A 53-year-old nonsmoking female patient had no underlying
disease. She had received regular health check-ups since 2016, and annual chest radiographs reported one enlarging lesion over right lower lung fi eld (Figure 1). She had no specifi c symptom except occasional cough. She visited our out-patient department. Chest Computed Tomography (CT) scan was arranged, and one soft -tissue nodule was found over right lower lobe of lung (Figure 2). Another protruding mass with overlying irregular mucosa from the RB8 orifi ce leading to 80% occlusion was noted by bronchoscopy (Figure 3).Bronchoscopic biopsy of the endobronchial lesion was done by
interventional pulmonologist, and pathology report showed chronicinflammation. CT-guided biopsy of the lung nodule was not feasible because the tumor was too close to blood vessels. Due to rapid progression of the lesions and the possibility of malignancy that could not be ruled out, surgical biopsy was arranged. Owing to the central location of the lesions, Video-Assisted Th oracoscopic Surgery (VATS) for RLL lobectomy with radical lymph node dissection was done in 2018. Intraoperative specimen revealed one intraparenchymal tumor and the other endobronchial tumor, causing obstructive pneumonitis. Surgical pathology disclosed Rosai-Dorfman disease with features of IgG4 related disease (Figure 4). Harvested lymph
nodes were all benign anthracosis. Postoperative serum levels of IgG and IgG4 were within normal range.
As a culmination of my time volunteering at Oregon Health and Science University(OHSU), I have crafted a quick informative slideshow that briefs on Idiopathic Pulmonary Fibrosis.
A 53-year-old nonsmoking female patient had no underlying
disease. She had received regular health check-ups since 2016, and annual chest radiographs reported one enlarging lesion over right lower lung fi eld (Figure 1). She had no specifi c symptom except occasional cough. She visited our out-patient department. Chest Computed Tomography (CT) scan was arranged, and one soft -tissue nodule was found over right lower lobe of lung (Figure 2). Another protruding mass with overlying irregular mucosa from the RB8 orifi ce leading to 80% occlusion was noted by bronchoscopy (Figure 3).Bronchoscopic biopsy of the endobronchial lesion was done by
interventional pulmonologist, and pathology report showed chronicinflammation. CT-guided biopsy of the lung nodule was not feasible because the tumor was too close to blood vessels. Due to rapid progression of the lesions and the possibility of malignancy that could not be ruled out, surgical biopsy was arranged. Owing to the central location of the lesions, Video-Assisted Th oracoscopic Surgery (VATS) for RLL lobectomy with radical lymph node dissection was done in 2018. Intraoperative specimen revealed one intraparenchymal tumor and the other endobronchial tumor, causing obstructive pneumonitis. Surgical pathology disclosed Rosai-Dorfman disease with features of IgG4 related disease (Figure 4). Harvested lymph
nodes were all benign anthracosis. Postoperative serum levels of IgG and IgG4 were within normal range.
As a culmination of my time volunteering at Oregon Health and Science University(OHSU), I have crafted a quick informative slideshow that briefs on Idiopathic Pulmonary Fibrosis.
Mondor Disease - An Underdiagnosed Pathology: Case Report and Review of Liter...asclepiuspdfs
Mondor penile disease is the thrombophlebitis of the superficial dorsal penile vein. The incidence is 1.39% with a prevalence of 1.4%. The most common risk factor for this entity is mechanical trauma through sexual activity. Due to its low incidence, this entity is still unknown for many physicians including urologists. Our aim is to describe the case of a 22-year-old male with a clinical and ultrasonographic diagnosis of Mondor penile disease and review the initial evaluation, pathogenesis, risk factors, diagnosis, and treatment. A 22-year-old male, whose chief complaint was a 12-h duration of pain in the dorsal face of the penis after a robust sexual activity. At physical exam, it was evident the painful in the duration of the superficial dorsal penile vein pathway. A color Doppler ultrasound was performed with evidence of low venous flow and a hypoechogenic image in the superficial dorsal vein, confirming the diagnosis of Mondor disease. He received expectant treatment, with partial recanalization 6 weeks after the event, without any adverse effect on his sexual function. Mondor disease is an undiagnosed pathology due to the fear of the patient to consult, or the medical team is unaware of the condition. Is very important to be familiarized with this pathology, so an accurate diagnosis and treatment are provided, avoiding unnecessary procedures. Is important to give education to decrease the anxiety related to the diagnosis and avoid performance issues.
