In this lecture, we review the pathophysiology of abdominal compartment syndrome and outline how it affects multiple organ systems. The clinical presentation and management of this medical emergency are described.

In this lecture, we review sodium homeostasis in the human body as well as hyponatremia. Critical care management of hyponatremia is discussed. The differential diagnosis of hyponatremia will be outlined and an approach to its etiology is reviewed.

In this video, we discuss the physiology of potassium homeostasis as well as the mechanisms used by the body to maintain a stable potassium concentration. Three clinical examples of hyperkalemia are noted. The acute and subacute management of this life-threatening disorder is discussed.

Dr. Luis A. Verduzco Intensivist, Anaesthesiologist Dr. Verduzco presents the diagnosis, labs, pathophysiology, and management of sepsis and septic shock.

In this lecture, we review neuroanatomy and neurophysiology as it pertains to traumatic brain injury (TBI). Various subtypes of TBI are described, and the ICU management of such emergencies is delineated. TBI complications are reviewed with a focus on Takotsubo cardiomyopathy.

In this lecture, we review neuroanatomy and neurophysiology as it pertains to traumatic brain injury (TBI). Various subtypes of TBI are described, and the ICU management of such emergencies is delineated. TBI complications are reviewed with a focus on Takotsubo cardiomyopathy.

ICU Station and analgesia The armamentarium of the multimodule regiment for the ICU sedation while minimizing adverse effects. Definition Alpha and beta elimination. Context sensitive half-life Sedatives Analgesia Exam questions

In the perioperative cardiac complications lecture, we describe multiple cardiac and non-cardiac complications of cardiac surgery; an anatomic and organ system approach is taken to describe the cardiac and non-cardiac issues, respectively. A special emphasis is placed on heparin-induced thrombocytopenia as well as intra-aortic balloon pumps. After this lecture, learners should feel significantly more comfortable in the cardio-vascular ICU.

In this video, we review clinically pertinent respiratory anatomy and physiology as it relates to obstructive lung disease. Functional residual capacity, hypoxic pulmonary vasoconstriction and flow loops are reviewed. Obstructive pulmonary disease is discussed with an emphasis on emphysema and its pathophysiology, diagnosis and acute treatment during exacerbations.

In this lecture, a PA catheter is shown to describe the various features of the actual catheter; indications and contraindications are noted. Waveform tracings and their relationship to the EKG are, in great detail, described; the critical data obtained from a PA catheter as well as dangerous pitfalls are highlighted. Additional cardivascular physiology principles such as the Fick cardiac output, the mixed venous oxygen tension, the wedge pressure, and the systolic pressure variation are described.

Dr. Luis Verduzco presents following topics in Medical Fallacies How the teaching may be based on poor data or empirical mindset. Crystalloids for Blood Tx. Platelets and Fluid Wamers. GI Prophylaxis in the ICU. Renal Failure and Crystalloids. Hypertoxic Harm. Lactic Acidosis. Ketamine and the Brain. Allen's Test.

This is a quick overview of how you may wish to approach a patient with chest pain. Asking the correct questions in a systematic way, and having a broad differential diagnoses is important!

How do we define a hypertensive emergency? How important is it? How would you manage it and what would be your treatment goals? This is a very short high yield summary on this topic!

Did you know that in 1837 Joseph Freidrich Sobernheim was the guy who coined the term myocarditis? He, however lumped disorders together including cardiomyopathies due to for example ischaemic heart disease and hypertensive heart disease. In the 1980s, the World Health Organization (WHO) and the International Society and Federation of Cardiology looked to differentiate myocarditis from other cardiomyopathies. Learn the high yield stuff on myocarditis in this lecture!

Here is a high-yield summary on restrictive cardiomyopathy! Do you know the most common cause in the US?

Peripartum cardiomyopathy is a serious condition that can cause significant cardiac problems late in pregnancy or even after delivery. Do you know the high yield points? This short overview will be a great refresher!

A great little review of the high yield points on effusion and tamponade!

In this talk Dr. Faraz Bhatti presents the following topics:

1. Introduction to hyperkalemia.

2. Physiology of potassium.

3. Definition, aetiology, epidemiology, and risk factors of hyperkalemia.

4. Signs and symptoms of hyperkalemia.

5. Diagnosing hyperkalemia.

6. Emergent management of hyperkalemia.

Concise and to the point - a quick look at atrial myxomas!

Chagas disease is caused by what parasite? After this high yield short topic review you will find out how it affects the heart. Did you know that it is the most common cause of non-ischaemic cardiomyopathy in Latin America? High yield, short topic review!

Mitral regurgitation - such an important valvular disorder. Did you know that it is the most common valvular abnormality worldwide? It affects >2% of the total population ... high-yield stuff only!

Airway, airway, airway - the thing that will kill first! If a patient doesn't have a patent airway, a cardiac arrest will ensue rapidly. Therefore basic airway management is a concept that every clinician should be well versed in. Are you able to maintain an airway? Are you able to understand what a difficult airway may look like? Do you know about the types of respiratory failure? Do you know about oxygen therapy? This is an introductory presentation on airway emergencies and will be followed by a second part exploring other ways to oxygenate and ventilate a patient. Hopefully this discussion will inspire viewers to read more into some of the topics discussed which may be explored further in future presentations.

This presentation offers an introduction to advanced airway management and builds on Airway Emergencies 1.

Here you will learn about airway adjuncts, supraglottic devices, and rapid sequence induction/intubation. This is an introductory presentation and advanced airway management should only be attempted by those trained and competent in the skill.

A great summary lecture on how to go about recognizing what is a common differential diagnosis - acute appendicitis! By the end of this discussion, you should have a good grasp on evaluating a patient with abdominal pain suspicious of acute appendicitis.

Pregnancy is a common phenomenon, and therefore it should be in every clinician's skillset to be able to diagnose pregnancy, and have an organised approach as early recognition will result in better antenatal care!

In this presentation you will learn more about hCG, fetal heart tones and ultrasound. This topic touches on the basics of general practice in the diagnosis and management of pregnancy. Vital for further knowledge on Obstetrics!

Tuberculosis (TB) is a serious bacterial infection, a worldwide killer. Spread by airborne droplets - this is an incredibly important disease to be aware of. Can you appropriately diagnose a patient who presents with symptoms of TB? This presentation will help you navigate the salient points of TB diagnosis, pathophysiology and management which should kickstart deeper reading into this important topic.

Anaphylaxis is an acute, severe life-threatening allergic reaction. It is vital for any physician to recognise signs and symptoms of anaphylaxis as its emergent management can save a life! Death from anaphylaxis is rare, and fatal anaphylaxis rates are estimated at 0.064-0.099 deaths, per 100,000 population per annum.

This module will offer an introduction to anaphylaxis, its pathophysiology, signs and symptoms - i.e. early recognition, and an evidence-based management algorithm. This module is key for all physicians, and aspiring clinicians to understand.

A cough, a wheeze, shortness of breath ... COPD? Do you know how to recognise and treat this common disorder? This presentation nicely summarises acute COPD exacerbation management. By the end you’ll know how to approach your COPD patient!

Tetanus and rabies, not the most common thing in the world - but interesting! After this quick clinical review, you will know more about things to look out for if you ever come across someone who has been bitten by a dog, or spent the night in a room with a bat! Interesting stuff ...!

Hypertrophic cardiomyopathy - all you really need to know in this quick topic review!

How much do you know about aortic regurgitation? This is where the aortic valve leaflets don't close properly. This review will serve as a quick review of a very important topic!

It is fairly uncommon under the age of 65 years, however, overall is a common valvular disorder. This short review will look at the important nuggets of information - and what you need to know about aortic stenosis.

Time = heart muscle. An incredibly important topic, where recognition of ST-elevation myocardial infarction is key to saving myocytes and saving lives. This is part 1 of a 2-part summary review of a very high yield topic.

Time = heart muscle. An incredibly important topic, where recognition of ST-elevation myocardial infarction is key to saving myocytes and saving lives. This is the final part of a 2-part summary review of a very high-yield topic.

Dr. Marc A. Levitt, MD Discusses Hirschsprung Disease

1 child out of 5,000 live births suffers from Hirschsprung disease. Let's discuss this illness with Dr. Levitt.
 
Dr. Marc A. Levitt's bio:
https://childrensnational.org/careers-and-training/employee-stories/marc-levitt

Marc Levitt is the Chief of Colorectal and Pelvic Reconstructive Surgery at Children's National Hospital, Washington D.C.  He has focused his clinical and academic career in helping patients with complex colorectal and pelvic problems.  He received his undergraduate degree from the University of Pennsylvania, his medical degree from the Albert Einstein College of Medicine, and his surgical training at the Mount Sinai Medical Center in New York and the Children's Hospital of Buffalo. He has previously directed the Colorectal Centers at Cincinnati Children's Hospital and at Nationwide Children's Hospital.  Dr. Levitt has published over 300 peer-reviewed manuscripts, 90 book chapters, and 4 books.  He has delivered over 500 national/international/local/regional presentations of his work and has been an invited visiting professor all over the world. Dr. Levitt has trained dozens of clinical fellows, research fellows, and students in his career and has directed numerous colorectal training courses attended by established surgeons and surgical trainees from all over the world. He dedicates much of his free time to mission trips around the world where he trains surgeons in complex colorectal surgical techniques.

Link to the department where Dr. Levitt works:
https://childrensnational.org/departments/colorectal

Topics to discuss today:
•Understand the diagnosis of Hirschsprung disease
•Recognize key signs of the disease and other conditions that mimic it
•Describe the diagnosis of Hirschsprung disease
•Understand the surgical treatments

Disclaimer:
This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only.
Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional.

URL list from Friday, Feb. 4 2022

DrBeen: Continuing Medical Education Online | USMLE Prep | CME and CE marketplace | Nurse Practitioner and Physician Assistant Training Programs | Medical Student Training
https://www.drbeen.com/

Pediatric Colorectal & Pelvic Reconstruction | Children's National Hospital
https://childrensnational.org/departments/colorectal

Marc Levitt - Employee Story | Children's National Hospital
https://childrensnational.org/careers-and-training/employee-stories/marc-levitt

Dr. Marc A. Levitt, MD Discusses Hirschsprung - Long Terms Concerns

1 child out of 5,000 live births suffers from Hirschsprung disease. Let's discuss this illness with Dr. Levitt.
 
Dr. Marc A. Levitt's bio:
https://childrensnational.org/careers-and-training/employee-stories/marc-levitt

Marc Levitt is the Chief of Colorectal and Pelvic Reconstructive Surgery at Children's National Hospital, Washington D.C.  He has focused his clinical and academic career in helping patients with complex colorectal and pelvic problems.  He received his undergraduate degree from the University of Pennsylvania, his medical degree from the Albert Einstein College of Medicine, and his surgical training at the Mount Sinai Medical Center in New York and the Children's Hospital of Buffalo. He has previously directed the Colorectal Centers at Cincinnati Children's Hospital and at Nationwide Children's Hospital.  Dr. Levitt has published over 300 peer-reviewed manuscripts, 90 book chapters, and 4 books.  He has delivered over 500 national/international/local/regional presentations of his work and has been an invited visiting professor all over the world. Dr. Levitt has trained dozens of clinical fellows, research fellows, and students in his career and has directed numerous colorectal training courses attended by established surgeons and surgical trainees from all over the world. He dedicates much of his free time to mission trips around the world where he trains surgeons in complex colorectal surgical techniques.

Link to the department where Dr. Levitt works:
https://childrensnational.org/departments/colorectal

Topics to discuss today:
•Understand the diagnosis of Hirschsprung disease
•Recognize key signs of the disease and other conditions that mimic it
•Describe the diagnosis of Hirschsprung disease
•Understand the surgical treatments

Disclaimer:
This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only.
Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional.

URL list from Friday

DrBeen: Continuing Medical Education Online | USMLE Prep | CME and CE marketplace | Nurse Practitioner and Physician Assistant Training Programs | Medical Student Training
https://www.drbeen.com/

Pediatric Colorectal & Pelvic Reconstruction | Children's National Hospital
https://childrensnational.org/departments/colorectal

Marc Levitt - Employee Story | Children's National Hospital
https://childrensnational.org/careers-and-training/employee-stories/marc-levitt

In this video Katherine and Lindsay from Children's Hospital present cases for bowel management. Multiple cases for constipation or incontinence are presented with possible solutions. Let's review this important topic together.

