Notes | غَيْث

⭐Lec 2 physio part 2 🌟parathyroid hormone (Ca releasing hormone): -Affects bone ,kidney,intestine 🌟ON kidney: 1- in distal part of nephrons---> ⬆️Ca reabsorption 2- in proximal tubules---> ⬇️phosphate reabsorption +⬆️phosphate excretion + ⬆️activation of vit d 3- ⬆️reabsorption of H ( to increase acidity which increases Ca absorption) and Mg ( لما ن absorb Ca من intestine بندخل Mg بداله ) 4- ⬇️reabsorption of Na, K, Amino Acids ( to preserve electricity of cells) 🌟ON Bone فالأول لازم نعرف إن ال Bone عبارة عن matrix مترسب فوقها Ca crystals وإن عندي osteocytic-osteoplastic membrane بيتكون من الخليتين دول وماسكين فبعض بال projections بتاعتهم 1-Rapid phase: ⚠️نركز ف دي عشان نفت الكلام اللي فالكتاب تمامًا ووارد تسأل فال mechanism -occurs in minutes to hours -via activation of osteocytes: 🌟Mechanism:- -PTH--->Activation of osteocytes---> ⬆️permeability of osteocytes to Ca -Ca moves from bone fluid to osteocytes-----> ⬆️Ca inside osteocytes-----> diffusion to osteoblasts - PTH----> Activates pumping mechanism of Ca ( by PTH) 🌟Slow phase: -occurs in days to weeks -Via activation of formed osteoclasts and formation of new ones 🌟ON Intestine -indirect action via ⬆️formation of vit d in kidney 🌟Control of PTH secretions - ⚠️ionized Ca is the main regulator of PTH، بينظموا بعض أيوه -⬇️Ca----> ⬆️secretion, وزيه ال Mg -⬆️Phosphate---> ⬆️secertion 🌟Hyperparathyrodism: -1ry or 2ry -hypercalcemia +hypercalcuria -hyperphosphatemia+ hyperphosphaturia ⚠️نصحح hypophsphatemia اللي فالكتاب ل hyperphosphatemia -⬆️Ca = 12: 15 mg/dl 🌟Maiefestations of hypercalcemia كل الكلام اللي فالكتاب اتقال بس هنقول أسباب المُسببات - Depression of nervous system ---> due to⬆️RMP، صعوبة الوصول لل Firing level - ⬆️gastric secretion---> due to continuous excitation of g cells---> Peptic ulcer -Abdominal groan---> stones+ constipation + Peptic ulcer -formation of stones/ crystals ---> هنا ال Ca, Phosphate مبقوش خاضعين لل solubility product ف هيترسبوا ويعملوا stones + crystals in soft tissues - polyuria---> due to⬆️ ca excretion---> ⬆️urine osmolarity - 🌟osteitis fibrosa cystica: هنا ال Bone مبقاش osteum, بقى fibrous cyst 🌟Hypoparathyrodism -more common -Manifestations: ⬆️phosphate ⬇️Ca ⬆️Neuromuscular excitability -tetanic spasm---> laryngeal spasm ---> death 🌟Tetany Due to ⬇️ ionized Ca 🌟Causes - كل ما يؤدي لنقص ال ca - كل ما يؤدي لAlkalosis 🌟Alkalosis بيخلي ال latent tetany يظهر ك manifest tetany حتى لو Ca مقلش عن 7 -قولنا قبل كده إن ال Ca بيقلل ال excitability ويمنع ال spontaneous AP، ال Ca قل دلوقتي يبقى دول هيزيدوا والنتيجة هتبقى tetanic mc contractions 🌟1-Manifest tetany Ca= <7 mg/dl----> Mc twitches, carpopedal spasm, laryngeal spasm, spasm of respiratory mcs 🌟2-latent tetany Ca= 7:9mg/dl Manifestations appear only in pregnancy, lactation, hyperventilation 🌟Calcitonin -Has lowering transient effect on Ca -act on Bone and kidney بأكشن عكس ال PTH -دوره بيظهر أكتر فالأطفال 🌟secreted within Ca level= 9.5mg 🌟⬆️secretion in pregnancy under effect of high levels of estrogen لأن PTH عالي ف بيزيد هو كمان عشان يعمل Protection to bone of mothers 🌟Mechanism of formation of Vitamin D: UV----> transformation of cholesterol in SC tissue or dietary to 7-dehydroxycholesterol -----> cholecalciferol-----> metabolized in liver----> hydroxylation of C25 -----> 25-hydoxycalciferol ----> kidney----> proximal tubule----> hydroxylation of C1----> 1-25-didydroxycalciferol ( active form) وده بيعمل negative feedback لنفسه 🌟Action of vit d -on intestine قولنا هو اللي بيزود ال ca binding protein -on kidney : ⬆️ Ca +phosphate reabsorption (influenced by Mg level) -on bone: stimulate bone deposition but in excess amount: Activates osteoclasts 🌟Regualtion of vit d is Mainly via plasma ca, Phosphate levels #EnRe_N #EnRe_physio

