Acute aortic syndromes include aortic dissection, intramural hematoma, and penetrating aortic ulcer. They involve a breakdown of the aortic wall layers. Type A dissection requires urgent surgery while type B can be managed medically or with TEVAR for complications. Intramural hematoma and penetrating ulcers are generally treated medically but TEVAR is considered for complications. Guidelines provide algorithms for diagnosis and management based on syndrome type, complications, and patient factors. TEVAR has become preferred over surgery for some conditions when anatomy is favorable.
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
SCAD is a rare, sometimes fatal, traumatic condition with approximately eighty percent of cases affecting women. The coronary artery can suddenly develop a tear, causing blood to flow between the layers which forces them apart, potentially causing a blockage of blood flow through the artery and a resulting heart attack. The condition may be related to female hormone levels, as it is often seen in post-partum women, or in women during or very near menstruation, but not always. It is not uncommon for SCAD to occur in people in good physical shape and with no known prior history of heart related illness. It is also not uncommon for SCAD to occur in people in their 20's, 30's, and 40's, as well as older.
Chronic coronary syndrome (CCS) is a term that defines coronary artery disease as a chronic progressive course. It has been introduced to replace the previous term ‘stable coronary artery disease’.
Speckle tracking echocardiography (STE) is an echocardiographic imaging technique that analyzes the motion of tissues in the heart by using the naturally occurring speckle pattern in the myocardium or blood when imaged by ultrasound.
http://www.theheart.org/web_slides/1416535.do
A trial to compare Fractional Flow Reserve versus Angiography for Guiding PCI in Patients with Multivessel Coronary Artery Disease II
SCAD is a rare, sometimes fatal, traumatic condition with approximately eighty percent of cases affecting women. The coronary artery can suddenly develop a tear, causing blood to flow between the layers which forces them apart, potentially causing a blockage of blood flow through the artery and a resulting heart attack. The condition may be related to female hormone levels, as it is often seen in post-partum women, or in women during or very near menstruation, but not always. It is not uncommon for SCAD to occur in people in good physical shape and with no known prior history of heart related illness. It is also not uncommon for SCAD to occur in people in their 20's, 30's, and 40's, as well as older.
Chronic coronary syndrome (CCS) is a term that defines coronary artery disease as a chronic progressive course. It has been introduced to replace the previous term ‘stable coronary artery disease’.
Speckle tracking echocardiography (STE) is an echocardiographic imaging technique that analyzes the motion of tissues in the heart by using the naturally occurring speckle pattern in the myocardium or blood when imaged by ultrasound.
http://www.theheart.org/web_slides/1416535.do
A trial to compare Fractional Flow Reserve versus Angiography for Guiding PCI in Patients with Multivessel Coronary Artery Disease II
postgraduate education for cardiothoracic anaesthesia and intensive care doctors in cardiac operations on patients with unstable ischemic heart disease
Aortic Aneurysm: Diagnosis, Management, Exercise Testing, And TrainingJavidsultandar
An aortic aneurysm is a balloon-like bulge in the aorta, the large artery that carries blood from the heart through the chest and torso.
Aortic aneurysms can dissect or rupture:
The force of blood pumping can split the layers of the artery wall, allowing blood to leak in between them. This process is called a dissection.
The aneurysm can burst completely, causing bleeding inside the body. This is called a rupture.
Dissections and ruptures are the cause of most deaths from aortic aneurysms.
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
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
- 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
1. MANAGEMENT IN ACUTE AORTIC
SYNDROME : WHEN IS TEVAR NEED?
F2 Parach Sirisriro
3rd Dec 2018
2. REFERENCE
Rutherford's Vascular Surgery and Endovascular Therapy, Chapter
81, 3183-3221.e
Textbook
Journal
- Members, A. T. F., et al. (2014). "2014 ESC Guidelines on the diagnosis and management of
acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute
Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the
European Respiratory Society (ERS)." European heart journal 35(43): 3033-3073.
- Erbel, R., et al. (2015). "Corrigendum to: 2014 ESC Guidelines on the diagnosis
and treatment of aortic diseases." European heart journal 36(41): 2779-2779.
JAMA. 2016;316(7):754-763. doi:10.1001/jama.2016.10026
- Choe, C. H. and R. R. Arya (2017). Management of Acute Aortic Syndromes.
Evidence-Based Critical Care, Springer: 163-170.
- Wells, C. M. and K. Subramaniam (2011). Acute aortic syndrome. Anesthesia and
Perioperative Care for Aortic Surgery, Springer: 17-36.
3. REFERENCE
• Hiratzka, L. F., et al. (2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for
the diagnosis and management of patients with thoracic aortic disease." Journal of the American
College of Cardiology 55(14): e27-e129.
• Group, J. J. W. (2013). "Guidelines for diagnosis and treatment of aortic aneurysm and aortic
dissection (JCS 2011)." Circulation Journal 77(3): 789-828.
• Mussa, F. F., et al. (2016). "Acute aortic dissection and intramural hematoma: a systematic review."
Jama 316(7): 754-763.
