Cobalamin (vitamin B12) deficiency is particularly common in the elderly (>65 years of age), but is often unrecognized because of its subtle clinical manifestations; although they can be potentially serious, particularly from a neuropsychiatric and hematological perspective.

As a curious child, you might remember staring at an older relative's thick stockings at the blue, gnarled veins lying under the skin like bumpy snakes. Known as varicose veins, these blood vessels, which return blood from the legs to the heart, are actually a more superficial system. The real, working venous system for the legs lies deeper, says to Robert A. Weiss, MD, assistant professor of dermatology at the Johns Hopkins School of Medicine in Baltimore. This is good news, because it means that if the surface veins begin to clump up and bulge, they can be removed or destroyed without ruining circulation to the leg. The National Institutes of Health estimates that 60% of all men and women suffer from some form of vein disorder. A quarter of varicose vein sufferers are men, although Weiss notes that it is almost always women who seek help for spider veins.

The Glasgow Coma Scale (GCS) is the most common scoring system used to describe the level of consciousness in a person following a traumatic brain injury. Basically, it is used to help gauge the severity of an acute brain injury.

Pyogenic granuloma (lobular capillary hemangioma[1] ) is a relatively common benign vascular lesion of the skin and mucosa whose exact cause is unknown. Also see the Medscape Reference article Oral Pyogenic Granuloma. Pyogenic granulomas are misnamed; they are neither infectious nor granulomatous. The lesion usually occurs in children and young adults as a solitary, glistening red papule or nodule that is prone to bleeding and ulceration. Pyogenic granulomas typically evolve rapidly over a period of a few weeks, most often on the head, neck, extremities, and upper trunk. Pyogenic granuloma often arises in pregnancy (or rarely with oral contraceptive usage), particularly on the gingiva or elsewhere in the oral mucosa, and then is termed the "pregnancy tumor." Other pyogenic granuloma variants that have been well documented include the disseminated, subcutaneous, intravenous, and medication-induced (for example, retinoid, antiretroviral, and oncologic agent) subtypes. Removal of pyogenic granuloma is indicated to alleviate any bleeding, discomfort, cosmetic distress, and diagnostic uncertainty. A number of malignant tumors may clinically mimic pyogenic granuloma, making histopathologic confirmation important if the presentation is atypical. Aside from cutaneous and oral lesions, pyogenic granuloma has been reported throughout the gastrointestinal tract and upper airway, at various ocular locations, the central nervous system, the bladder, and the internal vasculature. This article discusses only cutaneous and oral involvement.

Ewing's sarcoma typically occurs in children and young adults. It often begins in the legs, bones of the pelvis, and arms. Bone pain, localized swelling, and tenderness are symptoms. In rare cases bone fractures may also be found. Treatments include chemotherapy, surgery, and radiation.

Tobacco use is the most common preventable cause of death. About half of the people who don't quit smoking will die of smoking-related problems. Quitting smoking is important for your health. Soon after you quit, your circulation begins to improve, and your blood pressure starts to return to normal. Your sense of smell and taste return, and it's easier for you to breathe. In the long term, giving up tobacco can help you live longer. Your risk of getting cancer decreases with each year you stay smoke-free. Quitting is not easy. You may have short-term affects such as weight gain, irritability, and anxiety. Some people try several times before they succeed. There are many ways to quit smoking. Some people stop "cold turkey." Others benefit from step-by-step manuals, counseling, or medicines or products that help reduce nicotine addiction. Some people think that switching to e-cigarettes can help you quit smoking, but that has not been proven. Your health care provider can help you find the best way for you to quit.

Endometrial cancer is a type of cancer that begins in the uterus. The uterus is the hollow, pear-shaped pelvic organ in women where fetal development occurs. Endometrial cancer begins in the layer of cells that form the lining (endometrium) of the uterus. Endometrial cancer is sometimes called uterine cancer. Other types of cancer can form in the uterus, including uterine sarcoma, but they are much less common than endometrial cancer. Endometrial cancer is often detected at an early stage because it frequently produces abnormal vaginal bleeding, which prompts women to see their doctors. If endometrial cancer is discovered early, removing the uterus surgically often cures endometrial cancer.

Inner Workings tells the story of the ceaseless pull of the human heart — even as it works against the very stoic realism of the brain.

When the hematocrit rises to 60 or 70%, which it often does in polycythemia, the blood viscosity can become as great as 10 times that of water, and its flow through blood vessels is greatly retarded because of increased resistance to flow. This will lead to decreased oxygen delivery.

