Cavernous sinus thrombosis represents a rare but devastating disease process that may be associated with significant long-term patient morbidity or mortality. The prompt recognition and management of this problem is critical.
Supplemental corticosteroids for dental patients with adrenal insufficiencyR...DrKamini Dadsena
Primary Adrenal Insufficiency:
It is caused by a progressive destruction of the adrenal cortex, usually of an idiopathic nature (most commonly autoimmune), but also results from hemorrhage, sepsis, infectious diseases (such as tuberculosis, human immunodeficiency virus, cytomegalovirus and fungal infection), malignancy, adrenalectomy, amyloidosis or drugs.
Cavernous sinus thrombosis represents a rare but devastating disease process that may be associated with significant long-term patient morbidity or mortality. The prompt recognition and management of this problem is critical.
Supplemental corticosteroids for dental patients with adrenal insufficiencyR...DrKamini Dadsena
Primary Adrenal Insufficiency:
It is caused by a progressive destruction of the adrenal cortex, usually of an idiopathic nature (most commonly autoimmune), but also results from hemorrhage, sepsis, infectious diseases (such as tuberculosis, human immunodeficiency virus, cytomegalovirus and fungal infection), malignancy, adrenalectomy, amyloidosis or drugs.
Sedation in ophtalmology,Part presented to a Ophtalmic course in Lecce,Italy,2011.There is at the end an annotated bibliography on points of interest in ophtalmology,cataract surgery in particular.
Primary PCI with stenting immediately after coronary reperfusion salvage procedures jeopardizes myocardium, improves prognosis, and is the current standard of care for acute STEMI .
No-reflow is defined as an acute reduction in myocardial blood flow despite a patent epicardial coronary artery .
The pathophysiology of no-reflow involves microvascular obstruction secondary to distal embolization of clot, microvascular spasm, and thrombosis .
No-reflow occurs in ~10% of cases of primary PCI and is associated with patient characteristics such as advanced age and delayed presentation and coronary characteristics such as a completely occluded culprit artery and heavy thrombus burden .
Iatrogenic Ureteral Injuries in Non – Urological Surgeries: An Institutional ...iosrjce
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.
Upper gastrointestinal bleeding is the most common and potentially life threatening emergency. Despite great advances in the field of medicine, the optimal management of bleeding peptic ulcer with adherent clot on endoscopy is still controversial. The aim of this study is to compare the combined endoscopic and medical therapy with medical therapy alone for bleeding peptic ulcer with adherent clot (Forrest type IIB). During two-year study period, around 342 patients presented to our tertiary care hospital with acute upper gastrointestinal bleeding. Out of these, 81 patients were noted to have adherent clot (Forrest type IIB) during endoscopy and were included in study. 40 patients received combined endoscopic and medical treatment, whereas 41 patients received medical treatment only. The base line characteristics of patients in two groups were comparable. Primary Outcome being recurrence of bleeding within 7 days of treatment was less in combined therapy group compared to medical therapy group (2.5% vs. 17.1%). This was statistically significant. Secondary outcome like recurrence of bleed in 30 days and need for repeat endoscopy were less in combined group compared to medical therapy group. These were statistically significant as well. Other secondary outcomes like necessity for surgery and mortality were fewer in combined group, but these were not statistically significant. In conclusion combination endoscopic therapy consisting of epinephrine injection, removal of the adherent clot, and treatment of underlying stigmata is more effective than medical therapy alone.
Incisional Hernia, risk factors, management and relation to Surgical Abdomina...iosrjce
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.
Sedation in ophtalmology,Part presented to a Ophtalmic course in Lecce,Italy,2011.There is at the end an annotated bibliography on points of interest in ophtalmology,cataract surgery in particular.
Primary PCI with stenting immediately after coronary reperfusion salvage procedures jeopardizes myocardium, improves prognosis, and is the current standard of care for acute STEMI .
No-reflow is defined as an acute reduction in myocardial blood flow despite a patent epicardial coronary artery .
The pathophysiology of no-reflow involves microvascular obstruction secondary to distal embolization of clot, microvascular spasm, and thrombosis .
No-reflow occurs in ~10% of cases of primary PCI and is associated with patient characteristics such as advanced age and delayed presentation and coronary characteristics such as a completely occluded culprit artery and heavy thrombus burden .
Iatrogenic Ureteral Injuries in Non – Urological Surgeries: An Institutional ...iosrjce
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.
