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Sarcoidosis | Pathology | Immunology | Med Vids made simple - Duration: 10:44.

Hi, hello and welcome back to one of the most must-see YouTube channel

for all the Medical students across the globe ,Med Vids made simple

In this video, we're going to see about sarcoidosis

Let's begin!

Before watching this video,

if you haven't subscribed to my channel

already, please press the subscribe

button and the bell icon nearby to get notified as soon as I upload a new video!

So sarcoidosis it's a disease of unknown etiology

which means the cause of the disease is not exactly known.

And there is multi organ involvement in sarcoidosis.

which means various organs are involved in the patients of sarcoidosis.

So this picture is taken from Wikimedia.

This shows the common involvements in sarcoidosis

the patient can have organ involvement starting from head to toe anywhere and everywhere

for example here you can see in this patient there are brain complications

which is marked in the top

and there are few skin lesions which are marked in the legs

such as a erythema nodosum so there can be symptoms and signs anywhere in the body

the most commonly involved organ in sarcoidosis is lungs

which will lead to development of granulomas

and finally development of nodules so

let's see about individual things one by one and we'll get a clearer area of sarcoidosis.

So sarcoidosis is a systemic granulomatous disease which means

there will be formation of granulomas in

multiple organs in the body. Now what is granuloma? Granuloma is one of a

manifestation of chronic inflammation

This type of granuloma is non-caseating

so there are many diseases in which the formation of granulomas along with caseous necrosis

But in this condition in sarcoidosis the granulomas are non-caseating

which means there'll be granulomas but there won't be caseous necrosis

now this is a microscopic picture of granuloma

as you can see here there are multiple cells over here which looks like epithelium dispersed throughout the slide

they're actually activated macrophages which are known as epithelioid cells

and you can see a big cell with multiple nucleus at about 10 o clock position

that is a multinucleated giant cell

so these are the main features of granulomas

so how do the patients present in case of sarcoidosis

most commonly the patients are asymptomatic

they come to be diagnosed with sarcoidosis mostly by a chest x-ray

which has been done for some other cause

and on chest x-ray we can find nodular...

presence of nodules on the lungs or we

can see hilar lymphadenopathy so they

can also present with respiratory symptoms because of lung involvement

and erythema nodosum and arthralgia which are skin and joint involvements

are common in many patients

ocular symptoms such as uveitis which

can lead to pain, blurring of vision and

all that can occur in these patients

skin involvement is also common.

Superficial lymphadenopathy which means enlargement of the lymph nodes around the neck is also common

and there can also be other some other symptoms or other signs

such as elevated calcium levels in the blood which is called as hypercalcemia

and there can be hepatomegaly which is enlargement of the liver

and splenomegaly which is enlargement of the spleen

So now let us see the pathogenesis of sarcoidosis

Pathogenesis of sarcoidosis is not clearly known as I told you earlier

it is a disease of unknown etiology but it has been thought that there is the cause of sarcoidosis

is due to immune dysregulation in few genetically predisposed individuals

so in few people who are genetically predisposed

there is some sort of immune dysregulation

which will lead to increased CD4 positive T helper cell activity

okay so this activity of the CD4 positive T helper cells increases and they start to produce

lot of cytokines such as IL-2, interferon gamma, interleukin 8, tumor necrosis factor etc.,

all these are pro-inflammatory

and they increase the inflammation leading to the development of granulomas

so what happens is there will be multiple granulomas formation over

organs such as lungs liver spleen etc

and all these granules coalesce together to form consolidation and the consolidation

enlarges to form nodules which are about one to two centimeter in size and they are palpable

so the nodules are most commonly seen in lungs liver and spleen of patients of sarcoidosis

The most common finding in about 90% of the cases of sarcoidosis is bilateral hilar lymphadenopathy

which means lymphadenopathy or disease or enlargement of the lymph nodes which

are present around the lungs so this is the most common finding in about 90% of the patients of sarcoidosis

so this is the gross appearance or gross picture of bilateral hilar lymphadenopathy

As you can see here the hilar lymph nodes are so much enlarged in this picture

This is one of the most common finding in sarcoidosis.

