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But we have many more tools now than we did a year ago or two years ago. And I'm certain we will see data emerging that will help inform these different approaches and combination of approaches. To pick up on your last point, Lindsay, I think it's really important to think about the fact that we're using already very d... |
From the JAMA Network, this is Conversations with Dr. Bauchner, interviews featuring researchers and thinkers in healthcare about their publications in the latest issue of JAMA. Hello and welcome to this interview. This is Howard Bauchner and this is Conversations with Dr. Bauchner. And I'm here with Jeff Linder, who i... |
And then NICE, the National Institute for Health and Care Excellence in England and Wales, has this in their guideline too as a way of decreasing antibiotic prescribing. And I'm kind of concerned because it just doesn't make sense for a number of reasons. So people who come in with viral illnesses, so people who have t... |
Yeah. So again, it depends on what you want to use as your reference. in patient symptoms or outcomes when you compare an immediate versus a delayed versus a no antibiotic prescribing strategy. So if that's the case, why are we exposing people to a chemical that has the potential to hurt them and doesn't help them? Now... |
Absolutely. So it had changed for a few years. And somehow I feel like that progress has ended in the last four or five or six years. And that's really concerning that we had been making progress and it seems to have been stymied. Right. And I think even looking at data going up to about 2016, it did look like the anti... |
I'm Jan Engmeyer with JAMA. I'm speaking with Dr. Peter Pronovost from the School of Medicine at the Johns Hopkins University in Baltimore. Welcome, Dr. Pronovost. Please tell us about yourself and what you do at Johns Hopkins. Sure, thank you. I'm a professor of anesthesia and critical care medicine. I work clinically... |
Hi, and welcome back to Sharp Scratch. You're listening to episode 70. There's no pill for homelessness. This is a podcast brought to you by the BMJ and sponsored by Medical Protection, where we bring together medical students, junior doctors and expert guests who discuss all the things you need to know to be a good do... |
What can doctors do to better address the true cause of people's ill health? So I thought in this episode, we could talk a little bit about whether our medical education is teaching enough about social determinants of health and whether there's a disconnect between our undergrad training and actual clinical practice. S... |
And I'm sure that actually at the time I didn't particularly. So in a way it's kind of nice to know that my experiences and recollections still hold currency and remain valid. At the same time it's kind of a bit of a shame that things haven't quite sort of moved on as they might because I think that our understanding o... |
You know, there's all sorts of, and certainly if they're sort of homeless on the street, there's all sorts of ways in which that might impact how I choose to treat them. So, you know, I don't give them 56 tablets of whatever medication it is because they've got nowhere to put it. And I certainly don't give them a pile ... |
Am I going to be able to, you know, wash? Can I afford clothes? All these things like it's it's a very much a survival mindset. And I suppose, you know, with your experience, especially now you're kind of close to the end of medical school. And so I suppose how what kind of things would you want your fellow medics to u... |
I don't think that predictably we've been very good on that in the past. There tends, there tends to be sort of a fairly, we're pretty homogenous actually as a sort of profession in terms of social class, ethnicity. You know, we tend to sort of, you know, like, you know, patterns sort of get repeated. It's kind of like... |
So that's great. If you're playing a part in that, that's wonderful. But it's important to recognise that even within the NHS, people who are poorer, people who have poorer education, they tend to do worse. They have worse outcomes from care. They've got less satisfaction. They wait longer for appointments at their GP ... |
And yet for an awful lot of people, it's going to be absolutely intimidating. You know, it's full of like really well-educated people who are doing really, you know, sophisticated technical tasks. And it might be, you know, if you're homeless, that's a world away from your day-to-day experience. And it's pretty wacky t... |
I guess the important thing is that we sort of actually get the balance right so that we don't sort of, you know, sort of deliver more care to those people who have less need and that we do sort of try and deliver more care to those people who who have greater need. So but yeah, I think I think, you know, there's there... |
About $10 billion are spent on 600,000 patients a year who are hospitalized for pneumonia every year. Pneumonia is still a killer. About 5% of all comers who get admitted for pneumonia die. For the sickest of patients, that mortality increases to about a third of all patients. The key to saving these patients' lives is... |
But if you get it right, the benefits are big also. Fortunately, there's a couple of risk stratification tools you can use that work pretty well at putting sick patients in the right category so you can figure out who needs antibiotics and admission to the hospital. The first one is the, the pneumonia severity index. A... |
