The document discusses a case of a 22-year-old female university student presenting with a week-long continuous headache. Her physical exam was unremarkable and she reported stress from her studies. Differential diagnoses for her headache include tension headache given her age, stressors, and normal exam. The document then reviews classification of headaches, pathophysiology, relevant history to obtain, red flags, management options including analgesics and stress counseling, and evidence on headache evaluation and treatment.
A talk covering epidemiology, diagnosis and management of primary headache disorders, common cases of secondary headache disorders and when to order brain imaging, lumbar puncture in headaches.
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
A talk covering epidemiology, diagnosis and management of primary headache disorders, common cases of secondary headache disorders and when to order brain imaging, lumbar puncture in headaches.
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
Case Studies (Clinical Pharmacy Assignment)
Case Studies
Case Study 1. Drug Related Problem
Case Study 2. Alcohol Toxicity
Case Study 3. Patient Counseling
Case Study 4. Peptic Ulcer
Case Study 5. Drug and the Newborn
Case Study 6. Night time Anxiety
Case Study 7. Clostridium Difficile
Case Study 8. Epilepsy and Pregnancy
Case Study 9. Parkinsonism
Case Study 10. Treatment May Be Worse Than Condition
Carpen ini ditulis khas buat peserta misi kemanusiaan anjuran Kelas Peradaban Nabawi USMKK, Medical Student Relief Team (MERIT) dan juga Medical Student Awareness Team (MESAT). Semoga kita semua terus konsisten dengan usaha dakwah melalui program kesihatan. insyaALLAH suatu hari nanti Islam pasti akan tersebar ke serata dunia kerana “Islam itu Mudah dan Fitrah”
Cerpen ini ditulis khas buat adik-adik peserta SKSPM 2006/2007 dan 2007/2008 serta adik-adikku dan sahabat sekalian. Semoga kita cekal menghadapi hidup. Semoga kita meniti kehidupan ini sambil memandang ke kiri dan kanan kita. Sesungguhnya masih banyak bangsa kita yang berada dalam seribu satu kesusahan. Perjuangan kita bukan lagi perjuangan untuk memenuhkan oerut kita sebaliknya ia adalah perjuangan untuk memajukan bangsa. Inilah masa untuk Revolusi kita bagi mengembalikan kegemilangan ketamadunan kita.
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
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.
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.
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.
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
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!
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.
- 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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The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
Approach to headache family medicine case discussion 2010
1. Headache
Department of Family Medicine Case Discussion
A 22 years old female university student complained of headache for a week. The headache was
continuous, almost daily
She denied any other problem exept for the stress in her studies. Physical examination was not
remarkable.
Questions
1) What relevant history would you ask?
2) What are the differential diagnosis
3) What are the red flags of headache
4) What is the most probable cause of this patient’s headache
5) How will you treat this patient
2. Classification of the headache
Classification of headache according to American College of Emergency Physicians, “Clinical
“
Policy for the Initial Approach to Adolescents and Adults Presenting to the Emergency
Department With a Chief Complaint of Headache 1996
hief Headache”,
Headache Category Examples
I Critical secondary causes requiring Subarachnoid hemorrhage, meningitis, brain
emergent identification and treatment tumor with raised ICP
II Critical secondary causes not necessarily Brain tumor without raised ICP
requiring emergent identification or
treatment
III Generally benign and reversible secondary Sinusitis, hypertension, post–
–lumbar puncture
causes headache
IV Primary headache syndromes Migraine, tension type, or cluster
3. Pathophysiology of pain in headache
Notes: Brain cell do not have pain receptor. Therefore headache mainly arise due to
stimulation of pain receptor on vessel, meningeal irritation or by direct stimulation of
adjacent nerve.
Extracted from Clinical Policy: Critical Issues in the Evaluation and Management of Adult
Patients Presenting to the Emergency Department With Acute Headache, 2008
Headache can be caused by (1) distention, traction, or dilation of intracranial or extracranial
arteries; (2) traction or displacement of large intracranial veins or the dural envelope; (3)
compression, traction, or inflammation of cranial and spinal nerves; (4) head and neck muscle
spasm, inflammation, or trauma; (5) meningeal irritation; (6) raised intracranial pressure; and (7)
disturbance of intracerebral serotonergic projections
Maltifactorial triggers stimulating trigeminal nerve from the blood vessels of the pia mater and
dura mater
Onset of pain and releasing of neurogenic peptides from afferent C fibers innervating cephalic
blood vessels
These vasoactive substance stimulate endothelial cell, mast cells and platelets
Activate inflammatory cascade known as “neurogenic inflammation”
5-HT agonist (Triptans) or,
dihydroergotamine, prochlorperazine, and
metoclopramide, act at a variety of 5-HT and
other aminergic receptors
Vasodilatation with enhanced permeability of plasma proteins follows with a perivascular
inflammatory reaction
Eventhough neurogenic inflammation was proposed as pathogenic mechanism of pain,
however selective and potent inhibitors of neurogenic are proven ineffective in clinical trials.