So the nodules as I told you earlier is

formed by consolidation of various granulomas

The granulomas which are present at nearby sites join together or coalesce together to form

a consolidation and that will join together to form nodules

The nodules are most commonly seen in lungs, spleen and liver.

As a result of that slowly the liver begins to enlarge in size leading to development of hepatomegaly

the spleen also enlarge in size which is also known as splenomegaly

Skin lesions are very common, say, very very common in the patients of sarcoidosis

Various types of lesions can occur in the skin of these patients

they can be erythematous plaques which are red lesions present on the skin or they can

be various other types of skin lesions in these patients

which can be one of the factor which brings the patient to the doctor

the most common skin lesion which is found as a patients of sarcoidosis is erythema nodosum

Erythema nodosum is actually not a disease of

skin per se, not the upper layers of the skin

It is the inflammation of the subcutaneous tissue which is present under the skin

which should lead to a presentation of somewhat like this

you can see red lesions on the skin

if you palpate them, you can actually feel the raised surface around normal skin surface

This is the common presentation of sarcoidosis

Eye involvement is also very common in these patients

The most common association of sarcoidosis in relation to eye is

something known as uveitis which is

inflammation of the uvea which is the vascular coat present inside the eye

The uvea includes three divisions such as

Iris, ciliary body and choroid. All this

individually or together can be inflamed

leading to conditions such as iritis, iridocyclitis, etc.,

On long-standing cases there can be corneal opacity

glaucoma and all these worsens to develop total vision loss

Vision of the patient can be affected so severely

Lacrimation is also suppressed in these patients because

we all know that lacrimation is production of tears from the lacrimal gland

so what can happen is sarcoidosis can affect lacrimal glands also

there can be granuloma formation in sarcoidosis

which can affect its function so tears production can be affected

This can lead to decreased lacrimation in these patients

Musculoskeletal system is also involved in few patients.

There can be muscle weakness, tenderness and fatigue of the muscles.

This can be brought out in patients.. in few patients of sarcoidosis

In most of the cases, this is not the presenting complaint in most of the patients

if you're gonna see they're gonna present with respiratory symptoms, skin lesions or eye problems

but this is not one of the major complaint. You need to ask history regarding this to bring this out to light

Okay? So this is accompanied by arthralgia which is pain of the joints

It can involve bones also.

Most commonly involved bones are the bones which are present in the phalanges

the phalanges of hands and the phalanges of feet

Now let's see about the treatment of sarcoidosis.

In mild cases if there is acute attack of say erythema nodosum or some other complications

we can treat that with NSAID's and low dose corticosteroids

okay.. So, if there are increased respiratory symptoms such as

which can be due to increased involvement of the lung. We can increase the dose of corticosteroids

Increasing the dose of corticosteroids can help in those cases

but in severe cases you need to treat the patients severely with

drugs such as methotrexate, azathioprine which are immunosuppressants actually

they are anti-cancer drugs okay so these

drugs are associated with increased side effects or let's say adverse drug reactions

such as alopecia which is hair loss and so the treatment of

severe cases can itself lead to various other complications

So if you liked this video, please leave a LIKE

Share this video to your friends and give

your valuable suggestions in the comment section below

You can support me by donating on www.patreon.com/medvidsmadesimple

Don't forget to subscribe to my channel and press the bell icon to get notified

as soon as I upload a new video. Thank you!

For more infomation >> Sarcoidosis | Pathology | Immunology | Med Vids made simple - Duration: 10:44.

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How To Deal With Social Anxiety - 4 Simple Tips To Deal With Social Anxiety - Duration: 5:49.

- So you want to be able to go out into social settings.

You want to be able to go out with your friends.

You want to be able to go to the pub,

out for a meal, to the cinema.

You want to be able to go to the goddam supermarket

but every time you decide to go out the anxiety

inside of you prevents you from wanting to go out.

And as a result you become extremely isolated

and down and depressed.

Hi everybody.

In this quick video I'm gonna share with you

how to deal with social anxiety.

My name is Stephen Boylan.

I'm the founder of Natrui.

So to begin with the very first thing that you need

to do and need to know about if you want to be able

to deal with social anxiety is you need to know exactly

what maintains and keeps social anxiety going.

And that very thing is what we call

safety seeking behaviours.