Katie’s Bio
Katherine Worst, CPNP-AC
Katherine “Katie” Worst is a Certified Pediatric Nurse Practitioner with a background in acute care, surgery, intensive care, trauma and burns.  Katie served five years as a staff nurse at Children’s National before obtaining her Masters in Science as a Pediatric Nurse Practitioner in 2013.  As a mid-level provider, Katie worked with a team of surgeons caring for pediatric trauma, burn and general surgery patients. 
In 2017, Katie recognized a population of patients in need of long-term support, and she took the initiative to educate herself on this population, the colorectal patient surgical patient,  attending national conferences and spending time at other centers.  As a result, she was identified by the surgical team at Children’s National as an expert in their post-surgical care and ongoing bowel management.  She independently ran a bowel management program for surgical patients who struggle with constipation and incontinence following colorectal repair.
In 2019 Katie brought her experience running a bowel management program to the newly created Division of Colorectal and Pelvic Reconstruction, under the leadership of Dr. Marc Levitt, where Katie now serves as the Clinical Leader.   She has led education sessions both domestically and internationally, speaking on the care of the colorectal patient.
https://childrensnational.org/visit/find-a-provider/katherine-worst

Lindsay's Bio
Lindsay Pesacreta, FNP
Lindsay Pesacreta, FNP-BC, is a board certified family nurse practitioner at Children's National Hospital. She had five years of labor and delivery nursing experience in Boston and the Washington, DC, area prior to joining our team. Her primary focus is on the development of an institute program for environmentally acquired fetal and transitional conditions.
https://childrensnational.org/visit/find-a-provider/lindsay-pesacreta

Dr. Marc A. Levitt's bio:
https://childrensnational.org/careers-and-training/employee-stories/marc-levitt

Link to the department where Dr. Levitt works:
https://childrensnational.org/departments/colorectal
 

Dr. Marc A. Levitt, MD Discusses Anorectal Malformations. Pediatric Surgery Series

We will discuss the following topics today in the pediatric GIT surgery series:
Anorectal malformation, what is it?
Scrotal findings.
Types of malformations
A review of various malformations
Associated malformations

Dr. Marc A. Levitt's bio:
https://childrensnational.org/careers-and-training/employee-stories/marc-levitt

Marc Levitt is the Chief of Colorectal and Pelvic Reconstructive Surgery at Children's National Hospital, Washington D.C.  He has focused his clinical and academic career in helping patients with complex colorectal and pelvic problems.  He received his undergraduate degree from the University of Pennsylvania, his medical degree from the Albert Einstein College of Medicine, and his surgical training at the Mount Sinai Medical Center in New York and the Children's Hospital of Buffalo. He has previously directed the Colorectal Centers at Cincinnati Children's Hospital and at Nationwide Children's Hospital.  Dr. Levitt has published over 300 peer-reviewed manuscripts, 90 book chapters, and 4 books.  He has delivered over 500 national/international/local/regional presentations of his work and has been an invited visiting professor all over the world. Dr. Levitt has trained dozens of clinical fellows, research fellows, and students in his career and has directed numerous colorectal training courses attended by established surgeons and surgical trainees from all over the world. He dedicates much of his free time to mission trips around the world where he trains surgeons in complex colorectal surgical techniques.

Link to the department where Dr. Levitt works:
https://childrensnational.org/departments/colorectal

Topics to discuss today:
•Understand the diagnosis of Hirschsprung disease
•Recognize key signs of the disease and other conditions that mimic it
•Describe the diagnosis of Hirschsprung disease
•Understand the surgical treatments

Disclaimer:
This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only.
Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional.

URL list from Friday

Pediatric Colorectal & Pelvic Reconstruction | Children's National Hospital
https://childrensnational.org/departments/colorectal

Marc Levitt - Employee Story | Children's National Hospital
https://childrensnational.org/careers-and-training/employee-stories/marc-levitt

Dr. Marc A. Levitt, MD Discusses Postoperative Complications of Anorectal Malformations

We will discuss the following topics today in the pediatric GIT surgery series:
Anorectal malformation, what is it?
Scrotal findings.
Types of malformations
A review of various malformations
Associated malformations

Dr. Marc A. Levitt's bio:
https://childrensnational.org/careers-and-training/employee-stories/marc-levitt

Marc Levitt is the Chief of Colorectal and Pelvic Reconstructive Surgery at Children's National Hospital, Washington D.C.  He has focused his clinical and academic career in helping patients with complex colorectal and pelvic problems.  He received his undergraduate degree from the University of Pennsylvania, his medical degree from the Albert Einstein College of Medicine, and his surgical training at the Mount Sinai Medical Center in New York and the Children's Hospital of Buffalo. He has previously directed the Colorectal Centers at Cincinnati Children's Hospital and at Nationwide Children's Hospital.  Dr. Levitt has published over 300 peer-reviewed manuscripts, 90 book chapters, and 4 books.  He has delivered over 500 national/international/local/regional presentations of his work and has been an invited visiting professor all over the world. Dr. Levitt has trained dozens of clinical fellows, research fellows, and students in his career and has directed numerous colorectal training courses attended by established surgeons and surgical trainees from all over the world. He dedicates much of his free time to mission trips around the world where he trains surgeons in complex colorectal surgical techniques.

Link to the department where Dr. Levitt works:
https://childrensnational.org/departments/colorectal

Topics to discuss today:
•Understand the diagnosis of Hirschsprung disease
•Recognize key signs of the disease and other conditions that mimic it
•Describe the diagnosis of Hirschsprung disease
•Understand the surgical treatments

Disclaimer:
This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only.
Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional.

URL list from Friday

Pediatric Colorectal & Pelvic Reconstruction | Children's National Hospital
https://childrensnational.org/departments/colorectal

Marc Levitt - Employee Story | Children's National Hospital
https://childrensnational.org/careers-and-training/employee-stories/marc-levitt

Dr. Marc A. Levitt, MD Discusses Constipation and Fecal Incontinence

We will discuss the following topics:
Factors contributing to fecal incontinence.
Which children have problems with fecal incontinence?
Predictors of incontinence.
Bowel management
Treatment of incontinence
Hypermotility and its medical treatment
Role of a surgeon in these pathologies
Severe constipation
Management of severe constipation

Dr. Marc A. Levitt's bio:
https://childrensnational.org/careers-and-training/employee-stories/marc-levitt

Marc Levitt is the Chief of Colorectal and Pelvic Reconstructive Surgery at Children's National Hospital, Washington D.C.  He has focused his clinical and academic career in helping patients with complex colorectal and pelvic problems.  He received his undergraduate degree from the University of Pennsylvania, his medical degree from the Albert Einstein College of Medicine, and his surgical training at the Mount Sinai Medical Center in New York and the Children's Hospital of Buffalo. He has previously directed the Colorectal Centers at Cincinnati Children's Hospital and at Nationwide Children's Hospital.  Dr. Levitt has published over 300 peer-reviewed manuscripts, 90 book chapters, and 4 books.  He has delivered over 500 national/international/local/regional presentations of his work and has been an invited visiting professor all over the world. Dr. Levitt has trained dozens of clinical fellows, research fellows, and students in his career and has directed numerous colorectal training courses attended by established surgeons and surgical trainees from all over the world. He dedicates much of his free time to mission trips around the world where he trains surgeons in complex colorectal surgical techniques.

Link to the department where Dr. Levitt works:
https://childrensnational.org/departments/colorectal

Disclaimer:
This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only.
Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional.

URL list from Friday

Pediatric Colorectal & Pelvic Reconstruction | Children's National Hospital
https://childrensnational.org/departments/colorectal

Marc Levitt - Employee Story | Children's National Hospital
https://childrensnational.org/careers-and-training/employee-stories/marc-levitt

Bowel Management

Today we have Katie and Julie from Dr. Marc A. Levitt's office to discuss bowel management.

Katie’s Bio
Katherine Worst, CPNP-AC
Katherine “Katie” Worst is a Certified Pediatric Nurse Practitioner with a background in acute care, surgery, intensive care, trauma and burns.  Katie served five years as a staff nurse at Children’s National before obtaining her Masters in Science as a Pediatric Nurse Practitioner in 2013.  As a mid-level provider, Katie worked with a team of surgeons caring for pediatric trauma, burn and general surgery patients. 
In 2017, Katie recognized a population of patients in need of long-term support, and she took the initiative to educate herself on this population, the colorectal patient surgical patient,  attending national conferences and spending time at other centers.  As a result, she was identified by the surgical team at Children’s National as an expert in their post-surgical care and ongoing bowel management.  She independently ran a bowel management program for surgical patients who struggle with constipation and incontinence following colorectal repair.
In 2019 Katie brought her experience running a bowel management program to the newly created Division of Colorectal and Pelvic Reconstruction, under the leadership of Dr. Marc Levitt, where Katie now serves as the Clinical Leader.   She has led education sessions both domestically and internationally, speaking on the care of the colorectal patient.

Julie’s Bio
Julie Choueiki, MSN, RN
Julie completed her undergraduate studies in Nursing at The Ohio State University. She completed her Masters of Science in Nursing Administration at The University of Cincinnati. Julie has worked as a Trauma, Critical Care and Emergency Department Nurse, Nurse Educator, Informatics Educator, and Professional Development Nurse Specialist. She was the 2013 March of Dimes Nurse of the Year for Emergency Services Nursing.  She has been active on numerous hospital committees and task forces focusing on Quality Improvement, Patient and Staff Safety, and Evidence-Based Practice.
In 2019 Julie was recruited to join Dr. Marc Levitt at Children’s National in Washington, DC to build the Division of Colorectal and Pelvic Reconstruction; a comprehensive collaborative program designed to meet the complex needs of the colorectal patient and their families.
Her expertise in the field of Program Management and as a past Director of Strategy poised her to develop a collaborative center in the nation’s capital, treating and serving children from all over the United States and the world.  She has travelled domestically and internationally, speaking on the work of collaborative care centers, and providing education on program development. 

Dr. Marc A. Levitt's bio:
https://childrensnational.org/careers-and-training/employee-stories/marc-levitt

Link to the department where Dr. Levitt works:
https://childrensnational.org/departments/colorectal

Disclaimer:
This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only.
Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional.

URL list from Friday

Pediatric Colorectal & Pelvic Reconstruction | Children's National Hospital
https://childrensnational.org/departments/colorectal

Marc Levitt - Employee Story | Children's National Hospital
https://childrensnational.org/careers-and-training/employee-stories/marc-levitt

Chest X-Ray is a routine clinical investigation. It is important for healthcare professionals to be comfortable approaching and interpreting it. In this webinar, Dr. Alikhan shares his excellent method to identify key elements that are frequently encountered on the chest x-ray.

View Notes

All healthcare professionals must master the understanding and management of asthma. This lectures series helps us master asthma, its pathophysiology, diagnosis, and management. In this lecture Dr. Mobeen presents:

Asthma definition.
Asthma and COPD.
Asthma's pathophysiological triad.
Types of asthma including:

• Phasic (Immediate and late).
• Clinical types: Intermittent and status asthmaticus.
• Aetiology: atopic, non-atopic.
• Hygine theory.

Immune system abnormality to give rise to atopy.

Immune system behaviour for cytotoxic and humoral responses.

Airway structures that are affected by asthma:

• Respiratory epithelial cells.
• Mucoa and its glands.
• Smooth muscles of the airways.
• Submcosa, its glands, and nerves.
• Fibroblasts.
• T cells.
• B cells.

Why are eosinophils the dominant players in asthma pathology?
Cytokines and chemokines active in asthma development.

• IL2, IL3, IL4, IL5, IL13

We will discuss the foundational concepts that lead to the obstructive pulmonary diseases. Following topics are discussed:

• Diseases that are classified as obstructive pulmonary diseases.
• Anatomical and physiological functions.
• Airway structure.
• Parts of the airway that are involved in chronic obstructive pulmonary diseases (COPD)
• Pathology of chronic bronchitis.
• Pathology of emphysema.
• Pathology of bronchiolitis.
• Definition of chronic bronchitis and emphysema.
• COPD vs. Asthma
• How smoke and pollutants cause damage to large and small airways.
• Immune system and obstructive diseases.
• Protease and anti-protease imbalance. We will discuss acquired and genetic deficiencies of protease inhibitors, for example, alpha-1 antitrypsin.
• Oxidant and anti-oxidant imbalance.