Austin Journal of Urology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of Urology.
The aim of the journal is to provide a forum for urologists, nephrologists, research scholars, physicians, and other healthcare professionals to find most recent advances in the field of Urology.
Austin Journal of Urology accepts original research articles, review articles, case reports and short communication on all the aspects of Urology and relevant basic science issues.
Neuroendocrine Tumour in Meckel’s Diverticulum as a Cause of Acute Abdomensemualkaira
Meckel’s diverticulum is the most common congenital defect of the gastrointestinal tract, caused by an incomplete obliteration of ductus omphaloentericus (yolk sac) during intrauterine life. Given that the ductus omphaloentericus contains pluripotent cells during the intrauterine life, the diverticular mucosa may contain cell islets of different types of tissues, such as gastric and intestinal mucosa, pancreatic cells and others. However, the occurrence of neuroendocrine tumours in Meckel’s diverticulum is very rare. Causes ileus, besides its tumorous tissue, are fibrous changes in mesentery induced by the neuroendocrine tumour as well.
The paper presents a case of a 48-year-old patient with an acute abdomen, caused by perforation of Meckel’s diverticulum. Histological examination has revealed the presence of a neuroendocrine tumour spreading across muscularis propria and incipient spread into subserosa.
Atypical Presentation of Orbital Natural Killer cell Lymphoma | Crimson Publi...CrimsonpublishersMSOR
Natural killer (NK)/T-cell lymphoma is a rare malignancy accounting for less than 1 percent of all lymphomas in North America and Europe. Ocular manifestations frequently presented as orbital cellulites that does not improve with adequate antibiotics. We report a case of NK/T cell lymphoma with rare ocular manifestation that was initially confused with orbital cellulites and chronic sinusitis due to multiple negative biopsies. 92-year-old female presented with right eye vision loss, and ipsi lateral orbital swelling for four weeks. MRI demonstrated right intra-orbital extension to the orbital apex. Workups for infection and vasculitis were negative. Multiple biopsies with histopathology and flow cytology were unrevealing for malignancy. Patient failed to improve on antibiotics and steroids. Five months after the initial presentation, patient presented with the same complaint; however, the orbital mass had grown in size and involved the maxillary sinus and contra lateral side. Re-biopsy revealed positive CD 56 for NK lymphoma.
Fournier’s Gangrene in a 9 Yrs. Old Patient; A Rare Presentation in Paediatri...semualkaira
Necrotizing fasciitis of the perineum and external genitalia is a
life-threatening infective gangrene, primarily seen in adults but
relatively rare in children. We present a nine-year-old male child
with spinal bifida and double incontence who was admitted at our
hospital due to gangrenous right hemi-scrotal ulcer extending to
the right thigh. It was proceeded with painful swollen hemi-scrotum 2wks prior to admission. We treated him aggressively with
broad spectrum antibiotics and early surgical debridement. Being
paraplegic with double incontinence hence spending most of the
time dressed with diapers we therefore think of poor hygiene and
the diaper rash as the etiological factors. Early surgical debridement with appropriate antibiotics and aggressive supportive care
usually gave good results.
Fournier’s Gangrene in a 9 Yrs. Old Patient; A Rare Presentation in Paediatri...semualkaira
Necrotizing fasciitis of the perineum and external genitalia is a
life-threatening infective gangrene, primarily seen in adults but
relatively rare in children. We present a nine-year-old male child
with spinal bifida and double incontence who was admitted at our
hospital due to gangrenous right hemi-scrotal ulcer extending to
the right thigh. It was proceeded with painful swollen hemi-scrotum 2wks prior to admission. We treated him aggressively with
broad spectrum antibiotics and early surgical debridement. Being
paraplegic with double incontinence hence spending most of the
time dressed with diapers we therefore think of poor hygiene and
the diaper rash as the etiological factors. Early surgical debridement with appropriate antibiotics and aggressive supportive care
usually gave good results.
