awesome head around (it wasn’t ugly for me), I decided to force myself into honors level classes.  I wasn’t ready for it, and it was one heck of a rude awakening. But it forced me to put in the time and effort to succeed.

The struggle to achieve more than whatever false paradigm set in your mind must be the springboard to do more. We don’t have the time to settle. We only have the time to push through to the next challenge.

This week, I read a post on Facebook talking about how it is better to be a Computer Programmer than a Medical Doctor in 2014. Sure, that might be true for some people based on certain parameters. But the concept of it all really irked me. Who said you have fit into others’ model of success? Who said that being “X professional” is the only thing you can be?

Be whoever you want to be, even if that means you are a Dentist-Entrepreneur-Gardener-Ninja. We define who we are and pave the road to our own success.

Yes, you are your harshest critic. Let it be the driving force that propels you forward.