In the Dialysis Unit you have an opportunity to provide Dialysis care for a variety of patients, including those with End-Stage Chronic Kidney disease and acutely ill patients requiring dialysis and plasmapheresis.
The Chronic Dialysis Nurse focuses on patients receiving Hemodialysis, Peritoneal Dialysis, or Home Hemodialysis. Our patients range in age from newborns to young adults. The Hemodialysis patient receives their dialysis treatment in the clinic 3-5 times a week. The Peritoneal Dialysis and Home Hemodialysis treatments are provided in the patient’s home once the parent/caregiver is trained to operate the machine. They are followed monthly in clinic. The patient receiving Chronic Dialysis is supported by a multidisciplinary team that consists of a physician, nurses, social worker, nutritionist, pharmacist, child-life therapist, teacher, and counselor. The group works together to meet the medical and emotional needs of the patient and caregiver. Care is specialized to meet the needs of each individual patient.
The Acute Dialysis Nurse focuses on acute dialysis related therapies such as: Continuous Renal Replacement Therapy (CRRT); therapeutic plasmapheresis; or acute peritoneal dialysis. The acute dialysis team works with the multi-disciplinary inpatient nephrology team to provide acute dialysis services to the critically ill ICU patients. The work environment is highly technical and fast-paced.
The Dialysis Unit operates on 12hr shifts 7a – 7p; 7 days a week. Night call is required and shared by the nurses. We provide a detailed orientation plan to the nurse to become proficient in providing hemodialysis, peritoneal dialysis, continuous renal replacement therapy and plasmapheresis. Previous experience in dialysis or pediatrics is not required.

A simple test of fingernail clippings could replace a blood draw as a way to diagnose and monitor type 2 diabetes mellitus (T2DM), with huge implications for tracking the disease in the developing world. Research on this method by a team of Belgian researchers was reported July 28, 2015, at the 2015 American Association for Clinical Chemistry (AACC) Annual Meeting and Clinical Lab Expo in Atlanta. The team, led by Joris R. Delanghe, MD, PhD, of the Department of Global Chemistry, Microbiology and Immunology at Ghent University, collected nail clippings from 25 people with T2DM and 25 without the disease. The clippings were ground into a powder and tested with an inexpensive FT-IR photometer to measure how much the protein in the nails had bonded with sugar molecules, a process known as glycation. “We found a striking difference in the measurements between the control group and the patients with diabetes,” Delanghe said. In an interview with Evidence-Based Diabetes Management, he said replacing the standard blood test to measure glycated hemoglobin is a huge advantage. In many cultures, he said, “Taking blood is something that cannot be tolerated.” - See more at: http://www.ajmc.com/journals/evidence-based-diabetes-management/2015/september-2015/fingernail-tests-may-offer-cheap-simple-way-to-diagnose-diabetes#sthash.XQxnBcNO.dpuf

The famous question: Can I get LASIK surgery to correct my vision?

A man's age matters. As men get older, the chances of conceiving and having a healthy child decline. Male fertility starts to decline after 40 when sperm quality decreases. This means it takes longer for their partners to conceive and when they do, there's an increased risk of miscarriage.

This operation can be performed as an open or laparoscopic (keyhole procedure). During the operation the sigmoid colon is removed. This involves taking away the blood vessels and lymph nodes to that part of the bowel. The surgeon then re-makes the join (anastomosis) between the remaining left side of the colon and the top of the rectum. The surgeon may use either sutures or special staples to make this join.

Doctors at a Baltimore hospital have performed the world's most extensive penis transplant, this one also involving the scrotum and part of the abdominal wall.

