vitamin deficiency

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On the complexity of the body

We imagine the human body to be made of separate parts and discrete systems. But this is only for the sake of simplicity, since every organ is connected to every other organ. The human body functions as a whole and malfunctions as a whole.
This is what makes medicine and biology notoriously difficult and filled with mysteries and ambiguities, because the physician (who's a biologist at core) has to keep in mind the myriad connections that bind each body part to others, and trace the problem (the symptoms) to the original source of it (the malfunctioning organ).

The thyroid is a notorious example: it's a small gland in the neck, yet it controls the metabolism of the entire body, which is why when it becomes overactive (hyperthyroidism) it leads to widespread problems; palpitations, heat intolerance, diarrhea, weight loss, and anxiety. The patient presents with one of these problems, and it's the physician's task (and challenge) to trace the problem to the roots, which are often entangled and entertwined beyond recognition.

Another example is shortness of breath. A patient with shortness of breath could potentially have a problem in his lungs; asthma, infection, air outside the lungs, ...etc. Or a thyroid tumor pressing on his windpipe. He could also be suffering from heart, kidney, or liver failure causing fluid to accumulate there. Or he could be suffering from a blood problem like anemia.

Pre-eclampsia is another example as it can present with headache, abdominal pain, protein in the urine, seizure (thence it becomes eclampsia), or the mother may be unaffected yet the fetus is deteriorating. And chronic kidney disease hits the bones, immunity, sexual function, and the heart together.

So it is the case that in many diseases, virtually every system can be involved and every organ can be the cause. This is what makes medicine so complex and error so possible. And this is why a major part of studying medicine involves distinguishing between very different diseases presenting with very similar complaints.

خُذ مثلًا عددَ الأمراضِ التي تصيب الإنسان: تتباينُ التقديرات بين عدةِ آلاف إلى عشراتِ الآلاف (وإنْ كانت أغلبُها أمراضًا نادرة). قارِن عدد الأمراض مع عدد الأعراض التي يمكن أنْ تظهر على المريض، مثل الحمّى والألم والصداع والتقيؤ؛ إذ لا تعدو الأخيرة على بضعِ مئاتٍ في أفضل الأحوال. أعطالُ الجسدِ لا تُحصى لكنّ لغة الجسد، التي يعبّر بها عن هذه الأعطال، ليس فيها إلا بضعُ مئاتٍ من الكلمات.

Pills vs Scalpels ?

A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis

CONCLUSIONS
For the treatment of appendicitis, antibiotics were noninferior to appendectomy on the basis of results of a standard health-status measure. In the antibiotics group, nearly 3 in 10 participants had undergone appendectomy by 90 days. Participants with an appendicolith were at a higher risk for appendectomy and for complications than those without an appendicolith.

Antibiotics should only be used in non-obstructed appendicitis.

It must also be remembered that a significant number of patients treated medically had to undergo appendectomy 1 year later.

A scientific evaluation proposed that CPR enhances the defibrillation threshold by restoring substrates to myocytes for the facilitation or resumption of normal excitation-contraction coupling. Furthermore, CPR may wash out myocardial depressants that have built up during prolonged VF. Therefore administration of CPR before defibrillation in patients with suspected, prolonged VF is recommended in the prehospital setting.

باختصار، يكلك من يجيك مريض عنده VF قبلما يدخل للطوارئ، أول شي تسويله هو CPR بعدين defibrillation. لأن الـ CPR رح يخلّص الخلايا من الـ toxic metabolites وبالنتيجة يزيد فرص الـ defibrillation بالنجاح

A new TB guideline just dropped

This is milf MLF (Medial Longitudinal fasciculus).

It makes horizontal gaze (moving your eyes sideways) possible, since it connects the nuclei for cranial nerves III & VI so they can work in unison.

When MLF doesn't work properly, cranial nerve VI abducts the eye, as it normally would, but it won't be able to send the signal to the contralateral cranial nerve III to make it adduct the contralateral eye (so both eyes look in the same direction). This condition then is called internuclear ophthalmoplegia. Why inernuclear? Because the connection between (inter-) nuclei of cranial nerves III & VI becomes disrupted.