4/ Subsequent studies confirmed this association, with an overall odds ratio (OR) of 4.3 for achilles tendinopathy (tendonitis or rupture) resulting from fluoroquinolone use.
Patients on corticosteroids (OR 9.1) or dialysis (OR 20) are at highest risk.
6/ Before we explore mechanisms, let's review tendon structure.
Tendons are composed of collagen fibers surrounded by extracellular matrix (ECM). Tendon-specific fibroblasts called tenocytes produce the collagen and ECM, supporting a tendon' strength.
12/ Tendons constantly undergo a cycle of stress-strain and repair.
In patients w/ other risk factors (eg ESRD, steroid use), fluoroquinolones hamper tendon repair mechanisms, altering this stress-strain relationship and increasing the risk of rupture.
16/SUMMARY
🦶Fluoroquinolones increase the risk of tendinopathy
🦶Mechanisms include tenocyte toxicity, inflammatory responses, ⬇️ collagen production, and ⬆️ collagen degradation
🦶Aortopathy can occur by a similar mechanism
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I ask teams to focus on efficiency, ⬆️ time for teaching/ discussion
⏳⬇️ transitions b/w patients by alerting next RN
⏳Enter orders on rounds, w/ clearly defined roles as to who will do that
⏳Present from memory (if possible), focusing on critical issues
2️⃣ Education
🧠I ❤️ to teach but avoid overwhelming residents by teaching high yield points on 2-3 patients max. I supplement w/ PM chalk talks after lunch and notes are done
🧠 I also ask each learner to share one learning point from rounds, and do so myself as well
Somehow the liver has the incredible capacity to both heal itself after toxic injury and regrow after resection. No other solid organ in the body can regenerate like this.
2/ It's assumed that the ancient Greeks knew of the liver's unique regenerative capacity, based on the myth of Prometheus (his liver regrew daily after an eagle ate it).
At the same time, scholars have found no other ancient evidence of this knowledge.
2/ Pseudomonas was first isolated in 1882 by the French pharmacist Carle Gessard, after he cultured it from the blue-green pus on bandages of injured soldiers.