⭐Lec 2 physio part 1 أهم النقاط الي ذكرتها الدكتورة من دكتور زميلنا بارك الله فيها. 🌟Thyroid and parathyroid glands are complementary to each other الأولى بتنظم كل ال metabolism عدا ال Ca والتانية بتنظم ال Ca 🌟Role of Ca in body: -Neuromuscular excitability: Voltage gated Na channels are guarded with Ca ----> regulation of Na influx + prevent spontaneous leakage of Na ----> prevent spontaneous action potential ⚠️So, hypercalcemia--->⬇️ Neuromuscular excitability -activation of all protein digesting enzymes -act as 2nd messenger of all hormones -blood coagulation -preservation of cell membrane integrity برضو عن طريق Na channels guarding -formation of bone and teeth - Excitation- contraction coupling كان بيحصل عن طريق uptake of extracellular Ca أو ال Ca الموجود فال sarcoplamic reticulum 🌟 diffusible Ionized Ca is the physiological active form that pass through pores of capillaries, represents 50% of total body calcium فلما نتكلم عن ال hypocalcemia, hypercalcemia, tetani يبقى نقصد ال ionized form 🌟Diffusible non ionized بيقدر يعدي بس بعد ما يفصل من ال cations سواء phosphate, citrate, bicarbonate, represents 5% 🌟Non diffusible form: bound to pp هنا هنلاقي عيانين ال liver, kidney اللي عندهم Ca قليل مبيدخلوش ف tetani  لأن عندهم hyponatremia فكل ال Ca الموجود in diffusible form 🌟Absorption of Ca -Mainly in duodenum and upper jejunum due to presence of acidic chyme -poor= 35% only of dietary Ca 🌟Factors affecting Ca absorption اتشرحوا زي الكتاب لكن مثال عال acidifying salts = vit c +cortisol prevents formation of ca binding protein 🌟Ca bonding protein (Carrier of Ca) بينقل ال Ca من ال luminal surface لل jejunum cells، البروتين ده بيتحكم ف تكوينه vit d ⚠️So, vit d هو المتحكم الأول ف Ca absorption 🌟🌟🌟 عندي نوعين من ال mechanisms للتحكم في مستوى ال Ca 🌟1-Rapid Buffering system -via pumping of Ca Ca from bone fluids in minute spaces between trabeculae of cancellous bone -Bone fluid rich in Ca and phosphate ⬇️Ca in blood ---> ⬆️sensitization of Ca pumps on Bone membrane ---> pumping of Ca to extracellular fluid to maintain Ca level عند 7 gm 🌟2- long term mechanism -Hormonal Via PTH, calsitonin, calciferol +Other hormones: glucocorticoids,GH, Thyroid hormone, glucagon, estrogen, androgens دول اتقالوا بكل التفاصيل اللي فالكتاب بس ناخد بالنا إن GH محصلة شغله بيزود ال Ca؛ وإن Glucagon بيشتغل directly و indirectly 🌟phosphate metabolism -3:4 mg/dl in adult, higher in children(عندهم ⬆️ATP + ⬆️Bone formation) -absorbed from upper part of intestine 🌟-solubility product: حاصل ضرب ال Ca, Phosphate لازم يديني نسبة ثابتة عشان يفضلوا الاتنين ف صورة soluble وميترسبوش ويعملوا stones 🌟Importance of phosphate: -Major intracellular Buffering system -High energy compounds -protein formation -Blood phosphate is the controller of blood Ca #EnRe_physio #EnRe_N