The classic beta-lactams that are used for pneumonia are ceftriaxone, which is a third-generation cephalosporin. So ceftriaxone is the classic one. Cefuroxine is used at various times. Generally a second or third generation. Cephalosporin is used. And then the most common macrolide is azithromycin. Clorithromycin and e... |
The macrolides, there have been many studies recently concerning macrolides and cardiovascular morbidity. There was some concern about, you know, QT prolongation and about inciting heart attacks and things like that. And there have been a lot of studies. So that's certainly a concern. There have also been good studies.... |
Welcome. This is the New England Journal of Medicine. I'm Dr. Lisa Johnson. This week, April 28, 2016, we feature articles on transcatheter versus surgical aortic valve replacement, exazomib in myeloma, Ebola vaccine trials, and an experimental approach to treating Duchenne's muscular dystrophy, a review article on vio... |
No safety concerns were identified at any of the dose levels studied. Four weeks after immunization with the CHAD3 vaccine, Zaire Ebola virus, Zeebov-specific antibody responses were similar to those induced by RVSV Zeebov vaccination, which was assessed in another Phase 1 trial. Zeebov neutralization activity was also... |
The patient's husband alerted a flight attendant, and a passenger who was a physician informed the crew that they must transport her to a hospital within three hours to enable proper treatment. The pilot accelerated the aircraft to arrive in Boston within two hours after symptom onset. The patient was evaluated by emer... |
Okay, welcome. My name is Devine. I'm a resident. This is episode 206 of the Devine Intervention Podcast. And in this podcast, I'm going to begin a family medicine shelf exam rapid review series. I'll just be doing a bunch of cases that highlight topics and concepts that are commonly tested on the family medicine exam.... |
And like some key things, right? So say for example, right, they tell you that you see some of my buddies, my buddies from a pathology specimen of a cold thyroid nodule. What kind of cancer are you thinking about? Well, I hope you're thinking about papillary thyroid cancer. Remember, papillary thyroid cancer is popular... |
But usually they present with hypothyroid symptoms. And the hypothyroidism when you'll see on your exam, it will be something along the lines of like bradycardia, right? So usually people that are hypothyroid on MBM exams, their heart rate is usually less than 60 for whatever bizarre reason. At least probably like 80% ... |
But remember, those people can also have, so the prolactinoma, right, obviously will cause like gynecomastia, galactoria,oria infertility because prolactin is a suppressor of gnrh right and then um they can also have a pituitary another pituitary thing they can have right they can also have like a growth hormone secret... |
And then one thing I found to be high-yield for these family medicine exams is knowing the cholesterol screening guidelines, right? So those are things that people, unfortunately, tend to not know very well. They're kind of detailed. So, you know, they're kind of one of those annoying things that you need to like sort ... |
They can get Wernicke-Korsakoff syndrome. Remember, Wernicke-Korsakoff syndrome arises because you have issues with transketolase. Transketolase is one of those key enzymes in the non-oxidative phase of the pentose phosphate pathway, right? So, transketase uses thiamine, vitamin B1 as a cofactor. So if you're an alcoho... |
Remember carcinoid syndrome is where you have like a GI mass that makes a ton of serotonin. Well, think about it. Serotonin is known as 5-HT for a reason, right? 5-hydroxytryptophan, right? So that means it's derived from tryptophan. Well, guess what? What do you think we use to make niacin? We also use tryptophan to m... |
Because remember, it's B12 deficiency. That's cobalamin. It's B12 deficiency that will cause the methylmalonic acidemia in addition to the megaloblastic anemia and hyperhomocysteinemia. Because if you remember from step one, with your O-chain fatty acids, right? Like if you want to go from methylmalonyl-CoA to succinyl... |
And that can also cause B12 deficiency, right? Or if a person has like cystic fibrosis on a family medicine shelf, if you have CF, right, your pancreas, right, you have like an endocrine and exocrine pancreatic defect, right, because your pancreatic secretions are very thick, right? So you're not making lipase, you kno... |
From the JAMA Network, this is the JAMA Editor's Summary, a review of important research, viewpoints, and review articles appearing in the latest JAMA issue. I'm Dr. Kirsten Bibbins-Domingo, Editor-in-Chief of JAMA, and I hope you find this week's issue beneficial. Here's your host, Dr. Anthony Charles. Hello, and welc... |
This article is a study of the use of marijuana in the United States. This nationally representative survey examined the prevalence of self-reported Delta-8 THC and marijuana use among 12th grade students in the United States and its distribution across socio-demographic factors and state Delta-8 THC policies. Among th... |
