Recent technological and scientific advances have fuelled a neuroscientific revolution. Imaging techniques such as those shown above have given us an unprecedented view into the structure and function of our brain.
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@medicalexamination
Recent technological and scientific advances have fuelled a neuroscientific revolution. Imaging techniques such as those shown above have given us an unprecedented view into the structure and function of our brain.

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Fact of the day: Anaesthetic of choice in renal and hepatic failure
http://dlvr.it/NRswzF
Online colleges
The utopian life
Loops psychology

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Antibodies (Human)
The ‘foot’ (bottom) of the antibody is known as the Fc fragment - binds to cells, binds to complement = effector function (kills or removes antigen)
The top (antigen binding) is the Fab fragment
Chains are held together with disulphide binds
Associated molecules allow intracellular signalling
Normally 3X constant heavy chain domains per chain and a hinge region (except μ and ε which have 4 and no hinge region)
Classes of Immunoglobulins
The five primary classes of immunoglobulins are IgG, IgM, IgA, IgD and IgE, distinguished by the type of heavy chain found in the molecule.
IgG - gamma-chains
IgMs - mu-chains
IgAs - alpha-chains
IgEs - epsilon-chains
IgDs - delta-chains.
Differences in heavy chain polypeptides allow different types of immune responses. The differences are found primarily in the Fc fragment. There are only two main types of light chains: kappa (κ) and lambda (λ), and any antibody can have any combination of these 2 (variation).
IgG
monomer
Gamma chains
70-85% of Ig in human serum.
secondary immune response
only class that can cross the placenta - protection of the newborn during first 6 months of life
principle antibody used in immunological research and clinical diagnostics
21 day half life
Hinge region (allows it to make Y and T shapes - increasing chance of being able to bind to more than one site)
Fc strongly binds to Fcγ receptor on phagocyte - opsono-phagocytosis
Activates complement pathway
IgM
Serum = pentamer
Primary immune responses - first Ig to be synthesised
complement fixing
10% of serum Ig
also expressed on the plasma membrane of B lymphocytes as a monomer - B cell antigen receptor
H chains each contain an additional hydrophobic domain for anchoring in the membrane
Monomers are bound together by disulfide bonds and a joining (J) chain.
Each of the five monomers = two light chains (either kappa or lambda) and two mu heavy chains.
heavy chain = one variable and four constant regions (no hinge region)
can cause cell agglutination as a result of recognition of epitopes on invading microorganisms. This antibody-antigen immune complex is then destroyed by complement fixation or receptor mediated endocytosis by macrophages.
In humans there are four subclasses of IgG: IgG1, IgG2, IgG3 and IgG4. IgG1 and IgG3 activate complement.
IgD
B cell receptor
<1% of blood serum Ig
has tail pieces that anchor it across B cell membrane
forms an antigen specific receptor on mature B cells - consequently has no known effector function (don’t kill antigens, purely a receptor) (IgM as a monomer can also do this)
IgE
Extra rigid central domain
has the most carbohydrates
IgE primarily defends against parasitic invasion and is responsible for allergic reactions.
basophils and tissue mast cells express very high affinity Fc receptors for IgE - mast cells then release histamine
so high that almost all IgE is bound
sensitizes (activates) mucosal cells and tissues
protects against helminth parasites
IgE’s main purpose is to protect against parasites but due to improved sanitation these are no longer a prevalent issue across most of the world. Consequently it is thought that they become over activated and over sensitive while looking for parasites and start reacting to eg pollen and causing allergies.
IgA
Exists in serum in both monomeric (IgA1) and dimeric (IgA2) forms (dimeric when 2 Fcs bind via secretory complex)
15% of the total serum Ig.
4-7 day half life
Secretory IgA2 (dimer) = primary defense against some local infections
Secreted as a dimer in mucous (e.g., saliva, tears)
prevents passage of foreign substances into the circulatory system
Isotype: class of antibody (IgD, IgM etc)
Allotype: person specific alleles
Idiotype: (hyper) variable region - antibody specificity
ICU Materials part 1
After 4 years of volunteering in the ICU of the local hospital for respiratory diseases I’ve finally started to really understand a lot of the diagnostic procedures and the meaning of their results.
So I’ve decided to share with you some of the materials I use to study the ICU Stuff:
ABG interpretation
https://abg.ninja/abg - The site gives you a results from ABG analysis and you have to make a reading of them, then it show you if you are correct or wrong and gives you a full description why. On this site there some other very nice medical quzzes as well - Glasgow coma scale, Cranial Nerves, Basic ECG etc.
Lung function tests
http://www.ums.ac.uk/umj080/080(2)084.pdf
http://www.ics.gencat.cat/3clics/guies/184/img/–americanfamilyphysician.pdf In these PDFs the basic aproach to spirometry is described, everything you need to know when you stumble across spirometry results.