⭐Lec 2 physio part 1 أهم النقاط الي ذكرتها الدكتورة من دكتور زميلنا بارك الله فيها. 🌟Thyroid and parathyroid glands are complementary to each other الأولى بتنظم كل ال metabolism عدا ال Ca والتانية بتنظم ال Ca 🌟Role of Ca in body: -Neuromuscular excitability: Voltage gated Na channels are guarded with Ca ----> regulation of Na influx + prevent spontaneous leakage of Na ----> prevent spontaneous action potential ⚠️So, hypercalcemia--->⬇️ Neuromuscular excitability -activation of all protein digesting enzymes -act as 2nd messenger of all hormones -blood coagulation -preservation of cell membrane integrity برضو عن طريق Na channels guarding -formation of bone and teeth - Excitation- contraction coupling كان بيحصل عن طريق uptake of extracellular Ca أو ال Ca الموجود فال sarcoplamic reticulum 🌟 diffusible Ionized Ca is the physiological active form that pass through pores of capillaries, represents 50% of total body calcium فلما نتكلم عن ال hypocalcemia, hypercalcemia, tetani يبقى نقصد ال ionized form 🌟Diffusible non ionized بيقدر يعدي بس بعد ما يفصل من ال cations سواء phosphate, citrate, bicarbonate, represents 5% 🌟Non diffusible form: bound to pp هنا هنلاقي عيانين ال liver, kidney اللي عندهم Ca قليل مبيدخلوش ف tetani  لأن عندهم hyponatremia فكل ال Ca الموجود in diffusible form 🌟Absorption of Ca -Mainly in duodenum and upper jejunum due to presence of acidic chyme -poor= 35% only of dietary Ca 🌟Factors affecting Ca absorption اتشرحوا زي الكتاب لكن مثال عال acidifying salts = vit c +cortisol prevents formation of ca binding protein 🌟Ca bonding protein (Carrier of Ca) بينقل ال Ca من ال luminal surface لل jejunum cells، البروتين ده بيتحكم ف تكوينه vit d ⚠️So, vit d هو المتحكم الأول ف Ca absorption 🌟🌟🌟 عندي نوعين من ال mechanisms للتحكم في مستوى ال Ca 🌟1-Rapid Buffering system -via pumping of Ca Ca from bone fluids in minute spaces between trabeculae of cancellous bone -Bone fluid rich in Ca and phosphate ⬇️Ca in blood ---> ⬆️sensitization of Ca pumps on Bone membrane ---> pumping of Ca to extracellular fluid to maintain Ca level عند 7 gm 🌟2- long term mechanism -Hormonal Via PTH, calsitonin, calciferol +Other hormones: glucocorticoids,GH, Thyroid hormone, glucagon, estrogen, androgens دول اتقالوا بكل التفاصيل اللي فالكتاب بس ناخد بالنا إن GH محصلة شغله بيزود ال Ca؛ وإن Glucagon بيشتغل directly و indirectly 🌟phosphate metabolism -3:4 mg/dl in adult, higher in children(عندهم ⬆️ATP + ⬆️Bone formation) -absorbed from upper part of intestine 🌟-solubility product: حاصل ضرب ال Ca, Phosphate لازم يديني نسبة ثابتة عشان يفضلوا الاتنين ف صورة soluble وميترسبوش ويعملوا stones 🌟Importance of phosphate: -Major intracellular Buffering system -High energy compounds -protein formation -Blood phosphate is the controller of blood Ca #EnRe_physio #EnRe_N

