Created by world-class clinical faculty, Learning in 10 (LIT) Reviews covers topics in the United States Medical Licensing Exam (USMLE) Step 2CK examination.

The collection of ten minutes lectures can be used by medical students to supplement their lecture materials. Each video undergoes a peer-review process to ensure accuracy of information.

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“EBV causes typically an asymptomatic infection or can cause acute tonsillitis as a part of bigger infection called infectious mononucleosis also known as glandular fever. EBV typically occurs in adolescents and young adults and is transmitted orally via saliva. This is the reason EBV infections are also known as the kissing disease. Nearly everyone will become infected with EBV at some point, the good thing is for most of us it is asymptomatic. In this videos we will talk about a primary EBV infection which is asymptomatic and how the infection can evolve to be become infectious mononucleosis which is a symptomatic condition.

The pathophysiology of EBV infection begin with saliva transmission and the EBV virus targeting the tonsils which is a lymphoid tissue made up of T cells and B cells. In the tonsil the EBV target B cells and tonsillar epithelial cells. This is called the EBV primary infection and is usually asymptomatic. Once EBV infects the B cells the EBV has an Incubation period of about 2-6 weeks. During the incubation period a number of things happen:

EBV replicates in B-cell and the virus is shed intermittently into pharyngeal secretions, particularly saliva. Saliva is therefore how EBV is transmitted between people.

The cycle can continue and the person can be completely asymptomatic of course during this incubation and reactivation time the immune system will respond.

EBV Induces an immune response where by b cells capture an antigen of EBV and processes it, The b-cells can mount an immune response locally in the tonsils and the B cells enter circulation and mount an immune response in the lymph node, spleen and liver. Here the B cells stimulate CD8 T cell activity. CD8 t cells also known as cytotoxic t cells are important in the suppression of primary EBV infection. On a side note the CD8+ are thought to be the important players in preventing EBV reactivation and EBV associated lymphoproliferative disease. The B cells also activate CD4+ T cells through costimulation, which means the B cells also become activated. Activated B cells become plasma cells. The plasma cells are the antibody producing cells. The plasma cells will produce EBV specific antibodies which mean antibodies against components of the EBV – firstly the viral capsid antigen with IgM followed by the viral capsid antigen with igG. Plasma cells then eventually produce epstein Barr nuclear antigen igG once infection is resolved. The activation of other immune cells in the lymph nodes, spleen and liver is part of the immune response against EBV.

During the incubation period the EBV can also enter circulation. Here the immune cells in the blood will try to destroy them and also mount an immune response releasing cytokines. This interaction is one of the reasons why people in EBV infection become febrile and feel miserable.

During the incubation period the abnormal infiltrated B cells produce heterophile antibodies which is an important and quick marker for diagnosing EBV”

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#TheTraumasOfTrenchWarfare
A million British soldiers died in World War One, and double that amount came home injured. For many of those lucky enough to return, the wounds they had suffered in Europe would leave them permanently disfigured.
The trenches protected the bodies of soldiers, but in doing so it left their heads vulnerable to enemy fire. Soldiers would frequently stick their heads up above the trenches, exposing them to all manner of weapons.
At the start of the war, little consideration was given to the trauma of facial injuries. It came as something of a surprise that so many victims survived to the point of treatment. Escaping the war with your life was seen as reward enough. The advent of plastic surgery would radically change that perception.

The biggest killer on the battlefield and the cause of many facial injuries was shrapnel. Unlike the straight-line wounds inflicted by bullets, the twisted metal shards produced from a shrapnel blast could rip a face-off.
Not only that, but the shrapnel’s shape would often drag clothing and dirt into the wound. Improved medical care meant that more injured soldiers could be kept alive, but urgently dealing with such devastating injuries was a new challenge.

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Why World War I’s wounded needed a sculptor.