Common causes of the knee pain
Knee pain is very common and in this video we will present the most common problems that can cause pain in the knee. (Patella) itself, which is in front of the knee, or from the tendons that are attached to the kneecap (patellar tendon and quadricep tendon). One of the most common problems is patellar chondromalacia which is chronic pain due to the softening of the cartilage beneath the kneecap. The cartilage of the kneecap will have some erosions, defects, or holes from mild to complete inside the joint (exactly in the back of the kneecap).
• Pain in the front of the knee
• Occurs more in young people
• Becomes worse from climbing up stairs and going downstairs
Treatment is usually nonsteroidal anti-inflammatory medication, physical therapy, and surgery is very rare. Also in front of the kneecap, the patient may get pain due to prepatellar bursitis.
When there is prepatellar bursitis, the patient will see that the swelling, the inflammation, and the pain is located over the front of the kneecap. The bursa becomes inflamed and fills with fluid at the top of the knee, causing pain, swelling, tenderness and a lump in that area on top of the kneecap. If the pain is in front of the knee but below or above the patella, this may indicate that the patient has tendonitis. Patellar tendonitis is an overuse condition that often occurs in athletes who perform repetitive jumping activities. Patellar tendonitis is a knee pain that is associated with focal patellar tendon tenderness and it is usually activity related. It is located below the kneecap and is called "jumper's knee". Patellar tendonitis affects approximately 20% of jumping athletes. There will be tenderness to palpation at the distal pole of the patella in extension and not in flexion. Quadriceps inflexibility, atrophy and hamstring tightness are predisposing factors for this condition. Treatment is rest, anti-inflammatory medication, stretching and strengthening of the hamstrings and quadriceps. Use an eccentric exercise program. The early stages of patellar tendonitis will respond well to nonoperative treatment. Another important cause of knee pain is a meniscal tear. The meniscus is the cushion that protects the cartilage in the knee. Injury will cause pain on the medial or the lateral side of the knee exactly at the level of the joint. The patient will complain of a history of locking, instability and swelling of the knee. McMurray test will be positive. A painful pop or click is obtained as the knee is brought from flexion to extension with either internal or external rotation of the knee. Arthritis of the knee Knee arthritis is very common. The cartilage cells die with age and its repair response decreases in the joint collapses with increased breakdown of the framework of the cartilage. The patient will have progressive blurring away of the cartilage of the joint with decreased joint space as seen on x-rays. Another source of pain is the Baker's cyst. The cyst is in the back of the knee between the semimembranosus yes and the medial gastrocnemius muscles. Another important source of knee pain is a ligament injury. Here is a normal knee without a ligament injury. Here you can see from the front, you can see the lateral and medial collateral ligament. You can see the ACL and PCL from the side view. These ligaments are usually injured as a result of a sports activity. Here is an example of a sports knee injury. Here is an example of the medial collateral ligament injury. This is the most commonly injury knee ligament injury to this ligament is on the inner part of the knee. Here is an example of an injury of the anterior cruciate ligament. It involves a valgus stress to the knee. Lachman test is usually positive, and MRI is diagnostic. Another important cause of knee pain is iliotibial band syndrome of the knee. Inflammation of the thickening of the iliotibial band results from excessive friction as the iliotibial band slides over the lateral femoral condyle. The iliotibial band is a thick band of fascia that extends along the lateral thigh from the iliac crest to the knee. And as the knee moves, the IT band was repeatedly shifted forwards and backwards across the lateral femoral condyle. The patient will complain of swelling, tenderness, and crepitus over the lateral femoral condyle. The condition occurs in the ITB S occurs in runners, cyclist and athletes that require repeated knee flexion and extension. The pain may be reproduced by doing a single-leg squat. The Ober's test is used to at assess tightness of the iliotibial band. MRI may show edema in the area of the ITB. Treatment is usually nonoperative with rest and ice, physical therapy, with stretching, proprioception, and improvement in neuromuscular coordination. Training modification and injections may be helpful. Surgery is a last resort. Surgical excision of the scarred inflamed part of the iliotibial band.

This short course reviews the main features of EKG tracings. A method for analyzing EKGs is also presented. This method includes assessment of rhythm, calculating heart rate, observing P-wave forms, measurement of EKG intervals and segments and the evaluation of other relevant waves.

Transvenous cardiac pace maker, also called endocardial pacing, is a potentially life saving intervention used primarily to correct profound bradycardia. It can be used to treat symptomatic bradycardias that do not respond to transcutaneous pacing or to drug therapy.

I have shared with you in this video couple of exercises that you can follow immediately after your Knee injury.

As I promised here are 2 protocols to follow in this routine. I have also added my blog on how to strengthen your glutes and why that can help you with your knee pain.

1- Avoid Harm ( https://dublinsportsinjuryclin....ic.com/acute-injury-
2- POLICE PROTOCOL (https://dublinsportsinjuryclin....ic.com/acute-injury-
3- Read my blog and check how to strengthen your glutes (https://dublinsportsinjuryclin....ic.com/knee-injury-r

Please make sure to watch the video until the end since I'm sharing with you a couple of tips at the end of this video.

References:

1- https://www.ncbi.nlm.nih.gov/pmc/arti...

2- https://www.sciencedirect.com/science...

3- https://www.sciencedirect.com/science...

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Music: See You
Musician: @iksonofficial
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Knee Injury Rehabilitation [Early Stage] - (1st Two Weeks After Injury)

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