🌟Lec 1 physo part 2 ▪️ Thyroid hormone is necessary for carotene ➡️ vit A by liver ⭐ Effects on CVS * CNS first system affected thenCVS ▪️⬆️ Heart rate ( Direct effect on SA node increase it' metabolism & increase its sensitivity to catecholamines) ▪️⬆️ Strength of myocardial contraction (due to decrease viscosity & increase sliding of actin & myosin ) ⬆️ Venous return ( as a result of VD due to excess metabolites & increase temperature -SO ⬆️ cardiac output - at the begging there is a dramatic increase in cardiac output ▪️⬆️ Systolic blood pressure ⬇️ Diastolic blood pressure من اهم أسباب ال hyperdynamic circulation وتعمل water hummer pulse ⭐Effects on Respiratory system ▪️⬆️ Relate & depth ( due to ⬆️ cellular respiration) ⭐ Effects on GIT ▪️Increases : Appetite, food intake , secretion , motility , absorption & Improves GIT circulation ▫️ Effects on skeletal muscle زي ال protein ▫️ Effect on milk secretion ▪️⬆️ Milk secretion during lactation (secreting 1.5 to 2 l per day ) ▫️ Effects on other endocrine glands -3 direct effects ( on pancreas, parathyroid & pituitary due to ⬆️ metabolism ) -1 indirect effect on adrenal cortex (through ⬆️rate of inactivation of glucocorticoids by liver ) *pallor & anemia in hypo thyroid patient due to decrease erythropoiesis * enhance enzyme for absorption & Git circulation * stimulate active organe( sex organ,bone marrow,mamillary gland) *TSH increase both growth & activity thyroid gland * inhibition of TRH in sressful condition : 1-direct or central by activation of posterior & latral neucli of hypothalamus 2-prephral : increase catecholamines increase BMR lead to increase metabolites & tempreture * exposure to cold >> increase activity of heat gain center in hypothalamus >> increase TRH 💢Cretinism💢 * due to thyroid agenesis * ambilical hernia occures due to decrease motality of GIT ☆ myxedema *myxedema in female manifst by amnorrhea * myxedema more in female * voice change due to accumulation of maxymitous material in vocal cords * pallor due to anemia, hyper cartonemia , accumalation of maxymtous material under skin * scaly& dry skin as decrease BMR Lead to decrease regeneration in skin * atrophy in sweat gland due to upper hand of para sympathtic but sweat gland innervated with sympathtic *decrease absorbtion of lipid,protein,glucse 💢hyper thyrodism *malignant in thyroid has good prognosis * nails& hair are fine & brittle due to increase catabolism * initial increase in COP ( first 3 month) then heart failure late *Exphthalmos is unique sign to Grave disease & permenant * Exphthalmus occur due to 1- weakness extra occular muscle 2- accumulation of immune complex retro orbital which push orbit forward *diagnosis of exophthalmus : upper eye lid not cover the cornea or at limbus or sclera exposed 🌟Effect on sudden increase of iodine on thyroid gland ⬆️Iodine ----> short term inhibition of Thyroid gland Mechanism:- Sudden increase in Iodine----> inhibits thyropyroxidase enzyme----> prevent oxidation of iodine ----> Iodine is kept in inactive form----> no formation of monioido or diioido tyrosine ----> ⬇️Activity of gland +vasculature بتقل لنقص ال activity of gland التأثير ده بيدوم لمدة 3 أسابيع فقط، بعدين بيحصل habitation ويزيد ال activity من تاني عشان كده بندي iodine supplements بكمية كبيرة لعيان ال graves قبل ما نعمل له عملية ب3 أسابيع. #EnRe_physio #EnRe_N

حاجات قالتها الدكتورة -After given GH:- Follow up:- 1. Glucose level to prevent diabetes 2. WBCs level to prevent leukemia and malignancy 3. Visual assessment And it’s important to remove the nevus -Page 105 kinetics of somatropin 1. Sc 2. 6:7/week 3. Similar to prolactin 4. Increase releasing of IGF-1 from liver -Page 105 Another use of somatropin is prader willi syndrome -Central diabetes insipidus-Vasopressin and Desmopressin -Nocturnal enuresis-Desmopressin(Oral) -Hemophilia A-Desmopressin -Variceal bleeding-Vasopressin #EnRe_pharma #EnRe_N

