لاحظ هاوس گللهم انطوها thiamine وبعدين من يتعدل انطوها كيك او ايس كريم، لأن الدماغ يحتاج الـ thiamine بالـ metabolism فإذا ما عوضته أول شي، رح يزيد الـ damage.

في سياق متصل بما انو البارحة امتحنت توليد، وحدة من الـ changes اللي تصير خلال الحمل هي Hyperemesis Gravidarum, فالمريضة رح يصير عدها thiamine deficiency، همين بالـ management ما أنطي glucose اذا ما أعوض الـ thiamine.

Mirror neurons by Cajal

Mirror neurons were discovered at the Università degli Studi di Parma in the 1990s, and first described as nerve cells in the frontal and premotor cortex of macaques that fire both when the monkey performs a movement and when it observes the same movement by another monkey or a human. The presence of a ‘mirror’ system (describing a close match between execution and observation of movements) was then also confirmed in humans, but not in other species, indicating that this might be a peculiar feature of primates. Scientists have theorised that mirror neurons allow understanding of the meaning of another’s actions, and constitute the neural basis of imitation learning and empathy.

“Our work shows that the activation of those neurons in the premotor and motor area is a passive response to the observation of an action,” says Albertini.
"For the first time, a non-matching between observing and executing domains is reported," says Vassilis Raos, associate professor at the University of Crete and co-author of some of the seminal studies on mirror neurons, who was not involved in the study. “This finding opens a new era in studying the fundamental properties of mirror neurons”.
According to Gregory Hickok, a professor of cognitive science at the University of California Irvine and a critic of the original mirror neuron theory, “this is a confirmation that the mirror neuron system is not the basis of action understanding”. The new study, he notes, shows not only that mirror neurons respond to non-biological stimuli, but that these do not even have to include the core actions (here, a kind of grasp) to activate the network.

Observing non biological stimulus leads to imitative compatibility rather than stimulus response compatibility.

2021 (placental villous tree)

It can be roughly divided into these stages:

• It is asymptomatic initially, and does not produce symptoms until it becomes in an advanced stage.
• Microalbuminuria (without reduction in GFR or BP changes).
• Macroalbuminuria with GFR reduction and hypertension.
• End-stage renal failure: It is the most common cause of end-stage renal disease (ESRD) in the United States.

The recommended screening test is spot ACR (Albumin-Creatinine-Ratio). Preferably a first-void, or alternatively, early-morning specimen.

Normal < 30 mg/g
Microalbuminuria = 30-300 mg/g
Macroalbuminuria > 300 mg/g

ADA recommends annual screening for microalbuminuria beginning at the time of diagnosis for patients with type 2 DM, and starting at year 5 for patients with type 1 DM.

Because of the variability of ACR, 2 of 3 specimens in a 3- to 6-month period should be abnormal before diagnosing new or progressive diabetic nephropathy.

ليش؟
لأن الـ natural history مال المرض يختلف بين النوع الأول والنوع الثاني

بالسكري من النوع الأول، الـ microalbuminuria بالعادة تظهر بعد شي 10 سنوات، وراها تتطور إلى الـ stages اللي ذكرتهن فوك خلال 10 إلى 20 سنة

بينما بالنوع الثاني:
Natural history is less well defined because the onset of type 2 DM is usually not well defined, and other causes of kidney disease (such as hypertension and vascular disease) are common comorbidities.

The treatment is basically:
• First and foremost: tight glycemic control reduces both the risk and the progression of the nephropathy.

• Control the BP via ACE inhibitors or ARBs. This has the dual effect of reducing both hypertension and proteinuria (ACEi and ARBs were found to reduce proteinuria in general. i.e. in nephrotic syndrome). But they should not be used together; doing so increases the incidence of acute kidney injury and hyperkalemia without leading to benefits beyond using either agent alone.

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الـ DM طلع يونس الصراحة

بقن بس الـ crises مالته:
• Hypoglycemia
• DKA
• Hyperglycemic Hyperosmolar state (HHS)

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