This presentation looks at abnormal EEG patterns with examples for each. Benign variants, artifacts and focal ictal patterns are not part of this presentation.
This presentation looks at generalised periodic epileptiform discharges and the various disorders like Creutzfeldt Jacob disease (CJD), SSPE and metabolic encephalopathies in which it is seen. SIRPID is also discussed. Triphasic waves are described. Radermacker complexes in SSPE are described.
This presentation looks at abnormal EEG patterns with examples for each. Benign variants, artifacts and focal ictal patterns are not part of this presentation.
This presentation looks at generalised periodic epileptiform discharges and the various disorders like Creutzfeldt Jacob disease (CJD), SSPE and metabolic encephalopathies in which it is seen. SIRPID is also discussed. Triphasic waves are described. Radermacker complexes in SSPE are described.
This lecture is all about the recognition of an abnormal EEG, its characteristics, its appearance and all about how to differentiate the abnormal activity with normal EEG background.
This presentation discusses the basic principles governing EEG Rhythm Generation, and discusses the various circuits that generate and maintain cerebral oscillations.
EEG variants, are always to be recognized while interpreting the EEG one must be aware of these. Major and most common EEG is variants are discussed in the stated presentation.
Syed Irshad Murtaza.
This presentation reviews the common artifacts in EEG, their identification and rectification. Examples of various artifacts are provided in the presentation.
This presentation looks at EEG signal generation, pyramidal cells, recording of EEG, source localisation, polarity, analysis of dipole, derivations, montages,
This lecture is all about the recognition of an abnormal EEG, its characteristics, its appearance and all about how to differentiate the abnormal activity with normal EEG background.
This presentation discusses the basic principles governing EEG Rhythm Generation, and discusses the various circuits that generate and maintain cerebral oscillations.
EEG variants, are always to be recognized while interpreting the EEG one must be aware of these. Major and most common EEG is variants are discussed in the stated presentation.
Syed Irshad Murtaza.
This presentation reviews the common artifacts in EEG, their identification and rectification. Examples of various artifacts are provided in the presentation.
This presentation looks at EEG signal generation, pyramidal cells, recording of EEG, source localisation, polarity, analysis of dipole, derivations, montages,
This presentation looks at the benign or non-epileptiform variants in EEG, their characteristics and identification. Examples of the common benign variants are provided in the presentation.
Epilepsy Management: Key issues and challengesPramod Krishnan
This brief presentation summarises the key issues and challenges in Epilepsy management, including diagnosis, treatment, compliance, special populations, adverse effects, psychiatric comorbidities and ASM withdrawal.
This presentation focusses on the importance of diagnostic biomarkers for Alzheimer's disease. MRI, amyloid PET and CSF biomarkers are discussed in detail.
This is a brief review of autoimmune epilepsies, especially autoimmune encephalitis, SREAT, NORSE, FIRES and Rasmussen's encephalitis. A brief overview of investigations and treatment is included.
This presentation looks at the role of Pregabalin in refractory trigeminal neuralgia and chemotherapy induced peripheral neuropathy through illustrative case studies.
This review focusses on the role of role of gut microbiota in health and disease, specifically multiple sclerosis. It looks at the interaction of gut microbiota, enteric nervous system, central nervous system, neuroendocrine system in the pathogenesis of multiple sclerosis
This presentation summarises the importance of genetics in epilepsy, whom to test, and the various tests available. It looks at the role of genetics in various forms of epilepsy and recent advances in precision medicine.
EEG in convulsive and non convulsive seizures in the intensive care unitPramod Krishnan
Case based discussion regarding the utility of EEG in the management of convulsive and non convulsive seizures, including status epilepticus in the intensive care unit
A review of epilepsy in the elderly, the etiopathogenesis, clinical challenges, diagnosis, use of antiseizure drugs and outcomes. Also the various special considerations in managing elderly patients with epilepsy.
A review of the common antiseizure drugs with broad spectrum action. We look at the major evidence in favour of valproate, topiramate, perampanel and brivaracetam.
Treatment of epilepsy polytherapy vs monotherapyPramod Krishnan
This presentation reviews the evidence regarding use of early polytherapy in patients with epilepsy with regards to seizure control and adverse effects. The advantages and disadvantages of polytherapy compared to monotherapy is addressed.
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.
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.
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.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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.
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
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.
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
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Activation Proceedures in EEG.pptx
1. Activation Procedures in EEG
Dr Pramod Krishnan
Consultant Neurologist and Epileptologist
HOD Neurology
Manipal Hospital, Bengaluru
2. Activation procedures
• These are specific manoeuvres performed during the EEG recording to
bring forth abnormalities that would not be seen otherwise.