Upper gastrointestinal bleeding is the most common and potentially life threatening emergency. Despite great advances in the field of medicine, the optimal management of bleeding peptic ulcer with adherent clot on endoscopy is still controversial. The aim of this study is to compare the combined endoscopic and medical therapy with medical therapy alone for bleeding peptic ulcer with adherent clot (Forrest type IIB). During two-year study period, around 342 patients presented to our tertiary care hospital with acute upper gastrointestinal bleeding. Out of these, 81 patients were noted to have adherent clot (Forrest type IIB) during endoscopy and were included in study. 40 patients received combined endoscopic and medical treatment, whereas 41 patients received medical treatment only. The base line characteristics of patients in two groups were comparable. Primary Outcome being recurrence of bleeding within 7 days of treatment was less in combined therapy group compared to medical therapy group (2.5% vs. 17.1%). This was statistically significant. Secondary outcome like recurrence of bleed in 30 days and need for repeat endoscopy were less in combined group compared to medical therapy group. These were statistically significant as well. Other secondary outcomes like necessity for surgery and mortality were fewer in combined group, but these were not statistically significant. In conclusion combination endoscopic therapy consisting of epinephrine injection, removal of the adherent clot, and treatment of underlying stigmata is more effective than medical therapy alone.
Incisional Hernia, risk factors, management and relation to Surgical Abdomina...iosrjce
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.
Major surgery is a considerable physiologic insult that can be
associated with significant morbidity and mortality. The prevention of perioperative morbidity is a determining factor in providing high-quality in health care, since the occurrence of postoperative complications adversely affects postoperative survival and increase healthcare costs
Wound dehiscence in surgical procedures and its relationship to increased mor...AI Publications
This study aims to determine outcomes for Wound dehiscence in surgical procedures and its relationship to increased mortality. Twenty-five patients were collected from different hospitals in Iraq with intestinal obstruction, and they were distributed into two groups according to gender (15 males, ten females), and the average age ranged between 25-50 years. This retrospective study included those patients who were after bowel surgery at different hospitals in Iraq between January 6, 2020, and May 27, 2021, where information was obtained by reviewing clinical records.The statistical analysis program IBM SPSS SOFT 18 was also relied upon for the purpose of knowing the true value and standard regression in addition to the percentage of healthy variables to patients. Microsoft Excel 2013 was used for the purpose of describing and analysing demographic data. the results which found of this study collected 25 patients, and MEAN VALUE with slandered div of age patients was 39.4800 ± 6.8, and the type of anaesthesia used in this study was general anaesthesia. Causes of the bowel surgery according to the sex of the patients were (Mesenteric Ischaemia for one female patient and three male patients and Blunt trauma was one patient for both sexes. Bowel surgery, according to emergency basis and elective basis, was the emergency basis for 19 patients and elective for six patients. Association between Surgery * sex * presence of leaks Cross-tabulation were nine patients for an emergency basis and one patient for Elective. In this study, the mortality rate was higher for males than for females (1.4 patients), respectively and we concluded that there is a statistical relationship between the death rate and its prevalence among men
Open haemorrhoidectomy revisited: the study of 25 casesKETAN VAGHOLKAR
Background: Haemorrhoids continue to be the commonest benign anorectal condition presenting with bleeding and constipation. The presentation may vary depending on the grade of haemorrhoids. Deciding the best therapeutic option is the biggest challenge faced by the attending surgeon in an era where newer therapeutic technologies for treatment continue to evolve. Therefore, revisiting the traditional surgical option of excision and ligation technique for grossly symptomatic piles was evaluated taking into consideration the cost of the procedure. Twenty five consecutive patients of symptomatic grade III and IV haemorrhoids were selected for the study to determine the outcome of the traditional open method (Milligan Morgan technique)
Methods: Twenty five patients after having been checked for fitness for anaesthesia underwent the open method of haemorrhoidectomy under spinal anaesthesia. On admission to hospital a detailed proforma which contained demographic details, and comorbidities was completed. All 25 patients underwent the same procedure by ligation excision technique. Details of operative findings including post-operative outcomes were studied prospectively. Results were evaluated.
Results: Of the 25 patients, one patient developed bleeding in the immediate post-operative period which required relook surgery and undermining of the oozing stump. Four patients required catheterisation for urinary retention. A six month follow up did not reveal recurrence or any sort of discomfort while passing stools.
Conclusions: Open haemorrhoidectomy (Milligan Morgan) continues to be the most optimum method for treatment of symptomatic piles grade III and IV.