From the JAMA Network, this is the JAMA Editor's Summary, a review of important research and review articles appearing in the latest JAMA issue. Hello and welcome to this JAMA Editor's Audio Summary for our January 1, January 8 combined 2019 issue, Happy, Happy New Year. This is Howard Bauchner, Editor-in-Chief of JAMA... |
Welcome to the New England Journal of Medicine. I'm Dr. Michael Bierer. This week, June 4, 2015, we feature articles on high-flow oxygen in acute hypoxemic respiratory failure, follow-up of outcomes in type 2 diabetes, the promise and problems of precision medicine, the clinical genome resource, cancer-predictive Panel... |
This review summarizes the salient discoveries that culminated in the development of these drugs and focuses on what vasopressin antagonists do and do not do, side effects, emerging safety concerns, and important gaps in data. The authors attempt to reconcile the disparate recommendations for the use of vasopressin ant... |
The assignment of pathogenic status to genetic variants has been stymied by conflicting study results and lack of a publicly accessible database. Launched in April 2013, the publicly accessible ClinVar database, which is now part of the Clinical Genome Resource, serves as the primary site for deposition and retrieval o... |
Brazil's Family Health Strategy – Delivering Community-Based Primary Care in a Universal Health System, a perspective article by James Masinko from UCLA Fielding School of Public Health, Los Angeles. Brazil has made rapid progress toward universal coverage of its population through its national health system. Since its... |
From the JAMA Network, this is the JAMA Editor's Summary, a review of important research and review articles appearing in the latest JAMA issue. Welcome to this JAMA Editor's Audio Summary for the February 2, 2021 issue of JAMA. This is Preeti Malani, JAMA Associate Editor. This issue includes three original research a... |
Hello, and welcome to this week's Annals of Internal Medicine audio summary for our December 4th, 2007 issue. I'm Michael Berkowitz, Deputy Editor at Annals. We have another exciting issue for you this week, with articles on the use of telbivudine for the treatment of chronic hepatitis B, the three medications most res... |
And ultimately, I think professionalism is about, in a major way, self-regulation in the patient's and society's interest. One of the primary findings of the paper is that professional behaviors don't match attitudes. So how confident are you about that finding, given that all your behaviors were self-reported and that... |
So that's embodied by classic images of a doctor sitting at a patient's bedside through the night waiting to make sure that they get better, or stories of physicians canceling important personal commitments to attend to emergencies. And I wonder if you thought you could speak to that, and if there's a role for that kin... |
And we should be in the field, I would guess, within the next year or so. But in addition, we also plan to do this study comparing doctors in the UK versus doctors in Scotland so that we'll be able to get both a U.S., non-U.S. comparison as well as a comparison looking at the differences in professionalism while taking... |
For example, the Agency for Healthcare Research and Quality found that more than half of HMOs use pay-for-performance programs. And the Commonwealth Fund found that more than half of state Medicaid programs have one or more pay-for-performance programs, with nearly 85% expected to have them within the next five years. ... |
But at the end of the day, the sorts of measures that are going to reflect the best care, especially for patients with multiple chronic problems or the elderly, are very important. What we don't want, as we say in the paper, is the outcome where the patient died, but the electrolytes were in balance. Who does the commi... |
From the JAMA Network, this is JAMA Author Interviews, conversations with authors exploring the latest clinical research, reviews, and opinions featured in JAMA. Hello and welcome to this author interview. This is Howard Bauchner, Editor-in-Chief of JAMA, and I'm here with David Cutler, a member of our editorial board.... |
Over the same period, women in the top quartile gained 3.2 years, while life expectancy for women in the lowest income quartile was reduced by 0.4 years. For men, the top quartile gained 3.1 years, and the bottom gained only 0.9 years. David, these results are remarkable. I think they were surprising to the peer review... |
Yeah, it's a great question. We know some things by looking not just at the national data, but by looking within the country. So in the Chetty et al. paper in 2016 that you referred to, we did an analysis of how various aspects of medical care in different areas are related to life expectancy in those areas. Somewhat i... |
So it would say that they would need to be doing even more than that. percentile of the income distribution to the hundredth percentile of the income distribution in Norway is not as big a gap in life expectancy as from the 20th percentile of the income distribution in the US to the hundredth percent of the income dist... |
This is Derek Paul, and welcome to the Anti-Racism in Medicine series of the Clinical Problem Solvers podcast, where, as always, our goal is to equip our listeners at all levels of training with the consciousness and the tools to practice anti-racism in their health professions careers. Today's episode is titled Disman... |
