Presentacion sobre las principales características sobre la fisiopatología, manifestaciones clinicas, diagnostico, tratamiento y complicaciones de la otitis externa
Cellulitis is a spreading infection of subcutaneous &Fascial planes
Oedema gives rise to soft pitting, while if pus is present ,induration can always be felt
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. introduction
• Otitis externa (OE) is an inflammation or
infection of external auditory canal (EAC),
the auricle or both.
• It is a common disease that can be found in
all age groups
• OE usually represents an acute bacterial
infection of the skin of the ear canal but can
also be caused by other bacteria, viruses, or
a fungal infection.
3. •Several factors can contribute to EAC
infection and the development of OE,
including the following:
•Absence of cerumen
•High humidity
•Retained water in ear canal
•Increased temperature
•Local trauma (eg, use of cotton swabs or
hearing aids)
4. • Aquatic athletes are particularly prone to the
development of OE because repeated exposure to water
results in removal of cerumen and drying of the EAC.
• Retained water in the ear canal can cause maceration of
the skin and a milieu conducive to bacterial or fungal
proliferation.
• OE occurs more often in the summer months, when
swimming is more common, and it is also common in
tropical areas.
• Individuals with allergic conditions (eg, eczema, allergic
rhinitis, and asthma) are also at significantly higher risk for
OE
5. Classification
OE may be classified as follows:
•Acute diffuse OE
•Acute localized OE
•Chronic OE
•Eczematous (eczematoid) OE
•Necrotizing (malignant) OE
•Otomycosis
6. Acute diffuse OE
• This is the most common form of OE, typically seen
in swimmers;
• it is characterized by rapid onset (generally within
48 hours) and symptoms of EAC inflammation (e.g,
otalgia, itching, or fullness, with or without hearing
loss or jaw pain) as well as:
• tenderness of the tragus or pinna or diffuse ear edema
or erythema or both, with or without otorrhea,
• regional lymphadenitis,
• tympanic membrane erythema, or
• cellulitis of the pinna
7.
8. Acute localized OE
•This condition, also
known as furunculosis, is
associated with
infection of a hair follicle
9. Chronic OE
•This is the same as
acute diffuse OE
but is of longer
duration (>6 weeks)
10. Eczematous (eczematoid) OE
•This encompasses various
dermatologic conditions (eg,
atopic dermatitis, psoriasis,
systemic lupus erythematosus,
and eczema) that may infect the
EAC and cause OE
11. Necrotizing (malignant) OE
• This is an infection that extends into the
deeper tissues adjacent to the EAC;
• it primarily occurs in adult patients who are
immunocompromised (eg, as a result of
diabetes mellitus or AIDS) and is rarely
described in children;
• it may result in cases of cellulitis and
osteomyelitis
13. Pathophysiology
• OE is a superficial infection of the skin in the EAC.
• The processes involved in the development of OE
can be divided into the following 4 categories:
• Obstruction (eg, cerumen buildup, surfer’s exostosis, or
a narrow or tortuous canal), resulting in water retention
• Absence of cerumen, which may occur as a result of
repeated water exposure or overcleaning the ear
canal
• Trauma
• Alteration of the pH of the ear canal
14. • If moisture is trapped in the EAC, it may cause
maceration of the skin and provide a good
breeding ground for bacteria.
• This may occur after swimming (especially in
contaminated water) or bathing—hence the
common lay term “swimmer’s ear.”
• It may also occur in hot humid weather.
• Obstruction of the EAC by excessive cerumen,
debris, surfer’s exostosis, or a narrow and tortuous
canal may also lead to infection by means of
moisture retention.
15. • Trauma to the EAC allows invasion of bacteria into
the damaged skin.
• This often occurs after attempts at cleaning the ear
with a cotton swab, paper clip, or any other utensil
that can fit into the ear.
• Once infection is established, an inflammatory
response occurs with skin edema.
• Exudate and pus often appear in the EAC as well.
• If severe, the infection may spread and cause a
cellulitis of the face or neck.
16. Etiology
• OE is most often caused by a bacterial pathogen;
other varieties include fungal OE (otomycosis) and
eczematoid (psoriatic) OE.