Mondor Disease - An Underdiagnosed Pathology: Case Report and Review of Liter...asclepiuspdfs
Mondor penile disease is the thrombophlebitis of the superficial dorsal penile vein. The incidence is 1.39% with a prevalence of 1.4%. The most common risk factor for this entity is mechanical trauma through sexual activity. Due to its low incidence, this entity is still unknown for many physicians including urologists. Our aim is to describe the case of a 22-year-old male with a clinical and ultrasonographic diagnosis of Mondor penile disease and review the initial evaluation, pathogenesis, risk factors, diagnosis, and treatment. A 22-year-old male, whose chief complaint was a 12-h duration of pain in the dorsal face of the penis after a robust sexual activity. At physical exam, it was evident the painful in the duration of the superficial dorsal penile vein pathway. A color Doppler ultrasound was performed with evidence of low venous flow and a hypoechogenic image in the superficial dorsal vein, confirming the diagnosis of Mondor disease. He received expectant treatment, with partial recanalization 6 weeks after the event, without any adverse effect on his sexual function. Mondor disease is an undiagnosed pathology due to the fear of the patient to consult, or the medical team is unaware of the condition. Is very important to be familiarized with this pathology, so an accurate diagnosis and treatment are provided, avoiding unnecessary procedures. Is important to give education to decrease the anxiety related to the diagnosis and avoid performance issues.
Austin Journal of Urology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of Urology.
The aim of the journal is to provide a forum for urologists, nephrologists, research scholars, physicians, and other healthcare professionals to find most recent advances in the field of Urology.
Austin Journal of Urology accepts original research articles, review articles, case reports and short communication on all the aspects of Urology and relevant basic science issues.
Neuroendocrine Tumour in Meckel’s Diverticulum as a Cause of Acute Abdomensemualkaira
Meckel’s diverticulum is the most common congenital defect of the gastrointestinal tract, caused by an incomplete obliteration of ductus omphaloentericus (yolk sac) during intrauterine life. Given that the ductus omphaloentericus contains pluripotent cells during the intrauterine life, the diverticular mucosa may contain cell islets of different types of tissues, such as gastric and intestinal mucosa, pancreatic cells and others. However, the occurrence of neuroendocrine tumours in Meckel’s diverticulum is very rare. Causes ileus, besides its tumorous tissue, are fibrous changes in mesentery induced by the neuroendocrine tumour as well.
The paper presents a case of a 48-year-old patient with an acute abdomen, caused by perforation of Meckel’s diverticulum. Histological examination has revealed the presence of a neuroendocrine tumour spreading across muscularis propria and incipient spread into subserosa.
Atypical Presentation of Orbital Natural Killer cell Lymphoma | Crimson Publi...CrimsonpublishersMSOR
Natural killer (NK)/T-cell lymphoma is a rare malignancy accounting for less than 1 percent of all lymphomas in North America and Europe. Ocular manifestations frequently presented as orbital cellulites that does not improve with adequate antibiotics. We report a case of NK/T cell lymphoma with rare ocular manifestation that was initially confused with orbital cellulites and chronic sinusitis due to multiple negative biopsies. 92-year-old female presented with right eye vision loss, and ipsi lateral orbital swelling for four weeks. MRI demonstrated right intra-orbital extension to the orbital apex. Workups for infection and vasculitis were negative. Multiple biopsies with histopathology and flow cytology were unrevealing for malignancy. Patient failed to improve on antibiotics and steroids. Five months after the initial presentation, patient presented with the same complaint; however, the orbital mass had grown in size and involved the maxillary sinus and contra lateral side. Re-biopsy revealed positive CD 56 for NK lymphoma.
Fournier’s Gangrene in a 9 Yrs. Old Patient; A Rare Presentation in Paediatri...semualkaira
Necrotizing fasciitis of the perineum and external genitalia is a
life-threatening infective gangrene, primarily seen in adults but
relatively rare in children. We present a nine-year-old male child
with spinal bifida and double incontence who was admitted at our
hospital due to gangrenous right hemi-scrotal ulcer extending to
the right thigh. It was proceeded with painful swollen hemi-scrotum 2wks prior to admission. We treated him aggressively with
broad spectrum antibiotics and early surgical debridement. Being
paraplegic with double incontinence hence spending most of the
time dressed with diapers we therefore think of poor hygiene and
the diaper rash as the etiological factors. Early surgical debridement with appropriate antibiotics and aggressive supportive care
usually gave good results.