In many instances, it's like doing quantum physics because at its core, it doesn't actually make sense. And what I mean by that is we have something. So I'll get into the definition. You have folks like Dorothy Roberts and other critical race theory scholars that have guided us towards an enlightening definition of rac... |
And the reason I say in my definition that it was used for the purpose of allocating resources is that you have Johann Blumenbach, Carl Linnaeus in 1767 writing the book Systeme Naturae, and he literally created a taxonomy. There's an apex of the taxonomy and there's folks who are at the bottom of it. And if you look a... |
And I think that's important because there's many white folks say, oh, well, slavery existed across the globe. Yeah, but it was never actually based on the false articulation of physiological difference based on color. It was either you lost the war, it was religious persecution, but it wasn't race. And something about... |
Yeah, and it's, it runs deep. Again, going back to the early 18th century, going even before that, and I won't dig too far into it, but science and religion in the early 18th century and 17th century were like cousins. You couldn't read a scientific journal that didn't mention God. And so, religion was used in the medi... |
And the response, well, Edwin, what about heart disease? Or what about this comorbidity? It has higher rates in black people. Yes, it has higher rates in black people because we've subjugated black people through the arms of racism and strangled a community intentionally. And then you want to talk about gaslighting and... |
They have an expectation that they can go into any neighborhood they want to. But if they have that property right, that means it's at the exclusion of someone else's right. Because when I walk into a store, I keep my hands in my pocket. When I see blue and red lights, I make sure I slow down or I try to not bring atte... |
And I, I like edge cases because they sometimes help me understand what it is that, that, that we're saying. And one of the things that she says that I think was really interesting point to me and was about the way that sometimes the success of one person can actually be important to reinforcing the fact that racism do... |
So we need to be intensely clear in what it is that we're talking about. And so I think if someone were to say, well, what would you encourage folks to do? I say, let's assume the position that science when it comes to race has been wrong. And let's start building from there. Yeah, Edwin, I think that's so excellent. A... |
It explains the environment. It explains nutrition. It explains the weather. It explains the evolutionary process. Regardless of the race, if we're actually trying to find out what the genetic differences are. But when I start seeing journals that say, oh, black people have a greater concentration of this allele and th... |
And he's like, okay, I got to do some work for that because I don't know how that one works. But it's the logic steps that I think we've been conditioned with. And we do have to disabuse ourself and start from a place of maybe I don't know what I'm talking about. Maybe it's a shortcut that we use as clinicians, but it ... |
Today on Sharp Scratch, you'll learn whether you ever really stopped being a doctor, how normal it is to want to leave medicine, and what actually is a portfolio career. You're listening to Sharp Scratch, episode 28, Leaving Medicine. This is a podcast brought to you by the BMJ and sponsored by Medical Protection, wher... |
I would say for me it's more to do with imposter syndrome thinking oh am i actually good enough to be doing this right now rather than it just being oh i see so it's more of a self-doubting than a than a medicine isn't yeah kind of thing oh that's interesting that's really interesting which is completely different i gr... |
But I have missed seeing patients actually quite a lot more than I thought I was going to. So what was that like? Yeah, I agree. I mean, I think for two things, kind of changing your identity internally was tricky. And for a long time I said to people, you know, I'm a doctor, but I'm currently working as an editor. It ... |
And the idea of losing that is like it's not the most significant thing, but it's like a big paranoia at the back of my mind, like telling my mum. But actually, in in reality I have stayed because I can't imagine doing anything else I don't know what my job as a doctor will look like I don't know if it will be look lik... |
But for that reason, they started doing it because their families wanted them to and they had, had you know anxieties about you know having a i don't know all sorts of of sort of reasons other than feeling they want to be a doctor themselves so i think it's important to balance that and the car it can take a lot of cou... |
For like. Prizes and stuff. And one of the prizes was. The. Do you know. I study medicine. Prize. And I thought. No I didn't. I didn't win it. Thankfully. But. But I thought. No one would ever nominate me for this. But. Three of my friends did. And I was very shocked. And I'm like. Oh. Maybe. I am that person. So now I... |
And that's good. That's true. I think at its best, that is absolutely true. Maybe a little bit spurious in some cases, but I agree with you. There is a sense of joining some greater good. And to leave that represents some kind of wrench or some kind of betrayal, even perhaps at its worst. Definitely. I guess the questi... |