In this video, we review clinically pertinent respiratory anatomy and physiology as it relates to obstructive lung disease. Functional residual capacity, hypoxic pulmonary vasoconstriction and flow loops are reviewed. Obstructive pulmonary disease is discussed with an emphasis on emphysema and its pathophysiology, diagnosis and acute treatment during exacerbations.

This video presents Bronchiectasis a type of obstructive lung disease. Bronchiectasis is irreversible, chronic, dilatation of the bronchi and bronchioles due to or associated with the chronic infectious disease process.

This video presents following topics about Atherosclerosis: Cellular and chemical mechaisms of the atherosclerotic plaque development. Mechanism of damage that starts/accelerates atherosclerosis Initiation of the atherosclerosis Progression of the atherosclerosis Complications of the atherosclerosis

This video presents following topics about Atherosclerosis: Definition Epidemiology Risk factors Clinical aspects.

This video discusses following topics: Cellular and morphological events during the MI Diagnosis of an MI by the cardiac enzymes and EKG changes Management approach Complications including dressler's syndrome

Dr. Syed presents:

The terminology used for the cardiac chamber enlargement.

Principles of the EKG changes when chamber enlargement is present.

Right atrial enlargement, EKG changes, diagnostic criteria, and the pathologies.

Left atrial enlargement, EKG changes, diagnostic criteria, and the pathologies.

Right ventricular enlargement, EKG changes, diagnostic criteria, and the pathologies.

Left ventricular enlargement, EKG changes, diagnostic criteria, and the pathologies.

Both ventricular enlargement, EKG changes, diagnostic criteria, and the pathologies.

Dr. Anam Tariq from the John Hopkins School of Medicine's department of nephrology discusses epidemiology for hypertension. This is the foundational lecture for the management of hypertension.

The agenda for this discussion is the following:

1. High level blood pressure (BP) pathophysiology.
2. BP as a risk factor for the chronic kidney disease.
3. Descriptive epidemiology
4. Trial evidence
   1. Effects of specific anti-hypertensive medications.

This video presents following topics about hypertension: Defintion Classification Normal blood pressure controlling mechanisms Pathological mechanisms that result in the hypertension

Dr. Anam Tariq continues the discussion about hypertension. In this session, Dr. Tariq discusses with Dr. Mobeen the management aspects of hypertension. Questions from the community members are used to address common clinical scenarios and potential approach to consider.

The topics discussed are related to the following questions:

Questions from René Gardner: With the new guidelines recommending <130/80. How aggressively are they with pursuing this? Especially in older patients.
Related questions:
Kathy RN AHA vs. JNC8 guidelines?
AHA: elevated BP >130/80, stage 1 >130/80

Dr. Tariq discusses the definition and stages of abnormal blood pressure, according to the American Heart Association (AHA).

Question from Kat Tugado: Good evening, I would like to hear her insights on the latest management in pediatric hypertension. Thank you.

Question from Bishal Baishya I have a question with 2 parts -
"When new JNC and AHA guidelines were modified to remove Prehypertension, and reduce the upper roof of normal limits.
1. How do clinicians and patient themselves target for a level of healthy BP and management of hypertension? Because new levels are more of just numbers a patient can just dream to reach. It does have a negative psychological impact that they shall be always be unfit.
2.Does it necessarily mean that they should touch this new lower levels to stay fit when by region and altitude they were acclimatise to 110 to 120 systolic and likewise near diastolic levels?"

Question from Robert Adams: Is there a common mistake you see more “rookie” practitioners make treating hypertension, and if so , how can we avoid it?

Question from DrAlkesh Patel: How u predict or judge intermediate htn or border line htn
And mostly what the causative agent what true managment
Marwan Hassan A Is it advisable to restrict table salt for HTN patients who are on a treatment plan?

Dr. Anam discusses the correct process of taking a person's blood pressure. We believe this is a process that is overlooked in the majority of clinical practice. We hope our audience will take special note of this process and make it routine for their clinical practice.

Dr. Tariq discusses the potential for precise medical practice by using ambulatory monitoring devices for hypertension.

Question from Robert Adams: Is there good data for non pharmacological treatments like diet, exercise and increased higher quality sleep ? And what sort of reduction benefit might we expect from lifestyle changes , and over what time frame?

Questions from Robert Adams: A patient comes to you with a bp of 225/110 , how long would be an acceptable amount of time to get control of their bp and what might a reasonable bp be for them ?

Questions from Khaty RN: Patient with BP of 225/110 needs close monitoring and observation to prevent microvascular damage. PCP or family cannot manage unstable patients in the outpatient. That is why we refer to ED or cardiology.

Questions from Lee Ann Summers: does this person need to be sent to ED or can I start management in the outpatient setting?

Questions from Marlene Torres: Is it in the best interest of the patient to get a medication that will lower the blood pressure fast but possible give them rebound HTN? Or should be just give the patient HTN medication based on their ethnicity and bring them back in 1 week, so on and so forth so their BP comes down slowly instead of giving a quick result. I ask because this has been a blazing dispute between some providers in my clinic face.

Questions from Robert Adams: if this is chronic then they are no less stable than when they walked into your clinic to though, and probably much less stable if you begin aggressively lowering their bp secondary to hypo perfusing their brain and kidneys , the sepsispam trial might be able to offer us guidance on this in the inpatient setting
https://www.wikijournalclub.org/wiki/SEPSISPAM

Questions from Abdi Razak Yousuf Kahin: Why beta blockers are not a first line drug for HTN ?

Questions from Mohammad Salman: Resistant hypertension etiology and treatment plan.
Hypertensive urgency , emergency plus malignant Hypertension management.

Questions from Katanje Phiri: The approach in management of stroke secondary to severe hypertension.....?

Questions from DrHaseeb Ubaid Ullah: Resistant recurrent hypertensive urgency treatment plan
And basic treatment plan of a patient with raised BP during early period of ischemic attack

Questions from Marlene Torres: There is an attributing factor of a patient having OSA will also lead to AFIB. But is OSA also an attributing factor of HTN?

Questions from Marlene Torres: There is an attributing factor of a patient having OSA will also lead to AFIB. But is OSA also an attributing factor of HTN?

Questions from Robert Adams: How does obstructive sleep apnea play a role in your treatment of a hypertensive patient? Do you screen and treat early or do you wait till later?

Questions from Robert Adams: I hope at this point we all know smoking is terrible for us, is vaping as bad? I’ve also read pot has 10x the nicotine as cigarettes, is nicotine the culprit and if so have we seen any changes in rates of atherosclerosis or hypertension in legalized vs non legalized states?

Questions from Robert Adams: Do you know of any new treatments, drug trials , implantable mechanical devices that are promising for hypertension?

Dr. Syed continues the fable about the management of the hypertension. Topics discussed are: High renin vs. low renin hypertension. Causes of the hypertension including: Cushing disease and cushing syndrome Parathyroid abnormalities Hypothyroidism and hyperthyroidism Cardiac conditions Coarctation of Aorta Vascular conditions Supra-renal conditions including, 11 betahydroxylase deficiency, primary aldosteronism and pheochromocytoma Chronic kidney disease Fibromuscular dysplasia Atherosclerosis and the ostia of the renal arteries

List of anti-hypertensive drugs. Principles of therapy JNC-8 lifestyle guidelines JNC-8 high-level summary JNC-8 algorithm Important notes about various anti-hypertensive drugs Traditional therapeutic approaches. Disclaimer: these are generalized and high-level points to inform the healthcare professionals. These messages do not consist of a prescription for an individual patient. Each patient needs to have a complete assessment with physical examination, labs, other tests, etc. before a therapeutic approach.

In this lecture, we review the physiology of cardiac contraction and the cellular mechanisms involved in that process, including adrenergic receptors. Multiple inotropic and vasoactive agents are discussed in detail. Clinical examples are provided at the end of the lecture

In this lecture, we review the physiology of cardiac contraction and the cellular mechanisms involved in that process, including adrenergic receptors. Multiple inotropic and vasoactive agents are discussed in detail. Clinical examples are provided at the end of the lecture

Difference between intra-embryonic mesoderm and coelom Vasculogenesis angiogenesis Heart forming regions and the development of the heart tube Heart tube dilatations and their derivatives Septum transversum mesocordial septum transverse sinus Retinoic acid Levo Dyenin VE GF Kartagener's syndrome/primary cilliary disease Situs inversus.

STUDY NOTES:

HEART TUBES

INTRODUCTION: Cardiovascular system is the first organ system to start developing and reach a functional state; which is even before its own development is complete. Cardiovascular development occurs during the 3rd to 5th week of intraembryonic life. Up until the second week, diffusion is enough for embryo to receive the oxygen, nutrition and to get rid of the waste products. The lacunae of maternal blood filled spaces and embryonic villi of the syncytio-trophoblast are involved in an intimate relationship, which allows gaseous exchange via diffusion in between the developing embryo and the maternal blood. However, into the third week, diffusion alone is not sufficient to match the needs of the growing embryo and it needs a circulatory system, hence heart has to develop.

GASTRULA STAGE: Gastrula is a stage of development of embryo, when it is in the form of tri-laminar germ disc including ectoderm, mesoderm and endoderm. Endoderm is associated with umbilical vesicle; ectoderm is associated with Amniotic cavity. Cytotrophoblast around the gastrula develops multiple cavities. The cavities merge to form one big cavity called extraembryonic coelom. The cytotrophoblast is connected to embryo through the connecting stalk. The cellular layer from cytotrophoblast which covers the gastrula is called extraembryonic mesoderm. The Gastrula is a slipper shaped structure. From the dorsal view it has a neural plate with a primitive node a primitive pit and a primitive groove. Cranial side has a Buccopharyngeal membrane which would later develop into mouth. Caudal end has a cloacal membrane which would develop into anus.

HEART FORMING REGIONS: Around 15th day of intraembryonic life, multiple cavitations start appearing in the lateral plate mesoderm which later merge together to form a Horseshoe-shaped Intraembryonic Coelom. The Horseshoe shaped Coelom divides lateral plate mesoderm into two layers which are called Splanchnopleure (connected to underlying Endoderm) and Somatopleure (connected to overlying Ectoderm). It’s the splanchnic layer of mesoderm which mainly forms the cardiogenic area in the latter half of the 3rd week. In addition to this, Neural crest cells also contribute to heart formation especially the Aorticopulmonary septum and the Endocardial Cushion regions.

Around 17the day of intraembryonic life, the Endoderm layer of the Gastrula secretes VEGF, which causes Ectodermal cells to migrate into the cranial end of the underlying mesoderm and form Blood islands. A horseshoe shaped area forms on either side of the neural plate. The blood islands formed above the Prechordial plate (Cranial side) are called PrimaryCardiogenic or Heart-forming regions. 

CRANIAL & LATERAL BODY FOLDINGS: By the 17-18 days brain starts developing at a faster pace and overtakes the body’s growth so that the heart descends downwards to the chest region. Cephalic-caudal Body folding ensures that the cardiogenic area and septum Transversum (future diaphragm) come to lie under and below the prechordal plate and in frontof the foregut. The heart hangs from the foregut by a connection called prechordium.Lateral body folding approximates the intraembryonic coelom in the midline, folds of which give rise to adult pericardial sacs which envelope the cardiogenic area in the midline. 

DEVELOPMENT OF PRIMITIVE HEART TUBES: The ectodermal cells migrate into the mesoderm as cardiogeniccells which condense to form a pair of primordial Heart tubes. The pharyngeal area mesoderm contributes further cells which form a secondary heart forming region around the primordial heart tubes. Further cells are contributed the Splanchnic Mesoderm which form the myocardium around the primordial heart tubes. This newly formed Myocardium will start secreting Hyaluronic acid and other connective tissue components which are termed together and called as Cardiac Jelly. Cardiac jelly in future becomes the connective tissue of the heart. These newly formed primordial heart tubes are surrounded by pericardial cavity which provides the outer Parietal layer of the Pericardium which is adherent to the Fibrous pericardium in the adult heart. The Caudal or Inflow part of the Heart tube that is Sinus Venosus provides the cells which form the visceral or inner layer of pericardium, also called EPICARDIUM. By the 21st day the two primordial heart tubes fuse by apoptosis into a single endocardial or Heart tube. On 22nd day the embryonic heart starts beating.