42.Shilpa Sunil Khanna et al. Efficacy of Tranexamic Acid on Intraoperative Blood Loss in third molar Surgery: A Split Mouth Randomized Study. J Res Adv Dent 2020;10:3:192-196.
our study and experiences we thus conclude that the stapler haemorrhoidopexy is simple and safe procedure. It is a minimally invasive procedure and it is less associated with post-operative pain bleeding and prolapse. It can be done as the day care surgery.
Clinical assessment scoring system for tracheostomy (CASST) criterion: Objec...DrKamini Dadsena
Tracheotomy has been used for many centuries as a means to bypass upper airway obstruction.
Head and neck cancers are often associated with anatomic changes which can create a potentially difficult airway.
CARNOY’S SOLUTION AS A SURGICAL MEDICAMENT IN THETREATMENT OF KERATOCYSTIC O...DrKamini Dadsena
The term keratocyst was coined by Philipsen in 1956.
Unlike the other cystic lesion KOT, has got strong tendency for recurrence.
Treatment of these lesions remains controversial and has a number of dilemmas about the choice of treatment whether to use carnoys solution as an adjunct therapy after removal of the lesion.
Temporomandibular disorders (TMDs) are considered the major cause of orofacial pain. Internal derangement (ID) of the temporomandibular joint (TMJ), which is classified as disc displacement with or without reduction, is one of the disorders of the TMJ that is frequently seen.
Displacement of the articular disc can result in decreased joint space, joint noise (clicking, popping, or crepitation), arthritis, condylar resorption, inflammation, and compression of the bilaminar tissue, all of which can cause various degrees of pain and dysfunction.
Changing Guidelines of CPR & BLS For General Dental Practitioners & O...DrKamini Dadsena
The tolerance of the heart to anoxia is relatively high, but the central nervous system will show irreversible lesions if anoxia lasts for more than 3–4 min.
Though unusual, there are reports of deaths due to CPA in dental offices during dental treatment.
Cardiopulmonary resuscitation (CPR) is a vital skill which must be mastered by all health care professionals.
Therefore the thorough knowledge of CPR and Basic Life Support is of utmost importance to the dentist.
Neck Dissection: Nomenclature, Classification, and TechniqueDrKamini Dadsena
Removal of the at-risk lymphatic basins serves two important purposes.
First, it allows the removal and identification of occult metastasis in patients in whom cervical metastasis are a risk, - Elective neck dissection.
Secondly, it allows the removal of disease in patients in whom metastasis are highly suspected based on imaging, clinical examination or fine needle aspiration, - Therapeutic neck dissection.
Clinical use of botulinum toxins in oral and maxillofacial surgeryDrKamini Dadsena
Purified botulinum toxin (BTX) was the first bacterial toxin used as a medicine. Since its introduction into clinical use, over 30 years ago, it has become a versatile drug in various fields of medicine.
Its mechanism of inhibiting acetylcholine release at neuromuscular junctions following local injection is unique for the treatment of facial wrinkles.
Other dose-dependent anti-neuroinflammatory effects and vascular modulating properties have extended its spectrum of applications.
In 1989, Shetty and Freymiller [7] reviewed indications for removal of teeth in the line of fracture. They recommended the following indications:
1. Significant periodontal disease with gross mobility and periapical pathology
2. Partially erupted third molars with pericoronitis or cystic areas
3. Teeth preventing the reduction of fractures
4. Teeth with fractured roots
5. Teeth with exposed root apices or teeth in which the entire root surface from the apex to the gingival margin is exposed
6. Excessive delay from the time of fracture to the time of definitive treatment
In addition to these indications, another indication that requires extraction of teeth in the line of fracture is an acute, recurring abscess at the site of the fracture despite antibiotic therapy(8)
Assessment of lingual nerve injury using different surgical variables for man...DrKamini Dadsena
Assessment of lingual nerve injury using different surgical variables for mandibular third molar surgery
The objective of this study was to investigate the incidence of sensory impairment of the lingual nerves following lower third molar surgery and to compare the outcome with various operative variables.
Factors that predicted lingual nerve injury were lingual flap retraction, tooth sectioning, and buccal guttering.
Instruments in major oral and maxillofacial surgeryDrKamini Dadsena
A surgical instrument is a specially designed tool or device for performing specific actions and carrying out desired effects during surgery or operations.
Fracture is a break in the structural continuity of bone, And starts immediately after the fracture occurs.
fracture results in a well-defined progression of tissue responses that are designed to remove tissue debris, to reestablish vascular supply and to produce a new skeletal matrix.
