This document provides an overview of evaluating patients presenting with dizziness or vertigo. It discusses classifying vertigo based on duration, whether it is central or peripheral in origin, and non-vestibular causes. A thorough history and physical exam including neurologic and vestibular testing is outlined. Key diagnostic tests like Dix-Hallpike, caloric testing, and VEMP are described. Common causes of vertigo like BPPV, vestibular neuronitis, and Meniere's disease are highlighted based on presenting symptoms, exam findings, and test results.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
3. Introduction
• Dysequilibrium, unsteadiness, vertigo, and
lightheadedness
• Vertigo is an illusory sense of motion
– Internal feeling
– Objects in the surroundings are moving or tilting
– Sense of motion
• Rotatory
• Linear
• Change in orientation relative to the vertical
3
4. Introduction
• 9th Most common symptom
• Significant sorting problem
• Patients prefer a "symptom" oriented setting to a
"cause" oriented setting
• Causes
– Otologic (40-50%)
– Neurologic (10-30%)
– General medical (10-30%)
– Psychiatric/undiagnosed (15-50%)
4
14. Evaluation - history
• Define
– patient's dizziness - Vertigo, Impulsion, lightheaded, oscillopsia, ataxia, confusion.
• Timing
– (BPPV-seconds, TIA-minutes, meniere’s -hours, Vestibular Neuronitis-Days, ototoxicity-
years)
• Associations
– head motion or change in head position, hearing disturbance, headache, cognitive
symptoms, relation to stress.
• Review of systems
– especially vascular risk factors and ear surgery.
• Family History
– Similar disorder ? Migraine
• Medication History
– present and past exposures to ototoxins, antihypertensives.
• Previous studies
14
15. Topographical
Symptom Site of lesion
Tinnitus, hearing loss Peripheral (labyrinth / 8th CN)
Ear fullness, Tinnitus, hearing
loss
Labyrinthine
5th,6th,7th CN CP angle
EAC vesicles 7th , 8th neuritis
Diplopia, 3rd,4th,6th , facial
numbness, difficulty swallowig,
choking
Brainstem
Uni / bilateral numbness,
weakness, ataxia, long tract,
hemianopia
Cerebral hemisphere
15
24. Examination
• Cerebellar Tests
– Ataxia, atonia, and asthenia
– Intention tremor (tremor that increases on activity)
– Dyssynergia (incoordination)
– Dysmetria (overshooting or undershooting)
– Dysrhythmia (inability to repeat a rhythmic tap)
– Dysdiadochokinesis (difficulty with rapid alternating
movements)
– Dysarthria (staccato or scanning speech)
24
25. Examination
• Oculomotor examination
– Spontaneous nystagmus
• unilateral vestibular hypofunction +
• head is still, dampened by visual fixation
• increased or only becomes apparent when fixation is
eliminated
• Slow phase
– Alexander’s law
– Grading nysagmus
25
26. Examination
• Vestibular
examination
– Specific T
• Dix Hallpike T
• Fistula T
– Non Specific Test
• ENG
• Rotation T
– Otolith Function T
• Ocular counterrolling
• Parallel swing T
• Axis rotation T
– Whiplash T
• Passive neck torsion T
• Static Neck Torsion
– Vestibulospinal T
• Rhombergs T
• Untenberger T
• craniocorpography
• Posturography
• VEMP
– Others
• Caloric T
• Head shaking T
• Hyperventillation
26
27. Examination
• Dix hallpike T or Nylén-Bárány sign
– Procedure
• Head 45° turned
• Lowered & hyperextended -30 sec
– Rt Dix Hallpike
• Rt PSCC - Upbeat ,Torsional,
• Lt SSCC - Downbeat Torsional
– Lat SCC – modified T
• Geotropic, Ageotropic
27
28. Examination
• Nystamus
– Latency 5-10 s
– Max 1 minute
– Severe vertigo
– Fatigues rapidly