▪️ Thyroid hormone ⬆️ the need for vitamins ( due to catalytic reaction & vitamins needed in catabolism as COFACTORS) #EnRe_N

⭐lec 1 physo part-1 أهم النقاط والاضافات في المحاضرة من دكاترة زمايلنا بارك الله فيهم. 🌟Thyroid gland ▪️ Follicular cells secrete thyroid hormone (T3, T4) . ▪️ Parafollicular cells secrete calcitonin. ▪️Thyroid hormone = T3 ,T4 ▪️Thyroid hormones = T3 ,T4 & calcitonin ⭐دي جات قبل كدا ف امتحان + الدكتورة لما هتسأل عن disorders الهرمون بالجمع هتحتاج تعرف كل ال disorders اللي تخصهم بما فيهم ال calcitonin عشان نسيوها قبل كدا. ▪️Active form of hormone ➡️ T3 ( activated in liver ) ▪️Stored & less active form in blood ➡️ T4 ⭐Steps of synthesis of T3 , T4 : 1- transformation of iodine ( taken from diet) to iodide to enter plasma 2- Oxidation of iodide 3-Pumping of iodide against concentration gradient & trapping it in the acini 4- Iodination of tyrosine to form iodotyrosines 5- Coupling of monoiodotyrosine & diiodotyrosine to form T3 &T4 الدكتورة شرحت الخطوات دي بس قالت هناخدها ف البايو يعني. ▪️TSH stimulates thyroid gland to activate exocytosis of T3 , T4 ▪️Due to fat solubility of hormones , So it have to be bounded to plasma proteins to prevent its diffusion to other cells except for the target ▪️Thyroid hormone binds mainly to globulin وبنسميه thyroid binding globulin ودا بيمثل ال stored thyroid hormone in blood ▪️T4 has higher affinity to binding to plasma proteins & lesser activity than T3 ▪️Free forms of hormones are the physiological active form ⭐Physiological functions of thyroid hormone ▫️Effect on metabolic activity ▪️Thyroid is the main factor that controls BMR ➡️ ⬆️ BMR up to 100% ف الداتا مكتوبة انها بتزيد بنسبة ٦٠ ل ٧٠٪ بس الدكتورة قالت إنه ممكن يزوده ١٠٠٪ يعني لو كان ١٢٠٠٠ يخليه ٢٤٠٠٠ ▪️As a result of increased BMR ➡️ ⬆️ oxygen consumption & ⬆️ activity of the cells That will lead to ⬆️ number , activity of mitochondria to energize cellular function ▪️ Mitochondria has its own DNA وبالتالي ال replication بتاعها مش مرتبط بال nuclear activity ▫️Effect on growth ▪️ Thyroid hormone is essential for normal growth in synergy with growth hormone ▪️ Thyroid hormone is important for bone maturation more than soft tissue growth ▪️⬆️ Thyroid hormone in children ➡️ taller children BUT shorter adult This is due to ossification of epiphyseal plate > bone growth SO chondrocytes turns into osteocytes & lose the ability to divide and elongate bone SO epiphyseal plate closes early leads to shorter adult ▫️Effect on nervous system ▪️thyroxin works on 1-NEURONS to enhance its growth & maturation 2- glial cells especially ASTROCYTES to development of synapses & myelination ( هيخليها تطلع neurotropic growth factors ) 3- بيحافظ كمان علي ال activity of synapses وعشان كدا لو قل ف الكبار بيبقي فيه مشاكل ف ال memory & intellectual functions وكمان يحصل hyporeflexia +الحاجات اللي ف الداتا سلايد ٧ ▫️ Effects on sexual function ▪️ Thyroid hormone is essential for normal spermatogenesis, Oogenesis & ovulation ▪️1/3 cases of infertility is due to hypothyroidism ▪️Action of thyroid on sexual function is due to its metabolic effect (⬆️ energetics for division & synthesis of ova & sperm ) ▪️ Thyroxin gives the sexual organs its energy to do their normal function of production (Peripheral effect) ▪️ Thyroxin gives Ant. Pituitary the energy to produce FSH & LH to stimulate sexual organs to produce ova & sperm (Central effect) الدكتورة قالت بيأثر علي المصنع نفسه وعلي ال control بتاع المصنع اللي هي ال Pituitary ▫️ Effects on specific metabolism ▪️ ⬆️ Carbohydrate absorption through ⬆️ GLUT 2 , GLUT 5 & Sodium glucose transporter 1 ▪️⬆️ Gluconeogenesis , ⬆️insulin secretion to resume the absorption & ⬆️ utilization of glucose by cells ▪️⬆️ All aspects of fat metabolism ▪️ Thyroxin affects metabolism of 3 food stuffs BUT its effect is bigger on fat metabolism ▪️⬆️Excretion of cholesterol المرض الوحيد اللي بيقلل ال cholesterol ف الدم هو ال hyperthyroidism ▪️In normal level thyroxin has anabolic effect on protein & increase muscle building BUT excessive increase cause protein catabolism ( destruction of proteins & use it as a source of energy ) THIS IS DUE TO ⬆️ OF BMR