3. Activation procedures used in EEG
Routinely performed activation procedures
1. Eye opening and Closure
2. Mental alerting
3. Intermittent photic stimulation
4. Hyperventilation
5. Sleep.
Activation procedures performed in special situations
1. Scotosensitivity and Fixation off sensitivity
2. Cognitive tasks like arithmetic, problem solving, playing chess etc.
3. Pattern stimulation
4. Television and video games
5. Eating
6. Reading
7. Praxis
8. Hot water bath
5. Eye opening (negative deflection in Fp1 and Fp2) causing synchronous attenuation of posterior dominant
alpha rhythm. Eye closure (positive deflection in Fp1 and Fp2) results in return of alpha rhythm.
6. Manoeuvre Description
Eye closure sensitivity Generalised spikes occur immediately on eye closure and can last upto
4 sec. Eg Jeavons syndrome (classical), JME, JAE, IOE
Eye closed sensitivity Generalised or focal spikes occur only when eyes remain closed.
Disappear on eye opening. Eg. Childhood epilepsy with occipital
paroxysms.
Scotosensitivity Generalised spikes occur only in complete darkness, irrespective of
eyes being open or closed.
Fixation off sensitivity Generalised spikes occur when fixation is impaired. Eg using Frentzel
glasses.
7. Eye closed sensitivity: On eye closure repetitive generalised spike and waves are seen which continue for
several seconds unlike eye closure sensitivity where it does not last more than 4 sec.
8. Eye closed sensitivity: On eye opening, the spikes abruptly terminate. This pattern is most commonly seen
in idiopathic occipital lobe epilepsies. Eg Childhood epilepsy with occipital paroxysms.
9.
10. Fixation off sensitivity: This patient has eye closed sensitivity (top left), possibly fixation off sensitivity or
scotosensitivity (top right, bottom left), only fixation off sensitivity (bottom right)
12. Arithmetic calculation
• This is done with eyes closed.
• In an alert patient, mental activities like calculation cause attenuation
of the posterior alpha rhythm.
• In drowsy patients, mental activities increase the frequency of the
posterior dominant rhythm.
• If the background rhythm does not show increase in frequency on
alerting, it may be pathological slowing.
13. Mental arithmetic with eyes closed causes attenuation of the posterior alpha rhythm, which returns on
completion of the calculation task.
15. Intermittent photic stimulation
• Subject is asked to look at a series of flashing lights of different
frequencies ranging from 1 Hz to 50 Hz.
• Light source should be 30 cm away.
• Each frequency is delivered for 10 sec, which includes eyes open, eyes
closed and eye closing states.
• There is 10 sec gap between different frequencies.
• The sequence is 1, 3, 6, 8, 10, 12,14, 16, 18, 20, followed by 50, 40, 30, 24
and below.
• Red colored light and patterned IPS facilitate induction of PPR.
17. Photomyogenic artifact: Repetitive EMG artifacts that occur from facial muscles during photic stimulation.
They have a spike like morphology and are time locked to the photic flash.
18. Photomyogenic artifact: They lack after coming slow wave. They occur across all frequencies. They are
mainly seen over the frontal regions, and are bilateral. They do not occur beyond the photic stimulation.
23. Photic drive: They are monophasic transients seen over the occipital regions, and follow each flash by
a lag of 80-150 msec, at the same frequency, or sub- or supra harmonically.
24. Photic drive: The occipital transients are time locked to the stimulus.
25.
26. Ocular flutter: These are seen as rhythmic high amplitude deflections over the bifrontal regions that
resemble large amplitude delta waves.
28. Photo-paroxysmal response
• PPR is defined as occurrence of generalised spikes/ polyspikes at least
twice during the same frequency of IPS, irrespective of the duration of
the paroxysm, or whether it outlasted the paroxysm or not.
• IPS must be discontinued if PPR is seen.
• Stimulus frequency at which PPR most frequently occurs is 15-18 Hz.
• It is more prevalent in females, and in those between 5-20 years of age.
• The photosensitivity range may be determined by stimulating the
ascending and descending frequencies.
• PPR has a high correlation with clinical epilepsy.
29. Photo-paroxysmal response
• Prevalence in a cohort of 575 epilepsy patients from South India was 3.5%.
• PPR was highest in PME (67%), JME (22%), other IGE (3%). About 15% of
patients with focal epilepsy can have PPR.
• Photosensitivity can be familial. Nearly one-third of siblings of epilepsy
patients with PPR may exhibit photosensitivity.
Grade Description
Grade 1 Spikes confined to occipital region.
Grade 2 Spikes confined to parieto-occipital region.
Grade 3 Parieto-occipital spikes extending to frontal regions.
Grade 4 Generalised spikes/ polyspikes.
