This document provides an overview of approaches to evaluating and treating bleeding disorders and acute anemia. It discusses evaluating the clinical history and laboratory tests to distinguish between local and systemic bleeding issues and primary versus secondary hemostatic defects. Common causes of bleeding like hemophilia, von Willebrand disease, liver disease, and medications are reviewed. Emergency treatment options and dosing calculations for replacing coagulation factors in hemophilia are also covered.
Pancytopenia is a reduction in the number of RBC, WBC and platelet. It's a combination of anaemia, leukopenia and thrombocytopenia. Pancytopenia caused by Decreased bone marrow function and increased peripheral destruction. diseases are diagnosed by physical examination, complete blood counting, peripheral smear examination, bone marrow examination and other special methods. Treatment to pancytopenia is treated to anaemia, thrombocytopenia and leukopenia
This presentation is about anemia of chronic disease, nowadays also called as anemia of Inflammation. I have dealt with anemia in CKD and malignancy in detail.
metabolic acidosis develops because of defects in the ability of the renal tubules to perform the normal functions required to maintain acid-base balance.
Pancytopenia is a reduction in the number of RBC, WBC and platelet. It's a combination of anaemia, leukopenia and thrombocytopenia. Pancytopenia caused by Decreased bone marrow function and increased peripheral destruction. diseases are diagnosed by physical examination, complete blood counting, peripheral smear examination, bone marrow examination and other special methods. Treatment to pancytopenia is treated to anaemia, thrombocytopenia and leukopenia
This presentation is about anemia of chronic disease, nowadays also called as anemia of Inflammation. I have dealt with anemia in CKD and malignancy in detail.
metabolic acidosis develops because of defects in the ability of the renal tubules to perform the normal functions required to maintain acid-base balance.
Surgeons are doing surgeries because of normal blood clotting and wound healing. Suppose if your patient’s blood doesn’t clot properly and you come to know this only on the table, it would be a nightmare to any surgeon irrespective of their subspecialty. In this PPT, I am discussing about how to handle a patient with bleeding diathesis during and after surgery. Indeed it is a challenging and fascinating problem. I hope you will enjoy the video. You can watch all my teaching videos in the following links: surgicaleducator.blogspot.com; youtube.com/c/surgicaleducator.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
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
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
29. Intrinsic Pathway Extrinsic Pathway Common Pathway XII XIIa XI HK/PK IXa/ IX VIIIa XIa XII XIIa XI XIa HMWK IXa IX VIIIa/PL Tenase Ca ++ X Xa II IIa Va/PL Ca ++ Fibrinogen Fibrin X-linkedFibrin XIIIa Prothrombinase VIIa/TF VII VIIa TF Ca ++ X Xa II IIa Va/PL Ca ++ Fibrinogen Fibrin
32. Mixing Study + 0% 100% 50% <30% Correctable Normal coagulation time Uncorrectable prolonged coagulation time Deficiency Inhibitor
33. Isolated prolonged PT Mixing study Correctable Uncorrectable Deficiency Inhibitor Hereditary: FVII FVII Acquired: early liver impairment vitamin K antagonist vitamin K deficiency
34. Isolated prolonged aPTT Bleeding No bleeding Mixing study Mixing study Correctable Uncorrectable Correctable Uncorrectable Deficiency Inhibitor Deficiency Inhibitor Factor VIII / vWD Factor VIII Factor XII Factor XII Factor IX Factor IX HMWK HMWK Factor XI Factor XI Prekallekrein Prekallekrein Lupus anticoagulant
35. Prolonged aPTTand PT Correctable Uncorrectable Deficiency Inhibitor Hereditary:single factor FII, V, or X Hypofibrinogenemia Afibrinogenemia Dysfibrinogenemia Acquired:multiple factors Acquired: early liver impairment Heparin vitamin K antagonist Lupus anticoagulant vitamin K deficiency DIC
55. vWF panel: Interpretation Test/Type 1 2A 2B 2M 2N 3 BT N or ↑ ↑ ↑ N or ↑ ↑ ↑ N ↑↑↑↑ vWF:Ag ↓ ↓ ↓ ↓ or N ↓ or N ↓↓↓↓ vWFR:Co ↓ ↓↓↓ ↓↓ ↓ ↓ or N ↓↓↓↓ LD-RIPA - - ↑ - - - FVIII N or ↓ N or ↓ N or ↓ N ↓↓↓ ↓↓↓ Multimer N but ↓ abnormal abnormal N but ↓ N but ↓ absent
56.