Serotonin (5-HT) receptors are the main focus of pain management because they are known
to modulate neurogenic peptide release and vasoconstrict dilated dural vessels.
4. Further history to elicit in this patient
1) Elicit the life threatening cause of headache first
a) Is it the worst headache of life and characterized by thunder clap at occipital region-
subarachnoid hemorrhage
b) Any sign and symptoms of increase ICP (blurring of vision, projectile vomiting
especially in the morning, severe headache, altered mental status)
c) Fever, neck stiffness and vomiting to rule out meningitis.
d) Presence of neurological deficit to rule out stroke.
2) Once the life threatening causes has been rule out, then elicit history to exlude differential
diagnosis which is commonly primary headache.
a) Tension headache – diffuse and dull aching headache, tight band headache around
head, associated with stress, relieve on weekend
b) Migraine headache - pain in relationship to food like alcohol, chocolate and cheese,
relieve by sleep, family history of migraine, sensory aura
c) Cluster headache – Severe unilateral headache accompanied with tearing of the left
eye, left ptosis, rhinorrhea, left facial redness, pain on awakening from sleep,
recurrent attack with one episode lasting for 20-30 minutes.
3) If still no clue, then elicit the secondary causes of headache
a) Optic causes- any recent change of spectacle, blurring of vision, astigmatism
b) Ophthalmology pathology – acute closure glaucoma
c) Other secondary causes – VITAMIN CDE.
The Red Flag of Headache
Red flag means emergency and require further evaluation
including CT Scan.
1) Acute onset of first most severe headache ever in life.
2) Headache that is increase in frequency or intensity
3) New onset of headache after age of 50 years old
4) Present of mental state changes
5) Associated with fever, neck stiffness and vomiting
6) Presence of neurological deficit
7) Headache with evidence of increase ICP
Additional note: HIV-positive patients with a new type of headache
should be considered for an emergent neuroimaging study.
5. Provisional diagnosis
In this patient, the most likely diagnosis is TENSION HEADACHE because of few parameters
1) Young female
2) university student with stressful study life.
3) onset start within one week and continuous almost daily
4) unremarkable physical examination
Management for this patient
a) Pharmacological
Analgesic; paracetamol (1g PRN or QID) , Aspirin, NSAIDS (Tab Mefenamic acid 500
mg or sodium diclofenac 50 mg)
+ anti emetic like tab. Metaclopromide (maxalon) 10 mg stat.
b) Non pharmacology
1. Ice pack
2. Relaxation technique
c) Other management
1. Caunselling on stress management.
6. Evidence Based Medicine
Level A recommendations. Generally accepted principles for patient management that reflect a
high degree of clinical certainty (ie, based on strength of evidence Class I or overwhelming
evidence from strength of evidence Class II studies that directly address all of the issues).
Level B recommendations. Recommendations for patient management that may identify a
particular strategy or range of management strategies that reflect moderate clinical certainty
(ie, based on strength of evidence Class II studies that directly address the issue, decision
analysis that directly addresses the issue, or strong consensus of strength of evidence Class III
studies).
Level C recommendations. Other strategies for patient management that are based on
preliminary, inconclusive, or conflicting evidence, or in the absence of any published literature,
based on panel consensus.
Extracted from Clinical Policy: Critical Issues in the Evaluation and Management of Adult
Patients Presenting to the Emergency Department With Acute Headache, 2008
1) Response to therapy for prediction of acute headache aetiology
Level C recommendations. Pain response to therapy should not be used as the sole diagnostic
indicator of the underlying etiology of an acute headache.
Serotonin (5-HT) receptors are the main focus of pain management because they are known to
modulate neurogenic peptide release and vasoconstrict dilated dural vessels. Despite many
adverse effects, 5-HT is a potent vasoconstrictor, a property that may be a factor in its ability to
treat migraines
Some agents, such as the triptans, are specific agonists at the 5-HT1 receptor, whereas other
medications, such as dihydroergotamine, prochlorperazine, and metoclopramide, act at a variety
of 5-HT and other aminergic receptors
Numerous artile describes that most secondary headache show clinical improvement to many
different analgesic but not limited to the following. intracerebral hemorrhage/subarachnoid
hemorrhage (ibuprofen, ketorolac, prochlorperazine), viral meningitis/meningeal carcinomatosis
(dihydroergotamine and metoclopramide) carbon monoxide–induced headache (sumatriptan),
cerebral venous thrombosis (sumatriptan and various common analgesics),carotid artery
7. dissection (sumatriptan), subarachnoid hemorrhage (sumatriptan), and cysts of the cavum septi
pellucidi (indomethacin).
