DR F K

@ctisus Crohns

The Comb Sign on CT

Hahaha... or are they?

🚨⛔️ Jurrien Timber is out of Sporting vs Arsenal tomorrow, Mikel Arteta confirms.

Haha tactics za kishoga

This review article provides a comprehensive description of the diagnostic and therapeutic strategies for treating Morel-Lavallee lesions. @susan_kartiko; @Trauma_Q; #GW journals.lww.com/jtrauma/fullte…

Scenes

@franciscojlk SSC26 Doesn't not recommend

💙 Methylene blue in septic shock: miracle, myth… or misunderstood tool? We all know the scenario: 👉 Refractory vasoplegic shock 👉 Escalating norepinephrine 👉 Vasopressin, steroids… still hypotensive At some point, the question comes: Should we use methylene blue? ⚡ Mechanism Septic shock = NO-driven vasoplegia Methylene blue acts by: ❌ Inhibiting nitric oxide synthase (NOS) ❌ Blocking soluble guanylate cyclase ⬇️ Reducing cGMP ➡️ Restoring vascular tone 👉 A true catecholamine-sparing strategy 📊 What does the evidence say? Reality check: Use in practice is rare (~0.5% of septic shock patients) Often used as late salvage therapy Dosing strategies = highly variable But RCT signals are interesting: ↓ Vasopressor duration ↓ ICU / hospital length of stay Possible ↓ mortality (low certainty) 👉 Evidence is promising… but still weak 🚨 The clinical dilemma Timing is everything: Early use → potential physiologic benefit Late use → often too late to change trajectory 👉 Current practice is probably backwards ⚠️ What about safety? Potential concerns: Serotonin syndrome (with SSRIs) Pulmonary vasoconstriction G6PD-related hemolysis Interference with pulse oximetry 👉 Most serious effects seen with high doses 🧠 Take-home message > Methylene blue is not a “magic drug” but it may be a physiology-driven adjunct in vasoplegic shock ❓The real questions are: Who benefits? When to give it? At what dose? 🚀 Where we’re heading Ongoing trials (e.g., BLUSH trial) will clarify: ✔️ Early vs late use ✔️ Optimal dosing strategy ✔️ True impact on mortality 👉 This could redefine vasoplegic shock management 💡 Clinical reflection Next time you face refractory shock, ask: 👉 Is this still “fluid + catecholamine problem”… 👉 or already a NO-mediated vasoplegia problem? 📚 Reference Fernando, S. M.et al. Journal of Critical Care, 92, 155353. doi.org/10.1016/j.jcrc…

K!ller: ...and I will k!ll everyone you love Me: I love you K!ller:

Hahaha.... partly true. But because we are used to mediocrity it sounds weird.

guy who only knew jesus professionally: Honey, did you hear they CRUCIFIED our CARPENTER???

Revising for Exams First Question

Maliza hao wote, na their minions, fcvkers!

An interesting finding in the liver. What do you think has happened here?

As a continent, we are collectively foolish

Salary imenipata nkikula kamande sijawai tapika hivo😂

@Teirrah_HM Shindwe

Me reading this 50/50 story as the man of the house is making dinner

Stinging display of opulence

I doubt but, carry on

Aesthetics improved by Halloween mask, the first of it's kind.