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I must confess that I had most of my 2020 planned ( typically of type A me 😅) and that this year sort of sets the tone of the next chapter of my personal and professional life. But as any challenge we had in the past ( I'm considering to start sharing a bit more about that), I know that we'll get through this better and stronger by being productive. And to do so I reorganized my schedule so I'm officially starting my dedicated study for the USMLE Step 1.📚🙌🏻 Not gonna lie to you how afraid and anxious I'm feeling but staying in the comfort have never do good to anyone. If you guys have any experience, tips or are going through this path please let me know.🙈💙 #Medschool #medstudent #medlife #goals #2020 #womeninmedicine #USMLE #Step1 #FA (at Santo Domingo, Dominican Republic) https://www.instagram.com/p/B9-JWfzD4Cl/?igshid=nzvlse9s7y9t

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@ifmsard is the way to live!💃🏻🇩🇴 My Ifmsafam(ily)💕 It's coming the time to wrap things up and I still can't believe how fast this year has past since our 1st ever Congress. #scomedians #SCOME #ifmsamoments #ifmsafamily #medstudents #medgram #medschool #medlife #ODEM (at Colegio Dominicano De La Salle) https://www.instagram.com/p/B5i_p4UD6o2/?igshid=h33jxlogsl51

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Wallpapers de Bad Bunny para tu celular de confianza 🐰

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lockscreens

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Bruce Wayne watched both of his parents die.

Tony Stark has heart problems and anxiety.

Peter Parker saw his uncle being murdered.

Steve Rogers lost his best friend.

Bruce Banner attempted suicide.

If they can save the world, you can get through this day.

Never stop fighting.

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Toxic Friendships

A friendly reminder that a real friend will not:

Lie about you/to you for their own amusement

Spread false information about you to anyone

Share your secrets/personal information with other people

Make hurtful comments about your life/work/relationships

Try to manipulate you in any way, shape or form

Demand that you put in extra effort in the relationship while not holding up their end of the bargain

Use you as their personal therapist

Make you feel like it’s your responsibility to “fix” them

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Everything Okay?

If you or someone you know is struggling, you are not alone. There are many support services that are here to help. 

If you are located in the United States, consider reaching out to the National Alliance on Mental Illness HelpLine.

If you are located in the United Kingdom, The Mix is here to help you with any challenge you are facing.  Reach out online, on social or through their free and confidential helpline.

If you are reading this from in any other country in Europe,  Mental Health Europe has compiled a list of helplines and other resources in your country. 

For more resources, please visit our Counseling & Prevention Resources page for a list of services that may be able to help.

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me whispering to my dog in the dark: hey.. you still up?

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via weheartit

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being vulnerable enough to tell people how much you care about them is infinitely more brave than pretending to be above love and using edginess as a method of self-preservation

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Starting the week with positivity and motivation.🦉 "Decide that you want it more than you are afraid of it" -unknown 📸: @themedblogger making magic with my dark circles 🤣 (at Santo Domingo, Dominican Republic)

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Enzymes - clinical chemistry

ALP: 

Present in liver, bone, intestine, kidney, neutrophils and placenta. 

80% originates from bone. 

If GGT up, ALP from liver. 

If GGT normal, ALP from bones. 

ALP rises with obstruction to the biliary tract. 

ALT: 

Most present in the liver, but also found in other tissues. 

Very high levels suggest, viral hepatitis, diabetes, congestive heart failure, liver damage, bile duct problems, infectious mononucleosis or myopathy.

AST: 

Present in liver, heart, skeletal muscle, kidneys, pancreas, lungs, leukocytes and erythrocytes. 

Increased levels may indicate haemolytic anaemia, rhabdomyolysis, increased leucocyte count etc

Distinction in source can be made via CK and Troponin. 

AST<ALT = hepatic injury

AST>ALT = hepatocyte necrosis - poor prognosis (AST is found in the mitochondria, not spilled out until severe destruction) - CONSIDER MUSCLE SOURCE

AST:ALT Ratio: 

Greater than 2 = Hepatitis.

Less than 2= cholestatic disorder.

GGT: 

Found in both hepatocytes and biliary epithelial cells. 

Sensitive for hepatobiliary disease. 

5 times increase = good marker of alcohol abuse.

GST (Gluthathione S-transferase):

 Isoenzymes of GST are involved in the detoxification and conjugation of several electrophilic compounds with glutathione. 

Found to be a very good marker of acute hepatocellular damage with a half life of 90min. Not widely used.

CK: 

Found in heart, brain, skeletal muscle and other tissue. 

Released when muscle damage. 

Causes range from exercise injury to hormonal disorders.

LDH: 

Found in muscles, liver, heart, pancreas, kidneys, brain and blood cells. 

Used to used to diagnose and monitor heart attacks. 

Five types of isoenzymes can help determine location of damage. 

LDH-1 - heart, red cells, kidney, germ cells. 

LDH-2 - heart, red blood cells, kidney (lesser amounts than LDH-1).

LDH-3 - lungs and other tissues. 

LDH-4 - white blood cells, lymph nodes; muscle, liver (smaller amounts than LDH-5).

LDH-5 - liver, muscle.

Troponin: 

Highly specific marker for myocardial infarction or muscle cell death. 

Also used to diagnose other conditions which relate to cardiac muscle injury.

Lipase: 

Found in blood, gastric juices, pancreatic secretions, intestinal juices and adipose tissues.

Hydrolyses triglycerides  

Acute pancreatitis, pancreatic neoplasia, pancreatic abscesses, and pancreatic duct obstruction can result in high levels of lipase and usually are 2 to 3 times the upper limit of normal.

Amylase: 

Is made by the pancreas and by the glands in and around the mouth/throat. 

Catalyses hydrolysis of starch 

High amylase may indicate the presence of a condition affecting the pancreas. 

In acute pancreatitis the levels are 4-6 times normal and remains high until treated. 

Chronic pancreatitis, levels will be high but will decrease until problem is solved.

Acid phosphatase: 

Prostate cancer - raised in 80% of cases presenting with metastases. 

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“Friendship is unnecessary, like philosophy, like art… It has no survival value; rather it is one of those things that give value to survival.”

— C. S. Lewis (via goodreadss)

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“we almost dated” is such a weird relationship to have with someone

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Hump day motivation!🐫 #happyhumpday #dailyhustle #medicine #girlinwhitecoat