The neonatal bowel obstruction is suspected based on polyhydramnios in utero, bilious vomiting, failure to pass meconium in the first day of life, and abdominal distension.The presentations of NBO may vary. It may be subtle and easily overlooked on physical examination or can involve massive abdominal distension, respiratory distress and cardiovascular collapse.Unlike older children, neonates with unrecognized intestinal obstruction deteriorate rapidly.
Neonatal bowel obstruction is grouped into two general categories: high, or proximal, obstruction and low, or distal obstruction, both of which are suspected by failure to pass meconium at birth. High obstruction can be suspected based on the double bubble sign. Cases without distal gas are usually related to duodenal atresia, while high obstruction with distal gas need an upper gastrointestinal series because of the need to distinguish duodenal web, duodenal stenosis and annular pancreas from midgut volvulus, the latter being a surgical emergency. Confirmation is ultimately by surgical intervention.
Jejunal and ileal atresia are caused by in utero vascular insults, leading to poor recanalization of distal small bowel segments, a condition in which surgical resection and reanastamosis are mandatory. Hirschsprung disease is due to an arrest in neural cell ganglia, leading to absent innervation of a segment distal bowel, and appears as a massively dilated segment of distal bowel on contrast enema. Surgical resection is necessary for this condition as well. Imperforate anus also requires surgical management, with the diagnosis made by inability to pass the rectal tube through the anal sphincter.[6] Supportive intravenous hydration, gastric decompression, and ventilatory support may be needed due to poor neonatal nutrition resulting from dysfunctional bowel absorption.
A low obstruction is suspected on plain film, but needs follow up with a gastrografin enema, which itself can be therapeutic. The differential for low obstruction is ileal atresia, meconium ileus, meconium plug syndrome and Hirschsprung disease. In cases of meconium ileus or ileal atresia, the colon distal to the obstruction is hypoplastic, usually less than 1 cm in caliber, as development of normal colonic caliber in utero is due to the passage of meconium, which does not occur in either of these conditions. When diffusely small caliber is seen, it is referred to as microcolon. Radiographs in meconium ileus classically demonstrate a bubbly appearance in the right lower quadrant due to a combination of ingested air and meconium. If, on contrast enema, reflux into the dilated distal small bowel loops can be achieved, the study is both diagnostic and therapeutic, as the ionic contrast medium can dissolve the meconium to allow passage of enteric content into the unused colon.
If contrast cannot be refluxed into the distal small bowel, ileal atresia remains a diagnostic possibility.
With early intervention, morbidity and mortality.
Acute Pancreatitis.
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What is pancreatitis? Signs and symptoms of acute pancreatitis?
Diagnosis of acute pancreatitis
management and treatment of pancreatitis.
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.
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 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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
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
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. Q7: Timing of the first prophylactic
antibiotic dose
The first prophylactic antibiotic dose should
provide a sufficient antibiotic serum level
throughout the surgery to combat organisms
most likely to cause a site infection.
The first dose be timed to occur within 60
minutes before the surgical incision is made.
If a fluoroquinolone or vancomycin is chosen for
prophylaxis, the first dose should be
administered within 120 minutes of the start of
surgery.
Nir Hus
3. Timing of the first prophylactic
antibiotic dose
For most surgeries, the use of prophylactic
antibiotics should end within 24 hours after
surgery.
Cefazolin or cefuroxime are suggested for
cardiothoracic surgery, with the
recommendtion of extension of
prophylactic antibiotics up to 72 hours to
avoid deep sternal infections.
Nir Hus
4. Surgery Prophylaxis Comments
Cardiothoracic Cefazolin or cefuroxime; if beta 72-hour duration
lactam allergy, vancomycin or advocated by some, but
clindamycin 24 hours is likely to be
adequate
Vascular Cefazolin or cefuroxime; if beta
lactam allergy, vancomycin
with or without gentamicin, or
clindamycin
Colon Oral: neomycin, with Combination of oral and
erythromycin base or parenteral prophylaxis
metronidazole may decrease infection
rates
Adapted with permission from Bratzler DW, Houck PM. Antimicrobial prophylaxis for
surgery: an advisory statement from the National Surgical Infection Prevention Project.
Clin Infect Dis 2004,38:1707.
Nir Hus
5. Timing of the first prophylactic
antibiotic dose
Adaptedwith permission from Bratzler
DW, Houck PM. Antimicrobial prophylaxis
for surgery: an advisory statement from
the National Surgical Infection Prevention
Project. Clin Infect Dis 2004,38:1707.