57.
58.
59.
60.
61. Laboratory Evaluation PT aPTT TCT Fibrinogen D-dimer Hemophilias NL ↑↑ NL NL NL Liver disease ↑↑ ↑ NL or ↑ NL or ↓ NL or ↑ DIC (acute) ↑ ↑ NL or ↑ NL or ↓ ↑↑ Vit K Def. ↑ ↑ NL NL NL Heparin NL ↑↑ ↑↑ NL NL Warfarin ↑↑ NL or ↑ NL NL NL Acquired ↑* ↑* NL NL NL Inhibitors (*depends on type of inhibitors)
85. XII XIIa XI XIa HMWK IXa IX VIIIa/PL Ca ++ X Xa VIIa/TF VII VIIa TF Tenase II IIa Va/PL Ca ++ Fibrinogen Fibrin X-linkedFibrin XIIIa Prothrombinase Intrinsic Pathway Extrinsic Pathway Common Pathway
86. NL PT, ↑ aPTT ↑ PT, NL aPTT ↑ PT, ↑ aPTT NL PT, NL aPTT 50:50 mixing study Factor def.: FXI,IX, VIII Inhibitor Specific: XI, IX, VIII NS:antiphos-pholipid FVII def., Vit. K def, liver dz, DIC Normal Prolonged Inhibitor Specific: VII (rare) NS:antiphos-pholipid Factor def.: V, X, II, I Inhibitor Specific: X, V, II, I NS:antiphos-pholipid -Dysfibrinogenemia -FXIII deficiency - α 2-Antiplasmin def -Mild isolated factor def. -Elevated FDP -Monoclonal gammopathy -Qualitative or quantitative platelet disorders -Vascular Disorders
After TF binds to FVIIa, the complex enhances more conversion of FVII VIIa (CHECK ACCURACY) and also form extrinsic tenase which activates FX to activated form and FIX to IXa. FX activation is more efficient. FXa then converts small amounts of II—> IIa. This low conc. Of thrombin is suff. To amplify coagulation by activating FV and VIII (key cofactors in coagulation), plts and plt-bound FXI. 2) Coagulation is propagted when FIXa binds to VIIIa on the surface of activated plts to form intrinsic tenase, the complex that efficiently activates FX. FXa then binds to FVa on the activated plts surface in the presence of Ca++ to form prothrombinase, which converts prothrombin to thrombin. Thrombin also activate plt-bound FXI which will promotes more FXa generation. FXa also promotes more activation of FVII VIIa , all of which help promote propagation of coagulation. 3) The final step is fibrin formation is when thrombin converts FBG fibrin. Thrombin also activates FXIII, which cross-links and stabilizes the fibrin network. n the presence of Ca++, PL
Bleeding time is not predictive for post-op bleeding, should not be used solely to make a diagnosis of clinical bleeding risk, may begin to prolong when plt. < 100K but usua. Is not out of the upper normal range until plt. are < 50K Superimposed qualitative plt. Abn. Will cause a greater prolongation of the bleeding time than a decrease in plt. Count alone.
Emergency splenectomy prior to emergency craniotomy for intracranial hemorrhage. Treatment is generally not required at Plt >30-50 K. Life-threatening hemorrhage rarely occurs at Plt.> 10,000
Scan plt. Agg tracing
if > 2 hrs. there may be decay of labile clotting factors : FV and FVIII may cause erroneous results
Will discuss in more details in the second part of this lecture when talking about clinical approach of bleeding disorders
Antibodies were directed against platelet GP complexes e.g. GPIIb/IIIa, Ib/Ix, Ia/IIa, V, and IV
rapidly increase in platelet number after splenectomy removal of RE cells decreased antibody production
Ticlopidine
ASA irreversibly inhibit both COX1 (found in plts), COX2 block TXA2 no plt. Aggregation for the life of plts (7-10 d) NSAIDs reversible effect. Effect on TXA2 depends on half-life of the drug
Liver synthesize almost all the hemostatic protein except vWF and tPA. FFP 4-6 units if FVII level < 10% (INR > 2.5) q 4-6 hrs. Low dose vit K 0.5-1 mg IV
Prednisolone 1-2 mg/kg/d, Dexamethasone 5 mg iv q 6 hr