DILATATIONS & DERIVATIVES OF THE HEART TUBE: The Primordial heart tube now orients itself into a cephalic INFLOW (Venous region) and a cranial OUTFLOW (Arterial Region) ends. At this point the primitive heart tube has five dilatations which are as following:

1. Truncus Arteriosus (Arterial Outflow region): Forms Adult Aorta, Pulmonary trunk and their respective semilunar valves.
2. Bulbus Cordis: Forms Smooth parts of Adult right ventricle (conus arteriosus) and left ventricle (aortic vestibule).
3. Primitive Ventricle: Forms trabeculated/rough parts of right and left ventricles.
4. Primitive Atrium: Forms trabeculated/rough parts of right and left atriums i.e., the pectinate muscles.
5. Sinus Venosus: On the right side it forms Sinus Venarum (smooth part of right Atrium), Superior vena cava and the inferior vena cava. On the left side it forms Coronary sinus and oblique vein of left atrium.

Note: (a) The vascular parts when incorporated into the adult heart form the smooth regions of the heart whereas the primitive chambers form the rough or trabeculated parts of the respective adult heart chambers.

(b) Incorporation of parts of the Pulmonary veins forms the smooth-walled part of the left Atrium. On the right side, incorporation of right sinus venosus forms the smooth-walled part of right atrium.

DEXTRAL LOOPING: The heart tube at this point undergoes Right sided bending or rotation which referred to as Dextral looping. The Truncus Arteriosus or the ventricularend of the heart tube grows more rapidly and tends to fold downwards, forwards and to the right side. Subsequently, the lower parts of the tube i.e., the primitive atria and sinus venosus tend to fold upwards, backwards and to the left side. This dextral looping tends to place the chambers of heart in their adult anatomic positions where the right ventricle forms most of the right border plus the anterior surface of the heart and the left atrium is the posterior most chamber of the heart. Also, the ventricles are rather more anteriorly placed relative to atria in an adult heart.

THE ROLE OF LEVO-DYNEIN, DEXTROCARDIA, SITUS INVERSUS & KARTEGENER SYNDROME: Levo-Dynein is a protein which involved in the formation of Cilia. However, Levo-Dynein also functions to create symmetry within the human body. An abnormality of Levo-dynein can lead to symmetry problems such as, Situs Inversus whereas the visceras tend to be present on the opposite sides of their normal anatomical location. It can also lead to Dextrocardia, which is a rare clinical condition in which the Apex of the heart is located on the right side of the body. The above two abnormalities often present as part of Kartagener Syndrome (Primary Ciliary Dyskinesia). Kartagener Syndrome results due to a defect in the dynein arm of the cilia which renders cilia immotile. It is a cause of infertility in both males and females due to immotile sperm and dysfunctional fallopian tube cilia respectively. In females there's an additional risk of ectopic pregnancies. Besides Dextrocardia on CXR and infertility in both sexes, Kartagener Syndrome can also lead to Bronchiectasis and recurrent sinusitis due to ineffectiveness of mucociliary escalator.

MESOCORDIUM & TRANSVERSE SINUS: Post the cranial-caudal body folding, the embryonic heart tubes come to lie in front of the foregut. This is before the fusion of the primordial heart tubes into a single Heart tube. At this point the primordial heart tubes are connected to the foregut via the Mesocordium. The Mesocordium itself is a derivative of peritoneum. Subsequently, a gap appears within the Mesocordium which is called transverse sinus and this eventually results in degeneration of Mesocordium, following which the Pericardial cavity is thus separated from the Foregut.

TERATOGENS EXPOSURE: Teratogens are substances (normally drugs) which can either cause birth defects or they can accelerate other embryonic deformities that are present. Developing embryo is most susceptible to teratogens exposure during its embryonic period which is from 3rd to 8th week (first 2 months).This is because the embryonic period is the time when most organ systems are developing; hence teratogen exposure at this point can be disastrous. Teratogens frequently tested by the USMLE are given below:

1. ACE Inhibitors: Cause Renal damage
2. Aminoglycosides: Cranial nerve 8, Vestibulocochlear Nerve Abnormalities.
3. Carbamazepine: Facial dysmorphism, developmental delay and neural tube defects.
4. Lithium (used to treat the manic phase of Bipolar disorder): Ebstein Anomaly in which the tricuspid valve leaflets are displaced inferiorly into the right ventricle. It presents with widely split S2 and Tricuspid Regurgitation.
5. Phenytoin: Can cause fetal Hydantoin syndrome i.e., cleft palate, cardiac defects and phalanx or fingernail hypoplasia.
6. Tetracyclines: Discoloration of teeth.
7. Thalidomide: Limb defects.

ROLE OF RETIONOIC ACID: Increased retinoic acid concentration in an area of blood vessel formation leads to formation of a venous channel. However, a decrease in retinoic acid concentration favours the formation of an arterial channel.

DIFFERENCE BETWEEN VASCULOGENESIS & ANGIOGENESIS:  Vasculogenesis is defined as formation of a new blood vessel literally from nothing or scratch. Angiogenesis on the other hand is defined as, formation of a new blood vessel from an existing vascular channel by branching. Regions of an existing blood vessel bud of as part of angiogenesis to create a new branch.

Review Difference between intra-embryonic mesoderm and coelom Vasculogenesis angiogenesis Heart forming regions and the development of the heart tube Heart tube dilatations and their derivatives Septum transversum mesocordial septum transverse sinus Retinoic acid Levo Dyenin VE GF Kartagener's syndrome/primary cilliary disease Situs inversus

Cardiovascular issues are one of the most prevalent in the US and the world. It is essential for every great clinician to have a good grasp of the structure of the heart. Understanding and interpreting the heart sounds, murmurs, and EKG depend on the mastery of the heart's structure. 

This is your video to start the mastery of the structure of the heart.

In this video, Drbeen faculty, Dr. Adam Jones presents the structure of the heart. Following structural elements are presented and discussed. 
1. Heart's placement in the chest.
2. Chambers of the heart.
3. Chamber that we see from the front vs. back.
4. Epicardial fat.
5. Coronary vessels
6. Right Atrium.
7. Right Auricle.
8. Functions of an auricle.
9. Superior Vena Cava.
10. Inferior Vena Cava.
11. Coronary Sinus.
12. Interatrial septum
13. Fossa ovalis
14. Patent foramen ovalis and its consequence
15. Right atrioventricular valve or tricuspid valve
16. Right ventricle
17. Chordae tendineae
18. Papillary muscles
19. Trabeculae carneae
20. Tricuspid regurgitation
21. Pectinate muscle
22. Left atrium
23. Bicuspid valve or mitral valve
24. Mechanical valves25. Mitral valve regurgitation

General principles of the CVS Organization Heart as two pumps Series and parallel circuits Chemical composition of the venous and arterial blood Blood flow direction Various pressures in the CVS.

STUDY NOTES:

GENERAL PRINCIPLES OF CARDIOVASCULAR PHYSIOLOGY

ORGANIZATION OF THE CVS

HEART AS 2 PUMPS: The human heart has 4 chambers which are the two atria and the two ventricles. These 4 chambers are divided into 2 functional units referred to as the left heart and the right heart. These atria and ventricle in a single functional unit are separated by the atrioventricular valves. These AV valves are one way valves and allow blood flow in the forward direction only.

Right heart is formed by the right atrium and the right ventricle, and it forms one functional unit. The right atrium receives the venous deoxygenated blood from three sources, namely:

1) Superior vena cava: brings deoxygenated blood from the head, neck and upper limb region

2) Inferior vena cava: brings deoxygenated blood from the lower extremities, the abdominal region and the rest of the body except the heart itself.

3) Coronary sinus: brings deoxygenated blood from the veins of the heart itself.

During diastole when the atria contract, this deoxygenated blood is pumped into the right ventricle. During systole, the right ventricle pumps this deoxygenated blood out of the heart and into the pulmonary circuit via the pulmonary artery*. The right heart plus the pulmonary arteries, capillaries and veins together form the pulmonary circulation. The right side of the heart deals with deoxygenated blood only and it functions to send this deoxygenated blood to the pulmonary circulation to get oxygenated.

Left heart forms another functional unit and consists of the left atrium and left ventricle. The left atrium receives oxygenated blood from the pulmonary circuit via the 4 pulmonary veins*(two from each lung). When the atria contract, the left atrium pumps this oxygenated blood into the left ventricle. During systole, this oxygenated blood is pumped out of the heart via aorta, when the left ventricle contracts. The aorta then carries this oxygenated blood intothe systemic circulation. The left heart plus the systemic arteries (starting at the aorta), capillaries and veins together form the systemic circulation. For simplicity, it can be assumed that the left heart deals with the oxygenated blood and sends it to the systemic circulation via the aorta. 

NOTE: Arteries conduct blood away from the heart towards the tissues. Arteries normally carry oxygenated blood away from the heart, but an exception to this rule are the pulmonary arteries and the umbilical arteries(during fetal life only) which carry deoxygenated blood away from the heart and toward the lungs & placenta respectively. Veins normally carry deoxygenated blood, except the pulmonary veins in adults and the umbilical vein (during fetal life only) which bring back oxygenated blood to the heart from the lungs and the placenta respectively.

SYSTEMIC TISSUES:

As part of the systemic perfusion, the oxygenated blood in the aorta is eventually transported to the following 6 major systemic tissues. These systemic tissues receive blood via a parallel system of arteries which originate at various levels from the aorta itself.

1) Cerebral: The CNS plus the head & neck region. 15% of the cardiac output enters the cerebral arteries.

2) Coronary: The myocardium itself which receives oxygenated blood during diastole in contrast to the rest of the body which receives oxygenated blood as part of systole. 5% of the total cardiac output is designated for the myocardial perfusion via the kidneys.

3) Splanchnic: The gastrointestinal system and its accessory organs such as the liver, spleen, pancreas and the biliary system. 25% of the total cardiac output reaches the GIT system via the splanchnic arteries.

4) Renal: The kidneys and the genitourinary system. Kidneys, as part of the renal system, receive 25% of the total cardiac output.

5) Skeletal: Roughly 25% of the total cardiac output is reaches the skeletal system. Exercise increases the percentage of cardiac output which is made available for the skeletal system. Bones and the musculature of the body form part of this system.

6) Cutaneous: The skin and its associated structures (sebaceous glands, hair follicles). Around 5% of the total cardiac output reaches the cutaneous circulation. 

BLOOD FLOW DIRECTION & THE CHEMICAL COMPOSITION OF THE VENOUS & ARTERIAL BLOOD:

There are 4 pulmonary veins which bring back oxygenated blood from the lungs to left atrium. This blood is rich in oxygen (PaO2=100 mm Hg) and low in carbon dioxide(PaCO2=40 mm Hg). The mitral valve which forms the left atrioventricular valve, allows passage of blood from the left atrium into the left ventricle during the diastole phase. When the left ventricle begins to contract and its pressure rises more than the left atrial pressure, the mitral valve closes to prevent backflow of the blood. This ensures anterograde flow of blood in to the aorta i.e., the forward direction of blood flow. Backflow from the aorta back into the left atrium is prevented by the semilunar aortic valve. It's important to remember that all the valves of the heart are tricuspid i.e., having three cusps, except the mitral valve which is bicuspid i.e., having two cusps. However, only the right atrioventricular valve is referred to as the tricuspid valve. 

From the aorta, the blood is transported to the systemic tissues which are mentioned above. The aorta divides into large and medium sized arteries, which eventually give arise the arterioles. The arterioles continue to form capillaries, and these capillaries merge together to form venules at their venous ends. The venules eventually end up forming the veins. The veins are low pressure vessels which return the deoxygenated blood back to the right heart via the three above mentioned sources of venous return to the heart. This deoxygenated blood is low in oxygen (40 mm Hg) and rich in carbon dioxide (47 mm Hg). The right atrioventricular valve, which is also referred to as the tricuspid valve, allows this deoxygenated blood to flow from the right atrium into the right ventricle. During ventricular systole when the leftventricle contracts, this deoxygenated blood is pumped out ofthe right side of the heart via the pulmonary artery. The backflow of this deoxygenated blood into the right side of the heart during ventricular diastole is prevented by the semilunar pulmonary valve. This deoxygenated blood reaches the lungs and enters the pulmonary circuit to get oxygenated At this point the blood completes its route both around the pulmonary and systemic circuits.  

SERIES & PARALLEL CIRCUITS

The right and left sides of the heart are connected in a series circuit to both the pulmonary and systemic tissues respectively. By series circuit, what's meant here is that quantitatively, the blood flow through the lungs is equal to the blood flow through the rest of the body. For simplicity in understanding, it should be considered that the lungs are connected to the rest of the body in a series circuit. During a single cardiac cycle, the right and left ventricular outputs are the same. 

