Ekabut

|God first| |Biochemistry| |Medicine| |MUFC ❤| |Believe in yourself|

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@jay_menz_gh Are you now an Arsenal fan?

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@arliyyo 525

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@SqSehrish 8

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@renabaddie_ 52

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@eastsportsman 🤣🤣😂

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@OtiAdjei England 0-1 Ghana

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@UtdPlug 30 points secured

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@DrAmoakohene Congratulations

[𝐀𝐒𝐊 @askghmedia]

A hilarious incident occurred at Nkwatia Government Hospital, Kwahu, when the family of a man who had been declared dead arrived and paid his medical bills, only to discover that he was alive on the hospital bed.

According to reports, the man had been admitted with a serious illness, but all efforts to reach his family to settle the bills had proved futile. The nurses who had been caring for him for weeks then arranged a prank with him by obtaining his family’s contact details and informing them that he had passed away. In the twinkling of an eye, the family arrived and paid the entire bill, only to get the shock of their lives when they saw him alive.

[Ekabut @ekabut13]

@Mzdelah Ask for epidural analgesia.

[🇬🇭 Black Stars @GhanaBlackstars]

GFA part ways with Otto Addo https://t.co/HXaoJNQUGh

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@chloe_egray 🤣🤣🤣

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@garyalsmith 🤣🤣🤣🤣

[Dr. Nikhil @DrNikhilMD]

💩 Constipation : The Complete Clinical Guide

Constipation is more than “not going.” It’s a symptom, a syndrome, and often a signal of deeper disease. Let’s understand it from basics to advanced management 👇

🧠 Definition:
➡️ Textbook: Fewer than 3 bowel movements per week
➡️ Practical: Any change from normal pattern causing discomfort like straining, hard stool, or incomplete evacuation

🎯 Always identify the reason before starting laxatives.

🔍 Think LMNOP to remember causes:

L (Lifestyle):
Immobility, low fiber diet, poor hydration. Even light walking can stimulate bowel movement.

M (Metabolic):
Hypercalcemia slows gut and dehydrates, hypokalemia impairs muscle function, hypomagnesemia causes spasm, hypothyroidism slows transit (TSH >10).

N (Neurologic):
Seen in Parkinson’s disease, multiple sclerosis, dementia, spinal cord injury — these patients often need regular bowel regimens.

O (Obstructive):
Colon cancer, fissures, or strictures. Always rule out bleeding, weight loss, or new-onset constipation after age 50.

P (Pharmacologic):
Tricyclic antidepressants, calcium channel blockers, antipsychotics, antispasmodics, GLP-1 analogues, iron, calcium, and aluminum antacids.
💊 Don’t forget over-the-counter drugs like antihistamines, which are frequent hidden causes.

🥦 Non-Pharmacologic Management

Fiber:
Soluble fiber (psyllium, oats, methylcellulose) softens stool by retaining water.

Insoluble fiber (bran) can worsen bloating.

Start with 3–4 g/day and titrate to 20–30 g/day.
⚠️ Take with adequate water or it can worsen constipation.

💊 Psyllium should be taken 2 hours apart from thyroid or mineral supplements.

Hydration:
1.5–2 L/day is adequate; more adds little benefit if already hydrated.

Dietary Aids:
Prunes outperform psyllium in mild constipation.
Kiwi slightly increases stool frequency.

Physical Activity:
Even 15–20 minutes of daily walking improves motility.

💊 Pharmacologic Management

��️ Combine drugs with different mechanisms instead of repeating one type.

Osmotic Laxatives:

*Polyethylene Glycol (PEG) is safe, gentle, and works in 1–3 days.

*Magnesium citrate or oxide acts faster but is risky in renal dysfunction.

*Lactulose works in 1–2 days but can cause bloating and gas.

💡 Colonoscopy preps like GoLytely are high-dose PEG and can help in fecal impaction.