I actually have a friend who left medicine completely last year. So this friend was a first year at my uni and she was kind of like my daughter. And then she came to tell me, OK, I've got something to tell you. I was like, oh, what's going on? I thought something really bad was about to happen. And she said, oh, I've d... |
From the JAMA Network, this is JAMA Author Interviews, conversations with authors exploring the latest clinical research, reviews, and opinion featured in JAMA. Hello, and welcome to this JAMA Conversation. I'm Dr. Kirsten Bibbins-Domingo. I'm the Editor-in-Chief of JAMA and the JAMA Network, and I'm joined today by th... |
Whether high or low, short or long term, these health consequences represent a substantial impact on our patients, but also a substantial impact on our healthcare system. Third, this report is the first time that we've collected all the research that's happening, and it really is significant, all the research that's ha... |
Research shows that racial and ethnic minority groups, older adults, people with disabilities, those who are poor, they are suffering disproportionately by long COVID as well as the associated conditions. This was highlighted during the COVID-19 Health Equity Task Force, which was organized out of our office and our Of... |
Welcome. This is the New England Journal of Medicine. I'm Dr. Michael Bierer. This week, March 19, 2020, we feature articles on discectomy or conservative care for sciatica, no sedation or light sedation in ventilated ICU patients, long-acting therapy to maintain HIV-1 suppression, and a screening program to eliminate ... |
Mortality at 90 days was 42.4% in the non-sedation group and 37% in the sedated group, difference 5.4 percentage points. The number of ICU-free days and of ventilator-free days did not differ significantly between the trial groups. The patients in the non-sedation group had a median of 27 days free from coma or deliriu... |
The FLARE trial evaluated whether switching to monthly injections of long-acting cabotegravir plus rilpivirine would be non-inferior to continuing oral therapy in 809 patients with HIV type 1 who had viral suppression in response to oral induction therapy with dolutegravir-abacavir-lamivudine. At week 48, an HIV-1 RNA ... |
This article reviews the progress made during the past decade in elucidating the pathophysiological mechanisms of hereditary angioedema and the subsequent development of targeted treatments for the disorder, with anticipated reductions in morbidity and mortality and an improved quality of life. A clinical vignette illu... |
The goal was to screen all Egyptians 12 years of age or older for active hepatitis C virus replication, hypertension, diabetes, and obesity. Free treatment would be offered in government clinics for people who tested positive for hepatitis C, hypertension, or diabetes, and free counseling would be available for those c... |
From the JAMA Network, this is JAMA Cardiology Author Interviews, conversations with authors exploring the latest clinical research, reviews, and opinion featured in JAMA Cardiology. This is Clyde Yancey, Deputy Editor of JAMA Cardiology. I am delighted to be with you today to bring forward a very important podcast. Th... |
So for the audience that's listening, what you just said, Dr. Pandey, was novel and triplicate. First of all, you challenged the notion that there is a biological underpinning for race-based differences in our case, cardiovascular medicine. Second, you did a very exhaustive review of covariates, comorbidities, and the ... |
Okay, welcome. This is the 120th episode of the Divine Intervention Podcast. My name is Divine. I am an R01 Reology resident, I guess PGY2. And today I'll be continuing my rapid review series for the USMLE Step 1. And I will be, so this will be series, I mean, sorry, for the USMLE Step 2CK, and this will be series 4, a... |
Because if you understand the pathophase behind Tetralogy of Fallot, it makes perfect sense. Right. But those people, right, they have like the pulmonic stenosis. They have the, in in fact maybe let me try to take a small stab at um explaining it right so the thing is when you want to form the um usually usually the th... |
You should be thinking about aortic stenosis under those circumstances. Remember, it's a systolic murmur, right? Heard best at the right upper sternal border, right? And remember that those people, you have to replace the valve. You're not going to be messing around with, let's do a valvuloplastine. You don't do any of... |
That's the right answer. If it's a kid, it's very likely going to be patent ductus arteriosus. That is the right answer. The thing is, aortic regurg and patent ductus arteriosus, those things tend to have fairly similar, like, hemodynamic consequences, if you really think about it. Again, that's something for, not some... |
And the way I remember the right-sided heart problems is, like, with the pneumonic tips, right? So, like, tricuspid insufficiency and pulmonic stenosis, right? So those people have those kinds of symptoms. The reason you don't get left heart problems with carcinoid is, again, the lungs has the ability to metabolize tha... |