However, the blood supply of the systemic tissues is connected in a parallel circuit. This means that each organ system is supplied by an artery which originates as a branch of the aorta. This ensures that the blood which reaches a particular organ system is perfused at the same partial pressure of oxygen, as that of the site at which the branch originated from the aorta. If the organ systems were connected and perfused via a series circuit, by the time the blood reached the last organ system, it would have been completely depleted of oxygen and nutrients. The sum of blood flow to these individual systems adds up to the total left ventricular output (the cardiac output). 

VARIOUS PRESSURES IN THE CVS

• SYSTOLIC BLOOD PRESSURE (SBP): Systole is time interval when the ventricles are contracting. Systolic BP therefore is the pressure in the systemic arteries when the left ventricle is contracting. Therefore, SBP is the highest blood pressure in the systemic arteries during a cardiac cycle.

Average SBP in healthy adults is 120 mm of Hg.

• DIASTOLIC BLOOD PRESSURE (DBP): Diastole is the time interval when the ventricles are relaxing and therefore receiving blood from the atria. Diastolic BP is the pressure in the systemic arteries when the left ventricle is relaxing. DBP therefore is the lowest pressure in systemic arteries during a cardiac cycle. Average DBP in healthy adults is 80 mm of Hg.

• PULSE PRESSURE (PP): This is the difference between the systolic blood pressure and the diastolic blood pressure in the systemic arteries at any given time. Pulse pressure can therefore be calculated as following:

➢ Pulse pressure, PP = Difference between the systolic & diastolic blood pressures.

              PP= SBP- DBP

              PP = 120-80= 40 mm of Hg

Variations in pulse pressure can be in anaemia, fever, blood loss etc. Narrow pulse pressure can be seen when there is blood loss, aortic regurgitation. Pulse pressure widens during exercise.

• MEAN ARTERIAL PRESSURE: MAP is the average arterial pressure of the systemic arteries. However, quantitatively it's not an arithmetic mean of the SBP & DBP. Since the ventricular muscle spends 2/3 of the time of a cardiac cycle in diastole, the MAP is closer to the DBP, than it's to the SBP. 

MAP signifies the perfusion pressure of the tissues. If the MAP of the patient decreases below 60 mm of Hg, then it should be a cause of concern for the doctor. What this signifies is that a perfusion pressure below 60 mm of Hg would not be able to meet the nutritional needs of the systemic tissues. So, the MAP, which is easier to calculate quantitatively, can be used in lieu of systemic perfusion pressure.

➢ MAP = (CO x SVR) + CVP {CVP is negligible, so it can be ignored}

So, MAP = (CO X SVR) 

SVR is the sum of resistance of all the vessels in the systemic circuit. However, the major component of systemic vascular resistance is the arteriolar resistance.

Also, MAP can be calculated by using the following formula if the SBP and DBP are known:

➢ MAP = DBP + 1/3 (SBP - DBP) 

{For a normal healthy adult, DBP = 120 & SBP = 80}

So, MAP = 80 + 1/3 (120 - 80)

      MAP = 80 + 1/3 (40)

      MAP = 80 + 13.33

      MAP = 93 mm of Hg (After rounding off)

Alternatively MAP can also be calculated by the following formula:

➢ MAP= 2/3 DBP + 1/3 SBP

MAP= (2/3 x 80) + (1/3 x 120)

MAP= 53.33 + 40 = 93 mm of Hg

• PERFUSION PRESSURE: The pressure necessary to bring blood supply to the systemic tissues to ensure their nutritional needs.

Abbreviations:

• SBP= systolic blood pressure

• DBP=diastolic blood pressure

• MAP=mean arterial pressure

• PP= pulse pressure

• CO=cardiac output

• SVR=systemic vascular resistance

• CVP= central venous pressure

This video presents: Excitation contraction coupling in the heart tissue. Properties of the cardiac muscle compared to smooth and skeletal muscles Role of the extra cellular fluid calcium Beta agonists Action of actylcholine Cardiac glycocides (digitalis)

Why do we measure cardiac electrical activity (ECG)? Conduction medium of the heart ECG measurement from the body surfaces Properties of the ECG voltmeter ECG Paper Normal ECG

A healthy individual's standard wave form ECG waves ECG intervals ECG segments Interpretation of the ECG waveform

This video presents the 12 ECG leads and Einthoven's triangle. Leads presented are: 3 Bipolar Limb Leads 3 Unipolar Augmented Leads 6 Chest Leads Earth lead

Session 2 of the EKG interpretation.

Dr. Syed presents:

1. EKG leads setup.

2. Surfaces that the EKG leads look at.

3. Properties of QT interval.

4. QRS progression.

Ventricular Fibrillation is a terminal event for a dying heart. This talk discusses the:

• Primary pathophysiology
• Signs and symptoms
• EKG changes
• Management approach
• Potential outcomes

This video presents following topics:
Re-entry
Types of Supraventricular Tachycardia.
Mnemonic to remember supraventricular tachycardia.
Characteristics of Supraventricular Tachycardia.
AV Nodal Reentrant Tachycardia.
EKG changes
Pseudo R waves

Dr. Tatayana Travkina, MD/Anesthesiologist presents following topics for shock and its management: 1. Normal Cardiac Functions 2. Hypovolemic Shock 3. Distributive Shock 4. Pharmacology of the Shock Management 5. Cardiogenic Shock 6. Obstructive Shock

This video presents the introductory concepts to understand heart failure. Following concepts are discussed:

• Chambers of a human heart.
• Structures of a human heart.
• Valves between various chambers.
• Why is our heart divided two pumps?
• What are the two circulatory circuits?
• What is Ejection Fraction?
• How to calculate ejection fraction?
• How to visualize ejection fraction?
• Clinical considerations for heart failure.
• Signs and Symptoms of left heart failure vs right heart failure.
• Major pathologies leading to heart failure.

Following terms are discussed:

• Atria
• Ventricles
• Mitral valve
• Tricuspid valve
• Ejection fraction
• Calculating the ejection fraction
• End systolic volume
• End diastolic volume
• Left heart failure
• Right heart failure
• Systemic circulation
• Pulmonary circulation
• Etiology of the heart failure
• Signs and symptoms of the left heart failure
• Signs and symptoms of the right heart failure
• Right heart failure vs left heart failure
• Primary reasons for the heart failure
• Heart failure as a disease of old age

Dr. Travkina presents a case about Takotsubo. Takotsubo cardiomyopathy. Intracranial pathophysiology She discusses the course of action in the operating room. PACU ICU management Treatment

In this talk, we will review folate, tetrahydrofolate, 4-10 methionine THF, homocysteine, s-adenosyl homocysteine, s-adenosyl methionine, and metabolisms. We will also go over the importance of the methionine tetrahydrofolate reductase (MTHFR) enzyme deficiency and its association with cardiovascular system pathologies, and fetal neurological developmental abnormalities. We will especially look at the increased association with clotting in individuals with MTHFR mutated enzyme. We will also see the two common mutations and their high-level epidemiology. We will discuss how vitamins B6, B9 (folate or folic acid) and B12 can help reduce homocysteine levels.

Homocysteine and MTHFR Mutations | Circulation
https://www.ahajournals.org/doi/10.1161/circulationaha.114.013311

preprints202303.0418.v2.pdf
file:///C:/Users/s_mob/Downloads/preprints202303.0418.v2.pdf

Folate, MTHFR Gene and Heart Health
https://www.gbhealthwatch.com/GND-Cardiovascular-Diseases-MTHFR.php

Folate Insufficiency Due to MTHFR Deficiency Is Bypassed by 5-Methyltetrahydrofolate - PMC
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564482/

Frontiers | Prognostic Genetic Markers for Thrombosis in COVID-19 Patients: A Focused Analysis on D-Dimer, Homocysteine and Thromboembolism
https://www.frontiersin.org/articles/10.3389/fphar.2020.587451/full

Methylenetetrahydrofolate Reductase Deficiency - Medical Genetics Summaries - NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK66131/

Contribution of genotypes in Prothrombin and Factor V Leiden to COVID‐19 and disease severity in patients at high risk for hereditary thrombophilia - Kiraz - 2023 - Journal of Medical Virology - Wiley Online Library
https://onlinelibrary.wiley.com/doi/abs/10.1002/jmv.28457

Do MTHFR polymorphisms make you more susceptible to COVID-19? - MTHFR Support Australia
https://mthfrsupport.com.au/2021/08/do-mthfr-polymorphisms-make-you-more-susceptible-to-covid-19/

Acute Macular Neuroretinopathy Associated With COVID-19 Infection: Is Double Heterozygous Methylenetetrahydrofolate Reductase (MTHFR) Mutation an Underlying Risk Factor? - PMC
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9968507/

Methylenetetrahydrofolate reductase - Wikipedia
https://en.wikipedia.org/wiki/Methylenetetrahydrofolate_reductase
 

Dr. Priya Jaisinghani Discusses Diabetes (Lecture - 3, Pancreatic structure and function)

Today we have a rockstar physician with us. We will discuss diabetes with her. 

Dr. Jaisinghani's introduction:
Dr. Priya Jaisinghani is a board certified Internal Medicine physician who completed her training at Rutgers Robert Wood Johnson, NJ and is currently completing her fellowship in Endocrinology at New York Presbyterian Weill Cornell, NY.  Dr. Jaisinghani received a distinction in service to the community through her work at the The Boggs Center in medical school and was inducted into the AOA Honor Society in 2019 during her residency.  She also serves on the Board of Directors of a mental health organization called SAMHIN (South Asian Mental Health Initiative and Network) https://samhin.org. Dr. Jaisinghani plans to focus her career on Diabetes and Obesity Medicine while continuing to be an advocate for minority health and mental health. 
I also had privilege of serving India remotely during the second surge of COVID19 with my work being featured in The Times of India and Medscape. 
Below are the media links if you would like to view them:
https://www.medscape.com/viewarticle/950603 
https://timesofindia.indiatimes.com/world/us/young-desi-doctors-in-us-help-get-aid-for-india/articleshow/82448121.cms 
https://myemail.constantcontact.com/The-Dean-s-Weekly-View--News---Notes-from-Interim-Dean-Robert-L--Johnson--MD--FAAP.html?soid=1109962569672&aid=YBi71Fa-Sss

Pancreatic Structure and Function - Diabetes Lecture - 3
Pancreatic cell clusters (alpha and beta) - pancreatic acini and Islets of langerhans
Pancreatic blood circulates to beta cells and then to alpha.
Function of the beta cells. Type of the GLUT channels. How glucose levels influence these cells to produce insulin in the needed quantities?
Function of the alpha cells.
Structure of the insulin molecule (endogenous vs. exogenous.)
Function of the insulin on the peripheral tissues.
Insulin receptor and its function
Second messenger system inside the cells responding to the insulin molecule.

Disclaimer:
This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only.
Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional.

This video presents the following about diabetes mellitus:

Definition of Diabetes Mellitus. Molecular structure of Insulin Clinical importance of the C-Peptides.

Classification of diabetes mellitus. Defects of Insulin secretion. Defects of Insulin actions.

Classes presented are:

1. Type 1 diabetes mellitus.
2. Type 2 diabetes mellitus.
3. Maturity onset diabetes mellitus.
4. Genetic causes resulting in molecular polymorphism.
5. Exocrine pancreatitis.
6. Infections.
7. Endocrine pathologies.
8. Drugs.
9. Gestational diabetes mellitus.

In this lecture Dr. Syed presents the following topics about Insulin: 
1. Structure, synthesis, and maturation of an insulin molecule. 
2. Components of a vesicle containing the insulin molecule. 
3. Immunogenic components that may be present in the insulin containing vesicle. 
4. Insulin release mechanism. 
5. Physiological factors that regulate insulin. 
6. Pharmacological factors (drugs) that regulate insulin. 
7. Glucagon-Like Peptide Hormones (GLP) 
8. Gastric Inhibitory Peptide (GIP) 
9. Effect of autonomic system on insulin release 
10. Effect of stress on insulin release

11. Effect of drugs on insulin release

This video discusses the following:

Classes of type 1 diabetes mellitus based on the signs and symptoms.

Early onset type 1 diabetes mellitus.

Diabetic ketoacidosis.

Silent type 1 diabetes mellitus.

Explanation of:

Polyuria/Glycosuria

Polydipsia

Catabolic state/weight loss/polyphagia

Lens blurring and visual problems 

Reasons for the recurrent candidial infections.