Stimulant Laxatives:

Senna or Bisacodyl act in 6–12 hours and are best taken at night for a morning bowel movement.
🌿 Chronic use doesn’t damage the colon or cause dependence.

🧴 Rectal Therapies (Suppositories and Enemas)

Suppositories dissolve in the rectum while enemas instill liquid to soften stool.

Lubricant (mineral oil) coats stool and bowel wall.

Osmotic (Fleet, glycerin, lactulose) pulls water into the rectum but avoid in CKD or elderly due to electrolyte imbalance.

Irritant (tap water or soap suds) promotes peristalsis by mild irritation.

👩‍⚕️ Enemas are labor-intensive and messy, plan them early in shifts.

💉 Opioid-Induced Constipation (OIC)

Opioids slow gut, tighten sphincters, and reduce secretions.

1️⃣ Adjust opioid formulation if possible (fentanyl patch less constipating than oral morphine).
2️⃣ Start osmotic and stimulant laxatives.
3️⃣ If refractory, use PAMORAs like Methylnaltrexone.

These block gut μ-opioid receptors without reversing pain control.
Work within ~1.3 hours.
Side effects include abdominal pain or diarrhea.
🩹 Stop other laxatives before starting PAMORA; restart if no relief.

🧩 Key Takeaways

✅ Always search for reversible causes using LMNOP.
✅ Avoid stacking drugs from the same class; combine logically.
✅ Soluble fiber and hydration are the foundation.
✅ Avoid phosphate enemas in CKD and elderly.
✅ For opioid users, PAMORAs can be lifesaving.
✅ Encourage movement and a fiber-rich diet to prevent recurrence.

#Constipation #GutHealth #InternalMedicine #USMLE #NEETPG #Gastroenterology #ResidentLife #MedTwitter #EvidenceBasedMedicine

[Ekabut @ekabut13]

@Ama_Serwaaa Welldone Ama

[The Nobel Prize @NobelPrize]

BREAKING NEWS
The Norwegian Nobel Committee has decided to award the 2025 #NobelPeacePrize to Maria Corina Machado for her tireless work promoting democratic rights for the people of Venezuela and for her struggle to achieve a just and peaceful transition from dictatorship to democracy.

#NobelPrize

[The Nobel Prize @NobelPrize]

BREAKING NEWS
The 2025 #NobelPrize in Literature is awarded to the Hungarian author László Krasznahorkai “for his compelling and visionary oeuvre that, in the midst of apocalyptic terror, reaffirms the power of art.”

[The Nobel Prize @NobelPrize]

BREAKING NEWS
The Royal Swedish Academy of Sciences has decided to award the 2025 #NobelPrize in Chemistry to Susumu Kitagawa, Richard Robson and Omar M. Yaghi “for the development of metal–organic frameworks.”

[The Nobel Prize @NobelPrize]

BREAKING NEWS
The Royal Swedish Academy of Sciences has decided to award the 2025 #NobelPrize in Physics to John Clarke, Michel H. Devoret and John M. Martinis “for the discovery of macroscopic quantum mechanical tunnelling and energy quantisation in an electric circuit.”

[The Nobel Prize @NobelPrize]

Our immune system is an evolutionary masterpiece. Every day it protects us from the thousands of different viruses, bacteria and other microbes that attempt to invade our bodies. Without a functioning immune system, we would not survive.

One of the immune system’s marvels is its ability to identify pathogens and differentiate them from the body’s own cells. The microbes that threaten our health do not wear a uniform – they all have different appearances. Many have also developed similarities to human cells, as a form of camouflage. So how does the immune system keep track of what to attack and what to protect? Why doesn’t the immune system attack our bodies more frequently?

Researchers long believed they knew the answer to these questions: that immune cells mature through a process called central immune tolerance (see image). However, our immune system turned out to be more complex than they believed. Mary Brunkow, Fred Ramsdell and Shimon Sakaguchi have been awarded the 2025 Nobel Prize in Physiology or Medicine for their discoveries concerning peripheral immune tolerance.