Fournier’s Gangrene in a 9 Yrs. Old Patient; A Rare Presentation in Paediatri...semualkaira
Necrotizing fasciitis of the perineum and external genitalia is a
life-threatening infective gangrene, primarily seen in adults but
relatively rare in children. We present a nine-year-old male child
with spinal bifida and double incontence who was admitted at our
hospital due to gangrenous right hemi-scrotal ulcer extending to
the right thigh. It was proceeded with painful swollen hemi-scrotum 2wks prior to admission. We treated him aggressively with
broad spectrum antibiotics and early surgical debridement. Being
paraplegic with double incontinence hence spending most of the
time dressed with diapers we therefore think of poor hygiene and
the diaper rash as the etiological factors. Early surgical debridement with appropriate antibiotics and aggressive supportive care
usually gave good results.
Intrathoracic Giant Solitary Fibrous Tumor: Case Reportsemualkaira
Solitary Fibrous Tumor of the Pleura(SFTP) is exceedingly rare mesenchymal tumor commonly arising from the visceral pleura and accounts for < 5% of all pleural tumors.
Abstract—In Italy the hydatid disease is more prevalent and new cases are highlighted more frequently in Sicily, Sardinia, (Italy). Aim of this study is to put the indication in search of iaditea nature in both spleen swelling and muscle tendon.
Material and Method Patients observed during the period 2007-2009 at the Surgical Clinic III and Digestive Surgery, Policlinico G Rodolico were explored for Hydatid cyste at various sites. Diagnosis of cysts ecchinococcus occurred primarily for various four reasons either for compression of bodies involved or for eosinophilia or for instrumental investigation or for anaphylactic reaction to rupture of cysts. Biological diagnosis is based on serology rather than isolation of the parasite (indirect diagnosis);
Results Patients attended during the period 2007-2009 Hydatid cyst was found in 0.5% of all cases in liver along with 4 in the lung, 3 in splenic, 2 in the mammary and 2 in the chest wall No 2. The Surgical treatment with the complete removal of the cyst with a satisfactory postoperative course in the absence of cases of relapse of the disease and by following the therapeutic act, the assumption of mebendazole 50mg / kg / day for 3 weeks at a dose of 400mg for 4 months
Conclusions There is a need to define diagnostic methods with high specificity and sensitivity, which can provide a valid diagnostic aid for the cases clinically difficult to diagnose. And the final diagnosis must then also be based on the development of immunological methods that allow the determination of specific antibodies in the serum and their titration and / or the circulating antigen determination.
Hydatid cysts are most commonly found in the liver and lungs, although they may also occur in other organs, bones and muscles. The cysts can increase in size to 5 – 10 cm or more and may survive for decades. Non-specific signs include loss of appetite, weight loss and weakness
Echinococcus granulosus sensu lato occurs practically worldwide, and more frequently in rural, grazing areas where dogs ingest organs from
diagnosis
epidemiology
managment
Idiopathic Peritoneal Sclerosis: Case Presentation, And Literature Reviewsemualkaira
Most of the literature regarding peritoneal sclerosis is derived from nephrology literature surrounding peritoneal dialysis as the main and primary cause of this very rare and devastating disorder. The primary aim of this abstract is to encounter a case presentation of idiopathic peritoneal sclerosis and elaborate further on this rare condition.
Idiopathic Peritoneal Sclerosis: Case Presentation, And Literature Reviewsemualkaira
Most of the literature regarding peritoneal sclerosis is derived from nephrology literature surrounding peritoneal
dialysis as the main and primary cause of this very rare and devastating disorder. The primary aim of this abstract is to encounter
a case presentation of idiopathic peritoneal sclerosis and elaborate
further on this rare condition
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
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
- 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
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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
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
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.
2. Conclusion
In patients with chronic inflammatory conditions, including the use of injection drugs, who
experience acute onset of left upper quadrant pain, the diagnosis of atraumatic splenic rupture
must be considered.