Traditional classification were given 100 years back when RTA , assaults, sports injuries, industrial accidents were minimal.
Over the past 100 years RTA (high speed & Low speed) assaults, sports injuries (high contact/ low contact), industrial accidents have increased.
Fracture patterns which are not matching the traditional injuries pattern.
Can speed up diagnosis and treatment planning
Cohorting / clubbing of complication to Specific Fractures.
It facilitate communication between peers and assist documentation and research.
It also have prognostic value for patients and assist Surgeons in planning their management.
It serves as a basis for treatment and for evaluation of the results.
Different fractures/ Areas of fracture has different treatment plan / approaches.
Undisplaced fracture : conservative/ surgical
Displaced Fractures: Surgical/ conservative with traction
Trauma is a global problem and continues to be a leading cause of disability and death.
Approximately 25% to 30% of deaths caused by trauma can be prevented when a systematic and organized approach is used.
The main goal of the initial assessment
Recognize the patient who does have life-threatening injuries
Establish treatment priorities, and
Manage them aggressively
A flap is a unit of tissue that is transferred from one site (donor site) to another (recipient site) while maintaining its own blood supply or from a anastomised vessel.
Flaps come in many different shapes and forms. They range from simple advancements of skin to composites of many different types of tissue
The International Association for the Study of Pain (IASP)1 defines trigeminal neuralgia (TN) as a sudden, usually unilateral, severe brief stabbing recurrent pain in one or more branches of the fifth cranial nerve
synonyms
Idiopathic trigeminal neuralgia / Tic Doulourex.
Trifacial Neuralgia.
Fothergell’s disease.
In 1677 John Locke, a American physician and philosopher, accurately identified the major clinical features of TN
In 1756 the French physician Nicolaus Andre coined the term “Tic douloureux” to the condition.
The English physician John Fothergill in 1773 published detailed description of TN, since then, it has been referred to as ‘Fothergill’s disease’.
Peripheral injections
Long acting LA
Alcohol
Glycerol
Peripheral neurectomy/ nerve avulsion
Cryotherapy
Gasserian ganglion procedures
Percutaneous stereotactic radiofrequency thermal lesioning of the trigeminal ganglion and/or root (rfl)
percutaneous glycerol gangliolysis of the trigeminal ganglion
percutaneous balloon microcompression of the trigeminal ganglion
Intracranial procedures
MVD
Partial sensory rhizotomy
Gamma knife radiation to the trigeminal root entry zone GKR
An oroantral communication is an unnatural perforation between oral cavity and maxillary sinus.
Oroantral fistula is an epithelized, pathological, communication between these two cavities. A fistulous tract present more than 14 days should be considered as chronic fistula.
The practice of surgery rests on certain fundamental principles which remain unchanged, though to apply them the surgeon may have to modify techniques to suit the anatomical field, the type of operation and the conditions obtaining at the time.
Obstructive sleep apnea (OSA) is a prevalent chronic disease characterized by pharyngeal collapse during sleep.
Sleep disorder that involves cessation or significant decrease in airflow through the upper airway in the presence of breathing effort.
Obstructive sleep apnea is the second most common sleep disorder, insomnia being the most common.
Associated with recurrent oxyhemoglobin desaturations and arousals from sleep
Apnea index- no. of apneas /hr of total sleep time.
AHI (APNEA-HYPOPNEA INDEX)- No of apneas and hypoapneas/hr of total sleep time.
RDI (Respiratory Disturbance Index) – no. of apneas, hypoapneas and respiratory effort related arousals(RERA)/hr of total sleep time.
Pain pathway gate control theory
Pain management
An unpleasant emotional experience usually initiated by noxious stimulus and transmitted over a specialized neural network to CNS where it is interpreted as such.
1. Exteroceptors: arising from receptors from skin & mucosa. sensed at conscious level
E.g. Merkel corpuscles : Tactile receptors.
Free Nerve ending :Perceive superficial pain.
2. Proprioceptors : From musculoskeletal structures.
The presence , positions & movement of body. below conscious levels.
E.g. 1) Muscle spindles : Skeletal muscle fibers. Mechanoreceptors.
2) Free nerve ending : Perceive deep somatic pain & other sensations.
3. Interoceptors : From viscera of body below conscious level.
E.g. Pacinian corpuscles : perception of touch-pressure.
Free nerve ending : Perceive visceral pain & other sensations.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
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
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!
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.
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
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.