الأسئلة اللي دكتور مها قالتها فآخر المحاضرة من دكتور زميلنا بارك الله فيه. 1-Function of nucleui ( مثلًا Paraventricular، هتقول إنها بتفرز oxytocin وتقول وظيفته ,dorsimedial مثلًا) 2-Function of posterior nucleus of Hypothalamus 3-Relations and blood supply of thyroid gland واللي يعرف يرسم ال Relations يرسم بس يكتب برضو 4- Blood supply of Hypothalamus 5- Origin of cells of thyroid gland 6- mention devisions of nucleui of Hypothalamus 7-enumarate nucleui of medial region of Hypothalamus 8- Dates, origin of cells أهم حاجتين فالembryo وتجي سؤال complete 9-pituitary gland is divided into:.... 10-connections of fornix قالت إجابته فنص الكلام بين ال mamillary body وال hippocampus 11- تذكِرَة، نركز عالمقارنات اللي بين ال nucleui #EnRe_antomy #EnRe_E

💢Pharma lec -1 part 1 من دكتور زميلنا بارك الله فيه. ☆pan hypoputarism> multipe organ manifstatio of hypo pitutary hormone 💫GnrHagonist>> (leuprolide&nafareline) ☆Gnrh used by pulsatile maner to stimulate LH & fSH hormone while cntinonous to inhibition( as leuprolide &nafarlin ananlogues) ☆decreaseLH,FsH,RPogestrone ,estrogen ☆ all pitutary & hypo thalumus hormone are poly peptide >> No oral use ( only nasal spray _ sc- Iv ) 💫Drug used for increasing GH: 💥 GH inhibition hormone>> (somatostatin) ☆bind to somatostatin receptor ( sst) in pitutary & GIT ☆ somatostatin analogue>> octreotide ☆once a week( per4weeks) ☆ uses : decrease GH as in مهم * acromegaly * Bleeding varices(I.V infusion) * v.c of splanchmic vesseles so used as periopeeative prophlaxis in pancreatic surgery * carcinoid tumer ( flushing& diarrhea) ☆somatostatin antognist most pitutary hormone not only GH ( so that used in carceniod tumer) 💥pegvisomant * GH antagonist * used to treat 1-acromegaly in patient not response to SST analogue 2- PITUTARY ADENOMA 💥Cabergoline& promocriptine: * dopamine agonist * treat acromegaly ( with un knwn mechanism ) 💫GH(somatotrophin) ☆ most abundant pitutary hormone( 40-50%) ☆ it's action mediated by IGF-1( somatomedian C) from liver ☆ stimuate it's secration Ghrh & inhibited by hypthalamus somatostatin( sst) ☆SIMILAR TO PROLACTIN ☆ effects:مهم 1 stimulate linear & propotinate growth of bone unti epiphysis close 2 increase muscle bulk 3 increase growth & maturation of intestine 4 increase protein synthesis & lipolysis ☆ when Gh & iGf-1 increase >> negative feed back to hypothalamus & anterior pitutary while stimulation to somatostatin ☆ optimum secration at 12 mid night & regular exercise ☆ it's deficiency manifisted : *in children by short stature * in adult by ( increase adiposity - decrease mass& streanth of muscle - decrease bone density- fatigue,weakness,malaise - cardiac atrophy ) ☆ Diagnosis > provacative test using hypoglycemic drug 💥 drug used to treat it's deficiency 💥 1- synthetic GHRH《Semoreline 》 * used in defictive hypothalamus 2- Recumbinanthuman GH( somatrophin )> more common *indication مهم 1- growth failure in childern whith Gh deficiency 2 chronic renal failure 3 turner syndrome 4prader willi syndrome 5 idiopathic short stature 6 short bowel syndrome 7 wasting in HIV patient 8 anti aging 9 enhance performance in athletes 10 off label use by older people ☆ kinetics مهمه * t half is short(~25 min) * SC ( 6-7 times per week) ☆ADVESE EFFECTS: 1 in childeren : * increase ICP,papilloedema,visual change * scoliosis & skipped capital femoral epiphysis *hyperglycemia & impaired GTT *LUKEMIA 2 in adult : *carpal tunnel syndrome,myalgia ,arthralgia,joint&muscle pain * pancritatis ,navus growth,gynomastia * increased risk of recurrence & occurance of neuplasm ☆ contra indication: * closed epiphysis * active intra cranial lesion * malignancy *prolefrative diabetic retienopathy *acute critical ilness 3-Recombinant IGF-1(mecasermin) *uses; IGf-1 defeciency & resistant to GH as mecasermin rinfabate *kinitic: SC ,start small dose & then increase, twice daily * side effect:مهم 1 hypo glycemia 2 increse ICP 3Increase AST& ALT(liver enzyme) #EnRe_pharma #EnRe_N