• The most common causative bacteria are:
• Pseudomonas species (38% of all cases),
• Staphylococcus species,
• Anaerobes,
• gram-negative organisms.
17. •Fungal OE may result from
overtreatment with topical
antibiotics or may arise de novo from
moisture trapped in the EAC.
•It is caused by Aspergillus 80-90% of
the time;
•Candida and other organisms have
also been isolated.
18. •Eczematoid (psoriatic) OE is
associated with the following
conditions:
•Eczema
•Seborrhea
•Neurodermatitis
•Contact dermatitis from earrings or
hearing aid use
•Sensitivity to topical medications
19. • Necrotizing OE occurs in patients who are
immunocompromised and represents a true
osteomyelitis of the temporal bone.
• Risk factors for OE include the following:
• Previous episodes of OE
• Swimming, diving, or participating in aquatic activities
• Use of earplugs or probing of the EAC
• Hot, humid weather
• Use of a hearing aid
• Coexistence of eczema, allergic rhinitis, or asthma
• Comorbidities such as diabetes mellitus, AIDS,
leukopenia, or malnutrition
20. Epidemiology
• Although the infection can affect all age groups,
OE appears to be most prevalent in the older
pediatric and young adult population, with a peak
incidence in children aged 7-12 years
• OE affects both sexes equally.
• No racial predilection has been established,
though people in some racial groups have small
ear canals, which may predispose them to
obstruction and infection.
21. History
Patients with otitis externa (OE) may complain of the
following:
• Otalgia, ranging from mild to severe, typically progressing
over 1-2 days
• Hearing loss
• Ear fullness or pressure
• Tinnitus
• Fever (occasionally)
• Itching (especially in fungal OE or chronic OE)
22. • Severe deep pain – If this is experienced by a patient
who is immunocompromised or diabetic, be alerted to
the possibility of necrotizing (malignant) OE
• Discharge – Initially, the discharge may be clear and
odorless, but it quickly becomes purulent and foul-
smelling
• Bilateral symptoms (rare)
• Frequently, a history of exposure to or activities in
water (e.g, swimming, surfing, and kayaking)
• Usually, a history of preceding ear trauma (e.g,
forceful ear cleaning, use of cotton swabs, or water in
the ear canal)
23. Physical Examination
• The key physical finding of OE is pain
upon palpation of the tragus (anterior
to ear canal) or application of traction
to the pinna (the hallmark of OE).
• Examination reveals erythema, edema,
and narrowing of the external auditory
canal (EAC), and a purulent or serous
discharge may be noted.
• Conductive hearing loss may be
evident.
• Cellulitis of the face or neck or
lymphadenopathy of the ipsilateral
neck occurs in some patients.
24. • The tympanic membrane may be difficult to visualize and
may be mildly inflamed, but it should be normally mobile
on insufflation.
• Eczema of the pinna may be present.
• Fungal OE results in severe itching but typically causes less
pain than bacterial OE does. A thick discharge that may
be white or gray is often present.
• pseudomonal infection produces purulent otorrhea that
may be green or yellow,
• Aspergillus otomycosis looks like a fine white mat topped
by black spheres. Upon close examination, the discharge
may contain visible fungal elements (eg, spores or
hyphae) or have a fuzzy appearance.
25.
26. Complications
Complications of OE are rare and may include the
following:
• Necrotizing OE (the most significant complication)
• Mastoiditis
• Chondritis of the auricle (from spread of acute OE to the
pinna, particularly in patients with newly pierced ears)
• Bony erosion of the base of the skull
• Central nervous system (CNS) infection
• Cellulitis or lymphadenitis
27. Differential diagnosis
• Ear canal trauma
• Otitis media
• Hearing loss
• Intracranial abscess
• Furuncle
• Preauricular cyst and fistula
• Lacerations
• Atopic dermatitis
• Cerumen impaction
• Foreign body
28. investigations
• The patient’s history and physical examination
usually provide sufficient information to allow the
clinician to make the diagnosis of otitis externa
(OE). Most persons with OE are treated empirically.
• Thus, laboratory studies typically are not needed.
However, Gram staining and culture of any
discharge from the auditory canal may be helpful
if the patient is immunocompromised, if the usual
treatment measures are ineffective, or if a fungal
cause is suspected.