30. Grade 3 PPR (longitudinal bipolar montage): Parieto-occipital spikes extending to frontal regions, seen
consistently at 12 Hz, in a patient with JAE.
31. Grade 4 PPR (longitudinal bipolar montage): Generalised spikes/ polyspikes and waves were seen
consistently at a frequency of 8Hz in a patient with JME.
32. Grade 4 PPR (average referential montage): Generalised spikes/ polyspikes and waves were seen
consistently at a frequency of 8Hz in a patient with JME.
33. Grade 4 PPR (longitudinal bipolar montage): Generalised spikes/ polyspikes and waves were seen
consistently at a frequency of 16 Hz in a patient with JME.
34. PPR
EEG bipolar montage showing rhythmic frontally dominant generalised spike and dome activity triggered by
photic stimulation at 10Hz, in aptient with CAE.
37. Hyperventilation
• Breathe deeply at 20-30 breaths/ min for 3 minutes with eyes closed.
• Post HV observation should be for 3 minutes.
• Best seen in children between 8-12 years of age.
• Most prominent if blood glucose is below 80 mg/dl
• HV related changes diminish with age and is therefore not routinely
performed after age of 50 years.
• It should not be performed in patients with cardiovascular,
cerebrovascular or chronic lung diseases.
38. Abnormal slowing in HV
• Slowing can persist upto 1 min after cessation of HV.
• Focal slowing during HV may indicate an underlying pathology only if
it is also evident in the baseline EEG.
• Focal slowing only during HV should be interpreted with caution.
40. Hyperventilation: Initially there is diffuse slowing in the theta range, followed by high amplitude 1.5-4Hz
delta activity, called ‘build-up’.
41. Hyperventilation: Initial diffuse theta is followed by delta range slowing which is symmetrical and
synchronous, more in the anterior region in adults and post region in children.
42. Hyperventilation: hyperventilation induced high amplitude rhythmic slowing (HIHARS) is a
hypersynchronous slowing seen in children during HV and may be confused with absence seizures
because of intermixed fast activity that may mimic spikes.
43. Hyperventilation: can accentuate asymmetrical or focal pathological slowing. Here the asymmetry between
the left and the right is accentuated during hyperventilation.
44. Hyperventilation: can accentuate asymmetrical or focal pathological slowing. Here the asymmetry between
the left and the right is accentuated during hyperventilation.
45. Hyperventilation: can trigger spikes in epilepsy patients. This EEG shows bifrontal spikes noted during
hyperventilation. Spikes are followed by delta range slowing.
51. Sleep
• It is a powerful activator of nearly all forms of epilepsy.
• Routine EEG should include 20 min of awake and 20 min of sleep.
• Sleep deprivation can be used to obtain a sleep record. Patient is asked
to sleep 50% of his usual sleep time on the night prior to the recording.
• In children, Chloral hydrate (max 25 mg/kg) or Melatonin can be used
to induce sleep without significant drug induced alterations in the
EEG.
52. Referential montage showing frontally dominant generalised polyspike and wave discharges in a
22 year old patient with JME. Few focal frontal spikes are seen.
53. EEG bipolar montage: shows frontally dominant generalised polyspike and wave discharges
in sleep.
54. Longitudinal bipolar montage in a child with atypical BRE showing marked activation of spikes
in sleep, producing continuous spike and wave discharges in sleep.
55. Longitudinal bipolar montage in a child with LKS showing marked activation of spikes in sleep,
producing continuous spike and wave discharges in sleep.
56. MAMATA BAG(4714636)
Right and left frontal and fronto-temporal epileptiform discharges.
EEG Longitudinal bipolar montage of a 38 year old lady showing right fronto-temporal
spikes. MRI brain showed right fronto-temporal venous infarct.
57. Longitudinal bipolar montage of a 9 year old child with idiopathic occipital epilepsy showing
frequent occipital spikes in sleep on both sides.
58. Referential montage of a 5 year old boy showing frequent spikes in the central, parietal and
temporal channels, with phase reversal.
59. Referential montage of the same child showing marked activation of the spikes in sleep, which is
highly characteristic of BCECTS.
60. Special forms of stimulation
Watching TV Watch black and white TV at 2-3 m, and progressively reduce the distance to
30 cm. 40% of patients with PPR have seizures while watching TV. PPR may
occur only at high frequencies like 100 Hz.
Pattern sensitivity Invariably associated with photosensitivity. Isolated pattern sensitivity is
rare. Show a card of 30 cm width with alternating black and white stripes of
25 mm each at a distance of 50 cm from the eyes.
Somatosensory
stimulation
Touch, vibration may elicit myoclonus.
Lous sudden sound May elicit myoclonus or seizures in some.
Reading Silent and loud reading
Cognitive tasks Mental arithmetic, argumentative conversation, card or chess playing,
praxis.