Diabetic Ketoacidosis (DKA) is the second most common presentation of type 1 diabetes mellitus. (First most common being early onset diabetes Mellitus.)
In this first part of the lecture we discuss:
The reason for the higher propensity of type 1 diabetes mellitus patients to develop DKA.
Polyuria/Glycosuria/Polydipsia
Hypovolemia/Hypotension
Tachycardia/Skin Turgor
Kussmaul Breathing
Fruity Odor
The role of Insulin, Glucagon, Epinephrine, and Hormone Sensitive Lipase is discussed.
Potassium level disturbance in patients presenting with DKA.
Mechanism of acidosis in DKA.

Diabetic Ketoacidosis (DKA) is the second most common presentation of type 1 diabetes mellitus. (First most common being early onset diabetes mellitus.)
In this second part of the lecture we discuss:
Mechanism of the gastrointestinal (GIT) symptoms.
Bicarb levels in DKA.
A quick comparison of the metabolic disturbances in DKA and HHS.
The impact of acidosis and membrane potential predisposing cell to arrhythmias.
Metabolic picture of DKA.
Working up the labs' data for DKA patient.
Calculating osmolality.
Calculating expected PaCO2 levels using Winter's equation.

This lecture presents the management approach for the patients presenting with diabetic Ketoacidosis.
Following management methods and the principles behind the management are explained:
 Volume replenishment, volume types, the reason for choosing various types, benefits of the volume replenishment, and the complications of aggressive volume replenishment.
 Insulin administration. Caution for insulin administration when potassium levels are low. The amount of insulin to administer and the rate of fall of glucose levels. 
 Why do insulin and glucose need to continue even after a good glucose level has been established?
 What to expect in terms of potassium levels? How to manage potassium? How to correlated potassium levels to insulin and volume?
 What labs and signs and symptoms to monitor and how to adjust when ref-flags show up?
 How to approach bicarb deficiency?

In this talk Dr. Mobeen discusses:

1. Why do fats contribute to the insulin insensitivity?

2. Why does eating carb cause hunger again?

Dr. Mobeen presents:

*The role of FAT cells in modifying FFA levels, Liponectin levels, and Resistin levels.
*Insulin resistance due to the substances mentioned above.
*Burnout of the beta cells after the consistent elevation of glucose due to insulin resistance.

In this part of the insulin therapy webinar, Dr. Mobeen presents:

• Insulin types
• Differences among various types of insulin.
• Mnemonic to remember insulin types.
• Objectives of the insulin therapy.
• Considerations for the dose adjustment.
• Insulin dose adjustment considerations for various physiological or pathological conditions. For example:
• Pregnancy
• Exercise
• Obeseity
• Various eating habits.
• Hospitialized patient.
• Patients with infections.
• Elderly.
• Patients with chronic kidney disease.
• Patients with liver disease.
• The dawn phenomenon.
• The somogyi effect.
• Dose calculation:
  • Total daily insulin (TDI)
  • Calculating basal insulin dose/units.
  • Calculating bolus insulin dose/units.
• Insulin therapy types:
  • Intensive insulin therapy.
  • Conventional insulin therapy.
  • Sliding scale insulin therapy.
• Insulin injection sites and their properties:
  • Abdomen
  • Thighs and buttocks
  • Arms
• Insulin syringes.
• Insulin mixing.
• Insulin filling in the syringe.

Dr. Syed presents Myyasthenia Gravis. Clinical vignette Presentation Pathophysiology Diagnosis Treatment Differential Contraindicated medications for myasthenia patients

Dr. Priya Jaisinghani Discusses Diabetes (Lecture - 4, Classification of Diabetes Mellitus)

Today we have a rockstar physician with us. We will discuss diabetes with her. 

Link to the tweet: https://twitter.com/drbeen_medical/status/1453398833904324612?s=20

Dr. Jaisinghani's introduction:
Dr. Priya Jaisinghani is a board certified Internal Medicine physician who completed her training at Rutgers Robert Wood Johnson, NJ and is currently completing her fellowship in Endocrinology at New York Presbyterian Weill Cornell, NY.  Dr. Jaisinghani received a distinction in service to the community through her work at the The Boggs Center in medical school and was inducted into the AOA Honor Society in 2019 during her residency.  She also serves on the Board of Directors of a mental health organization called SAMHIN (South Asian Mental Health Initiative and Network) https://samhin.org. Dr. Jaisinghani plans to focus her career on Diabetes and Obesity Medicine while continuing to be an advocate for minority health and mental health. 
I also had privilege of serving India remotely during the second surge of COVID19 with my work being featured in The Times of India and Medscape. 
Below are the media links if you would like to view them:
https://www.medscape.com/viewarticle/950603 
https://timesofindia.indiatimes.com/world/us/young-desi-doctors-in-us-help-get-aid-for-india/articleshow/82448121.cms 
https://myemail.constantcontact.com/The-Dean-s-Weekly-View--News---Notes-from-Interim-Dean-Robert-L--Johnson--MD--FAAP.html?soid=1109962569672&aid=YBi71Fa-Sss

Classification of Diabetes Mellitus - Diabetes Lecture - 4
Type 1 Diabetes
Beta cell destruction, usually leading to absolute insulin deficiency
Type 2 Diabetes
Combination of insulin resistance and beta cell dysfunction
Genetic Defects of Beta Cell Function
Maturity-onset diabetes of the young (MODY), caused by mutations in:
Hepatocyte nuclear factor 4α gene (HNF4A)—MODY1
Glucokinase gene (GCK)—MODY2
Hepatocyte nuclear factor 1α gene (HNF1A)—MODY3
Pancreatic and duodenal homeobox 1 gene (PDX1)—MODY4
Hepatocyte nuclear factor 1β gene (HNF1B)—MODY5
Neurogenic differentiation factor 1 gene (NEUROD1)—MODY6
Maternally inherited diabetes and deafness (MIDD) due to
mitochondrial DNA mutations (3243A→G)
Defects in proinsulin conversion
Insulin gene mutations
Genetic Defects in Insulin Action
Insulin receptor mutations
Exocrine Pancreatic Defects
Chronic pancreatitis
Pancreatectomy
Neoplasia
Cystic fibrosis
Hemochromatosis
Fibrocalculous pancreatopathy
Endocrinopathies
Growth hormone excess (acromegaly)
Cushing syndrome
Hyperthyroidism
Pheochromocytoma
Glucagonoma
Infections
Cytomegalovirus infection
Coxsackievirus B infection
Congenital rubella
Drugs
Glucocorticoids
Thyroid hormone
β-Adrenergic agonists
Genetic Syndromes Associated with Diabetes
Down syndrome
Klinefelter syndrome
Turner syndrome
Gestational Diabetes Mellitus
Diabetes associated with pregnancy

Disclaimer:
This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only.
Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional.

Carbohydrate Digestion, Absorption, and Metabolism with Dr. Priya Jaisinghani (Diabetes Mellitus Lecture 2)

Dr. Jaisinghani's introduction:
Dr. Priya Jaisinghani is a board certified Internal Medicine physician who completed her training at Rutgers Robert Wood Johnson, NJ and is currently completing her fellowship in Endocrinology at New York Presbyterian Weill Cornell, NY.  Dr. Jaisinghani received a distinction in service to the community through her work at the The Boggs Center in medical school and was inducted into the AOA Honor Society in 2019 during her residency.  She also serves on the Board of Directors of a mental health organization called SAMHIN (South Asian Mental Health Initiative and Network) https://samhin.org. Dr. Jaisinghani plans to focus her career on Diabetes and Obesity Medicine while continuing to be an advocate for minority health and mental health. 
I also had the privilege of serving India remotely during the second surge of COVID19 with my work being featured in The Times of India and Medscape. 
Below are the media links if you would like to view them:
https://www.medscape.com/viewarticle/950603 
https://timesofindia.indiatimes.com/world/us/young-desi-doctors-in-us-help-get-aid-for-india/articleshow/82448121.cms 
https://myemail.constantcontact.com/The-Dean-s-Weekly-View--News---Notes-from-Interim-Dean-Robert-L--Johnson--MD--FAAP.html?soid=1109962569672&aid=YBi71Fa-Sss

Introduction to Diabetes Mellitus Lecture 2
Topics to discuss today
1. Carbohydrates in foods. Some foods are made of carbs, some have carbs added to them. (We will do a separate discussion to talk about carbs themselves.)
2. The role of chewing and mixing of saliva with carbs in our mouth.
3. Role of stomach to further breakdown carbs.
4. Pancreatic beta cell's role of releasing insulin when carbs are present in our intestine/GIT. (Summary, we will discuss details in separate lectures.)
5. Absorption of the glucose from the GIT into the blood.
6. Movement of the glucose into the cells and the dependence of this movement on Insulin. Cells that require insulin to get glucose, vs., those that do not need insulin to pick up glucose.
7. A quick note of what happens to the glucose inside the cell. That is, it is further metabolized to finally become ATP.
8. Use of ATP as the final common and universal energy providing molecule for all of our energy dependent processes.
9. Presence of lipids and proteins in the meal and their effect on carbohydrate absorption. (If any.)
10. Can glucose be gotten from proteins and lipids as well?

Link to the twitter: https://twitter.com/drbeen_medical/status/1442930017898401795?s=20

Disclaimer:
This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only.
Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional.

Dr. Syed starts the series about the antibiotics' usage. The first lecture in the series presents the following topics about penicillins: 1. Discovery. 2. Types. 3. Mechanism of action. 4. Coverage of gram positive and negative pathogens by various types. 5. Pathogen resistance to penicillins. 6. Penicillin combinations with lavulanic acid etc. to overcome the resistance. 7. Usage in various infections.

In this video today, we will learn about the fascinating process of generalized and specialized transduction. Transduction is the bacterial genetic recombination mediated by bacteriophages. There are two types of transduction, generalized and specialized. Let's review.

(Please first watch the previous video in the series: “Bacteriophage” )

Remember: In a bacterial cell there are ribosomes, plasmids with genetic material, and chromosomes that are a closed circle shape.

Transduction is a bacteriophage mediated genetic recombination (a DNA change)  in bacteria.This mechanism of a bacterium’s genetic material transfering to another bacterium is called horizontal gene transfer (HGT), because the gene transfer is occurring in the same generation instead of from one generation to another.

Two types of gene transduction:

  TC 3:35

1. Generalized - mediated by virulent bacteriophages - which can take random pieces of DNA to another bacterium. 

When a virulent phage infects a host bacterium, the phage DNA is transcribed, replicated and translated into capsids and enzymes. This destroys the host DNA often leaving fragments intact. If these pieces are a similar size to the phage DNA they can get accidentally packaged into the phage capsid head.  After bacterial lysis (inevitable with virulent phages), the newly created phages escape the demised bacterium. A phage with the host DNA in its head can then infect another bacterium.  If the foreign strand is homologous to the recipient genome, it can become incorporated and encode a protein with a characteristic the recipient didn’t have in the first place, like resistance to antibiotics. 

In this case, because the phage has transferred bacterial DNA to the next bacterium, not phage DNA,  the recipient will not succumb to lysis.

TC 8:46

1. Specialized transduction - mediated by temperate bacteriophages. Once they infect a bacterium and transform into prophages (DNA incorporated in the chromosome of the bacterium) then are activated, they will transfer specific genes.

A prophage causes its host bacterium to become lysogenic (meaning it’s a ticking time bomb). When the bomb is detonated activating the prophage, its DNA is spliced out of the bacterial chromosome, and is then replicated, translated and packaged into a capsid.  An error in splicing can cause a piece of bacterial DNA on one side or the other (not both) of the prophage DNA to be carried along and packaged with the phage DNA, resulting in a transfer of a piece of bacterial DNA to another bacteria. This could be a toxin like Escherichia coli or Corynebacterium Diphtheriae resulting in a lysogenic conversion from a non-pathogenic bacterium into a pathogenic one..

Because the wayward DNA is from a temperate (friendly) phage, it will not trigger lysis in the host bacterium.

See you in the next video: “Bacterial Genetic Recombination Via Transformation.

Azithromycin is an antibiotic used for the treatment of a number of bacterial infections.[3] This includes middle ear infections, strep throat, pneumonia, traveler's diarrhea, and certain other intestinal infections.[3] It can also be used for a number of sexually transmitted infections, including chlamydia and gonorrhea infections.[3] Along with other medications, it may also be used for malaria.[3] It can be taken by mouth or intravenously with doses once per day.[3]

https://en.wikipedia.org/wiki/Azithromycin

Macrolides

https://en.wikipedia.org/wiki/Macrolide#:~:text=The%20mechanism%20of%20action%20of,well%20as%20inhibiting%20ribosomal%20translation.