Introduction
Atraumatic splenic rupture (ASR) can be caused by neoplastic diseases, hematological disorders,
infection and chronic inflammatory states [1]. Patients who are hospitalized rarely experience
ASR, which carries a mortality of approximately 12% [1]. ASR from amyloidosis has been
documented previously in three case reports, but no patients with chronic injection drug use as
the etiological factor in the development of systemic acquired A (AA) amyloidosis have been
described [2-5]. We report the case of a hospitalized patient who experienced atraumatic splenic
rupture from acquired systemic AA amyloidosis, most likely resulting from chronic injection
drug use.
Case presentation
A 58-year-old Caucasian man with an extensive history of injection drug use was hospitalized
with a diagnosis of infective endocarditis (IE); eight months earlier, he had experienced an
episode of IE that was treated surgically with a bioprosthetic valve. Blood cultures taken during
the current admission revealed methicillin-resistant Staphylococcus aureus infection.
Transesophageal echocardiography revealed a 2 cm linear vegetation on the prosthetic aortic
valve and a possible ring abscess without evidence of aortic insufficiency. Therapy with
intravenous ciprofloxacin, gentamicin and levofloxacin was initiated.
On the third day of hospitalization, our patient experienced an acute onset of left upper quadrant
abdominal pain. No history of recent trauma could be elicited. Our patient's vital signs were as
follows: temperature 40°C, blood pressure 85/48 mmHg, heart rate 104 beats/minute, respiratory
rate of 20 breaths/minute, and an oxygen saturation of 99% breathing room air. On physical
examination our patient was found to be in mild distress and diaphoretic with dry mucous
membranes. The skin of the upper and lower extremities was indurated at sites of frequent
subcutaneous injections, but without erythema, exudate or abscess. No petechiae of the skin or
nail beds were identified. A cardiac examination revealed a III/VI crescendo/de-crescendo
systolic ejection murmur radiating to the apex and to the carotid arteries. An abdominal
examination revealed a distended abdomen and tenderness to palpation in the left upper
quadrant. A computed tomography (CT) scan of the abdomen and pelvis revealed an enlarged
and fractured spleen with surrounding hematoma, but no evidence of liver laceration, infarct or
intra-abdominal abscess (Figure 1).
3. Figure 1. Computed tomography (CT) scan. The CT scan demonstrates
hemoperitoneum and a grade IV splenic laceration in our patient, who had no history of trauma.
Our patient underwent an emergency splenectomy. A subcostal incision revealed approximately
2L of blood inside the abdominal cavity, an enlarged spleen with grade IV disruption (Figure 2),
and an aneurysmal splenic artery. The spleen was freed at its attachments and the arteries and
veins at the hilum were ligated. The aneurysmal splenic artery was dissected medially for
sufficient proximal exposure and was then ligated. Abdominal exploration revealed no further
gross pathological findings. A histopathological evaluation of other organs for evidence of
amyloidosis was not performed. Our patient's early post-operative recovery was uneventful.
However, he later died from complications of endocarditis and ring abscess.
Figure 2. Initial view of the gross spleen. The enlarged and fractured spleen as
seen through a left subcostal incision.
When the gross spleen was sectioned along its short axis in the operating room (Figure 3) no
abscess was found. Microbiological examination revealed few polymorphonuclear leukocytes
(PMNs), many red blood cells, and rarely S. aureus bacteria. A pathological examination
revealed very few PMNs and none of the acute inflammation expected in cases of splenic
infarction. The splenic red pulp was almost totally replaced by plasma cells. Staining for amyloid
was strikingly positive (Figure 4). Characteristic talc crystals were observed inside the splenic
parenchyma (Figure 5).
Figure 3. Gross spleen. The grossly enlarged spleen cut along the short axis
with no evidence of abscess formation.
Figure 4. Hematoxylin and eosin staining results. Hematoxylin and eosin stain
of splenic tissue at 40 × magnification showing amyloid around a blood vessel (arrow).
4. Figure 5. Peri-vascular amyloid. Positive peri-vascular amyloid A
immunoperoxidase staining at 40 × magnification.