2) Which patient should be evaluated with CT Scan
Level B recommendations.
a. Patients presenting to the ED with headache and new abnormal findings in a neurologic
examination (eg, focal deficit, altered mental status, altered cognitive function)-
noncontrast head CT.
b. Patients presenting with new sudden-onset severe headache - head CT.
c. HIV-positive patients with a new type of headache - neuroimaging study.
Level C recommendations
a. Patients who are older than 50 years and presenting with new type of headache but with a
normal neurologic examination
3) Role of Lumbar puncture in ED patient who being worked up for non traumatic SAH
but with normal non contrast CT Scan
Level B recommendations. In patients presenting to the ED with sudden-onset, severe headache
and a negative noncontrast head CT scan result, lumbar puncture should be performed torule out
subarachnoid hemorrhage.
4) Lumbar puncture in patient complaint of lumbar puncture but no prior neuroimaging
study
Level C recommendations.
a. Adult patients with headache and exhibiting signs of increased intracranial pressure (eg,
papilledema, absent venous pulsations on funduscopic examination, altered mental status,
focal neurologic deficits, signs of meningeal irritation) should undergo a neuroimaging
study before having a lumbar puncture.
b. In the absence of clinical findings suggestive of increased intracranial pressure, a lumbar
puncture can be performed without obtaining a neuroimaging study. (Note: A lumbar
puncture does not assess for all causes of a sudden severe headache.)
5) Role of Emergent angiography in patient presented with sudden-onset, severe headache
who has negative findings in both CT and lumbar puncture
Level B recommendations.
8. Patients with a sudden-onset, severe headache who have negative findings on a head CT,
onset, who
normal opening pressure, and negative findings in CSF analysis do not need emergent
angiography and can be discharged from the ED with follow up recommended.
follow-up
6) Indication for imaging for children with headache in ED
Ref: Faiqa Qureshi &Donald Lewis
7) Acute Migraine Treatment (update in medicine) based on study by Kostic MA, Gutierrez
FJ, Rieg TS, Moore TS, Gendron RT. Emerg Med. 2009 Dec 31, “A Prospective,
Randomized Trial of Intravenous Prochlorperazine versus Subcutaneous Sumatriptan in
Acute Migraine Therapy in the Emergency Department", and summarized by Associate
Professor Rashidi Ahmad (Emergency specialist HUSM) in his blog,
http://drcd2009.wordpress.com/2010/01/07/579/
ress.com/2010/01/07/579/
1) Single dose aspirin 1000 mg + 10 mg Metoclopramide
- Effective in more than half of the patient.
- Aspirin reduced associated symptoms of nausea, vomiting, photophobia, and phonophobia
- More superior to sumatriptan 50 mg for 2 hours pain relief and pain free.
2) Sumatriptan 100 mg
- Superior to aspirin plus Metoclopramide for 2 h pain free.
Ref: Emma Hitt, " Single Dose of Aspirin Effective in Relieving Migraine Pain",
http://cme.medscape.com/viewarticle/720439?src=cmenew
http://cme.medscape.com/viewarticle/720439?src=cmenews&uac=113567PT
3) 500mL NS + IV stemetil 10 mg + IV promethazine 12.5 mg
- IV prochlorperazine with diphenhydramine is superior to subcutaneous sumatriptan in the
treatment of migraine.
10. 9) Post headache recurrence after ED discharge
Regardless of type of primary headache disorder, ED headache patients frequently experience
pain and functional impairment during the hours and months after discharge. [Ann Emerg Med.
2008;52:696-704.]
10) Treating headache recurrence within 48 hours post ED discharge
In this trial, nearly three quarters of patients reported headache recurrence within 48 hours of ED
discharge. Naproxen 500 mg and sumatriptan 100 mg taken orally relieve post-ED recurrent
primary headache and migraine comparably. Clinicians should be guided by medication costs,
contraindications, and a patient’s previous experience with the medication. [Ann Emerg Med.
2010;56:7-17.]
Take home message
Extra notes
1) Most of the headache are primary headache
2) Patient with Subarachnoid hemorrhage may explain the headache as acute onset, most
severe headache in their life, thunder clap around occipital area.
3) Primary headache can be safely manage with NSAIDs
4) Brain cell do not have pain receptor. Headache usually cause by stretching of pain
receptor in blood vessel either due to direct insult or increase ICP.
5) Although first line of treatment for migraine is 5HT3 antagonist or triptans group, patient
can be managed with IV NSAIDs + IV Maxalon.
6) Hypertension rarely cause headache unless the diastolic blood pressure more than 120
mmHg.