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
2. ASSESSMENT OF THE RISK OF
HAEMORRHAGE AND ITS CONTROL
FOLLOWING MINOR ORAL SURGICAL
PROCEDURES IN PATIENTS ON ANTI-PLATELET
THERAPY: A prospective study
Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil
Vidyanagar, Nerul, Navi Mumbai, India
Int. J. Oral Maxillofac. Surg. 2014; 43: 99–106
3. ABSTRACT
Controversy exists concerning the suspension
or maintenance of anti-platelet drugs before
elective surgical procedures. Authors assessed
the association of the risk of prolonged
postoperative bleeding with anti-platelet
therapy by type of minor surgical procedure
and the association between anti-platelet
therapy and the level of hemostatic measures
required.
4. THE CURRENT STUDY WAS
UNDERTAKEN IN ORDER TO
ASSESS:
(1) the association between anti-platelet therapy
and prolonged postoperative bleeding;
(2) the association between prolonged
postoperative bleeding and the type of minor
surgical procedure performed; and
(3) the association between anti-platelet therapy
and the level of hemostatic measures required.
6. SAMPLE SIZE:
1121 patients were included in this study
Males- 686 and Females- 435
Group A (aspirin)-310 patients
Group B (clopidogrel)- 97 patients
Group C (aspirin and clopidogrel)- 139 patients
Group D (control group)- 575 healthy
individuals.
7. INCLUSION CRITERIA:
patients on single and dual anti-platelet
therapy, with a normal blood count and
coagulation profile.
Age - 40 to 75 years.
11. Preoperative haematological investigations
comprising a complete blood count and
coagulation profile were performed for all patients.
The patient’s cardiologist/physician, who had
advised discontinuation of antiplatelet therapy,
received a written explanation of the nature of the
procedure to be carried out and assurance of
hemostasis being achieved in the chair.
Written consent to carry out the surgery without
stopping the antiplatelet therapy was received.
12. Following surgery, a pressure pack was applied
for 30 min.
Suturing was done using a simple interrupted
technique with 3-0 mersilk.
Patients were kept under observation for a
further 30 min with the pressure pack in place
after completion of the procedure.
Prolonged bleeding was defined as uncontrolled
bleeding that continued in spite of the pressure
pack given for 30 min postsurgery.
13. If bleeding persisted, it was controlled with
various local hemostatic measures. such as
pressure pack
suturing (simple interrupted technique)
local hemostatic agents like gel foam
surgical diathermy.
14. The local hemostatic measures were
categorized into five levels based on the
commonly followed sequence of their use to
achieve hemostasis in minor oral surgical
procedures:
level 1, pressure pack;
level 2, suturing;
level 3, local hemostatic agent and suturing;
level 4, surgical diathermy;
level 5, platelet transfusion.
15. For patients who bled during the postoperative
period, a pressure pack was applied and suturing
was done when indicated.
In certain procedures (multiple extractions and
surgical extractions) prolonged postoperative
bleeding was controlled with gel foam and
resuturing was done.
In certain biopsy cases, Surgical diathermy was
chosen as a measure to control ongoing bleeding
when other local hemostatic measures failed.
Paracetamol was prescribed as the postoperative
analgesic to prevent interaction with the anti-
platelet drugs.
16. Patients were discharged with strict
postoperative instructions and were advised to
report any excess bleeding immediately.
Follow-up was completed after 24, 48, and 72 h
and at 1 week (when the sutures were removed).
All patients were given the contact number of
the surgeon so that they could report any
episode of bleeding. In the absence of any call,
the surgeon contacted the patient in the
evening.
17. STATISTICAL ANALYSIS
Cramer’s V test was used to assess any possible
association between anti-platelet therapy and the risk of
prolonged postoperative bleeding; statistical significance
was set at the 0.05 level.
The odds ratio was also used to assess any association
between the risk of prolonged bleeding and the type of
minor surgical procedure performed.
Fisher’s exact test was performed to examine the
significance of the association between
single/dual/control classification of the patient and the
level of hemostatic measures used to control bleeding.
19. ASSOCIATION BETWEEN ANTI-PLATELET
THERAPY AND THE RISK OF PROLONGED
POSTOPERATIVE BLEEDING
The results of the Cramer’s V test associated with the cross table were
statistically significant (P < 0.05). However the magnitude of Cramer’s V,
at 0.13, indicates a weak relationship between the two variables: anti-
platelet therapy and immediate post-operative bleeding.