جزء ال Pitutary وthyroid و parathyroid من دكتور زميلنا بارك الله فيه. Pitutary gland👇 #site >>hypophyseal fossa (sella turcica) #anterior lobe (adeno hypophysis )>>connect by tubero_infundibular tract with hypothalamus #posterior lobe(neurohypophysis) >>connect by hypothalamohypophysial tract with hypo thalamus #arterial supply : superior & inferior hypophysial artery (branches of ICA) 💢Thyroid gland 💢👇 # pyramidal lobe attached with hyoid bone with( levator glandulae thyroideae band) # latral lobe extend from oblique line of thyroid cartilage to six tracheal ring # isthmus extend in front of 2,3,4 tracheal rings # surrounded by pre tracheal facia #relation of lobes: 1-latral ( superfichial ) surface: * skin,superficial& deep fascia * infrahyoid muscles& sternocliedomastoid M 2- medial surface: * larynx & pharynx * esophagus & trachea *RECURENT LARYNGEAL NERVE & external laryngeal nerve 3- posterior surface: * carotid sheat (CCA+IJV+ vagus N) * sympathatic trunk # relation of isthmus 1- superior>> anastmosis of 2 superior thyroid artery 2- inferior >> anastmosis of 2 inferior thyroid artery & thyrodia ima artery 3- posterior>>2,3,4 tracheal rings # arterial supply: 1- 2superior thyroid A( brancher ofECA) 2- 2inferior thyroid A(branches of thyrocervical trunk which branche of first part of sub clavien artery &give also supra scapula A &transverse cervicalA) # venous drainge: * superior& middle thyroid vein ( drain into IJV) * inferior thyroid vein ( drain into Lt braichocephalic V) # lymphatic drainge :مهم 1- para tracheal 2-pre tracheal 3- upper deep cervical 💢para thyroid gland 💢👇 # site : * superiorpara thyroid >> at the middle of posterior border * inferior para thyroid>> at the inferior of posterior boder # blood supply:inferior thyroid A # venous drainge: inferior thyroid V #EnRe_antomy #EnRe_N

