Sore throat

"Sore throat” or pharyngitis is one of the most frequent complaints of patients in the acute care setting. On the surface, pharyngitis would appear to pose few challenges to the clinician; the site of infection is both visible and accessible for inspection and culture, and the majority of pharyngeal pathogens are self-limiting respiratory viruses. Unfortunately, the diagnosis and management of acute pharyngitis is complicated by the 10% to 30% of cases caused by bacterial pathogens, particularly group A beta-hemolytic streptococci (GAS). Concerns over the risk of suppurative and nonsuppurative complications associated with GAS pharyngitis have fueled the widespread practice of empirical antimicrobial?therapy. However, the consequences of antimicrobial overuse, measured by cost, adverse events, and bacterial resistance, have refocused attention on the need for targeted therapy based on an appreciation of the epidemiology and diverse clinical presentations of acute pharyngitis.


Clinical Manifestations
The principal challenge IS TO MAKE DIFFIRENCE  BETWEN viral AND bacterial causes, Pharyngitis IS defied as mucous membrane inflmmation either

localized to the posterior pharynx or contiguous with the adjacent membranes of the posterior nares or larynx. 

How endocarditis takes place ? (PATHOGENESIS)

The pathogenesis of endocarditis starts with an area of endocardial injury leading to platelet-firin deposition. The next step requires a microorganism to enter the bloodstream and adhere to the area of injury. Injury and infection most commonly occur on the valve leaflts but can also occur on or near congenital defects, chordae, chamber walls, prosthetic valve attachments, pacemaker leads, or any other endocardial location where conditions are met. Subacute bacterial endocarditis most commonly occurs on the downstream side of a signifiant pressure gradient related to the rheumatic heart lesions, bicuspid aortic valve, or a variety of congenital heart lesions such as ventricular septal defect. Predisposing factors select organisms to enter the blood stream, and once present, adherence factors determine the like lihood of a particular organism causing endocarditis. Adherence facilitates the initial colonization of the valve surface. Certain species of bacteria—for example, Staphylococcus and Streptococcus species—produce the majority of the human cases of endocarditis because of their ability to adhere to damaged tissues of the heart. Conversely, Escherichia coli can be a common cause of bacteremia from urinary or gastrointestinal sources but is a rare cause of endocarditis because it lacks these adherence factors.


In 1978 Drs. Sheld, Valone, and Sande described the role of dextran, platelets, and fibrin in the adherence of streptococci to damaged endocardial tissue. Staphylococci use a variety of surface-bound adhesion components to bind to firinogen for colonization and fironectin for invasion. Certain enzyme possess clumping factor binding firinogen and fironectin as a virulence factor. Once attached to the platelet-firin nidus, bacteria begin to multiply, increasing coagulation activation, attraction of leukocytes, and growth of inflmmation-promoting vegetation This in effect buries bacteria deep within the mature vegetation, contributing to the treatment challenge of IE.

Acute appendicitis

Acute appendicitis is the most common surgical emergency, and appendectomy is the most common emergency operation, with more than 250,000 procedures reported annually in the United States. Acute appendicitis results from appendiceal endoluminal obstruction, typically caused by a fecalith. Although no specifi risk factors have been identifid, it is slightly more common in males and in the young and the elderly, with more advanced disease on presentation in the elderly. Clinical fidings in combination with basic laboratory tests are often enough to establish
the diagnosis, and imaging studies, such as abdominal ultrasound or computed tomography (CT), can be helpful to confim the diagnosis and rule out other potential pathologies in selected individuals. The treatment for acute appendicitis is appendectomy, and the laparoscopic approach is preferred, given its association with better postoperative outcomes. In later stages, appendicitis may be complicated with phlegmon or intraabdominal abscess. For these patients, aggressive medical treatment with broad-spectrum antibiotics and percutaneous drainage when indicated is the initial treatment of choice, and the operative approach is reserved for when this treatment fails and in the setting of peritonitis. Interval appendectomy after an episode of appendicitis treated with antibiotics, although still controversial, must be considered to minimize the risk of recurrent inflmmation, which is associated with worse outcomes.
Good outcomes are generally seen in patients diagnosed and treated early, and this should be the main goal when approaching patients with suspected acute appendicitis.

Cardiac cell membrane VS The current of activation and ECG presentation

As you can see the negative ions migrate to the outer surface of the cell and the positively charged
ions pass into the cell; this reversal of polarity is called depolarization phase 1
This traffic ions determine the Potential of charges :
So the difference of electrical charge not equal  
i will develop this in the future posts :)

What to do in Shock (circulatory)?