Coagulation tests
http://thrombosiscanada.ca/wp-content/uploads/2013/08/Bloody_Easy_Coag_2013.pdf
http://www.pathology.vcu.edu/clinical/coag/Lab%20Hemostasis.pdf Very consise and well writen guidelines for coagulation tests interpretations.
Chest radiology
https://lane.stanford.edu/portals/cvicu/HCP_Respiratory-Pulmoanry_Tab_2/Chest_X-rays.pdf
http://www.southsudanmedicaljournal.com/assets/files/Journals/vol_1_iss_2_may_08/how%20to%20read%20a%20cxr.pdf Basic guidelines for reading a Chest X-ray
Echography - Ultrasound Imaging
http://www.sah.org.au/assets/files/PDFs/For%20Doctors/2011-crit-care-us-heart.pdf
http://www.cardioegypt.com/cardioeg/ACSCA2014-Presentations/002001.pdf
http://www.annalsofintensivecare.com/content/pdf/2110-5820-4-1.pdf
http://www.cardiovascularultrasound.com/content/pdf/1476-7120-12-25.pdf
http://www.ccforum.com/content/pdf/cc5668.pdf Very simple and easy to understand presentations for the newbies(like me) in Ultrasound imaging. To be continued…
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More like this
amazing work
Dyingggggg
Part of me wants to save this for a Punday, but no.
Sweet, there’s a Freud one in here ;)
Why Is NPO The Default Diet For Trauma Patients?
I’ve watched it happen for years. A trauma patient is admitted with a small subarachnoid hemorrhage in the evening. The residents put in all the “usual” orders and tuck them away for the night. I am the rounder the next day, and when I saunter into the patient’s room, this is what I find:
They were made NPO. And this isn’t just an issue for patients with a small head bleed. A grade II spleen. An orbital fracture. Cervical spine injury. The list goes on.
What do these injuries have to do with your GI tract?
Here are some pointers on writing the correct diet orders on your trauma patients:
Is there a plan to take them to the operating room within the next 8 hours or so? If not, let them eat. If you are not sure, contact the responsible service and ask. Once you have confirmed their OR status, write the appropriate order.
Have they just come out of the operating room from a laparotomy? Then yes, they will have an ileus and should be NPO.
Are they being admitted to the ICU? If their condition is tenuous enough that they need ICU level monitoring, then they actually do belong to that small group of patients that should be kept NPO.
But here’s the biggest offender. Most trauma professionals don’t think this one through, and reflexively write for the starvation diet.
Do they have a condition that will likely require an emergent operation in the very near future? This one is a judgment call. But how often have you seen a patient with subarachnoid hemorrhage have an emergent craniotomy? How often do low grade solid organ injuries fail if they’ve always had stable vital signs? Or even high grade injuries? The answer is, not often at all! So let them eat!
Bottom line: Unless your patient is known to be heading to the OR soon, or just had a laparotomy, the default trauma diet should be a regular diet!
Source: http://thetraumapro.com/?p=2424

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Everyone realizing they still have to remember all the anatomy we learnt in first year
Which one’s your favourite?
COPD: Tips for step 2 CK and rounds
Hello! I have a pulmonary rotation going on and I thought I’d shed light on management of COPD :D During rotations, you may be asked what you want to do for the patient. I have written “Plan” for what you might want to answer to impress your attending. I’ve included a few common brand names too :) Inhalers: Remember inhalers only improve symptoms and have no mortality benefit and do not affect the progression of the disease. For all patients with COPD: A short-acting bronchodilator (eg, beta-agonist, anticholinergic agent) is prescribed for use as-needed for relief of intermittent increases in dyspnea. Plan: Albuterol PRN COPDers in whom intermittent short-acting bronchodilators are insufficient to control symptoms or two or more exacerbations in the previous year: Add a regularly scheduled long-acting inhaled bronchodilator. The long-acting inhaled anticholinergic (muscarinic) agent (LAMA) is preferred to the twice daily long-acting beta agonists (LABAs). Plan: Albuterol PRN Tiotropium OD (Spiriva) Important for step 2 CK: Inhaled anti-cholinergics are the most effective in COPD. (Contrary to asthma, where you start Inhaled steroids if symptoms aren’t controlled by short acting bronchodilator like albuterol alone.) Mnemonic: antiCholinergics are the Coolest in COPD. For patients who continue to have respiratory symptoms or exercise limitations when using long-acting inhaled bronchodilator monotherapy, add a second long-acting bronchodilator from another class (LAMA or LABA), rather than adding an inhaled glucocorticoid. For patients who continue to have symptoms or have repeated exacerbations despite an optimal long-acting inhaled bronchodilator regimen, add an inhaled glucocorticoid (ICS). An inhaled glucocorticoid may be warranted earlier (ie, at the same time that the long-acting inhaled bronchodilator is initiated) if there are signs of inflammation or an asthmatic component to the COPD. Personally, I have seen them prescribed together in clinical practice rather than one after the other. Plan: Albuterol PRN Tiotropium OD Fluticasone / Salmeterol BD (Adavir) Or Budesonide / Formoterol BD (Symbicort) Stuff that has a mortality benefit: Oxygen therapy Smoking cessation Vaccination (Influenza, pneumococcal) Clinical pearl: Always ask your COPD patient when was their last flu shot. If your attending asks, you’ll know it like a boss B) When do you start O2? Start O2 when pO2 < 55, sat < 88% (Silly question that I asked and answered myself: Why don’t we start O2 right away if it’s so awesomee? Because carrying an O2 cylinder around isn’t always feasible lol.) Other things to shine on rounds: Know that COPD is a systemic disease, not just a lung disease - Depression, osteoporosis, weight loss, etc are also a part of the disease. Read about BODE index. Know about the anti-inflammatory effects of macrolides in COPD exacerbations. That’s all! We rise by lifting others :) -IkaN
Thank you
Have a long layover at DFW airport? Learn CPR or check your current skills doing compressions. It tells you your compression rate and depth.
