A SORE STORY : THE PROPELLORS OF #INFLAMMATION

🔥The process of inflammation is maintained by 3 important mechanisms:

✔️Vasodilation 

✔️Increased capillary permeability 

✔️Migration of leucocytes

🔥WHO IS DOING THESE?

▪️PLASMA DERIVED MEDIATORS 

✔️BRADYKININ --> Vasodilation & Increased capillary permeability 

✔️COMPLEMENT MEDIATORS --> Mast cell degranulation --> Vasodilation & Increased capillary permeability + activate neutrophils and phagocyte migration 

✔️COAGULATION: Forms a protective clot over the injured area

✔️ FIBRINOLYSIS: Activates neutrophils & macrophages by Fibrin Degradation Products (FDP)

▪️CELL DERIVED MEDIATORS

✔️HISTAMINE (from basophils and mast cells) --> Vasodilation & Increased capillary permeability 

✔️LEUKOTRIENES (from basophils and mast cells) --> chemotaxis of granulocytes 

Ⓜ️NEMO> " leukoTRYenes TRY to catch granulocytes"

✔️TUMOR NECROSIS FACTOR (cytokine from macrophage) --> activates endothelial cells , enhances phagocytosis 

Ⓜ️NEMO> "TN(F)™ = F for 'Fagocytosis' TM= TNF is from Macrophages "

✔️CHEMOKINES are chemotactic #cytokines

✔️NITRIC OXIDE (from endothelial cells and macrophages) is a powerful vasodilator and smooth-muscle relaxant.

#anesthesia , #anaesthesia , #pathology , #exams , #MedicalStudents , #MedicalExams

VITAMIN K

♈️Vitamin K is so named as it was originally called Koagulationsvitamin.

♈️The body stores about 1 week’s supply of vitamin K.

♈️Vitamin K is a fat-soluble vitamin

♈️ Vitamin K is required for the synthesis of six factors in the clotting cascade : factors II, VII, IX, X and the anticoagulants protein C and protein S.

♈️ γ -Carboxylation of these factors is carried out by the vitamin K-dependent carboxylase. This reaction subsequently allows calcium binding and the conformational change required to become active. The reaction involves the oxidation of vitamin K. Warfarin works by stopping the reversal of this oxidation.

♈️ Bile is required for absorption of vitamin K in the gut.

♈️ Menadiol, a synthesized form of vitamin K (K3), is water-soluble and therefore can be absorbed in conditions in which bile secretion is low. But, it is not recommended for use in neonates as it may produce haemolysis.

♈️ Haemorrhagic disease of the newborn is caused by a relative vitamin K deficiency.

♈️ Prophylaxis against haemorrhagic disease of the newborn is usually given at birth as an injection of the naturally occurring fat-soluble phytomenadione.

#VitaminK , #nutrition , #Vitamin , #medicine , #MedicalExam

Don't run away; it's simple : PARALLEL Vs CROSS OVER DESIGNS IN RANDOMIZED CONTROLLED TRIALS

 CONTROLLED TRIALS 

⏸Parallel groups 

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(👳🏻🔷vs 👳▪️ ) Simple, head-to-head comparison of two or more treatments 

1️⃣Subjects are allocated at random to a single treatment or a single treatment programme for the duration of the trial 

🆓The groups are independent  of each other

 🔀Crossover trials 

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(💂🔷  ➡ ️vs  💂▪️)This involves a single group study, where each patient receives two more treatments in turn; i.e. Each patient acts as their own control and comparisons of treatments are made within patients 

2️⃣Two or more treatments are given to each patient in random order 

✅useful for chronic conditions  such as pain relief in long-term illness or the control of high blood pressure where the outcome can be assessed relatively quickly

✴️It may not be feasible for treatments for short-term illnesses that once treated are cured, for example antibiotics for infections

😃Advantages of parallel group designs

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✔️The comparison of the treatments takes place concurrently 

✔️Can be used for any condition, especially an acute condition which is cured or self-limiting such as an infection 

✔️No problem of carry-over effects 

😬Disadvantages of parallel group designs 

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✖️The comparison is between patients and so usually needs a bigger sample size than the equivalent cross-over trial 

😃Advantages of crossover designs 

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✔️Treatments are compared within patients and so differences between patients are accounted for explicitly 

✔️Usually need fewer subjects than the equivalent parallel group trials 

✔️Can be used to test treatments for chronic conditions 

😬Disadvantages of crossover designs 

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✖️Cannot be used for many acute illnesses 

✖️Carry-over effects need to be controlled 

✖️Likely to take longer than the equivalent parallel designs 

✖️Statistical analysis is more complicated if subjects do not complete all periods

ѦԀԀIṬIȎṄѦʟ IṄҒȎ➕ 

〰〰〰〰〰〰〰

🏃🏾In cross over trials, it is important to avoid the 'carry-over effect' of one treatment into the period in which the next treatment is allocated. 

↔️This is usually achieved by having a gap or 'washout period'  between treatments

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