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أوكي أكو غلط هنا:
بحالة التدخين، الـ acrolein يوصل للرئة بس ما يوصل للمثانة فيسبب سرطان الرئة والجهاز التنفسي بس ماكو ربط (بسياق التدخين) بينه وبين سرطان المثانة.
اللي يسبب سرطان المثانة بحالة التدخين هو مركب إسمه:
Naphthylamine

In patients less than 55 years of age, the diastolic and systolic blood pressures are both predictive of adverse events from cardiovascular disease. However, because the diastolic blood pressure declines on average after the age of 55 years, its predictive value is diminished in older patients.

That's why in such scenarios, we can also use pulse pressure as a predictive factor.

Never trust an electronic device

خاصةً أجهزة الضغط
As if those MFs were designed to make false readings...

الـ high arch مال القدم يسموها pes cavus
والـ muscle atrophy يكون بإتجاه distal to proximal لهذا تشوف الرجل والكاحل ضعيفات كلش بينما الساق calf تكون ممتلئة نسبيًا (ومرات بيها pseudo-hypertrophy)، وهالشي ينطيها شكل بطل موكفيه بالمكلوب inverted champagne bottle

~90% of creatinine is freely filtered through the glomerulus. The other 10% is secreted in the proximal tubules.

That's one reason why we love it: because it is helpful as a rough estimate of GFR.

Cimetidine increases serum creatinine levels because it inhibits creatinine secretion.

Therefore: cimetidine has been used clinically to improve the accuracy of the creatinine clearance. By competitively inhibiting creatinine secretion, the creatinine clearance becomes a more accurate measure of the true glomerular filtration rate.

الفكرة هي أنّ الكرياتنين يتفلتر passively عبر الـ glomerulus فنكدر نستخدمه بصفته مقياس للـ GFR. بس المشكلة هي أنّ نسبة قليلة منه (10%~) تنفرز بشكل active بالكِلية... لهذا احنة نستخدم الـ cimetidine حتى نلغي افراز الكرياتنين بالكِلية ويبقى بس الـ passive filtration اللي هو مقياس دقيق إلى حد كبير للـ GFR.

فكرة ذكية الصراحة

المهم

An exact GFR calculation is not necessary, and a 24-hour urine collection is inconvenient and no longer required to estimate it.
We rely, instead, on estimated GFR (eGFR) to monitor renal function. The CKD-EPI formula is the one most used today for eGFR and there are many calculators online for easy use.

TMP/SMX also causes an isolated increase in creatinine (without increasing the serum urea). The elevated creatinine does not necessarily indicate nephrotoxicity (although TMP/SMX can sometimes cause it).

TMP/SMX:
Trimethoprim-sulfamethoxazole

الاختصارات بالطب أصعب من الطب

The traditional teaching method of “see one, do one, teach one” in surgical residency programs is simple but still applicable

Notes on ECG:

• RBBB (Right-Bundle Branch Block) is usually benign and can be considered a normal variant in ECG, while LBBB is always pathological.

• Right-axis deviation can be benign especially in tall, thin people. While left-axis deviation is always pathological.

• 1st degree heart block and Mobitz l (wenckebach phenomenon) are also relatively benign in themselves, although they can be signs for other abnormalities like coronary heart disease. Mobitz ll is always pathological.

To be clear ماعرف اذا داخلات بالامتحان لو لا