■ Hospitalization in intensive care or intensive care unit USIC.
• optimal oxygenation (O2, VNI, intubation, mechanical ventilation).
• Monitoring ECG, blood pressure, saturation, bloody blood pressure. 
■ First Routes veineux.Types treatment
Cardiogenic shock: dobutamine, diuretic IV, specific treatment
Hypovolemic shock :Fluid replacement by crystalloid or colloid solutions, blood transfusion, the treatment purpose is to increase blood volume Fluid replacement septic shock,
-dopamine, 
-dobutamine,
-norepinephrine
, antibiotic therapy in septic shock, corticosteroids adrenal insufficiency, treating the cause,
 hémofitration continuous high speed,
 activated protein C (CRP)
Fluid replacement anaphylactic shock, epinephrine, corticosteroids

Fibroblast and allergy

Fibroblasts proliferate in response to several cytokines and mediators generated during an allergic inflmmatory response. Recognized firoblast mitogens include histamine, heparin, and tryptase derived from mast cells, and major basic protein (MBP) and eosinophil cationic protein (ECP) from eosinophils. The cytokines TGF- β as well as platelet-derived growth factor (PDGF), b-firoblastgrowth factor (b-FGF), insulin-like growth factor 1 (IGF1), IL-1, and endothelin released during chronic allergic inflmmation promote fibroblast proliferation, differetiation, and activation.TGF-β enhances production of a range of extracellular matrix components, and decreases the synthesis of matrix-degrading enzymes while increasing the synthesis of protease inhibitors. Thus, TGF- β promotes the deposition of extracellular matrix while inhibiting its degradation, and contributes to the widespread subepithelial extracellular matrix deposition that may be associated with chronic allergic inflmmation.Chronic allergic inflmmation may lead to the deposition of types III and V ‘repair’ collagens in the lamina reticularis beneath the types IV and VII ‘reticular’ collagens, which largely make up the basement membrane.The altered sub-basement membrane region also contains increased deposition of extracellular matrix components including fironectin, tenascin, and lamin. Myofiroblasts present below the basement membrane are increased in number in asthma and are the source of many of the extracellular matrix products that are expressed after allergen challenge. so as you see the allergy is phenomenon complex ...

Asthma vs genetics

Now we will talk about asthma and one of the very important question the genetic side of this disease as you know, The dawn of the new century has seen a revolution in our understanding of the
genetic basis of common diseases such as obesity, diabetes, heart disease,
cancer - pathogenenetics -, and neuropsychiatric conditions. These diseases are termed ‘complex
genetic diseases’ as they result from the effect of multiple genetic and interacting environmental factors Like these other common conditions, the role of a heritable component to susceptibility to allergic disease has long been recognized, with atopy and the clinical manifestation of allergy such as asthma and atopic dermatitis resulting from the interaction between an individual’s genetic make-up and their environmental exposures. Recent years have seen considerable progress in unravelling the contribution of specific genetic factors to an individual’s susceptibility, subsequent development, and severity of allergic disease. This has resulted in increasing insight into novel areas of allergic disease pathophysiology. Furthermore, studies of gene–environment interaction have lead to greater insight into the importance of environmental triggers for the initiation, exacerbation, and persistence of allergic diseases. i will develop this soon 

DISTRIBUTION AND COMPOSITION OF BODY WATER

Everybody drink water every day but did you know how much of water countain your bady ?

In normal persons adult, the total body water constitutes 50–60% of lean bodyweight in men and 45–50% in women. In a healthy 70 kg male, total body water is approximately 42 L.This is contained in three major compartments:■ intracellular fluid (28 L, about 35% of lean bodyweight)■ extracellular – the interstitial fluid that bathes the cells(9.4 L, about 12%)■ plasma (also extracellular) (4.6 L, about 4–5%).
In addition, small amounts of water are contained in bone, dense connective tissue, and epithelial secretions, such as the digestive secretions and cerebrospinal flid. The intracellular and interstitial flids are separated by the cell membrane; the interstitial flid and plasma are separated
by the capillary wall (Fig. 12.1). In the absence of solute, water molecules move randomly and in equal numbers in either direction across a permeable membrane. However, if solutes are added to one side of the membrane, the inter molecular cohesive forces reduce the activity of the water molecules. As a result, water tends to stay in the solute containing compartment because there is less free diffusion across the membrane. This ability to hold water in the compartment can be measured as the osmotic pressure. 

