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.
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.
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.
Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a procedure to dilated the mitral valve in the setting of rheumatic mitral valve stenosis. A catheter is inserted into the femoral vein, advanced to the right atrium and across the interatrial septum. Then the mitral valve is crossed with a balloon and it is inflated to relieve the fusion of the mitral valve commissures effectively acting to increase the mitral valve area and reduce the degree of mitral stenosis. Mitral regurgitation is a potential complication and thus PBMV is contraindicated if moderate or severe regurgitation is present. The Wilkins score examines mitral valve morphology and is determined via echocardiography to assess the likelihood of using PBMV based on certain echocardiographic criteria.
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.
Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a procedure to dilated the mitral valve in the setting of rheumatic mitral valve stenosis. A catheter is inserted into the femoral vein, advanced to the right atrium and across the interatrial septum. Then the mitral valve is crossed with a balloon and it is inflated to relieve the fusion of the mitral valve commissures effectively acting to increase the mitral valve area and reduce the degree of mitral stenosis. Mitral regurgitation is a potential complication and thus PBMV is contraindicated if moderate or severe regurgitation is present. The Wilkins score examines mitral valve morphology and is determined via echocardiography to assess the likelihood of using PBMV based on certain echocardiographic criteria.
determining the suitability of the mitral valve for repair most likely in patients with mitral regurgitation due to myxomatous degeneration and is least likely in patients with regurgitation due to endocarditis most likely with posterior prolapse or flail, whereas ileaflet involvement and isolated anterior leaflet prolapse reduce the likelihood of successful repair substantially.
Variations In Branching Pattern Of Coeliac Trunkiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
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
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.
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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!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
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
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
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
3. The mitral valve was the first of the four
cardiac valves to be evaluated with
echocardiography.
This was due to the relatively high prevalence
of rheumatic heart disease and the relatively
large excursion of the mitral valve leaflets,
which made them an easier target for early
M-mode techniques
4. The mitral valve has a triple function:
it regulates blood flow towards the left
ventricle during diastole at low pressure
gradient while preventing systolic backflow
towards the left atrium
it contributes to the formation of the left
ventricular outflow tract during systole and
its integrity is essential to maintain normal
size, geometry and function of the left
ventricle.
5. The mitral valve, located between the left
atrium and left ventricle, is a functional
complex that relies on normal morphology,
geometrical relations and function of all its
constituents: the left atrium, the mitral
annulus, the mitral leaflets, the subvalvular
apparatus (tendinous chords and papillary
muscles) and the left ventricle.
6. It is important to recognize that the leaflets
of the mitral valve constitute only a portion of
the mitral valve apparatus and that diseases
resulting in mitral dysfunction often are
caused by abnormalities in the overall
apparatus rather than in the actual leaflets.
7. Normal mitral valve function depends on perfect
function and complex interaction between various
structures
The broader concept of “mitral valve complex” allows a
better characterization of both normal and abnormal
valvular function.
Mitral annulus
Mitral
valve Mitral valve
complex
Mitral leaflets
Chordae
tendineae
Sub valvular
apparatus
Papillary
muscles
Left Ventricular wall
Left atrium
9. MITRAL ANNULUS
The mitral annulus constitutes the anatomical
junction between the LV and the LA, and serves as
insertion site for the leaflet tissue.
It is oval and saddle shaped.
The mitral annulus is a fibrotic ring that consists of
an anterior part and a posterior part
10.
11. The anterior portion of the mitral annulus is attached to
the fibrous trigones and is generally more developed than
the posterior annulus.
The aortic-mitral curtain is a fibrous structure that
connects the anterior mitral annulus intimately with the
aortic valve annulus (at the level of the left and non-
coronary cusps)
The annulus is deficient anteriorly at the level of the aorto
mitral curtain.
12. • The posterior part of the mitral annulus is not
enforced and rather discontinuous (making it prone
to dilatation)
• Both parts of annulus may dilate in pathological
conditions
• The antero-posterior diameter forms the minor axis
and the inter-commissural distance refers to the
major axis
13. identifying the mechanism of valvular
insufficiency,
is useful to determine the type of mitral valve
intervention in case of dysfunction and
is of interest to size mitral valve prosthesis or
annuloplasty ring.
14. MITRAL ANNULUS
The anterior-posterior diameter can be measured
using real-time 3D or by conventional 2D in the
parasternal long-axis view.
Conventionally, a parasternal long axis transthoracic
view has been advocated for measuring minor
annular diameter
15.
16. More appropriate measurement of the minor
axis (antero-posterior diameter) of the mitral
annulus can be performed at end-systole
during transthoracic echocardiography in the
apical long axis view (3-chamber view) or its
transoesophageal equivalent, found at mid-
oesophageal level with 135° tilt of the probe
17. The major axis (inter-commissural
diameter) of the mitral annulus is found at a
bicommissural 2-chamber transthoracic
echocardiographic view (when P1-A2-P3
mitral leaflet scallops are visualized) or a
mid-oesophageal bicommissural view at 45-
60° during transoesophageal
echocardiography
18.
19. MITRAL ANNULUS
The orifice at the level of the left AV junction is ovoidal
with a longer intercommissural (IC) and a shorter
septal-to-lateral axis (SL).