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World War I’s horrors not only resulted in death, but severe disfigurement. When plastic surgeons were unable to heal the wounded, a unique solution came in play: sculpting.
Facial prostheses in World War I were a new solution to a difficult problem, and sculptor and writer Anna Coleman Ladd led these efforts for the American Red Cross in France. She made more than 150 masks for the wounded in an effort to provide some semblance of normalcy after their severe injuries.

These masks were made by making casts of the wounded faces, and then sculpting restored faces from that. Those sculptures were then used as a cast for thin copper-plated attachments, which were then attached to the wounded soldier’s face and painted. Though the process wasn’t restorative, it did provide some comfort to the wounded.

That experience shaped Anna Coleman Ladd’s art as well. When she returned to America, she was willing to depict the horrors of war in her War Memorial, as well as the possibility for a new and better day ahead.

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Check out our new website, http://www.evanshealthlab.com/
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Dr. Mike Evans is founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael’s Hospital.

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©2014 Michael Evans and Reframe Health Films Inc.

Severe Lower Back Pain Gone After 1 Adjustment At Advanced Chiropractic Relief by Your Houston Chiropractor Dr. Gregory Johnson of Advanced Chiropractic Relief LLC in Houston Texas. This patient drove 3 hours to Houston from Waco Texas because he had not gotten any relief from other healthcare providers, MD’s and DC’s alike. Dr Johnson Provides His Patients with Personalized examinations, UNIQUE, safe and effective Chiropractic Adjustments, Therapeutic Exercises, Manual Therapy, BioPhysics Adjustments, Full Spine Manual Spinal Decompression,”Ring Dinger” to give people the ultimate experience in Chiropractic Care, Please call (281) 405-2611 or visit us online at http://advancedhoustonchiropractor.com/ for an appointment. There is a reason we’re called Advanced Chiropractic Relief LLC so find out for yourself why so many people are choosing Your Houston Chiropractor Dr. Gregory Johnson at Advanced Chiropractic Relief LLC located at 363 N Sam Houston Pkwy E Suite 1060 Houston Texas 77060. We look forward to helping you with your Chiropractic needs at Advanced Chiropractic Relief in Houston Texas. We’ll see y’all soon!!!

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Next time your little one strikes a fever it doesn’t mean you need to get overheated. There are a handful of things to remember to help you keep a cool head. First, it’s not considered a fever until the temperature tops 100.4.

“We like to know about fevers over the 100.4 mark. Anything above the 103.5 — 104 range can be associated with significant infections,” says Dr. Nancy Witham, pediatrician with Lee Memorial Health System.

Secondly, fever is a healthy response for the body.

“People always assume the fever itself may be part of the sickness, but a fever is oftentimes what your body is doing to help you fight off an infection,” says Dr. Witham.

Third on our list is to treat the symptoms, not the number. Instead of focusing on the thermometer’s fluctuations, pay attention to what’s making your child feel bad.

“You’re giving your fever reducer not so much to bring down the fever. It’ll do that hopefully, but it is also going to make them feel a little bit more comfortable. Maybe make them a little bit more likely to drink the juice you think they need,” says Dr. Witham.

Fourth up – in babies use a rectal temperature. A rectal thermometer gives true core temperature whereas forehead and ear thermometers aren’t nearly as accurate.

And finally, keep your doctor updated. And tell them about symptoms that might be a sign of something more serious.

“We would like to know where you’ve taken your temperature and what you’ve gotten, what you’re noticing as a parent. Your child is lying around even after the anti fever medicine and has that stiff neck. You might also want to notice any skin rashes; that can be very important,” says Dr. Witham.

Another important point, is to stay calm, most fevers subside in a matter of days.

View More Health Matters video segments at leememorial.org/healthmatters/

Lee Memorial Health System in Fort Myers, FL is the largest network of medical care facilities in Southwest Florida and is highly respected for its expertise, innovation and quality of care. For nearly a century, we’ve been providing our community with everything from primary care treatment to highly specialized care services and robotic assisted surgeries.

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