Effect of Azithromycin on NK cells

https://pubmed.ncbi.nlm.nih.gov/22410149/

Dr. Mobeen presents the classification, diagnostic testing, metabolic properties, antigenicity, treatment, and vaccination for streptococcus pneumoniae. This pathogen is also called S. Pneumoniae, Pneumococcus, and Diplococcus.

Following identifying characteristics are presented:

• Gram positive staining
• Catalase negative
• Bile sensitive
• Optochin sensitive
• Latex agglutination test positive for pneumococcal antigens
• Teichoic acid
• Diseases caused:
  • Conjunctivitis
  • Meningitis
  • Otitis Media
  • Pneumonia
  • Sinusitis
• Quellung positive testing
• Alpha hemolysis
• Antigenecity
  • IgA protease
  • Pneumolysin
• Vaccination
  • 23 valent polysacchride vaccine
  • 13 valent conjugated polysacchride vaccine
• Penicillin G and V
• 3rd Generation cephalosporins
  • Ceftriaxone
  • Cefotaxime
• Vancomycin

This video presents following topics about tuberculosis: Epidemiology Etiology Pathogenesis Secondary Tuberculosis Morphology Clinical

Clostridium tetani is an obligate anaerobe, rod shaped, gram positive bacteria. It causes tetanus, which if not treated, can be lethal. In this talk, we will discuss the properties and pathophysiology of the tetanospasmin exotoxin, management, and vaccination.

Clostridium Botulinum is a gram positive, obligate anaerobe, spore forming, motile rod. It produces botulinum neurotoxin (BoNT) which is the most potent toxin known to man. 1-2 microgram/kg body weight is lethal. C. Botulinum spores are quite hardy and heat resistant. If these spores are present on foods that are cooked at low heat and then stored in sealed containers (anaerobic environment) e.g. cans or ziploc, then the spores will germinate resulting in C. Botulinum making BoNT. We will discuss the pathogenesis, clinical presentations of the adult, infant, and wound botulism, and finally, the management approaches.

In this talk, we will discuss the properties, habitat, transmission, and pathogenesis of clostridium difficile. We will also discuss the diseases caused by this bacteria and its toxins, diagnosis, and management.

Objectives for this lecture are:

1. Understanding the types of immune defenses.

2. Understanding the role of each arm of the immune system.

3. Understanding the differences of each arm of the immune system.

Objectives for this lecture are:

1. Understanding the types of immune defenses.

2. Understanding the role of each arm of the immune system.

3. Understanding the differences of each arm of the immune system.

In this talk we will present the first foundational set of concepts about the immune system. We will discuss the parts of the immune system. General properties of the innate and acquired or adaptive arms. Cells of the innate arm. Proteins of the innate arm. And, the functions of various aspects of the innate arm. In the next talk, we will discuss the overview of the adaptive arm.

NK cells originate from the lymphoid progenitors, however, these cells function as the innate arm component. NK cells induce apoptosis in the infected and cancerous cells. NK cells secret perforins and granzymes for this purpose. NK cells are activated by IL-12 from the macrophages and IFN alpha and beta from the infected cells. NK cells can in turn release IFN gamma to activate the macrophages.

References Natural Killer Cells: Development, Maturation, and Clinical Utilization - PMC https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6099181/

Stem cell - Wikipedia https://en.wikipedia.org/wiki/Stem_cell

In this fascinating in-vitro and ex-vivo study the researchers from Harvard Boston and Cairo found the mechanism of impaired immune system during the cold temperatures. Researchers found that the extracellular vesicles produced as a result of toll-like receptor 3 (TLR3) are functionally impaired and reduced in numbers when the temperature drops in the anterior nasal mucosa even by 9 degrees Fahrenheit. Let's review this fascinating study.

Cold exposure impairs extracellular vesicle swarm–mediated nasal antiviral immunity - Journal of Allergy and Clinical Immunology https://www.jacionline.org/article/S0091-6749(22)01423-3/fulltext#%20

Cold exposure impairs extracellular vesicle swarm-mediated nasal antiviral immunity https://www.jacionline.org/action/showPdf?pii=S0091-6749%2822%2901423-3

MicroRNA Mimics or Inhibitors as Antiviral Therapeutic Approaches Against COVID-19 - PMC https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910799/#:~:text=In%20fact%2C%20miRNAs%20have%20been,or%20by%20enhancing%20the%20expression

Why colds and flu viruses are more common in winter | CNN https://www.cnn.com/2022/12/06/health/why-winter-colds-flu-wellness/index.html

This video presents the structure, function, and neuronal loops of the Cerebellum.

In this anatomy lecture, Drbeen faculty, Dr. Adam Jones discusses the Eye, Orbit and Cranial Nerves II, II, IV, VI. This is the second part of a two-part lecture. The following structural elements are presented and discussed. 

Superior orbital fissure
Foramen Rotundum
Ophthalmic nerve
Maxillary nerve
Mandibular nerve
Foramen ovale 
Sphenoid bone
Oculomotor nerve
Superior rectus
Superior Palpebrae Superioris
Medial rectus
Inferior rectus
Inferior Oblique
Ciliary muscle
Constrictor Pupillae
Oculomotor nucleus
Edinger-Westphal nucleus
Posterior cerebral artery
Superior cerebellar artery
Cavernous sinus
Midbrain
Brainstem
Pons
Medulla
Trigeminal nerve
Abducens nerve
Trochlear nerve

Brain Fog, Myalgia, Depression, And Fatigue In Long-Haulers

Some long-hauler symptoms
https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(20)30606-6/fulltext

Anosmia is an indication that COVID-19 has effected the glymphatic drainage. This results in waste products and inflammatory cytokines to collect in the brain parenchyma leading to the nervous system symptoms like fatigue, depression, brain fog, myalgia, etc.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320866/

What is the glymphatic system?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636982/

Outline of the glymphatic system
https://www.researchgate.net/figure/Outline-of-the-glymphatic-system-This-figure-illustrates-that-perivascular-clearance_fig1_322688508

Can physical assessment techniques aid diagnosis in people with chronic fatigue syndrome/myalgic encephalomyelitis? A diagnostic accuracy study
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695376/

Cerebrospinal fluid and its flow
https://en.wikipedia.org/wiki/Cerebrospinal_fluid

Defeat Brain Fog With New Neurons | A Review of Neurogenesis for Long COVID

And, more sex for more neurons. Let's review the exciting science of neurogenesis.

Disclaimer:
This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only.
Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional.

URL list from Thursday, Jun. 23 2022 

You can grow new brain cells. Here's how | Sandrine Thuret - YouTube
https://www.youtube.com/watch?v=B_tjKYvEziI

A hypothalamic boost for neurogenesis | Nature Reviews Neuroscience
https://www.nature.com/articles/s41583-022-00607-3

Robust adult neurogenesis in the primate hippocampus | Nature Neuroscience
https://www.nature.com/articles/s41593-022-01075-9

Hypothalamic modulation of adult hippocampal neurogenesis in mice confers activity-dependent regulation of memory and anxiety-like behavior | Nature Neuroscience
https://www.nature.com/articles/s41593-022-01065-x

Single-nucleus sequencing finds no adult hippocampal neurogenesis in humans | Nature Neuroscience
https://www.nature.com/articles/s41593-021-00991-6

Diet and depression: exploring the biological mechanisms of action | Molecular Psychiatry
https://www.nature.com/articles/s41380-020-00925-x

Stress and adolescent hippocampal neurogenesis: diet and exercise as cognitive modulators | Translational Psychiatry
https://www.nature.com/articles/tp201748

Running increases cell proliferation and neurogenesis in the adult mouse dentate gyrus | Nature Neuroscience
https://www.nature.com/articles/nn0399_266

Running increases cell proliferation and neurogenesis in the adult mouse dentate gyrus | Nature Neuroscience
https://www.nature.com/articles/nn0399_266

Neurogenesis in the adult human hippocampus | Nature Medicine
https://www.nature.com/articles/nm1198_1313

Professor Sandrine Thuret Dr. rer. nat. FHEA
https://www.kcl.ac.uk/people/sandrine-thuret

Sandrine Thuret: How Can Adults Grow New Brain Cells? : NPR
https://www.npr.org/2021/03/05/973801760/sandrine-thuret-how-can-adults-grow-new-brain-cells

Hippocampus in health and disease: An overview
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548359/

Frontiers | Beyond the Hippocampus and the SVZ: Adult Neurogenesis Throughout the Brain | Cellular Neuroscience
https://www.frontiersin.org/articles/10.3389/fncel.2020.576444/

In this new study from the Rush University Medical Center Chicago, the researchers have demonstrated an association of reduced cognitive decline with the daily intake of flavonols. This was a prospective cohort study with 961 participants who were followed for 6.9 years. Let's review this study to identify food and fruits that can be valuable for our and our patient's cognitive abilities.

Association of Dietary Intake of Flavonols With Changes in Global Cognition and Several Cognitive Abilities | Neurology https://n.neurology.org/content/early/2022/11/22/WNL.0000000000201541#%20

Flavonoid - Wikipedia https://en.wikipedia.org/wiki/Flavonoid

Flavonols - Wikipedia https://en.wikipedia.org/wiki/Flavonols

Kaempferol - Wikipedia https://en.wikipedia.org/wiki/Kaempferol

Low Dose Naltrexone (LDN) - Mechanism of Action

LDN is used for chronic diseases, multiple sclerosis, autoimmune thyroid disease, and various cancers. Let's review its mechanism of action.

Disclaimer:
This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only.
Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional.

URL list from Wednesday, Feb. 2 2022

Naltrexone | Naltrexone - Bupropion Combination - Mechanism of Action
https://psychscenehub.com/psychinsights/naltrexone-naltrexone-bupropion-combination-mechanism-of-action-psychopharmacology-and-clinical-application-2/

IL-6 in Inflammation, Immunity, and Disease - PMC
https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4176007/

Ventral tegmental area - Wikipedia
https://en.wikipedia.org/wiki/Ventral_tegmental_area

Mesolimbic pathway - Wikipedia
https://en.wikipedia.org/wiki/Mesolimbic_pathway

Striatum - Wikipedia
https://en.wikipedia.org/wiki/Striatum#Structure

Frontiers | Naltrexone Inhibits IL-6 and TNFα Production in Human Immune Cell Subsets following Stimulation with Ligands for Intracellular Toll-Like Receptors | Immunology
https://www.frontiersin.org/articles/10.3389/fimmu.2017.00809/full

Animal studies have demonstrated the neuroprotective role of methylene blue especially when administered within an hour of transient ischemic insult of the neurons. Methylene blue is antioxidant, anti-inflammatory, and induces autophagy while reducing apoptosis. Let's review its mechanisms.

Contraindications: https://www.rxlist.com/consumer_provayblue_methylene_blue/drugs-condition.htm

The Effects of Methylene Blue on Autophagy and Apoptosis in MRI-Defined Normal Tissue, Ischemic Penumbra and Ischemic Core | PLOS ONE https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0131929

AMPK - Legere Pharmaceuticals https://www.legerepharm.com/ampk/

Schematic illustration of the mTOR signaling pathway. AMPK indicates... | Download Scientific Diagram https://www.researchgate.net/figure/Schematic-illustration-of-the-mTOR-signaling-pathway-AMPK-indicates-AMP-activated_fig1_228089413

Model of the AMPK and mTOR signaling network in mammalian cells. AMPK... | Download Scientific Diagram https://www.researchgate.net/figure/Model-of-the-AMPK-and-mTOR-signaling-network-in-mammalian-cells-AMPK-inhibits-mTOR_fig1_221865491

Frontiers | Protection against neurodegeneration with low-dose methylene blue and near-infrared light https://www.frontiersin.org/articles/10.3389/fncel.2015.00179/full

Mitochondria as a target for neuroprotection: role of methylene blue and photobiomodulation | Translational Neurodegeneration | Full Text https://translationalneurodegeneration.biomedcentral.com/articles/10.1186/s40035-020-00197-z

Dr. Steven Phillips Discusses Dementia and Chronic Diseases

Today we have Dr. Steven Phillips with us to discuss the higher incidence of dementia in individuals with comorbidities in their early part of life. 

