Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
“Love is like the human appendix. You take it for granted while it's there, but when it's suddenly gone you're forced to endure horrible pain that can only be alleviated through drugs.”
― Reverend Jen,
“Love is like the human appendix. You take it for granted while it's there, but when it's suddenly gone you're forced to endure horrible pain that can only be alleviated through drugs.”
― Reverend Jen,
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
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.
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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.
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
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.
3. Between 4-6 weeks, the cloaca becomes the
common depository for the developing urinary,
genital and rectal systems.
Than cloaca divided into an anterior urogenital
sinus and a posterior intestinal canal by the
urorectal septum.
Two lateral folds of cloacal tissue join the
urorectal septum.
3
4. Anorectal atresia occurs in one of every 4000 to
5000 newborns.
Slightly more common in males.
The most frequent defect-
◦ Male- anorectal atresia with
rectourethral fistula.
◦ Female- anorectal atresia with
rectovestibular fistula.
4
5. MALES -
1. Rectobladder neck fistula
2. Rectourethral fistula
Prostatic
Bulbar
3. Imperforate anus with no fistula
4. Perineal fistula
5. Rectal Atresia
5
6. FEMALES -
1. Rectovestibular fistula (most common)
2. Perineal fistula (2nd most common)
3. Cloaca (3rd most common)
with a common channel longer than 3 cm
with a common channel shorter than 3 cm
4. Imperforate anus with no fistula
5. Complex malformations
6
9. Only true supralevator malformation
Incidence- 10% of total male ARM.
Rectum opens into the bladder neck
Levator muscles, striated muscle complex, and
the external sphincter are poorly developed,
sacrum is often deformed and short, perineum is
often flat
Poor prognosis
9
11. Most frequent defect.
Fistula may be located at the lower (bulbar) or the
higher (prostatic) part of the urethra.
Immediately above the fistula, the rectum and
urethra share a common wall.
Meconium through the urethra-unequivocal sign of
a rectourinary fistula.
11
12. RECTOURETHRAL BULBAR FISTULA-
◦ Usually associated with good-quality muscles, a well-
developed sacrum, a prominent midline groove, and a
prominent anal dimple.
RECTOURETHRAL PROSTATIC FISTULA-
◦ more frequently
◦ associated with poor-quality muscles, an abnormally
developed sacrum, a flat perineum, a poor midline
groove, and a barely visible anal dimple.
12
14. Incidence - 5%
Most patients have – well developed sacrum and
good muscles
Good prognosis
The rectum usually terminates approximately 2 cm
from the perineal skin.
Rectum and urethra separated only by a thin,
common wall.
14
15. 50% pt also have Down syndrome.
More than 90% of patients with Down syndrome
and imperforate anus have this defect.
Down syndrome does not interfere with good
prognosis for bowel control.
15
16. Extremely unusual defect in male patients (~1%).
The lumen of the rectum is totally (atresia) or
partially (stenosis) interrupted.
The upper pouch - dilated rectum
The lower portion - small (1-2 cm) anal canal in
the normal location
These two structures may be separated by a thin
membrane or by dense fibrous tissue.
Excellent functional prognosis.
Must be screened for a presacral mass.
16
17.
18. It is defined as a defect in which the rectum,
vagina, and urinary tract meet and fuse, creating a
single common channel.
This defect should be suspected in a female born
with imperforate anus and small-looking genitalia
On inspection- single perineal orifice.
Length of the common channel varies from 1 to 7
cm.
18
19. Frequently, the vagina is abnormally distended
and full of secretions (hydrocolpos)
It compresses the trigone and frequently
associated with megaureters
Hydrocolpos may become infected (pyocolpos)
and may lead to perforation and peritonitis
Also associate with different degrees of vaginal
and uterine septation or duplication
Rarely, patients may have cervical atresia
19
23. This defect can be repaired with a posterior
sagittal operation without opening the abdomen.
Usually associated with a well-developed sacrum,
a normal-appearing perineum, and adequate
muscles and nerves therefore, a good functional
prognosis.
23
25. It is the most common defect in girls
Excellent functional prognosis.
On inspection - normal urethral meatus and a
normal vagina, with a third hole in the vestibule,
About 5% of these patients will have two
hemivaginas with a vaginal septum.
25
27. It is equivalent to the perineal fistula described in
the male patient.
The rectum is well positioned within the sphincter
mechanism, except for its lower portion, which is
anteriorly located.
The rectum and vagina are well separated
27
29. Same therapeutic and prognostic implications as
described for male patients.
29
30. Unusual and bizarre anatomic arrangements can
be seen.
No general guidelines can be drawn for the
management of these patients.
Each case must be individualized.
30
31. The term vaginal fistula is frequently erroneously
used in patients who actually have a vestibular
fistula or a cloaca.
A true vaginal fistula occurs in less than 1% of all
cases.