• Rozado, J., et al. (2017). "Comparing American, European and Asian practice guidelines for aortic
diseases." Journal of thoracic disease 9(Suppl 6): S551.
Song, C., et al. (2016). "The new indication of TEVAR for uncomplicated type B aortic dissection."
Medicine 95(25).
5. DEFINITION
• Acute aortic syndromes :
- Emergency conditions with similar
clinical characteristics involving the aorta.
- Breakdown of the intima and
media.
- Result in IMH, PAU, or in separation
of aortic wall layers,leading to AD or even
thoracic aortic rupture
European Heart Journal (2014):doi:10.1093/eurheartj/ehu281
9. PROGRESSION OF ONE TYPE OF ACUTE AORTIC
SYNDROME
TO ANOTHER TYPE
Classical
dissection
Intramural
hematoma
Acute Aortic
Synrdrome
Aortic ulcer
European Heart Journal (2014):doi:10.1093/eurheartj/ehu281
18. ● Diagnosis: circular or crescentic
thickening >5 mm of the aortic
wall in the absence of
detectable blood flow.
● 10-25% of AAS
– 30% ascending aorta
– 10% arch
– 60-70% descending TA (Type B)
INTRAMURAL HEMATOMA (IMH)
Type A
19. ● Diagnosis → CT/MRI
– Unenhanced acquisition + contrast-enhanced acquisition in CT →
sensitivity 96%
● Type-A IMH
– In-hospital mortality similar to type-A AD
– 30-40% evolve into AD
● Type-B IMH
– In-hospital mortality similar to type-B AD
INTRAMURAL HEMATOMA (IMH)
JAMA. 2016;316(7):754-763. doi:10.1001/jama.2016.10026
20. PREDICTOR OF IMH COMLICATION
European Heart Journal (2014):doi:10.1093/eurheartj/ehu2
23. • ● Ulceration of an atherosclerotic plaque
penetrating through the internal elastic lamina
into the media.
● 2-7% of all AAS.
● Most commonly located in the middle and
lower distal thoracic aorta (type-B PAU).
● Elderly patients, smokers, HTN,
associated CAD, COPD, AAA
● Diagnosis → unenhanced/contrast enhanced CT
PENETRATING AORTIC ULCER
JAMA. 2016;316(7):754-763. doi:10.1001/jama.2016.10026
25. • Main symptoms
Present in Both
type A and B
• Almost present
in Type A
Main clinical presentations and complications of patient with
acute aortic dissection
−
26. Main clinical presentations and complications of patient with
Acute aortic syndrome
Intramural hematoma
Chest or back pain,
tamponade
High blood pressure ,
rarely any malperfusion
Penetrating ulcer
Painless or low intensity
pain
Pain located in back or
abdomen
High blood pressure,
collapse with perforation
Traumatic dissection or
rupture
Deceleration trauma,
severe pain, pulse
differential, syncope,
Exsangunation,
tamponade
Stable at low blood
pressure , rapid pulse
prior to exsanguination
JAMA. 2016;316(7):754-763. doi:10.1001/jama.2016.10026
27. 2014 ESC Guidelines on the Diagnosis and
Treatment of Aortic Diseases
- Imaging Techniques -
28. Diagnostic value of various imaging modalities of acute aortic
syndrome
European Heart Journal (2014):doi:10.1093/eurheartj/ehu281
36. COMPLICATED TYPE-B AD
- Persisting/recurrent pain
- uncontrolled HTN on full
medication,
- Early aortic expansion,
malperfusion,
- signs of rupture (haemothorax,
periaortic and mediastinal
hematoma↑)
European Heart Journal (2014):doi:10.1093/eurheartj/ehu28
37. TEVAR FOR COMPLICATED TYPE-B AD
Thoracic endovascular aortic repair (TEVAR) treatment of
choice
→closure of the primary entry tear
→ decompression and thrombosis of the false lumen
→ malperfusion (if present) may resolve
→ aortic remodeling and stabilization
** Surgery reserved for patients not candidate for TEVAR
European Heart Journal (2014):doi:10.1093/eurheartj/ehu28
47. CONCLUSIONS ACUTE THORACIC AORTIC
SYNDROMES
● Potentially deadly but at the same time treatable conditions to
be considered in the differential diagnosis of acute chest pain.
● Decision making in suspected AAS should be based on the a
priori probability based on a clinical score and according to the
score results it should include biomarkers (D-dimers) and
imaging.
● TTE: initial imaging investigation, frequently complemented by
TOE/CT/MRI.
● Type-A AD → urgent surgery.
● Type-B AD
→ complicated →TEVAR
→ uncomplicated →TEVAR to be considered.
48. CONCLUSIONS ACUTE THORACIC AORTIC
SYNDROMES (2)
• ● IMH
– Type-A → surgery recommended
– Type-B → OMT; if complicated TEVAR should be
considered
● PAU
– Type-A → surgery should be considered
– Type-B → OMT; if complicated TEVAR should be
considered
● (Contained) rupture of TAA and traumatic aortic injury
– If anatomy favorable and expertise available
→ TEVAR preferred over surgery