20. The results of the Cramer’s V test associated with the cross table
were not statistically significant (P = 0.60). Thus, no relationship
was found between anti-platelet therapy and bleeding in the 24-h
postoperative period.
21. Compared to controls, the risk of prolonged bleeding in the immediate
postoperative period was significantly higher in patients on dual therapy,
followed by clopidogrel and aspirin.
All odds ratios were nonsignificant for the 24-h postoperative period, i.e.
there was no significant difference in the risk of prolonged bleeding on
comparing these groups for this time period.
22. ASSOCIATION BETWEEN THE RISK OF
PROLONGED BLEEDING AND THE TYPE OF
MINOR SURGICAL PROCEDURE PERFORMED
The odds ratio values for all the procedures were non-significant both in
the immediate postoperative period and in the 24-h postoperative period.
Hence, the risk of prolonged bleeding was determined to be independent
of the type of minor oral surgical procedure performed
24. The majority of patients, bleeding was controlled with the
pressure pack alone (n = 20), followed by suturing (n = 13).
5 patients required the use of gel foam and
4 required the use of diathermy
25. The results of fisher’s exact test to assess the association between anti-platelet therapy and
the level of hemostatic measures required (table 10; stratified as level 1 and level >1)
showed a statistically significant association between dual ther- apy and more than level 1
hemostatic measures when compared to the control group (P = 0.004)
26. The other results were non-significant. When assessing the same association
with the levels stratified as level 2 and level >2 hemostatic measures (table 11),
the results were statistically significant for dual therapy when compared to the
control group (P = 0.035). The other results were non-significant.
27. DISCUSSION:
Several studies have advocated stopping aspirin therapy
either 7–10 days 11– 15 or 24–48 h 16,17 before elective surgery
because of the fear of excessive bleeding intraoperatively and
during the following 24–48 h.
Vaclavik J et al have reported that the risk of cardiovascular
events increases three-fold after aspirin withdrawal.18
Wahl and Howell 19 were conclude that the risk of
haemorrhage after dental surgery may be greatly outweighed
by the risk of thromboembolism after withdrawal of anti-
thrombotic therapy.
A study by Collet et al. reported that patients for whom
aspirin was recently discontinued developed acute coronary
syndrome (ACS).20
28. Biondi-Zoccai et al have reported cardiovascular event
rates of 2.3–6% after discontinuing aspirin therapy.
risk of developing major cardiovascular events after
aspirin withdrawal has also been reported to be three
times higher than in those who continue aspirin
21
Anti-platelet therapy withdrawal in stent patients is
extremely risky and can lead to the development of
stent thrombosis, with a 57-fold increase in the risk
this event with clopidogrel withdrawal and a 10-fold
increase in the risk with aspirin withdrawal. 22
In patients with a recently implanted stent, anti-
therapy withdrawal in the perioperative period has
found to represent an average mortality rate of 20–
40%.22–24
29. In this study the percentage of patients in the study
group experiencing prolonged immediate
postoperative bleeding was greatest for those on dual
therapy, followed by those on clopidogrel and then
those on aspirin.
Cramer’s V results for the immediate post-operative
period showed a statistically significant value but a
weak relationship, which infers that anti-platelet therapy
is not the sole cause of postoperative bleeding.
Bleeding within the 24-h postopera-tive period was
found to be independent of anti-platelet therapy.
30. Factors other than anti-platelet therapy may aggravate
postoperative bleeding may include:
1. acute inflammation, periodontitis, and pericoronitis.
2. Leftover granulation tissue.
3. Accidental contact with the inferior alveolar canal
4. Excessive tension during closure led to the opening of
sutures and prolonged bleeding.
5. Stress-induced hypertension
6. Giant cell lesions,
7. pyogenic granuloma, and
8. inflammatory lesions of the tongue and floor of the
mouth caused prolonged bleeding
31. OTHER OBSERVATIONS MADE DURING
THIS RESEARCH WERE:
(1) careful curettage and debridement should be
done whenever granulation tissue is present, as this
could be the cause of bleeding postoperatively;
(2) firm pressure should be maintained for 30 min
and after that check for bleeding. If haemorrhage is
evident, then either suturing or a local hemostatic
agent along with suturing is advised;
(3) the patient should be observed for the next 30
min at a minimum;
32. (4) in cases of biopsy, where excessive bleeding is
anticipated, surgical diathermy should be kept on
standby. It may be easier and faster to use
diathermy than other local hemostatic measures in
such circumstances; and
(5) surgeons should personally consult the
patient’s physician and discuss the nature of the
procedure to be performed and its safety with
continued anti-platelet therapy. The dental
fraternity should be urged to discuss treatment
with the patient’s physician so that the patient is
not deprived of the benefit of anti-platelet therapy
33. STERNGTH OF THE STUDY:
Strengths of this study include the large
sample size and the variety of minor oral
surgical procedures performed.