Body-weight-corrected data are: 0.39-0.59 mm/kg for
the IC and 0.32-0.48 mm/kg for the SL diameters
respectively .
However, dimensions are underestimated “in vivo” by
2D ECHO as compared by 3D ECHO and with MRI.
Annular dilatation is present when
the ratio annulus/anterior leaflet during diastole is
>1.3
the diameter is ≥ 35 mm
20. • MITRAL ANNULUS
• The annulus depicts complex modifications during
the cardiac cycle
• Annular flexion - a 23-40% variation in the annular
circumference between the systolic and diastolic
configuration
• Excursion Or Annular Descent - movement in apical-
to-basal direction
• The Rotation represents the torque movement while
the complex 3D modifications in shape are called,
Folding of the annulus.
• All such modifications are reduced or disappear with
the use of rigid annuloplasty rings, postoperative
fibrosis or extensive reduction of the posterior
21. MITRAL ANNULUS
Changes to be
observed are
Mitral annulus
diameter
Mitral annular
motion
Calcification
Perivalvular Leak
(Prosthetic Valves)
22. The mitral valve consists of an anterior and
posterior leaflet that converge at
the posteromedial and anterolateral
commissures
Line of contact between leaf lets is termed
as coaptation line
Region of leaf let overlap is called zone of
apposition
23. The largest part of the atrial floor is formed
by the anterior mitral valve leaflet.
Normal leaflets are thin and pliable structures
with a thickness <5 mm
Normal mitral valve area is 4 to 5 cm2
24. MITRAL VALVULAR LEAFLETS
Leaflets Commisure Coaptation
line
Zone of
apposition
25. Posterior mitral leaf let
The posterior leaflet has a quadrangular shape
Attached to approximately two-thirds of the
annular circumference.
The posterior leaflet typically has two well defined
indentations which divide the Leaflet into three
individual scallops as P1,P2,P3.
26. The P1 scallop corresponds to the external
anterolateral portion of the posteror leaflet.
close to the anterior commissure and the left
atrium (LA) appendage.
The P2 scallop medium and more developed.
The P3 scallop is internal and close to posterior
comissure and tricuspid annulus
27. Anterior mitral leaf let
Anterior leaf let has semicircular shape
Is in continuity with non coronary cusp of aortic valve
The free edge of leaf let is not having any indentation
but divided into three segments A1 A2 A3
corresponding to posterior leaf let
28.
29.
30. By Echocardiography,
The presence and the extent of inadequate tissue
Of excess leaflet tissue and the precise localization
of the leaflet lesions should be analysed.
Describing the mitral valve segmentation is
particularly useful to precisely define the
anatomical lesions and the prolapsing segments in
patients with degenerative MR
TEE still remains the recommended approach
TTE predict accurately valve reparability.
43. TEE is probably the method of choice
Multiple views are available which permit to
precisely determine the localization and the
extent of prolapse.
The 'en face' view seen from the LA
perspective is identical to the surgical view
in the operating room.
This view allows to perfectly analysing the
extent of commissural fusion in rheumatic
MR.
44.
45. Chordae tendinae
There are three sets of chordae arising from the
papillary muscles. They are classified according to
their site of insertion between the free margin and the
base of leaflets.
Marginal chordae (primary chordae) are inserted on
the free margin of the Leaflets and function to prevent
prolapse of the leaflet margin.
46. Intermediate chordae (secondary chordae) insert on
the ventricular surface of the leaflets and relieve
valvular tissue of excess tension. Often two large
secondary or „strut‟ chordae can be individualized.
They may be important in preserving ventricular
shape and function.
Basal chordae (tertiary chordae) are limited to the
posterior leaflet and connect the leaflet base and
mitral annulus to the papillary muscle.
50. Commisural chordae arise from ALPM &PMPM
and branch in a fan like fashion and insert
onto both commisures .
These chordae divide about 3 times before
their final attachments leading to around 120
chordal attachment to both leaflets .
52. Papillary muscles
The papillary muscles of the LV are three types
1. Completely tethered papillary muscle: In this
type papillary muscle was fully adherent to the
subjacent ventricular myocardium and
protruded very little into the ventricular cavity
with few trabecular attachments.
53. 2. Finger like papillary muscle: in this type one third
or more of the body of the papillary muscle protruded
freely into the ventricular cavity with very few or no
trabecular attachments.
3. Mixed type papillary muscle: This papillary muscle
had part of the body protruding freely into the
ventricular cavity but also with considerable
trabecular attachments and tethering.
54. The posteromedial PM gives chords to the
medial half of both leaflets (i.e.
posteromedial commissure, P3, A3 and half
of P2 and A2). Similarly, the anterolateral PM
chords attach to the lateral half of the MV
leaflets (i.e. anterolateral commissure, A1,P1
and half of P2 and A2)
58. Real-time 3-dimensional echocardiography
of the mitral valve allows easy identification
of different anatomical segments of the mitral
valve, including both commissures
The `en face` view of the mitral valve can be
constructed and refers to exposure of the
mitral valve from the atrial perspective,
similar to the surgeons view during mitral
valve surgery.