It is not considered part of the proposed
classification.
31
32. 1. Urologic defects (approx 50%)
2. Spinal and sacral defects (approx 30%)
3. Tethered cord and other cord abnormalities
(approx25%)
4. Cardiovascular malformations (approx 30%)
but only 10% have important hemodynamic
repercussions, requiring treatment
5. Esophageal atresia (approx 5–10%)
32
36. MALE :
• Meconuria
• Midline raphae
• Size and position of anal dimple
• Gluteal folds
• Good looking perineum
• Imperforate anus with no fistula
• Flat bottom, bifid scrotum
FEMALE :
• Number of openings
• One/two/three/four
37.
38. Does the baby has a serious associated
defect that endangers life.?
Does the baby need a colostomy or we
perform a primary repair of
malformation?
39. During the first 24 hours :
the neonate should
• Take nothing orally
• Receive intravenous fluids
• And antibiotics
• Look for other associated defects
41. • Examination of spine
• Passage of nasogastric tube
• Central cyanosis
• Limb anomaly
• Examination of genitalia
42. • USG abdomen to R/O Hydronephrosis &
Megaureter
• USG pelvis in a female to R/O Hydrocolpos
• USG spine for tethered cord
• Xray spine & sacrum for anamolies
• Clinical evaluation for CVS defects( along with
Echocardiograghy) & Esophageal atresia
43. After 24 hrs :
• Re evaluate
• Look for passage of meconium, if not we go for
investigation
52. COLOSTOMY
HIGH PRESSURE DISTAL COLOSTOGRAM AT 2-3
MONTHS OF AGE
PSARP DONE AT 6MONTHS TO 1 YEAR OF AGE
DILATION BY HEGAR DILATOR OF DIFFERENT SIZES
DEFENATIVE SURGERY
71. Laparoscopically assisted anorectal
pull through (LAARP) for high ARM
• Advantages:
• LAARP allows the surgeon to treat a high
lesion like a low lesion.
• No need to divide the muscle complex from
below.
• Immediately after the procedure strong and
symmetric contraction of the sphincter around
the neoanus can be seen.
72. • It also avoids complication and multiple
procedures associated with colostomy.
• More rapid return of bowel function
• Improved cosmetic appearance
• Shorter postoperative recovery
• Decreased postoperative complications
73. REFERNCES :
• Paediatric surgery-Diagnosis & management by
P.Puri & M Hallworth
• Ashcraft’s paediatric surgery 5th ed.
• Holshneider anorectal malformations in children
THANK YOU
Editor's Notes
Vacterl anomoly can be associated with klippel feil and golden har syndrome. Among vacterl anomoly vertebral defetcs are 80% wich constitues hypoplasa, hemi vertebrae,scoliosis,etc.. Anal atresia and imperforate anus, Cardiac defects 75% wich has VSD as MC, ASD, TOF…, TEF, Esophageal atresia, Renal agenesis, Radial anomoly
Hydrocolpos means distension of vagina due to fluid accumulation proximally. Obstruction might be bcos of imperforate hymen, transverse vaginal septum.
Tetherd cord means pulling of cord making it taught due to attachment to the canal. They are called tethered cord syndrome(TCS) or occult spinal dysraphism sequence which consists on multiple neurological defects that relate to malformation of spinal cord. Like tight filum terminale, dermoid cyst, cystocele, diastematomeylia(split cord malformation), lipomeningomyelocele.
Invertogram is obselete nowadays bcos of many disadvanatges like faulty techique, aspiration by baby in inverted position. Rectal gas to skin length less than 1cm ,more than 1 cms are all obselete. Imp feature to remember is both the GT shud superimpose
Level of PC line denotes the bladder neck, verumontanum, pelvic reflection from rectum to prostate, external OS of cervix. I line corresponds to upper surface of bulb of urtehra in amle and upper limit of perineal body n the level of triangular ligament in female. Errors due to insufficient time, meconium plug, gas escaping thru fistula, inapprop placement of anal marker.
After 4 weeks we go for cologram. #8 foley catheter is introduced in the mucous fistula 2-3cms n balloon infalted with 1-2ml water. Then we inject around 100ml of water sol contrast. Initially the contrast stops at PC line creating a line. This represents the muscle tone of levator ani. Not to confuse with high arm. Now inject with more pressure to overcome the tone. Not possible in RVF, bcos it immediately leaks and we cannot create pressure. In high fistula we have to go by APPSARP/APPT.
For the imaging study, your child will not be sedated and the procedure will last approximately 15 minutes. The team will inject a special dye into the distal stoma, and use other tools to help push the dye into the final segment of the colon and rectum. This procedure gives the surgeon a very clear image of the defect and surrounding anatomy.
This procedure is done in an outpatient setting. The surgical team will be able to proceed with your child’s final repair surgery after the distal colostogram.