OMG I WANT TO TRY THIS I DONT CARE THAT IM ACLS CERTIFIED AND HAVE DONE COMPRESSIONS BEFORE THIS IS AMAZING!
What a great idea!

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@infomedicos
So I made another collection! This round of inspirational quotes goes to the philosophers. Like the other times, I hope you enjoy these inspirational quotes and find them inspiring too!
Plato
“The beginning is the most important part of the work.”
“A good decision is based on knowledge and not on numbers.”
“The good is the beautiful.”
Lao Tzu
“From caring comes courage.”
“Do the difficult things while they are easy and do the great things while they are small. A journey of a thousand miles must begin with a single step.”
“When you are content to be simply yourself and don’t compare or compete, everybody will respect you.”
“At the center of your being you have the answer; you know who you are and you know what you want.”
“Life is a series of natural and spontaneous changes. Don’t resist them - that only creates sorrow. Let reality be reality. Let things flow naturally forward in whatever way they like.”
Aristotle
“Happiness depends upon ourselves.”
“You will never do anything in this world without courage. It is the greatest quality of the mind next to honor.”
Socrates
“Be as you wish to seem.”
“It is not living that matters, but living rightly.”
“Let him that would move the world first move himself.”
Epictetus
“No great thing is created suddenly.”
“The key is to keep company only with people who uplift you, whose presence calls forth your best.”
“It takes more than just a good looking body. You’ve got to have the heart and soul to go with it.”
“First say to yourself what you would be; and then do what you have to do.”
“Practice yourself, for heaven’s sake in little things, and then proceed to greater.”
“There is only one way to happiness and that is to cease worrying about things which are beyond the power of our will.”
“Make the best use of what is in your power, and take the rest as it happens.”
“Do not seek to bring things to pass in accordance with your wishes, but wish for them as they are, and you will find them.”
“It is not he who reviles or strikes you who insults you, but your opinion that these things are insulting.”
“Neither should a ship rely on one small anchor, nor should life rest on a single hope.”
“It’s not what happens to you, but how you react to it that matters.”
“The greater the difficulty the more glory in surmounting it. Skillful pilots gain their reputation from storms and tempests.”
“You may be always victorious if you will never enter into any contest where the issue does not wholly depend upon yourself.”
Soren Kierkegaard
“Be that self which one truly is.”
“Life has its own hidden forces which you can only discover by living.”
“The highest and most beautiful things in life are not to be heard about, nor read about, nor seen but, if one will, are to be lived.”
“Face the facts of being what you are, for that is what changes what you are.”
“Life is not a problem to be solved, but a reality to be experienced.”
Hypatia
“Life is an unfoldment, and the further we travel the more truth we can comprehend. To understand the things that are at our door is the best preparation for understanding those that lie beyond.”
“Reserve your right to think, for even to think wrongly is better than not to think at all.”
Confucius
“The will to win, the desire to succeed, the urge to reach your full potential… these are the keys that will unlock the door to personal excellence.”
“It does not matter how slowly you go as long as you do not stop.”
“Everything has beauty, but not everyone sees it.”
“Wherever you go, go with all your heart.”
“When it is obvious that the goals cannot be reached, don’t adjust the goals, adjust the action steps.”
“Our greatest glory is not in never falling, but in rising every time we fall.”
Albert Camus
“To be happy we must not be too concerned with others.”
“Basically, at the very bottom of life, which seduces us all, there is only absurdity, and more absurdity. And maybe that’s what gives us our joy for living, because the only thing that can defeat absurdity is lucidity.”
“I know of only one duty, and that is to love.”
“The only way to deal with an unfree world is to become so absolutely free that your very existence is an act of rebellion.”
“You cannot create experience. You must undergo it.”
“You will never be happy if you continue to search for what happiness consists of. You will never live if you are looking for the meaning of life.”