Sunday, June 20, 2010

Delirium Mnemonics

Here is a simple mnemonics for delirium: DELIRIUM(S)

D Drugs, Drugs, Drugs
E Eyes, ears.......

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Transsphenoidal Surgery

Transsphenoidal surgery is a procedure used to remove pituitary tumors from the brain. The surgeon works through a small opening (ostium) at the back of the nose (septum) that leads to an air pocket called the sphenoid sinus. To access the pituitary tumor, the surgeon goes through the sphenoid sinus and cuts through the tissue covering the pituitary gland. The tumor is removed with small instruments called curets. A small scope inserted through the sphenoid sinus helps the surgeon to visualize the tumor. A large tumor may need to be cut into smaller pieces before it's removed.

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Cells of Immune response

The main cell of the specific immune response is the small lymphocyte.


1) B and T lymphocytes constantly enter the blood stream from the peripheral lymphatic tissue via the lymphatics and the thoracic duct and circulate around the body. '

2) They reenter the lymphoid tissue at another site.

3) Lymphocytes form 20 - 40% of the circulating white blood cell Circulating lymphocytes are mainly T cells with a few B cells.

Immune response & elimination of antigen

1) Antigens can enter the body through the mucosa or skin.

2) Meeting the mucosa associated lymphoid tissue or the cutaneous lymphoid tissue.

3) The antigens are carried to the regional lymph nodes via lymphatics

4) If the antigen enters the blood stream it will be filtered by the spleen.

5) Lymphocyte recirculation ensures that B and T lymphocytes are constantly patrolling the body looking for antigen.

6) Antigen will meet the corresponding lymphocytes specific for the antigen →immune response (activation, proliferation and differentiation of lymphocytes)

7) The immune response takes place in the PERIPHERAL LYMPHOID TISSUE(rich in macrophages and dendritic cells).

* At the mucosal or skin surface immune response takes place in the MALT or cutaneous immune system.
* o The immune response to tissue antigens takes place in the lymph node.
* o The immune response to circulating antigens takes place in the spleen.

8) Antibodies from B cells or effector T cells go to the site of infection and eliminate the antigen.

9) The memory cells remain in the lymphoid tissue.

10) The second time the antigen enters there are a large number of antigen specific lymphocytes (memory cells) in the lymphoid organs so the secondary response is faster and greater than the primary response.


1) Cytokines are small soluble proteins that act as multipurpose chemical messengers,secreted by a cell, and act on itself or another cell to change the activity of that cell.

2) They play an important role in both non-specific and specific immunity.

3) cytokines Can be produced by a wide variety of cells such as endothelial cells etc.

4) Some cytokines act on the bone marrow to increase cell proliferation and differentiation.

* eg. colony stimulating factors include GM-CSF, G-CSF, M-CSF.

Feature of cytokines

1) ONE cytokine can ACT on many different cells.

* e.g. TNF acts on the liver to produce acute phase proteins and on the Neutrophils to activate it.

2) DIFFERENT cytokines can have the SAME action.

* e.g. TNF from macrophages and lymphotoxin from T cells have the same actions.

3) Cytokines can act on the same cell that produced it (AUTOCRINE ACTION), on nearby cells (PARACRINE ACTION) or on distant cells (ENDOCRINE ACTION).


lawyers opinion :risky business tweeting the symptoms of social media

"To date there are at least 540 hospitals in the United States utilizing social media tools: Hospitals account for 247 YouTube channels, 316 Facebook pages, 419 Twitter accounts, and 67 blogs.

The number of individual and independent medbloggers is in the thousands.

In December of 2009, a hospital employee was forced to resign because of a single tweet.

On October 29, 2008, a patient provided what is believed to be the first live tweet from the operating room. “Bad bad stick. Ow ow ow ow ow.”

In response to online physician rating websites, like Yelp, RateMD, and others, a company now offers physicians an antidefamation service, including contract provisions restricting a patient’s right to make negative comments on rating websites.

There are a number of other scenarios that could lead to liability. For example, what happens if an “off-duty” physician responds to a health question by a neighbor while doing yard work? Suppose the same exchange occurs through online “messages” between a physician and one of the physician’s “friends” on Facebook, creating an electronic record of the exchange that could potentially support the existence of a physician-patient relationship, thereby creating certain liability arising therefrom (e.g., HIPAA, medical malpractice, patient abandonment, etc.).

The authors of a National Law Journal article warn that bosses who “friend” are begging to be sued."