So what is a safety seeking behaviour?

A safety seeking behaviour is something

that you do to seek safety.

It's something that you do to make yourself

feel less anxious.

So for example a prime safety seeking behaviour

when it comes to social anxiety is avoidance

so you avoid the social settings.

And the more that you avoid them

the anxiety reduces when you avoid them.

Therefore what your brain and you technically learn

is that that is the best way to deal with social anxiety

so you continue to avoid the social settings.

And the more you do it the better you get at it.

Even though it doesn't serve you in the long-term

you can become extremely isolated, down and depressed

where in the short-term you feel safe

and, therefore, you continue to do it.

So ultimately the only way to deal with social anxiety

is to face the social settings that you were avoiding.

So what I'm going to do now is share with you

four simple really steps that you can use

to deal with social anxiety.

So the first tip that I have for you, you need

to grab a piece of paper and then what you need

to do is list out all the social settings

that you are currently avoiding because of the anxiety.

You then need to rank each one in terms of how much

anxiety that social setting creates for you.

So zero is no anxiety at all and 10 is extreme anxiety.

So you need to rank each one on a scale of naught to ten.

Then the next tip I have for you, you need

to grab another piece of paper and I'll explain

why this tip is important in a minute.

You need to split that piece of paper into three columns.

The first column is what we call before.

The second column is what we call during.

The third column is after.

So you write that at the top before, during, and after.

The next step, the third tip, you need to use

what we call positive self-talk.

You need to tell yourself that you can do this.

You need to tell yourself you are not going to win anxiety.

You need to look yourself in the mirror and you need

to tell yourself that you can do this and that you

are not going to let this anxiety win.

You need to do this all the way through

when you're facing social settings because 80%

of what we achieve in our life is down to our mind.

So you've got to work really hard at telling yourself

that you can do it and believing that you can do it.

And then the final tip, and that's where that column

piece of paper comes back in, before, the during

and after, you need to grab that one and then you need

to start to face each of the social settings.

Before you do it you need to give yourself a rating

of how much anxiety you have before you go

into the social setting.

So you pick the easiest one off the list

that you did in the beginning.

Then you need to rate it when you're in

that social setting and then, and the last one,

you need to rate it after that social setting.

And you need to keep doing it until

them ratings come down at least by half.

When they come down by half you can move

on to the next social setting that creates

the next level of anxiety for you.

And then if you use this process, use these tips,

these tips will help you to deal with social anxiety.

So that's how you deal with social anxiety.

So if you've enjoyed this video don't forget to like it.

Don't forget to ask questions.

I would love to give you more help

in dealing with social anxiety.

You can comment below.

Also, if you liked it, don't forget

to share it with your friends.

And if you've not already subscribed to our channel

don't forget to subscribe to our channel

for even more videos like this on dealing

with mental health and well-being problems.

Thank you for watching this video

and I'll see you in the next one.

For more infomation >> How To Deal With Social Anxiety - 4 Simple Tips To Deal With Social Anxiety - Duration: 5:49.

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Compression 101 | How to Understand Compressors (Made Simple) - Duration: 5:54.

In this video, I'm going to be showing you the simplest way to understand a mixing technique called compression.

Understanding compression overall is one of the ways to get your sounds sounding professionally and

properly mixed into your tracks and allow you to use any compressors that you see out there from the most basic compressors to multiband compressors.

I'm Wilson from CScales, and today you're going to learn the easiest way to understand compression that makes your music sound louder and clearer.

To Start off,

If you haven't watched my video on how to easily understand mixing, check that out first

because this video is going to use some of the basic concepts from that video.

Simply put, compression is just a more advanced way to control one of the three basic mixing movements, which is volume.

Let's define the differences between what compression literally does to the sound and what it's used for in mixing because this can seem confusing at

first. If you look at the sounds through an EQ,

you'll notice the sounds frequency bands. In some sounds sometimes, there are frequencies that are way bigger than the rest of the other frequencies.

What a compressor literally does is lower the volume of these frequencies.