Nir Hus
6. Q8: Incarcerated Groin Hernia
Incidence of incarceration ~10% among
inguinal hernias.
Cannot be reduced into the abdominal
cavity.
Strangulated hernias have incarcerated
contents with vascular compromise.
Frequently, intense pain is caused by
ischemia of the incarcerated segment.
Nir Hus
7. Q8: Incarcerated Groin Hernia
Incarcerated inguinal hernias present with
abdominal distention, pain, nausea, and
vomiting due to intestinal obstruction.
Plain abdominal X-rays may verify
intestinal obstruction in cases of
incarceration.
Nir Hus
9. Q9: Short Bowel Syndrome
Etiology for extensive resection:
Congenital anomalies leading to short bowel syndrom include –
Intestinal atresia
Midgut volvulus w/ intestinal necrosis
Necrotizing enterocolitis.
In Middle-aged adults –
IBS
Trauma
In the elderly-
Mesenteric ischemia
Strangulated hernia
Extensive resection due to malignancy.
Nir Hus
10. Q9: Short Bowel Syndrome
Resection resulting in less than 120cm of intact
bowel leads to SBS.
Resection of up to 50% of small bowel is
tolerated.
Resection of up to 70% is tolerated if terminal
ileum and cecum are preserved.
Infants may tolerate upto 85% of small bowel
resection.
Nir Hus
11. Q9: Short Bowel Syndrome
Loss of the ileocecal valve results in rapid
emptying of enteral contents into the colon
and reflux of colonic bacterial flora into
small bowel.
The entire jejunum can be resected
without serious adverse nutritional
sequela.
Nir Hus
12. Q9: Short Bowel Syndrome
Adaptation:
Cellularhyperplasia and bowel hypertrophy
occur over a 2- to 3-year period, increasing
the absorptive surface area.
Fat absorption is most likely permanently
impaired.
Nir Hus
14. Q10: Malabsorption & Malnutrition
Gastric hypersecretion – in early postop period.
Increased acid load may injure distal bowel
mucosa hypermotility & impaired absorption.
Cholelithiasis – altered bilirubin metabolism after
ileal resection increased risk of pigmented
gallstones stones that is 2nd to a decreased bile
salt pool. TPN also may lead to increased risk of
cholelithiasis.
Nir Hus
15. Q10: Malabsorption & Malnutrition
Hyperoxaluria & Nephrolithiasis –
Excessive fatty acids within the colonic lumen
bind intraluminal calcium.
Unbound oxalate that normally is made
insoluble by Ca-binding and is excreted in
feces is thus, readily absorbed.
This results in hyperoxaluria and calcium
oxalate urinary stone formation.
Nir Hus
16. Q10: Malabsorption & Malnutrition
Diarrhea & Steatorrhea –
Caused by rapid intestinal transit.
Presence of hyperosmolar enteric contents.
Disruption of enterohepatic bile acid
circulation.
Fat absorption is most severly impaired by
ileal resection.
Nir Hus
17. Q10: Malabsorption & Malnutrition
Intestinal Microflora –
Loss of ileocecal valve permits reflux of
colonic bacteria into small bowel.
Intestinal dysmotility increases colonization.
Bacterial overgrowth & change in flora results
in pH alteration & deconjugation of bile salts.
This results malabsorption, fluid loss,
decreased vit B12 absorption.
Nir Hus
18. Q11: Effect of ASA on Plt.
Irreversiblyacetylates cyclooxygenase
Results in inhibiting plt synthesis of
Thromboxane A2.
Decreases plt function.
Higher doses than > 80 – 160mg PO / day
donot have a higher efficacy.
Nir Hus
19. Q12: Synergism Ampicillin /
Sulbactam (Unasyn)
PCN:
GPC – streptoccocci, syphilis,
GPR - Neisseria m., C. perfringens,
Beta-hemolytic strep, antrax
Not effective for Staph or Enterococcus
Ampicillin/amoxicillin: PCN + Enterococcus coverage
Unasyn: PCN + GPC (staph & strep), GNR +/-
anaerobic coverage, enterococci.
NOT FOR Pseudomonas, Acinetobacter, or Serratia.
Sulbactam & Clavulanic acid – are beta-lactamase
inhibitors.
Nir Hus