The vast majority of glucocorticoid activity in most mammals is from cortisol, also known as hydrocortisone. Corticosterone, the major glucocorticoid in rodents, is another glucocorticoid. Cortisol binds to the glucocorticoid receptor in the cytoplasm and the hormone-receptor complex is then translocated into the nucleus, where it binds to its DNA response element and modulates transcription from a battery of genes, leading to changes in the cell's phenotype. Only about 10% of circulating cortisol is free. The remaining majority circulates bound to plasma proteins, particularly corticosteroid-binding globulin (transcortin). This protein binding likely decreases the metabolic clearance rate of glucocorticoids and, because the bound steroid is not biologically active, tends to act as a buffer and blunt wild fluctuations in cortisol concentration.

How to Check Cervical Mucus

a disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood and urine.

CPAP, or continuous positive airway pressure, is a treatment that uses mild air pressure to keep the airways open. CPAP typically is used by people who have breathing problems, such as sleep apnea. CPAP also may be used to treat preterm infants whose lungs have not fully developed.

Direct Laryngoscopy: MICU Fellows Airway Course

High Resolution Upper Airway Anatomy

Cervicitis is an inflammation of the cervix, the lower, narrow end of the uterus that opens into the vagina. Possible symptoms of cervicitis include bleeding between menstrual periods, pain with intercourse or during a cervical exam, and abnormal vaginal discharge. However, it's also possible to have cervicitis and not experience any signs or symptoms. Often, cervicitis results from a sexually transmitted infection, such as chlamydia or gonorrhea. Cervicitis can develop from noninfectious causes, too. Successful treatment of cervicitis involves treating the underlying cause of the inflammation.

Dr. Nick demonstrates how easy it is to have stitches taken out and that it is not painful!

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The superior sagittal sinus (also known as the superior longitudinal sinus), within the human head, is an unpaired area along the attached margin of falx cerebri. It allows blood to drain from the lateral aspects of anterior cerebral hemispheres to the confluence of sinuses.

-Korsakoff's syndrome is a common and preventable sequel of Wernicke's encephalopathy. Thiamine, if given during the stage of Wernicke's encephalopathy, can prevent the onset of Korsakoff's psychosis. The administration of glucose prior to thiamine can precipitate Korsakoff's syndrome, as seen in this case. In such patients, brain MRI frequently shows abnormal enhancement of the mammillary bodies & thallamus

Alcohol not broken down by the liver goes to the rest of the body, including the brain. Alcohol can affect parts of the brain that control movement, speech, judgment, and memory. These effects lead to the familiar signs of drunkenness: difficulty walking, slurred speech, memory lapses, and impulsive behavior.

The patient has spasticity in the lower extremities greater than the upper extremities. The hips and knees are flexed and adducted with the ankles extended and internally rotated. When the patient walks both lower extremities are circumducted and the upper extremities are held in a mid or low guard position. This type of gait is usually seen with bilateral periventricular lesions. The legs are more affected than the arms because the corticospinal tract axons that are going to the legs are closest to the ventricles.

Neck Examination - Cervical Spine Assessment - Clinical Skills - Dr Gill

Compose a new pain within athletes is cervical spine discomfort, thankfully in the vast majority of cases when the neck is examined the cause of the neck pain is found to be muscular.

However, pain can also refer from the neck to the arm, in which case it is important to be able to assess for cervical radiculopathy prior to gaining more information which may indicate an MRI is needed

We assess for radiculopathy by doing Spurling's test, an often overlooked part of the neck examination, but it should be included for completeness and reassurance of the patient - not forgetting the athlete or not, neck pain can be a considerable source of distress, so it's vital to be able to get information from the neck examination which allows you to safely reassure a patient when appropriate, or comment that neck exam found evidence that needs further investigation

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Holter monitoring, electrocardiogram or echocardiogram are only recommended if a cardiac cause (e.g., arrhythmias, possible cardiac syncope, myocardial ischemia) is suspected.

Possible causes include a combination of biological, psychological, and social sources of distress. Increasingly, research suggests these factors may cause changes in brain function, including altered activity of certain neural circuits in the brain. The persistent feeling of sadness or loss of interest that characterizes major depression can lead to a range of behavioral and physical symptoms. These may include changes in sleep, appetite, energy level, concentration, daily behavior, or self-esteem. Depression can also be associated with thoughts of suicide. The mainstay of treatment is usually medication, talk therapy, or a combination of the two. Increasingly, research suggests these treatments may normalize brain changes associated with depression.

Mitral Valve Prolapse and Mitral Regurgitation. Review of mitral valve anatomy and function, including papillary muscle structure and function, with severe mitral valve prolapse and mitral regurgitation due to a flail segment caused by ruptured papillary muscle and chorda tendinae attachment.

Indwelling urinary catheters are commonly used in hospitals and can lead to preventable catheter-associated UTI. How can rates of catheter-associated UTI be reduced in hospitals? New research findings are summarized in a new NEJM Quick Take. Learn more at http://nej.md/1WoeHdF SHOW MORE

Aspergillosis is the name given to a wide variety of diseases caused by infection by fungi of the genus Aspergillus. The majority of cases occur in people with underlying illnesses such as tuberculosis or chronic obstructive pulmonary disease (COPD), but with otherwise healthy immune systems.

This is a brief overview of antifungal agents, their mechanisms of action, and some fungi that they affect.

Encopresis is a problem that children age four or older can develop due to chronic (long-term) constipation. With constipation, children have fewer bowel movements than normal, and the bowel movements they do have can be hard, dry, and difficult to pass. The child may avoid using the bathroom to avoid discomfort.