Dr. Steven Phillips' bio:
Steven Phillips, MD is a well published, Yale-trained physician, researcher, and bestselling author, whose focus of medical practice and research is that chronic and autoimmune illness can be caused by underlying infections.

Disclaimer:
This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only.
Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional.

URL list from Thursday, Feb. 3 2022

Is Exposure to BMAA a Risk Factor for Neurodegenerative Diseases? A Response to a Critical Review of the BMAA Hypothesis - PMC
https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC7904546/

Number of adults with dementia to exceed 150m by 2050, study finds | Dementia | The Guardian
https://www.theguardian.com/society/2022/jan/06/number-adults-with-dementia-exceed-150-million-2050-study

Two or more chronic health problems in middle age ‘doubles dementia risk’ | Dementia | The Guardian
https://www.theguardian.com/society/2022/feb/02/two-chronic-health-problems-middle-age-double-dementia-risk-multimorbidity-study?CMP=oth_b-aplnews_d-1

Association between age at onset of multimorbidity and incidence of dementia: 30 year follow-up in Whitehall II prospective cohort study | The BMJ
https://www.bmj.com/content/376/bmj-2021-068005#:~:text=Compared%20with%20people%20with%20no,multimorbidity%20was%20at%20age%2070

Chemically induced models of Parkinson's disease - PubMed
https://pubmed.ncbi.nlm.nih.gov/34673252/

Pesticide use in agriculture and Parkinson’s disease in the AGRICAN cohort study | International Journal of Epidemiology | Oxford Academic
https://academic.oup.com/ije/article/47/1/299/4609336?login=false

Amazon.com: Chronic: The Hidden Cause of the Autoimmune Pandemic and How to Get Healthy Again (Audible Audio Edition): Steven Phillips MD, Dana Parish, Teri Schnaubelt, Thomas Allen, Brilliance Audio: Books
https://www.amazon.com/Chronic-Hidden-Autoimmune-Pandemic-Healthy/dp/B0851RT3C6/ref=sr_1_1?crid=Q2RRSHAQ0S90&keywords=chronic&qid=1643936441&sprefix=chronic%2Caps%2C129&sr=8-1

An introduction consisting of the importance of dermatology, the structure and function of the skin, how to describe a rash and how to describe a skin lesion.

Introductory talk about acne with Dr. Thomas King. 

Introductory talk about benign lesions with Dr. Thomas King. 

A lecture about the different kinds of eczema including atopic dermatitis and contact dermatitis.

An overview of the risk factors, and epidemiology of melanoma.

How to assess pigmented skin lesions.

Subtypes of melanoma covered.

Overview of staging,

5 year survival and treatments.

A talk with Dr. Thomas King about the epidemiology, pathogenesis, clinical presentation, and treatments of non-melanoma skin cancers and precursors.

Psoriasis is a common condition, with worldwide prevalence of about 2%. It predominantly occurs in two peaks. One at 20-30 years of age and the second peak at 50-60 years of age. Let's review the following topics with Dr. King.

Epidemiology

Pathophysiology

Presentation

Differential diagnosis

Approach to management plans

Assessment of comorbidities

An introduction to skin infections in dermatology. This talk is the first of a 2 part talk, focusing on bacterial and viral infections. Fungal infections and infestations are covered in part 2

An introduction to skin infections in dermatology. This talk is the second in a two-part talk, focusing on fungal infections and infestations. Bacterial and viral infections are covered in Skin Infections (Part 1).

Aspirin has antithrombotic, anti-inflammatory, analgesic, and anti-pyretic effects.

Aspirin plus Vitamin D trial for COVID-19

The LEAD COVID-19 Trial: Low-risk, Early Aspirin and Vitamin D to Reduce COVID-19 Hospitalizations (LEAD COVID-19)

https://clinicaltrials.gov/ct2/show/NCT04363840

Aspirin

http://tmedweb.tulane.edu/pharmwiki/doku.php/aspirin

Leukotrienes and allergies

https://en.wikipedia.org/wiki/Leukotriene#:~:text=Leukotrienes%20are%20a%20family%20of,the%20enzyme%20arachidonate%205%2Dlipoxygenase.

WHO's list of essential medicines: safest and most effective drug needed in the health system.

Used for acetaminophen/paracetamol overdose and to loosen thick mucus.
Appears to be safe in pregnancy

How does NAC break disulfide bonds?
https://www.researchgate.net/figure/Structural-formula-of-N-acetylcysteine-NAC-A-Disulfide-bonds-in-proteins-P-can-be_fig1_299401240

It increases the levels of glutathione in paracetamol overdose.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241507/

Role of glutathione in immunity and inflammation in the lung
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048347/

Disulfide bond reduction of vWF
https://www.ncbi.nlm.nih.gov/pubmed/20946172

N-Acetylcysteine as an antioxidant and disulfide breaking agent: the reasons why
https://www.tandfonline.com/doi/full/10.1080/10715762.2018.1468564

NAC functions
https://www.sciencedirect.com/topics/chemistry/cysteine

Dr. Sameer Islam, MD., Gastroenterologist presents: General introduction to the Liver Function Tests Categories of Liver abnormalities. • Acute hepatitis • Chronic hepatitis • Cholestatic hepatitis • Hyperbillirubinemia • PT/INR and albumin Liver biopsy and non-invasive testing

In this talk Dr. Hameed presents: Natural history of cirrhosis and varices. Primary and secondary prophylaxis. Managing bleeds

In this amazing review of long COVID studies, researchers have identified the blood biomarkers that are statistically significantly associated with long COVID and various classes of it. Let's review the neurological dysfunction aspect of the labs.

Frontiers | Biomarkers in long COVID-19: A systematic review
https://www.frontiersin.org/articles/10.3389/fmed.2023.1085988/full?utm_source=substack&utm_medium=email#F3

fmed-10-1085988-t003.jpg (2961×1181)
https://www.frontiersin.org/files/Articles/1085988/fmed-10-1085988-HTML/image_m/fmed-10-1085988-t003.jpg

Frontiers | Biomarkers in long COVID-19: A systematic review
https://www.frontiersin.org/articles/10.3389/fmed.2023.1085988/full#supplementary-material

Interleukin 6 - Wikipedia
https://en.wikipedia.org/wiki/Interleukin_6

Acute-phase protein - Wikipedia
https://en.wikipedia.org/wiki/Acute-phase_protein

Hypothalamus - Wikipedia
https://en.wikipedia.org/wiki/Hypothalamus

Tumor necrosis factor - Wikipedia
https://en.wikipedia.org/wiki/Tumor_necrosis_factor

CCL2 - Wikipedia
https://en.wikipedia.org/wiki/CCL2

CCL5 - Wikipedia
https://en.wikipedia.org/wiki/CCL5

Glial Fibrillary acidic protein: From intermediate filament assembly and gliosis to neurobiomarker - PMC
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559283/

Neurofilament light chain as a biomarker in neurological disorders | Journal of Neurology, Neurosurgery & Psychiatry
https://jnnp.bmj.com/content/90/8/870

In this amazing review of long COVID studies, researchers have identified the blood biomarkers that are statistically significantly associated with long COVID and various classes of it. Let's review the neurological dysfunction aspect of the labs.

Frontiers | Biomarkers in long COVID-19: A systematic review
https://www.frontiersin.org/articles/10.3389/fmed.2023.1085988/full?utm_source=substack&utm_medium=email#F3

fmed-10-1085988-t003.jpg (2961×1181)
https://www.frontiersin.org/files/Articles/1085988/fmed-10-1085988-HTML/image_m/fmed-10-1085988-t003.jpg

Frontiers | Biomarkers in long COVID-19: A systematic review
https://www.frontiersin.org/articles/10.3389/fmed.2023.1085988/full#supplementary-material

Interleukin 6 - Wikipedia
https://en.wikipedia.org/wiki/Interleukin_6

Acute-phase protein - Wikipedia
https://en.wikipedia.org/wiki/Acute-phase_protein

Hypothalamus - Wikipedia
https://en.wikipedia.org/wiki/Hypothalamus

Tumor necrosis factor - Wikipedia
https://en.wikipedia.org/wiki/Tumor_necrosis_factor

CCL2 - Wikipedia
https://en.wikipedia.org/wiki/CCL2

CCL5 - Wikipedia
https://en.wikipedia.org/wiki/CCL5

Glial Fibrillary acidic protein: From intermediate filament assembly and gliosis to neurobiomarker - PMC
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559283/

Neurofilament light chain as a biomarker in neurological disorders | Journal of Neurology, Neurosurgery & Psychiatry
https://jnnp.bmj.com/content/90/8/870

Introduction To P Values and Power

In this talk we will discuss at a high level the following concepts:
** Null hypothesis
** Type 1 error
** Type 2 error
** Power
** P value

We will use data from this study to calculate the p values
https://clinicaltrials.gov/ct2/show/results/NCT04523831

We will use the following calculator for the Chi Square calculation
https://www.socscistatistics.com/tests/chisquare/default2.aspx

Zeshaan Maan M.D., discusses the basic management of hand trauma.
The following questions are answered:

• What is a nail-bed injury?
• When do you need to surgically treat it?
• Can it be managed in the ER?
• How do you manage finger lacerations?
• How do you assess for blood vessel injury?
• How do you assess for nerve injury?
• How do you assess for tendon injury?
•  What if there is a fracture?

Basic Assessment and Management of the Burns

In this webinar, Dr. Zeshaan Maan discusses the basic approach to manage a patient with burns.

He discusses the basic structure of the skin, the largest organ in the human body. 

Skin consists of an epidermal layer and a dermal layer. It also contains structures like hair follicles, sweat, and sebaceous glands. These structures reside in the deepest part of the dermis along with the blood vessels and the nerve endings. These are part of the invaginations of the epidermis in the dermis. Proliferating epithelium and the keratinocytes are present here as well. These cells, in turn, are essential to resurface the injured areas of the skin.

Skin provides a barrier function to help protect the body from the pathogens outside. It also prevents the loss of fluids from the internal environment of the body.

After discussing the normal structures and functions of the skin, Dr. Maan discusses the pathophysiology of the burns and various zones that form in burn injuries. 

He discusses zones of:

1. Coagulation
2. Stasis
3. Hyperemia

Following the pathophysiology, he discusses the method to measure the total body surface area of the burn.

Cardiovascular system instability, fluid loss, vasoconstriction, and myocardial contractility reduction due to the tumor necrosis factor alpha is discussed.

Respiratory changes, for example, adult respiratory distress syndrome and metabolic changes like increased metabolic rate and splanchnic hypoperfusion are discussed.

Following this discussion, the classification of the burns is presented.

Burns are classified as:

1. Superficial
2. Superficial partial thickness
3. Deep partial thickness
4. Full thickness

A discussion of the possible outcome, healing process, and the scar formation in various classes are discussed.

A rigorous discussion of the calculation of the percent total body surface area (TBSA) burnt is presented. Palmer method and the rules of 9 method are discussed.

Classification of burns based on the causative agent is discussed next. Following important types are presented:

1. Thermal
2. Chemical
3. Electrical

Management Approach

1. First Aid
   1. Removal of the hot, burnt, or chemical infused clothing
   2. Cooling or irrigation of the burnt area
   3. Maintenance of the patient's body temperature
   4. Understanding that the trauma is an important factor to consider in a burns' patient. In fact, in the ATLS protocol, the burns are considered a distracting injury.
2. ATLS Protocol
   1. The airway is to be secured
   2. Consider the edema/swelling of the upper airway.
   3. Breathing and ventilation managed
   4. Circulatory system management. 
   5. Consideration for the escherotomy
   6. ETc.

Following management techniques are discussed in detail:

1. Parkland formula for the burns' management is discussed.
2. Topical applications of various creams, drugs, and grafts, etc. are discussed.
3. Surgical approach to the management is discussed in depth.
4. Split thickness skin grafting is discussed next.
5. Donor site choices, considerations, and limitations are discussed.
6. More modern approaches such as sprayed skin, cell culture to form skin, etc. are discussed.

A question-answer session is conducted at the end.

Part 2 of this Q&A will be published next.

In this exclusive webinar, Dr. Zaina Al-Mohtaseb joins Dr. Ahmed Zaafran to present the most important aspects of the basic eye examination with an emphasis on the following topics:

1)History and Physial Examination of Opthalmic Emergencies

2) Vision testing

3) Retinopathy due to Diabetes Mellitus

4) Hypertensive Retinopathy

5) Intraocular Pressures

6) External Examinations