Osmotic pressure

Osmotic pressure is the primary determinant of the distribution of water among the three major compartments.is like a magenet of water :)  The concentrations of the major solutes in these flids differ, with each compartment having one solute that is primarily limited to that compartment and therefore determines its osmotic pressure. The intracellular flid the potassium (K+) is major (most of the cell Mg2+ is bound and osmotically inactive) and in the extracellular compartment, Na+ salts predominate in the interstitial side, and proteins in the plasma

respiratory system

The main role of the respiratory system is to extract oxygen from the external environment and dispose of waste gases, principally carbon dioxide CO2. This requires the lungs to function as efficient bellows, bringing in fresh air and delivering it to the alveoli, and expelling used air at an appropriate rate. Gas exchange is achieved by exposing thin-walled capillaries to the alveolar gas and matching ventilation to blood flw through the pulmonary capillary bed. In doing this, the lungs expose a large area of tissue, which can be damaged by dusts, gases and infective agents. Host defence is therefore a key priority for the lung and is achieved by a combination of structural and immunological defences.

Is FOOD healthy ?

the food is an amazing thing :) but did you know that :

In developing countries, lack of food and poor usage of the available food can result in protein–energy malnutrition ; 50 million pre school African children have PEM. In developed countries, excess food is available and the most common nutritional problem is obesity. Diet and disease are interrelated in many ways. Excess energy intake, particularly when high in animal (saturated) fat content, is thought to contribute to a number of diseases, including ischaemic heart disease and diabetes. A relationship between food intake and cancer has been found in many epidemiological studies; an excess of energy-rich foods (i.e.fat and sugar containing), often with physical inactivity, plays
a role in the development of certain cancers, while diets high in vegetables and fruits reduce the risk of most epithelial cancers. Numerous carcinogens, either intentionally added to food (e.g. nitrates for preserving foods) or accidental contaminants, may also be involved in the development of cancer.The proportion of processed foods eaten may affect the development of disease. A number of processed convenience foods have a high sugar and fat content and therefore may predispose to dental caries and obesity, respectively. They also have a low fire content, and dietary fire is possibly necessary in the prevention of a number of diseases Some epidemiological data suggest that there are long-term effects of undernutrition, low growth rates inutero being associated with high death rates from cardiovascular disease in adult life. 

Vitamin C -very important vitamin-

Very important vitamine because :Ascorbic acid is a powerful reducing agent controlling the redox potential within cells. It is involved in the hydroxylation
of proline to hydroxyproline, which is necessary for the formation of collagen. The failure of this biochemical pathway
in vitamin C defiiency accounts for virtually all of the clinical effects seen.Humans, along with a few other, are unusual in not being able to synthesize ascorbic acid from glucose. Vitamin C is present in all fresh fruit and vegetables.
Unfortunately, ascorbic acid is easily leached out of vegetables when they are placed in water and it is also oxidized todehydro-ascorbic acid during cooking or exposure to copperor alkalis. Potatoes are a good source as many people eat alot of them, but vitamin C is lost during storage.
It has been suggested that ascorbic acid in high dosage (1–2 g daily) will prevent the common cold. While there issome scientifi support for this, clinical trials have shown no signifiant effect. Vitamin C supplements have also been advocated to prevent atherosclerosis and cancer, but again a clear benefi has not been demonstrated.Vitamin C defiiency is seen mainly in infants fed boiled milk and in the elderly and single people who do not eat vegetables. 

Abnormal perceptions ?

Illusions are misperceptions of external stimuli and are most likely to occur when the general level of sensory stimulation is reduced.
■ Hallucinations  Healthy people occasionally experience hallucinations, such as innormal grief, or during the transition between sleeping and waking.its may affect any of the perceptions: auditory, visual, tactile, gustatory, olfactory or of deep sensation.
■ Pseudohallucinations are usually auditory, and are either true externally sited hallucinations, but with insight into their imaginary nature, or are sited within internal space (ex. ‘someone talk to me in my head’). They can occur in mood disorders and do not indicate apsychosis.
■ Depersonalization is a change in self-awareness such that the person feels unreal or detached from their body. The individual is aware, however, of the subjective nature of this alteration.
■ Derealization is the unpleasant feeling that the external environment has become unreal and/or remote; patients may describe themselves as though they are in adream-like state. Both this and depersonalization canoccur in healthy people when they are tired

