Kindly leave your comment if you found this helpful ;)
Some of the slides, i hide it from my real presentations for my own reference. Download to see all of them.
Kindly leave your comment if you found this helpful ;)
Some of the slides, i hide it from my real presentations for my own reference. Download to see all of them.
assessing neonatal systolic and diastolic cardiac function by echo. also assessing how PDA influences cardiac and systemic flow in neonates.
a new unique modility in NICU
- 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
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
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.
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.
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.
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.
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Aortic stenosis may 2021
1. Aortic stenosis
DR J P SONI
Professor and Head of the Department Paediatrics
Division of Pediatric Cardiology
DR S N Medical College
Jodhpur
Doc_jpsoni@yahoo.com
3. Acyanotic
CHD
Without shunt(normal
or decreased flow)
Right side of heart
PULMONARY
STENOSIS
Left side of heart
AORTIC STENOSIS
COARCTATIONOF
AORTA
L-> R SHUNT ↑ PBF
ASD
VSD
P.D.A.
Aorto-pulmonary
Window
4. Aortic stenosis (AS) is most often due to stenosis of the aortic valve (80%–85%), but can also be
due to obstruction below the valve (sub-valvular, 15%, mostly due to discrete membrane) or above
the valve (supravalvular, least common).
AS is more common in males.
The aortic valve can be unicuspid or bicuspid in patients with valvular AS. Patients with unicuspid
aortic valve present commonly in neonatal period with critical stenosis, whereas patients with
bicuspid valve present more commonly during childhood. BAV has been identified in 1% of the
general population; however, the incidence of valvular AS is 0.2–0.4/1000 live births. BAV occurs
in 9% of asymptomatic first-degree relatives of patients with BAV. Severity of AS usually
progresses in 89% of children under 2 years, and 61% of children over 2 years show progression.
Ascending aorta dilation (aorto-pathy), as defined by a Z score >2, has been seen in 74% of
children with BAV and the dilatation tends to worsen over time.
The incidence of endocarditis in AS is 2.7/1000 patient-years. Untreated aortic valve stenosis
presenting in infancy carries a mortality rate of 23%; mortality decreases after that (1.2% per
year for the first two decades of life). The risk of sudden death is 0.4%–0.9% per year.
Supravalvular stenosis is often associated with Williams–Beuren syndrome.
5. Diagnostic Work up
i. Clinical assessment
ii. X-ray chest: Normal-sized heart with post-stenotic dilation of ascending aorta is seen when
obstruction is at valve level. Cardiomegaly indicates severe obstruction with left ventricular
dysfunction. More diffuse dilation of aorta indicates associated aorto-pathy and does not
correlate with severity of AS. The cardiac apex may be left ventricular. Pulmonary venous
hypertension is seen in severe cases. Adults with valvular AS may show calcification of the valve.
ECG:
ECG may be completely normal even in severe AS. Neonates with severe AS may show right
ventricular hypertrophy. The presence of left ventricular hypertrophy with ST-segment
depression and T wave inversion in the left precordial leads (“strain” pattern) indicates severe
AS. Exercise testing can precipitate ST-T changes in asymptomatic patients with severe AS and
normal resting ECG. ECG in supravalvular AS can show features of myocardial ischemia due to
associated obstruction of coronary ostia.
6. Normal anatomy of arch
Ascending AO
Ascending AO - part of arch upto right common carotid
Proximal arch - Part between right and left carotid
Distal arch - Part between left carotid and after left
subcalivan artery
Isthmus - Part of aorta just after left subcalivan artery
When to say arch hypoplasia –
Arch diameter < 50% of aorta at the level of diaphragm
Roger Me - < baby weight +1 mm
Z score < - 2 SD
7. Fetal arch circulation
Ascending aorta, both carotid and left subclavian is perfused By left
ventricular flow and descending aorta is perfused by Ductal flow from right
ventricle. Isthmus is relatively under-perfuse water shed zone.
When there is Critical aortic stenosis, ascending aorta will be perfuse by
retrograde blood flow from PDA, there by head and upper limb.
Thus fetal echo will Depict retrograde flow in ascending aorta With
enlarge RA and RV.
8. Echocardiography
It is the key diagnostic imaging technique for assessing the -
1. site and severity of AS (peak-to-peak and mean gradients),
2. Morphology of the aortic valve
3. Diameter of aortic annulus
4. Evaluation of left ventricular dimensions
5. Mass and systolic function as well as
6. Evaluation of associated lesions such as AR, mitral valve disease, and CoA.
Transoesophageal echocardiography is useful in patients with suboptimal transthoracic window.