Another advantage is that authors compared
the study group to healthy individuals and
found similar episodes of bleeding, all of
which could be controlled with local
hemostatic measures.
34. LIMITATION OF THE STUDY
A limitation of the study is that the platelet
aggregation test was not used as it is expensive
and also because its predictive power is not well
documented.
Further, the intraoperative bleeding was not
quantified to estimate and compare the blood
loss amongst the study and control groups.
35. SUMMARY OF THE STUDY:
(1) the risk of prolonged postoperative bleeding is
independent of the type of minor surgical
procedure performed;
(2) patients on dual therapy are at the greatest risk
of prolonged postoperative bleeding;
(3) pro-longed bleeding in patients on single drug
anti-platelet therapy can be managed in a similar
fashion to healthy individuals, with a pressure pack
as the first line of control wherever possible;
36. (4) patients on dual therapy require higher levels of
hemostatic measures, thus suturing should be the
first line of control to arrest bleeding. This leaves
patients with an additional factor of safety; and
(5) no patient required a blood transfusion. Hence
there is no need to expose the patient to the risk of
thromboembolism, cerebrovascular accidents, or
myocardial or renal infarction by discontinuing anti-
platelet therapy before minor oral surgical
procedures, which could cost the patient his or her
life.
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JOURNAL OF ORAL & MAXILLOFACIAL RESEARCH Mendes et al.
Anatomical Relationship of Lingual Nerve to the Region of Mandibular Third Molar
Marcelo Breno Meneses Mendes1, Carla Maria de Carvalho Leite Leal Nunes2, Maria Cândidade Almeida Lopes3
1Piracicaba Dental School, State University of Campinas, Piracicaba, Sao Paulo, Brazil.
2Department of Morphology, Center for Health Sciences, Federal University of Piauí, Teresina, Piauí, Brazil.
3Department of Pathology and Dental Clinics, Federal University of Piauí, Teresina, Piauí, Brazil.
4.4 mm horizontal
16.8 mm vertical
Controversy exists concerning the suspension or maintenance of anti-platelet drugs before elective surgical procedures. We assessed the association of the risk of prolonged postoperative bleeding with anti-platelet therapy by type of minor surgical procedure and the association between anti-platelet therapy and the level of hemostatic measures required. Five hundred and forty-six patients were included in the study group: those on aspirin (n = 310), clopidogrel (n = 97), and aspirin + clopidogrel dual therapy (n = 139); the control group comprised 575 healthy individuals. Cramer’s V test was significant (P < 0.05) but showed a weak association between anti-platelet therapy and prolonged immediate postoperative bleeding. Compared to controls, the odds ratio revealed that the risk of prolonged bleeding in the immediate postoperative period was significantly higher with dual therapy, followed by clopidogrel and aspirin. Prolonged bleeding occurred in 22 patients in the study group and 20 in the control group, and was successfully controlled with local hemostatic measures. Fisher’s exact test showed a significant association between dual therapy and higher levels of hemostatic measures (P = 0.004; P = 0.035). Prolonged bleeding in patients on anti-platelet therapy was independent of the type of minor surgical procedure. The greatest risk of prolonged bleeding was found in patients on dual therapy; this required higher levels of hemostatic measures.
The study group comprised 546 patients on anti-platelet therapy and the control group consisted of 575 healthy individuals.
The study group was further categorized into 4 subgroups:
group A, comprices 310 patients, who were on aspirin therapy
group B on clopidogrel therapy (n = 97), and
group C who were on dual therapy (n = 139).
The control group was designated group D.
The dose of aspirin used by patients in the study group ranged from 75 to 150 mg, and clopidogrel was used at 75 mg. For dual therapy, doses ranged from aspirin 75 + clopidogrel 75 to aspirin 150 + clopidogrel 75.
Surgical procedures performed in all groups included multiple extractions, surgical extractions, flap surgery, biopsies, and alveoloplasties (Table 1).