Discussion
Amyloid, which appears as pink, amorphous, intercellular material in tissue sections stained with
hematoxylin and eosin, can be deposited in any tissue, and may be localized or widespread in its
deposition. The most common sites are liver, spleen, adrenal, and kidney, where amyloid is
frequently deposited around vascular structures. Amyloidosis is subclassified by the type of
proteins that make up the amyloid fibrils. The basic structure of all amyloid types is a β-pleated
sheet of fibrils 7.5 to 10 nm wide. Numerous methods can demonstrate the presence of amyloid,
but the most specific is Congo Red stain, followed by microscopic examination with polarizing
lenses that show a characteristic bright green birefringence. Immunoperoxidase staining is then
performed to detect acquired systemic AA amyloidosis [6].
The most common type of amyloidosis in the USA is immunological. This type is composed of
light chains (Bence-Jones proteins) secreted by plasma cells of multiple myeloma [6,7].
Amyloidosis may also be secondary to chronic inflammatory conditions such as autoimmune
diseases, chronic infections, and some neoplasms (for example, Hodgkin's lymphoma and renal
cell carcinoma) [1]. The amyloid fibrils in inflammatory conditions are composed of serum
amyloid-associated protein. The heredofamilial type of amyloidosis is an autosomal dominant
condition [8].
Pre-operatively, our patient was presumed to have splenic infarct or abscess as the cause of
splenic rupture because up to 51% of patients with IE suffer emboli to major organs [9]. During
surgery, we questioned that diagnosis when no abscess was seen in the spleen, and the cross-
sectioned tissue appeared grossly homogeneous.
Pathological evaluation was consistent with acquired systemic AA amyloidosis, which was
previously called secondary amyloid because it was seen secondary to inflammation. This type
of amyloidosis is a rare systemic condition that can occur in the context of chronic inflammation
in which there is protracted breakdown of cells. This condition is seen most commonly in
rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease, and the drug use
method referred to as 'skin popping', as in our patient [10]. Skin popping is the injection of
narcotics, commonly heroin, just under the skin. Black tar heroin is used on the west coast of the
USA and is considerably 'dirtier' than its east coast heroin counterpart. Users tend to have a high
incidence of abscess formation, IE, and possibly reactive systemic amyloidosis, as in our patient.
The cytokine release during chronic bouts of inflammation is thought to lead to increased
production of AA protein in the liver; this protein is then released into the blood stream and
deposited in small blood vessels throughout the body. This protein deposition leads to vessels
that are delicate and easily disrupted.
5. Patients who are hospitalized rarely experience ASR. However, septic emboli are common in
patients with IE who are hospitalized, occurring in up to 51% [9]. In left-sided endocarditis,
these emboli can travel to the spleen and lead to infarction and splenic rupture. Our patient was
hospitalized for IE, but pathological evaluation of the spleen revealed no evidence of bacterial
embolization, infarction or abscess; therefore, the ASR most likely resulted from systemic AA
amyloidosis.
Conclusion
Patients with a history of 'skin popping', especially with black tar heroin, are at risk for AA
amyloidosis. In patients with chronic inflammatory conditions who develop an acute onset of
abdominal pain, the possibility of splenic rupture should be considered, even if no history of
trauma can be elicited.
Consent
Written informed consent for publication could not be obtained because the patient is now
deceased and we were unable to contact a next of kin despite all reasonable attempts. Every
effort has been made to protect the identity of the patient and there is no reason to believe that
the patient or their family would object to publication.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
GRR contributed to the surgical care of our patient, the literature review and manuscript
preparation and revision. AYL contributed to the literature review and manuscript revision. KR
contributed to the surgical care for our patient and manuscript revision. BV contributed to the
surgical care of our patient and direction of manuscript preparation. DKH performed the
histological analysis of our patient's spleen, contributed the pathology discussion in the
manuscript and prepared the images. MMK contributed to the surgical care of our patient, and
manuscript preparation and revision. FJR contributed to the medical care of our patient and
oversaw manuscript preparation and revision. All authors read and approved the final
manuscript.
Acknowledgements
The authors would like to thank Pamela Derish in the Department of Surgery at UCSF for
assistance in the preparation of this manuscript.
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