30. CT, MRI, Bone Scan, and Gallium
Scan
• Imaging studies are not required for most cases of OE. However,
radiologic investigation may be helpful if an invasive infection such as
necrotizing (malignant) OE is suspected or if the diagnosis of
mastoiditis is being considered.
• High-resolution computed tomography (CT) is preferred and better
depicts bony erosion.[6] Radionucleotide bone scanning and gallium
scanning have been used to make the diagnosis. Magnetic resonance
imaging (MRI), though not used as often, may be considered
secondarily or if soft tissue extension is the predominant concern.[7]
31. Otoscopy
• In cases of external ear
infection, otoscopic
examination must be
performed in
conjunction with
evaluation of related
structures (eg, the
external ear and the
head and neck).
32.
33. The otoscope
• An otoscope consists of a head and a handle and is used
to examine the external auditory canal (EAC), the
tympanic membrane, and the middle ear.
• A magnifying lens enhances the clinician’s view.
• The following 2 types of head are available for the
otoscope:
• Diagnostic head – This head is fixed to the otoscope and does
not allow the use of microinstruments through the scope
• Working (operating head) – This head has a magnifying lens that
can slide to the side, enabling passage of microinstruments
through the speculum into the EAC and the middle ear
34.
35. • For optimal viewing of the tympanic membrane in an
adult, retract the auricle posteriorly and superiorly to
straighten the EAC;
• for optimal viewing in a child, pull the auricle posteriorly.
• Remove any debris or cerumen to allow an adequate
examination.
• Proceed with the examination as follows:
• First, examine the EAC for masses, skin changes, and
otorrhea
• Next, examine all parts of the tympanic membrane
• Next, assess the motion of the tympanic membrane by
means of pneumatic otoscopy
• Finally, attempt a thorough examination of the middle
ear contents through the tympanic membrane.
36.
37. TREATMENT
Primary treatment of otitis externa (OE)
involves:
• management of pain,
• removal of debris from the external auditory
canal (EAC),
• administration of topical medications to
control edema and infection, and
• avoidance of contributing factors.
38. • Most cases can be treated with over-the-
counter analgesics and topical eardrops.
• Commonly used eardrops include:
•acetic acid drops, which change the pH of
the ear canal;
•antibacterial drops, which control bacterial
growth; and
•antifungal preparations.
•topical steroid drops.
39. Removal of Debris From Ear Canal
• Removal of debris from the ear canal improves the
effectiveness of the topical medication.
• Gentle cleaning with a soft plastic curette or a
small Frazier suction tip under direct vision is
appropriate.
• Irrigation with a mix of peroxide and warm water
may be useful for removing debris from the canal,
but only if the tympanic membrane is intact.
• Any water instilled must be removed to keep from
exacerbating the condition.
42. •Treat underlying course if it known.
•Preparations with steroids help to
reduce edema and otalgia.
•Systemic antibiotics are indicated for
infections that spread beyond the EAC.
•Fungal infections need antifungal
agents such as nystatin or clotrimazole.
•Eczematous reactions of the pinna
require application of anti allergic
creams or ointments
43. •Medication may be instilled as drops twice a
day, painted on the meatal walls with cotton
wool on a wire wool carrier, inserted on an
impregnated gauze wick, or insufflated as a
powder after toilet.
•Systemic antibiotics are never necessary.
•Topical preparations should not be used for
long periods (7–10 days at most).
•There is, however, a case for applying drops
intermittently (for example once a week) to
try to prevent repeated relapses.
44. Surgical Debridement and Drainage
• Surgical debridement of the ear canal is usually
reserved for necrotizing OE or for complications of
OE (eg, external canal stenosis).
• It is often necessary in more severe cases of OE or
in cases where a significant amount of discharge is
present in the ear.
• An otolaryngologist usually performs debridement
using magnification and suction equipment.
• Debridement is the mainstay of treatment for
fungal infections.
45. •Occasionally, an abscess forms in
the ear canal; this usually occurs in
cases of OE caused by S aureus.
•Treatment of the abscess is often
accomplished by means of a simple
incision and drainage procedure
that is usually performed by an
otolaryngologist using a needle or a
small blade.