Medicine

Perioperative Direct Oral Anticoagulant (DOAC) Dosing Schedule

Mechanisms of Action and Common Adverse Effects of 3 Classes of Antiobesity Medication

AMPA indicates α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid; GABA, γ-aminobutyric acid; GIP, glucose-dependent insulinotropic polypeptide; GLP-1, glucagon-like peptide 1.

Bed bugs are small parasitic insects that eat only one thing—human blood—and they get it only one way: by biting people.
A bed bug does not eat much or often. If many bed bugs are present, occupants are more likely to see and be bothered by them. Bites may be red, swollen and itchy, and new bites may be seen each morning. Fortunately, bed bugs do not transmit any diseases.
Bed bugs are found worldwide from fancy hotels to ordinary homes. Because bed bugs seem to leave some people alone (even if they sleep in the same bed) and some people have almost no reaction to the bites, it is often difficult for people to accept that their home has bed bugs.

Use of 24-Hour History for Insomnia Assessment.
Insomnia manifests as a sleep problem but affects — and is affected by — daytime behaviors. A thorough insomnia history helps evaluate symptoms and behaviors both at night and during the day. Shown are key parts of an insomnia assessment across a 24-hour day.

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Magnesium and Cell Function.
Magnesium is an important cofactor for numerous enzymes. All ATPase reactions require Mg2+–ATP, including those involved in RNA and DNA biologic functions. It opposes calcium actions and acts as a second messenger. Magnesium influences circadian-clock genes, which control circadian rhythm in biologic systems. ADP denotes adenosine disphosphate.

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Buridan’s Assay and Nephrogenic Diabetes Insipidus.
In Buridan’s assay, a food- and water-restricted mouse is provided with two equally accessible reward spouts that contain liquid food in one and water in the other. Panels A and B are adapted from Richman et al.2 In Panel A, the “energy landscape” with wells for hunger and thirst represent a model explaining choice. If hunger and thirst are equal, the wells have equal depth and the initial choice between eating and drinking in this mouse model is random. As one urge starts to become satisfied, the landscape shifts, favoring the other urge; the mouse acts accordingly and alternates between drinking and eating until both urges are fully satisfied, as shown in Panel B. Richman et al. monitored the activity of mice deprived of food and water. After an olfactory cue, the mice could lick toward either food or water. The x axis in Panel B denotes trials across a session, and the y axis shows the cumulative number of licks after each olfactory cue.

Transmission of Taste Information.
Fibers innervating the taste buds transmit signals to the gustatory region of the nucleus of the tractus solitarius (NTS), then to the thalamus and the gustatory cortex (pathway depicted in red). Each taste bud is innervated by primary intragemmal gustatory fibers, which extensively branch and connect with multiple taste buds, interacting with many TRCs. This results in electrical activity that reflects the input from numerous TRCs. Taste buds in the fungiform papillae are innervated by sensory neurons of the geniculate ganglion, traveling through the chorda tympani branch of the facial nerve (cranial nerve [CN] VII). Taste buds in the posterior third of the tongue are innervated by sensory neurons of the petrosal ganglion, traveling through the lingual branch of the glossopharyngeal nerve (CN IX).

Types of Flat Head Syndrome

There are 2 types of flat head shapes, although some infants can have both forms. In plagiocephaly, the back of the head is flat on one side. In severe cases, this may cause the ear on that side of the head to appear pushed forward and/or lead to an uneven appearance of the face, neck, or jaw. In brachycephaly, the back of the head is flat and the head appears wider than normal.

Flat head syndrome does not affect brain development or intelligence. Approximately 1 in every 8 healthy infants younger than 1 year have flat head syndrome, although most have a mild form. Diagnosis is made by a clinician based on physical examination.

Rates of flat head syndrome increased after the 1994 recommendation that infants sleep on their backs to prevent sudden infant death syndrome (SIDS).


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Mechanisms of Respiratory Failure in Patients with Botulism.
The botulinum neurotoxin can lead to respiratory failure by affecting the muscles involved in respiration, the muscles involved in maintaining airway tone, or the muscles involved in airway clearance. In addition, autonomic dysfunction may contribute to the development of respiratory failure.

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alpha-gal syndrome is a type of food allergy to mammalian (red) meat products.
Alpha-gal syndrome is associated with tick bites, most commonly from the Lone Star tick in the US, but also from different types of ticks in other areas of the world. During a bite, a tick injects a type of sugar molecule (galactose-alpha-1,3-galactose), also called alpha-gal, which leads to formation of an antibody. Because alpha-gal is present on cells of most mammals, including cows, pigs, lambs, and goats, when affected individuals eat these animal products, an allergic reaction may occur.

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Clinical Manifestation of Age-Related Macular Degeneration (AMD) A, Early AMD with multiple medium-sized drusen (asterisks) without pigment abnormalities. Drusen shown as yellowish material on color fundus image (left panel), variable signal on fundus autofluorescence (middle panel), and dome-shaped elevations on optical coherence tomography (OCT) (right panel). Note increase in size from early AMD (A) to intermediate AMD (B). B, Intermediate AMD with large drusen (asterisks) and pigment abnormalities. C, Late-stage AMD. Area of geographic atrophy (pink arrowheads) with well-demarcated borders on fundus autofluorescence (middle panel) that correspond to the area of photoreceptors and retinal pigment epithelium loss on OCT (right panel). D, Exudative neovascular AMD. Asterisks indicate drusen; black arrowheads, small hemorrhage; white arrowheads, leakage on fluorescein angiography (middle panel)

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