The various indications for which patients were on anti-platelet therapy are shown in Table 2.
term derives from the Latin angere ("to strangle") and pectus ("chest"), and can therefore be translated as "a strangling feeling in the chest". is the sensation of chest pain, pressure, or squeezing, often due to ischemia of the heart muscle from obstruction or spasm of the coronary arteries
Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, occurs when blood flow stops to a part of the heart causing damage to the heart muscle
Stroke, also known as cerebrovascular accident (CVA), cerebrovascular insult (CVI), or brain attack, is when poor blood flow to the brain results in cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. They result in part of the brain not functioning properly
Deep vein thrombosis, or deep venous thrombosis, (DVT) is the formation of a blood clot (thrombus) within a deep vein,[a] predominantly in the legs. Non-specific signs may include pain, swelling, redness, warmness, and engorged superficial veins.
These are the first-line basic laboratory tests of platelet function used to investigate bleeding diathesis.8
All vital signs such as blood pressure, pulse rate, respiratory rate, and temperature were recorded prior to the commencement of the procedure.
All of the minor surgical procedures were performed on an outpatient basis under local anaesthesia with lignocaine hydrochloride 2%–1:80,000 adrenaline.
Suturing using a simple interrupted technique with 3-0 mersilk was done as part of the procedure protocol in certain cases of multiple extractions involving full quadrant, surgical extractions, alveoloplasties, and biopsies.
. For the purpose of this study, the postoperative period was classified into immediate, within 24 h, and after 24 h
The local hemostatic agents
absorbable gelatin,
oxidized regenerated cellulose
collagen with suture.
topical thrombin, tranexamic acid, and 1% feracrylum solution.
In patients with prolonged bleeding, blood pressure was measured again to rule out stress induced hypertension. The coagulation profile was then obtained to check for any deviation from original values.
In certain procedures such as multiple extractions and surgical extractions where suturing was done primarily as a part of the procedure, prolonged postoperative bleeding was controlled with gel foam and resuturing was done. In certain biopsy cases,
For this comparison, the levels of hemostatic measures were divided into level 1, greater than level 1 and up to level 2, and greater than level 2. The results were considered statistically significant if the P-value was less than 0.05.
Cramer’s V test is a measure of association between two nominal variables, giving a value between 0 and +1 (inclusive). It is based on Pearson's chi-squared statistic also be applied to goodness of fit chi-squared models
The odds ratio it is measure of the strength of association btw risk factor and outcome
Fisher’s exact test The test is useful for categorical data that result from classifying objects in two different ways; it is used to examine the significance of the association (contingency) between the two kinds of classification
The odds ratio was used to assess the risk of prolonged postoperative bleeding in the various groups (Table 5). Compared to controls, the risk of prolonged bleeding in the immediate postoperative period was significantly higher in patients on dual therapy, followed by clopidogrel and aspirin.
The risk of prolonged postoperative bleeding was compared between patients on anti-platelet therapy and those in the con-trol group for the various minor oral sur-gical procedures performed (Table 6). The odds ratio values for all the procedures were non-significant both in the immedi-ate postoperative period and in the 24-h postoperative period. Hence, the risk of prolonged bleeding was determined to be independent of the type of minor oral surgical procedure performed.
Prolonged bleeding occurred in 22 patients in the study group and in 20 patients in the control group
. All cases of prolonged bleeding in both the study group and the control group were success-fully controlled with these measures.
the levels of hemostatic mea-sures were divided into level 1, greater than level 1 and up to level 2, and greater than level 2. The results were considered statistically significant if the P-value was less than 0.05.
the levels of hemostatic mea-sures were divided into level 1, greater than level 1 and up to level 2, and greater than level 2. The results were considered statistically significant if the P-value was less than 0.05.
the levels of hemostatic mea-sures were divided into level 1, greater than level 1 and up to level 2, and greater than level 2. The results were considered statistically significant if the P-value was less than 0.05.
The last few decades have seen an increase in the use of low-dose aspirin either alone or in combination with other anti-platelet drugs, the most common being clopidogrel. When these patients require dental or maxillofacial treatment, the dentist, oral and maxillofacial surgeons, and physicians have to decide whether to continue or stop the use of the anti-platelet drugs in order to minimize the bleeding risk associated with the surgical procedure.
Acute coronary syndrome (ACS) refers to a group of conditions due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies
22. Iakovou I, Schmidt T, Bonizzoni E, San-giorgi GM, Stankovic G, Airoldi F, et al. Incidence, predictors and outcome of throm-bosis after successful implantation of drug eluting stents. JAMA 2005;39:2126–30.
34,35A platelet aggregation test checks how well your platelets clump together.