Rhinosinusitis is inflammation of the nasal passages and sinuses. The paranasal sinuses are air spaces surrounding the nasal cavity. Common causes include viral or bacterial infection leading to blocked sinus drainage and inflammation. Symptoms include facial pain, pressure, congestion, and mucus discharge. Treatment involves antibiotics, nasal steroids, surgery to improve drainage if symptoms persist long-term. Chronic rhinosinusitis lasts over 12 weeks and may require repeated treatments.
Inflammation of the mucosa of sinuses associated with inflammation of the nasal mucosa is called rhinosinusitis (RS).
CLASSIFICATION:
• Acute RS: Symptoms lasting for less than 4 weeks with complete resolution.
• Subacute RS: Duration 4-12 weeks.
• Chronic RS: Duration ~ 12 weeks.
• Recurrent RS: Four or more episodes of RS per year; each lasting for 7-10 days or more with complete resolution in between the episodes.
• Nasal obstruction.
• Nasal discharge/congestion, anterior, or posterior in the form of postnasal drip.
• Facial pain or pressure.
• Alteration in the sense of smell, hyposmia or anosmia.
• Other symptoms include cough, fever, halitosis, fatigue, dental pain, pharyngitis, headache or ear fullness.
Presented by Subhangi Shukla on topic diseases of nasal passage .
5 Diseases are here discussed and effect of covid on nasal passage with introduction of black fungus.
Pleases Follow, like and comment if you like PPT
Define allergic rhinitis
Pathophysiology of allergic rhinitis
Signs/symptoms of allergic rhinitis
Diagnosis
Investigations
Complications
Treatment
Non allergic rhinitis
Pathogenesis
Signs/symptoms
Treatment
“It is an IgE-mediated immunologic response of nasal mucosa to airborne allergens and is characterized by watery
nasal discharge, nasal obstruction, sneezing and itching
in the nose. This may also be associated with symptoms
of itching in the eyes, palate and pharynx”
. Two clinical types have been recognized:
1. Seasonal. Symptoms appear in or around a particular
season when the pollens of a particular plant, to whic
the patient is sensitive, are present in the air.
2. Perennial. Symptoms are present throughout the year
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
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.
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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. • Inflammation of the mucous membrane of
nose and paranasal sinuses
• since the nasal cavity & sinuses have the same
MM, so any pathological changes affecting the
nasal mucosa can spread to the paranasal
sinuses.
3. • The paranasal sinuses are a group of air containing
spaces that surround the nasal cavity
• Each sinus is name for the bone in which it is located:
Maxillary (one sinus located in each cheek)
Ethmoid (approximately 6-12 small sinuses per side,
located between the eyes)
Frontal (one sinus per side, located in the forehead)
Sphenoid (one sinus per side, located behind the
ethmoid sinuses, near the middle of the skull)
4. • The ethmoid and
maxillary sinuses are
present at birth.
• The frontal & sphenoid
sinuses are not … they will
develop later
7. Sinuses have small orifices (ostia) which open into recesses
(meati) of the nasal cavities.
• Meati are covered by turbinates (conchae).
• Turbinates consist of bony shelves surrounded by erectile soft
tissue.
• There are 3 turbinates and 3 meati in each nasal cavity
(superior, middle, and inferior).
The drainage of the sinuses
• Frontal, maxillary, anterior ethmiod middle meatus
• Posterior ethmoid superior meatus
• Sphenoid sphenoethmoidal recess
8.
9.
10.
11. • Solid facial skeletal elements surrounding the nose are invaded
by respiratory mucosa and subsequently pneumatized.
• Begins in 3rd- 4th month of fetal life and further development
takes place after birth
• The Ethmoid sinuses are present at birth, reach adult size by
age 12.
• The Maxillary present at birth.
• Frontal sinus rarely present at birth; usually not visible until
age 2, great variability in size; congenitally absent in 5%
• Sphenoid sinuses are rarely present at birth, usually seen
around age 4.
12. 1. Sinuses are normally sterile, but their proximity to
nasopharyngeal flora allows bacterial and viral
inoculation following rhinitis.
2. Diseases that obstruct drainage can result in a
reduced ability of the paranasal sinuses to function
normally. The sinus ostia become occluded, leading to
mucosal congestion.
3. The mucociliary transport system becomes
impaired, leading to stagnation of secretions and
epithelial damage, followed by decreased oxygen
tension and subsequent bacterial growth.
13. Why pain ??
Air trapped within a blocked sinus, along with pus or
other secretions may cause pressure on the sinus wall that
can cause the intense pain of a sinus attack.
14. • Acute Rhinosinusitis … up to 4 weeks
• Sub acute Rhinosinusitis … 4 to 12 weeks
• Chronic Rhinosinusitis .. > 12 weeks
• Recurrent acute Rhinosinusitis
15. o It is an inflammatory condition of one or more
of the para-nasal cavities
o Lasts up to 4 weeks
o Can range from acute viral rhinitis (common
cold) to acute bacterial rhino-sinusitis
16. • lasts 4-12 weeks
• Sub-acute rhino-sinusitis usually involves one
or two pairs of the paranasal cavities.
17. • It is the inflammatory and infection that
concurrently affects the nose and para-nasal
sinuses
• Lasts for longer than 12 weeks
18. • 4 or more recurrences of acute disease within a 12-
month period,
• With resolution of symptoms between each episode
lasts greater than 2 months .