– Fatiguability
• A positive dix-hallpike maneuver has a 50-80 percent sensitivity
• Contra indications
– carotid stenosis
– vertebrobasilar vascular disease
– cervical spine disease
– spinal injury
– cardiovascular disease or cardiac dysrhythmia
28
29. Examination
• Fistula T
– Procedure
• Politzer bag
• Siegle otoscope
• Digital pressure
• Impedance bridge
– Bony fistula in a Lat semicircular canal
– Vestibulofibrosis
• Hennebert's sign - +ve in > 25% of Ménière's patients
– Perilymph fistula of the oval or round window
29
30. Caloric T
• Robert Barany in 1906
• Nobel prize 1914
• Mechanism
– Barany
• Convective flow
– Coats and Smith
• direct effect of temperature on hair cells or vestibular-nerve
afferents
– Scherer and Clarke
• thermal expansion of labyrinthine fluids will result in a
maintained cupular displacement
30
31. Caloric T
• Tests
– Fitzgerald hallpike Alternate binaural, bithermal T
– Air Caloric T
– Kobrak’s T
– Dunda’s T
• Fitzgerald hallpike T
– Testing procedure
• Lat SCC
– closest to EAC
– oriented in the plane of the temperature gradient
31
32. Caloric T
– Head elevated – 30 degree
– Irrigation
• 250 ml, 60 cms high, over 60 sec
• right warm, left warm, right cold, left cold
• COWS – 2-3 mins
• 10 mins - between successive irrigations
– Results
• Jonkees, Maas & philipzoon Formula
– Canal paresis
– Directional preponderance
• Significant
– UW of greater than 20%
– DP of greater than 25%
32
33. Caloric T
• Air caloric T
• Kobrak’s T
• Dundas Grant cold air Caloric T
– Ethylene chloride sprayed
– Cloth wrapped Coiled copper tube
– Air blown through coil
33
35. Examination
• Rhomberg’s T
– Sensory From cerebellar
– Sway > 10 cms
• Craniocorpography
– Crude Test
– Dark room
– Stepping T
– Rhomberg’s T
35
36. Examination
• Cervicogenic Vertigo
– Vascular theory
– Neurosensory theory
• Whiplash T
– Passive neck torsion T
• Head mobile
– Static Neck Torsion
• Body mobile
36
38. ENG
• Saccade T
• Tracking T
• Optokinetic T
• Gaze T
• Positional T
• Caloric T
38
39. ENG
• Gaze T
– N – end point nystagmus > 40 degree
– Vertical N – CNS pathology
– Horizontal N
• BL , equal – CNS
• BL , unequal – CNS
• Unilateral - peripheral
39
40. VNG
• Method of oculography
• Frenzel glasses with VNG apparatus
• Video recording
– Torsional movt
– No artefacts as in ENG
40
41. ENG Vs VNG
• ENG
– 50 – 1000 Hz recordable
– Eyes closed / open
– Artefacts +
– Torsional Nyst -
– Calibration difficult
– Cheap
• VNG
– 60 Hz only
– Eyes open
– No Artefacts
– Torsional Nyst +
– Calibration easy
– Expensive
41
42. Rotatory Chair
• Principle
• Testing procedures
• Indications
– Bilateral canal paresis
– Inconclusive/equivocal
ENG reults
– Testing of special
populations (pediatric,
handicapped)
– Evaluation of vestibular
compensation
– Ototoxicity management
42
43. Posturography
• Nasher & Black
– Sensory organisation
– Motor coordination
• Procedure
– Sensory organisation chart
– Motor coordination T
• Sudden movement
• emg of gastrocnemius
43
47. BPPV
• Vertigo without auditory symptoms
• Severe vertigo < 1 min
• Triggerred by head movt
• Latent period after head movement
• Dix hallpike is confirmatory
• ENG
47
48. Vestibular neuronitis
• Vertigo without auditory symptoms
• Lasts for > 24 hrs
• h/o preceding URTI
• Unilateral
• Caloric T - Canal paresis
48
49. Meniere’s disease
• Episodic vertigo with fluctuant hearing loss
• Vertigo lasting upto 20 min
• Tinnitus with aural fullness
• Electrocochleography
• Glycerol dehydration T
49