However, when we use a compressor in music,

we're actually making the overall sound louder because when we decrease the volume of the loudest frequencies,

we have to increase the overall volume to compensate for the lost volume from the compression. In other words

what a compressor does is actually boost the lower volume frequencies to match the higher volume frequencies. For this reason

I like to think of a compressor as a tool to shorten the distance between smaller and bigger frequencies,

Instead of a tool that lowers bigger frequencies. So how do we compress a sound? Even though there are many different types of compressors,

they all fundamentally have the same five features which are the threshold, ratio, attack, release and gain. So, how do they work?

Let's relate this to a bullet.

The bullet is a representation of one of the frequencies in a sound and a decibels are the distance the bullet travels in the air.

Let's say you shoot a bullet up in the air. The highest point that it reaches is the volume without any compression.

The atmosphere is zero decibels, the loudest point possible before the sound starts to distort and shatter into more higher

frequencies and becomes impossible to change back.

So generally we don't want to go past this point in compression and mixing in general unless we want to achieve that sort of effect

in a sound. Starting with the threshold, this sets of points where anything louder than this points will have its volume lowered.

I like to think of this as an extra layer of gravity at the

point you choose to set it. When you shoot a bullet past this point,

gravity will push it down even more,

which will lower the bullets distance. How intense the gravity is comes down to the next feature of the compression

which is ratio. Ratio determines how much volume is reduced when a sound goes past a threshold.

So if we shoot our bullet up into our three to one ratio,

gravity will pull our bullets max height down by 1/3

once it hits our threshold. Now

sometimes the gravity becomes so strong that a bullet can't actually get past our threshold and it seems like it's heinous steel wall.

This is a high ratio compression.

which is more commonly called a limiter, which prevents sound from passing a certain volume.

Attack is how fast the compressor gets activated or how fast gravity comes in as soon as the bullet is shot past the threshold.

While release is how fast the compressor turns off or how fast the gravity turns off after the bullet drops down the threshold.

Finally the gain is simply a volume control on the compressor output, which means it's the volume after the compression has been applied.

This is how you compensate for the volume loss during compression and it's like moving the starting position of the gun and a threshold closer

to the atmosphere at zero decibels.

The compression is the same, but it's louder because it's closer to the zero decibels.

Remember again that this bullet is just one of the frequencies of the sound. The compressor acts on every single frequency

that is in the sound. So you really see a bunch of these bullets being compressed differently depending on their volume.

So how do we apply these compression features?

There's two parts of the sound, the transient or the head which is the part of the sound that allows the sound to cut through

the mix, and the tail which is the part of the sound that gives the body and presence.

Compressionn is all about balancing these two parts of the sound to create clarity in both parts of the sound.

Because of this, compression on a kick is completely different from a vocal because their transients and tails are completely different.

I don't want to get into too much

specifics on how to compress every single type of sound, but here are five general compression tips to get you started.

The first tip is that you want to start with a ratio of around three to one and lower the threshold down until the sound

is lowered to about five to ten decibels before adjusting the gain to compensate.

This is typically a good starting range to play with in compression because allows you a middle point to determine whether you should compress some

more or compress less. The second tip is to adjust the release based off of how fast the sound repeats.

If you have a fast repeating sound like a hi-hat, have shorter releases.

This will keep the important transients clear.

If you have a long drawn out

sound like a bass, have a longer release to give it more fullness and sustain on the tail ends of the sound.

The third tip is that if you want to lower the transients in general, set the thresholds to just above the tail with a ratio

of around three to one a low attack. This will compress the transients while leaving the tails untouched. The fourth tip

Is that if you want to lower the tails in general, you want to set the threshold

below the tail with around a three to one ratio and an attack just beyond the transients.

The longer attack is going to have the transients avoid the compression but still have the tails compressed. And finally number five,

Avoid overcompressing the sound.

Overcompression is when you bring the lower sounding frequencies of the sound too high up to the point where it actually interferes with the

other sounds in the track. Your sound should always have the ability to have a full range in dynamics. Ff there are no breaks in

the sound

chances are you're compressing too much and you need to tone the compression down by starting with lowering the threshold and ratio before moving on

to the attack and release. So now I want to hear from you guys. What compression tips are you going to try first?

Are you going to start by lowering your tails for your sound? Are you going to try avoiding over compression?

Let me know in the comments below. Ff you liked this video and want to see more

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