CAUSES OF A PSYCHIATRIC DISORDER

A psychiatric disorder may result from several causes which may interact.■ Predisposing factors often stem from early life and include genetic, pregnancy and delivery, previous emotional traumas and personality factors.
■ Precipitating factors may be physical,psychological or social in nature. Whether they produce
a disorder depends on their nature, severity and the presence of predisposing factors. For instance a death of a close, rather than distant, family member is more likely to precipitate a pathological grief reaction in someone who has not come to terms with a previous bereavement.
■ Perpetuating (maintaining) factors prolong the course of a disorder after it has occurred. Again they may be physical, psychological or social, and several are often active and interacting at the same time. For example, high levels of criticism at home combined with taking cannabis, as relief from the criticism, may help to maintain schizophrenia

Would you like to be a psychiatric doctor?

I ask you this question to discuss about psychiatry en general ill develop this tags soon :)
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Factors increasing the risk of psychiatric disorders in the general hospital

Patient factors
Previous psychiatric history
Current social or interpersonal stresses
Homelessness
Recent alcohol misuse
Treatment
Certain drugs
Second postoperative day
Surgery affecting body image 

Physical conditions
Chronic ill-health
Chronic pain
Life-threatening illness
Recent bad prognostic news
Disabling condition
Brain disease
Recent live birth, stillbirth or miscarriage
Functional illness

Setting
A&E department
Neurology, oncology and endocrinology wards
Intensive care unit
Renal dialysis unit

Symptoms of poisoning -almond- !

If ingestion of intact almond causes only mild digestive disorders (Abdominal pain, vomiting, diarrhea), severity of poisoning appear when the almonds are chewed (mastication causes
the release of hydrogen cyanide) and then swallowed. For less than five almonds, abdominal pain are observed, vomiting, diarrhea, dizziness, sometimes sleepiness or agitation. Beyond ten almonds, intoxication is severe: hypersalivation, sweating, dizziness, tremors, bradycardia, bradypnea, cyanosis, cardiovascular collapse, convulsions .
Hospitalization should be routine for a quantity supposedly ingested upper almonds to 10. the Treatment is symptomatic
(Oxygen therapy, correction of metabolic acidosis,vascular filling). An antidote treatment with hydroxocobalamin may be considered in severe poisoning. It is right to remember that these cyanogenic glycosides are also present in almonds bitter almond (Prunus amygdalus), plum, peach
or apricot.

Xenobiotics in the humain body

the xenobiotic in the body pass by 5 steps, summarized in four or five letters: "ADME" or "ADMET" - thelast measurement, toxicity, being sought systematically in certain
Preclinical studies (eg bradypnea / apnea after intravenous administration of morphin)
• "A" for absorption (absorption / penetration in the body);
• "D" for Distribution (dissemination);
• "M" for metabolism (biotransformation);
• "E" for disposal;
• "T" for toxicity (when it can directly determine a limiting effect
dependent on the concentration in the central compartment). illustrates the fate of a drug in the body.

We describe the stages of absorption, distribution and disposal require the crossing of physiological barriers by the xenobiotic.Books and more specialized sites will find more aspects

Pharagitis diseases - How to be able to diagnostic pharagitis easly

"Sore throat” or pharyngitis is one of the most frequent complaints of patients in the acute care setting. On the surface, pharyngitis would appear to pose few challenges to the clinician; the site of infection is both visible and accessible for inspection and culture, and the majority of pharyngeal pathogens are self-limiting respiratory viruses. Unfortunately, the diagnosis and management of acute pharyngitis is complicated by the 10% to 30% of cases caused by bacterial pathogens, particularly group A beta-hemolytic streptococci (GAS). Concerns over the risk of suppurative and nonsuppurative complications associated with GAS pharyngitis have fueled the widespread practice of empirical antimicrobial?therapy. However, the consequences of antimicrobial overuse, measured by cost, adverse events, and bacterial resistance, have refocused attention on the need for targeted therapy based on an appreciation of the epidemiology and diverse clinical presentations of acute pharyngitis.


Clinical Manifestations
The principal challenge IS TO MAKE DIFFIRENCE  BETWEN viral AND bacterial causes, Pharyngitis IS defied as mucous membrane inflmmation either

localized to the posterior pharynx or contiguous with the adjacent membranes of the posterior nares or larynx.