So you're no longer making aldosterone. Your zona fasciculata will not work. So you're no longer making cortisol. And your zona reticularis will also not work. So you're no longer making sex steroids. Although that's maybe not the most important consideration in the world. But you won't be making things like GHEAS anym... |
Well, here's the thing. The thing is steroids, glucocorticoids, basically, they cause apoptosis of eosinophils, right? So the thing is, if you have glucocorticoid deficiency, because your zona fasciculata is all knocked out with Addison's disease, well, your eosinophils will persist for a longer time in the serum becau... |
Welcome back to Run the List, a medical education podcast in partnership with McGraw-Hill Medical. Our hosts are Dr. Naveen Kumar, Dr. Walker Redd, Dr. Emily Gutowski, Dr. Joyce Au, and myself, Blake Smith. As a quick disclaimer the most important areas in the practice of medicine, goals of care conversations. We're re... |
We want to have a framework going in, and that's going to allow us to be more successful. The framework I use to navigate goals of care conversations is called WeMAP. And this is a five-step framework, or what we often call a talking map, for navigating goals of care conversations. And this was developed by the communi... |
Great. This is incredible. So I think this REMAP framework can be a really good way to walk into a room or talk to a patient with this approach in mind. So let's go back to this PCP of Mr. R's. So he does exactly this. He follows a framework such as REMAP. And he has this conversation during which he's struck by how st... |
And I'm going to use that information headline again, that key information that they need to know for us to move forward. So that might be something like, Mr. R, I'm worried that you're getting sicker overall as a result of the liver disease. And I hope we'll see things improve. And also there's a real chance that thin... |
And also there's a very real chance that you may continue to get worse, that you use and instead of but. I think this is something that I've noticed that you can have both of them at the same time. And I think the second thing was when you talked about this plan to start with something that we would do before we dive i... |
And it was clear that what she meant was that she was relieved of the fact that she wouldn't have to carry the weight of having to have made that decision with her forever. She could hold a narrative of, I just followed the doctor's guidance. I just did what the doctors recommended that I do. And that was so powerful. ... |
Well, on that Indian note, welcome to the 13th episode of the Divine Intervention Podcast. My name is Divine. I am a fourth year medical student. Some friends of mine, I have an appreciation for Indian music and I've been trying to learn one song. So I was discussing with some friends of mine yesterday about trying to ... |
So let's talk about pyrimidines. Let's make the nitrogen base first and then we add the sugar. So to make the base first, all of this actually happens in the cytosol or nucleotide synthesis in general happens in the cytosol. So the first thing that happens is that you condense glutamine and carbon dioxide with some oth... |
Now, if you then jump down to thymidylate synthase, thymidylate synthase, which helps us go from DUNP to DTNP, that enzyme can be inhibited by a drug known as 5-fluorouracil. Okay, 5-fluorouracil. So 5-fluorouracil is an anti-cancer drug. The thing is, if you look further upstream, there is an arrow going from 5FC to 5... |
So, in the urea cycle, stuff, including ammonia, is acted on by carbamoyl phosphate synthetase 1 to make carbamoyl phosphate okay that's the first step of that cycle and then that carbamoyl phosphate can be converted to citrulline by an enzyme known as onythine transcarbamylase okay so onythine transcarbamylase convert... |
If you have a CPS deficiency, it's a urethyl cycle problem. So your ammonia levels are up, but your carbamoyl phosphate and uric acid levels are down. If you have another uric cycle deficiency that's a little more downstream, onythin transcarbamolase deficiency, your ammonia levels go up because again, it's a uric cycl... |
And then those nitrogenous bases, they can be converted by xanthine oxidase in two sequential steps to uric acid. And then that uric acid is actually poorly soluble. So if you have too much uric acid in your blood, you could get gout or you could get nephrolithiasis from uric acid stones. Remember, uric acid stones are... |
Okay. Lesch-Nyhan syndrome, it was actually discovered at my, at my med school by a med student, go figure, and some physician. You can look that up in your free time so lesh-nyhan syndrome it's a hgprt deficiency and the thing is if you think about it if hgprt is deficient you basically kill the pathway that helps us ... |
The thing is S-adenosyl homocysteine is actually toxic to B and T lymphoblasts, okay? So if you kill your B and T lymphoblasts, you do not make B or T cells. So you get something called a severe combined immunodeficiency, okay? So that's the pathophysiology behind adenosine deaminase deficiency being one cause of autos... |
They actually also work in the proximal convoluted tubule. Okay. They actually work in the kidney as well. In fact, I'll just tell you this as a general principle. Most transporters you'll find in the small intestine are also found in the proximal tubule. Why does that make any sense? The thing is, both parts of the bo... |
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