أهم النقاط في الجزء الاول من محاضرة الاناتومى hypothalamus وneucli من دكتور زميلنا بارك الله فيه. #separeta hypothalamus from thalamus>> hypothalamic sulcus # components of inter peduncular fossa of mid brain : *hypothalamus (at the floor) *optic chaesma *tuber cinerum *mamillary body #thymus remenant site>> anterior mediastinum #site of pancrease>>posterior abdomen surrounded by second part of dudenum (Hypo thalamus )👇 #hypo thalamus >behind lamnia terminalis & anterior commisure below thalamus #preoptic & antaerior neuclus <<parasympathatic center #lateral & dorsomedial neuclus>> hunger center #ventromedial>> satiety center #para venturicular > secrete oxytocin H # supra optic> secrete ADH # mamilary body>> role in emotion & memory *المقارنات اهم من الجدول اللى مجمع كل الneucli عشان ف اختلاف بينهم والدكتوره قالت لو سألت هتسأل فى المقارنات لانها updative #EnRe_antomy #EnRe_N

.﴿يَا أَيُّهَا الَّذِينَ آمَنُوا صَلُّوا عَلَيْهِ وَسَلِّمُوا تَسْلِيمًا﴾ اللهم صلِّ على محمد، وعلى آل محمد، كما صليت على إبراهيم، وعلى آل إبراهيم، إنك حميد مجيد، اللهم بارك على محمد، وعلى آل محمد، كما باركت على إبراهيم، وعلى آل إبراهيم، إنك حميد مجيد ‏ قال رسول الله ﷺ : (من قرأ سورةَ الكهفِ في يومِ الجمعةِ ، أضاء له من النورِ ما بين الجمُعتَينِ). أنيروا جمعتكم ب قراءة سورة الكهف لن تذبل روحاً اصبح لها القرآن ساقيًا.

السلام عليكم ورحمة الله وبركاته لعل الجميع بخير باذن الله السنادي هنكرر حملتنا لتجميع الالحفة للمرة الثالثة واللى هنطلق عليها اسم شتاء دافي وبإذن الله نستمر فيها ما حيينا اول سنة جمعنا 11.5 الف وعملنا 50 لحاف, تانى سنة جمعنا 6.5 الاف وعملنا 30 لحاف هدفنا السنادي نجمع عدد اكبر مالسنتين اللى فاتوا سعر اللحاف 380 يعنى لو حبينا نجمع 50 لحاف محتاجين نوصل 20 الف همتكم معانا عاوزين نلحقهم من البرد بسرعة وكل ما تبقى بردان افتكر اخواتك البردانين بس مش معاهم شئ يدفيهم وساهم بأى شئ تقدر عليه. هنبداء نجمع خلال الفترة دي بعون الله الي حابب يتبرع يدي للمسؤول في السكشن بتاعه وتقدروا تبعتوا فودافون كاش عالرقم دا 01026283678 طبعا ياريت ترنوا تتاكدوا من وصول التحويل وجزاكم الله كل خير.

السلام عليكم ورحمة الله وبركاته لعل الجميع بخير باذن الله السنادي هنكرر حملتنا لتجميع الالحفة للمرة الثالثة واللى هنطلق عليها اسم شتاء دافي وبإذن الله نستمر فيها ما حيينا اول سنة جمعنا 11.5 الف وعملنا 50 لحاف, تانى سنة جمعنا 6.5 الاف وعملنا 30 لحاف هدفنا السنادي نجمع عدد اكبر مالسنتين اللى فاتوا سعر اللحاف 380 يعنى لو حبينا نجمع 50 لحاف محتاجين نوصل 20 الف همتكم معانا عاوزين نلحقهم من البرد بسرعة وكل ما تبقى بردان افتكر اخواتك البردانين بس مش معاهم شئ يدفيهم وساهم بأى شئ تقدر عليه. هنبداء نجمع خلال الفترة دي بعون الله وتقدروا تبعتوا فودافون كاش عالرقم دا 01026283678 طبعا ياريت ترنوا تتاكدوا من وصول التحويل وجزاكم الله كل خير.

ناخد بالنا م السؤال دا عشان الدكتور ريهام قالت إنه الإجابة هتكون Case report مش زي ما متجاوب ف الفايل.. من زميلتنا #vertical