• In most cases, each episode lasts for at least 7 days
19. • URTI
• Cold weather
• Day care attendance
• Smoking in the home
• Anatomic abnormalities (nasal polyps, ciliary disorder, septal deviation,
concha bullosa, turbinate hypertrophy, tumors, congenital abnormalities i.e.
cleft palate)
• Immunesupressed
• Direct extension: dental infection, facial fractures
• Inflammatory disorder:
– Wegener's Granulomatosis
– Sarcoidosis
• Mucosal disorder
– CF
– Allergic Rhinitis and other hyperreactivity
– Samter syndrome
• Asthma
• Nasal Polyps
• Aspirin intolerance .
22. Definition
• Hypersensitivity of the nasal mucosa due to
exposure to allergens
• Acute & seasonal or
• chronic & perennial
23. What happens in allergic rhinitis?
1. Exposure to allergen
2. IgE production by the body
3. Formation of allergen IgE complex
4. Binding of the complex to mast cells
5. Degranulation of the mast cells and release of
inflamatory mediators including histamine.
6. Vasodilation
7. Increase in capillary permability.
24. Clinical features
Symptoms:
Nasal obstruction with sneezing
Clear rhinorrhea (containing increased eosinophils)
Itching of eyes with tearing
Frontal headache and pressure
Signs:
Mucosa edematous, pale or violet in color
Allergic salute transverse nasal skin crease from
rubbing the nose
28. Types
2 Types:
• Seasonal (summer, spring, early autumn)
– Tree pollens, grass pollens, mold spores
– Lasts several weeks
– Disappears and recurs following year at the same time
• Perennial
– Inhaled: house dust, wool, feathers, foods, tobacco, hair
– Ingested: wheat, eggs, milk, nuts
occurs intermittently for years with no pattern or may be
constantly present
29. Complications
• Chronic sinusitis
• Polyps (swollen edematous nasal mucosal
tissue, they can cause complete nasal
obstruction)
• Serous otitis media
30. Diagnosis
• History (atopy & family history)
• Physical examination:
1. Redness ,swelling of the mucosa (particularly
the turbinates) & mucoid discharge.
2. Check for structural anomalies (septal deviation
or nasl polyps).
• Sensitivity test for specific allergen (skin prick tests)
31. Treatment
1. Identification and avoidance of allergen
2. During the acute attack:
1. Antihistamine (systemic or intranasal)
2. Local steroids
3. Decongestant (ephedrine)
3. Sodium cromoglycate (mast cell stabilizer used as
prophyaxis)
4. Desensitization (we keep exposing the body to gradually
increased amounts of allergen until the body fails to produce
IgE as a result to exposure).
34. Definition
• Very common
• Non-inflammatory, non-allergic rhinitis
• Characterized by a combination of symptoms that
includes nasal obstruction and rhinorrhea
• Vasomotor rhinitis is a diagnosis of exclusion reached
after taking a careful history, performing a physical
examination, and, in select cases, testing the patient with
known allergens
• 2 types ; eosinophilic & non-eosinophilic (according to
the number of eosinophils found in the nasal secretion)
42. Clinical features
Sudden onset of :
• Facial pain or pressure
• Nasal blockage & or nasal discharge/ posterior nasal drip
• Hyposmia
Signs more suggestive of a bacterial etiology:
• Erythematus nasal mucosa
• Mucopurulent discharge
• Pus originating from middle meatus
• Presence of nasal polyps of a deviated septum
Acute viral rhinsinusitis lasts < 10 days.
43. Diagnosis
• History & PE
• Anterior rhinoscopy
• X-ray/ CT scan not recomnded unless
complications are suspected
44. Management
• Symptoms relieved within 5 days symptomatic
relief and expectant management
• Moderate symptoms that worsen or persist
beyond 5 days intranasal corticosteroid spray
• Severe symptoms that worsen or persist beyond 5
days and refractory to intranasal corticosteroid
Clarythromycin, INCS , referral to specialist
• Surgery if medical treatment fails
50. Treatment
• Antibiotics for 3 to 6 weeks for infectious etiology
– Augmented penicillin (Clavulin™)
– Macrolide (clarithromycin)
– Fluoroquinolone (levofloxacin)
– Clindamycin, FlagyjTM
• Topical nasal steroid, saline spray
• Surgery if medical therapy fails or fungal sinusitis
• Surgical Treatment
– Removal of all diseased soft tissue and bone
– Post-op drainage
– Obliteration of pre-existing sinus cavity
• FESS: functional endoscopic sinus surgery
51. • Benign to potentially fatal
• The incidence of complications from both acute and
chronic rhinosinusitis has decreased as a result of the
use of antibiotics.
• Complications can be divided into 3 categories:
– Orbital
– Intracranial
– Bony
Complications
52. Orbital complications
• Most commonly involved in complicated sinusitis.
• Orbital extension is usually the result of ethmoid
sinusitis.
• Children are more prone to orbital complications,
probably secondary to high incidence of URI and
sinusitis.
53. IC complications
• Uncommon but devastating.
• 2 major mechanism:
– Direct extension.
– Retrograde thrombophlebitis via valveless
diploe veins.
* Frontal sinus is rich in diploe veins
especially during adolescence