It is reasonable to screen first-degree relatives of patients with BAV or unicuspid aortic
valve with echocardiography for valve disease and aortopathy.
9. Aortic stenosis (AS) is most often due to
1. stenosis of the aortic valve (80%–85%)
2. Sub-valvular, 15% - obstruction below the valve, mostly due to discrete membrane
3. Supra-valvular - above the valve, least common.
27. CTA/cMRI may be required in older patients with BAV to assess severity of
aortopathy and in select cases of supravalvular AS.
Cardiac catheterization: Performed primarily for therapeutic balloon valvuloplasty
for valvular AS.
Exercise test: May be performed for asymptomatic patients with borderline
gradients and a normal ECG. This test should not be done in symptomatic
patients.
28. Indications and timing of treatment
Valvular aortic stenosis
i. Immediate intervention required for:
a. Newborns with severe AS who are duct dependent (balloon dilation or surgical valvotomy)
(Class I)
b. Infants or children with left ventricular dysfunction due to severe AS, regardless of the
valve gradient (Class I).
ii. Elective balloon dilation for:
a. Asymptomatic or symptomatic patients with AS having gradient by echo-Doppler of >64
mmHg peak or >40 mmHg mean or peak-to-peak gradient of ≥50 mmHg, measured invasively
at cardiac catheterization (Class I).
29. b. Patients with symptoms due to AS (angina, exercise intolerance) or ECG showing ST-segment
changes at rest or during exercise: balloon dilation should be considered for lower gradients
(invasively measured) of ≥40 mmHg (Class I).
c. Asymptomatic child or adolescent with a peak to peak gradient (invasively measured) of ≥40
mmHg, but without ST–T wave changes, if the patient wants to participate in strenuous
competitive sports (Class IIb).
30. Sub-valvular aortic stenosis due to discrete membrane:
Surgical intervention indicated in
i. Patients with a peak instantaneous gradient of ≥50 mmHg (Class I)
ii. Patients with a peak instantaneous gradient of <50 mmHg associated with AR of more
than mild severity (Class I)
iii. Patients with a peak instantaneous gradient between 30 and 50 mmHg (Class IIb)
iv. Symptomatic patients with a peak instantaneous gradient <50 mmHg in the following
situations:
a. The presence of left ventricular dysfunction attributable to obstruction (Class I)
b. When pregnancy is being planned (Class IIa)
c. When the patient plans to engage in strenuous/ competitive sports (Class IIa).
v. Intervention not indicated for asymptomatic patients with gradient of <30 mmHg with no
or trivial AR (Class III). Balloon dilation may be attempted in select cases with thin
membranes which are away from the aortic valve (Class IIb).
31. Supravalvular aortic stenosis:
Surgical intervention indicated in
i. Symptomatic patients with peak instantaneous gradient ≥64 mmHg and/or mean gradient
≥50 mmHg on echo-Doppler (Class I)
ii. Patients with mean Doppler gradient <50 mmHg, if they have any of the following
(Class I):
a. Symptoms attributable to obstruction (exertional dyspnea, angina, and syncope)
b. Left ventricular systolic dysfunction attributable to obstruction
c. Severe left ventricular hypertrophy attributable to obstruction
d. Evidence of myocardial ischemia due to coronary ostial involvement
iii. Asymptomatic patients with mean Doppler gradient ≥50 mmHg may be considered for
surgery when the surgical risk is low (Class IIb).
All patients with AS must be advised to maintain good oro-dental hygiene.
32. Important determinants of long-term prognosis
Residual or recurring stenosis
progressive aortic dilation,
complications related to prosthetic valve function, such as stuck valve leaflet,
paravalvular leak, patient–prosthesis mismatch, and pannus formation. Dysfunction of
RV-to-pulmonary artery conduit in those undergoing Ross operation.
33. Recommendations for follow-up -
i. All patients with AS require lifelong follow-up irrespective of the type of intervention.
ii. Clinical assessment, ECG, and echo are required, the interval depending on the severity of
stenosis.
iii. Those who have undergone a valve replacement, periodic monitoring of anticoagulation
(international normalized ratio [INR] levels) is essential. Follow-up after valve interventions
should be done annually.
iv. Echocardiography is the mainstay for follow-up for the assessment of aortic valve and
ventricular function and above-listed postoperative issues.
v. Patients who have significant AS and are planned for an intervention, should refrain from any
sporting activity. Those with asymptomatic moderate stenosis can exercise with low or
moderate intensity. Patients with mild degree of stenosis can participate in all sports.
vi. IE prophylaxis is recommended in patients with a prosthetic valve. However, all patients with
AS are advised to maintain good oro-dental hygiene.