- Obesity is a major global health issue, with two-thirds of adults in western countries overweight or obese. Obesity increases the risk of various diseases and reduces life expectancy.
- Bariatric surgery is effective for long-term weight loss and treatment of obesity-related diseases in severely obese individuals. Common bariatric procedures include gastric bypass, sleeve gastrectomy, gastric banding, and biliopancreatic diversion/duodenal switch.
- Bariatric surgery leads to significant and long-lasting weight loss of 15-25% over 20 years by altering metabolic processes and appetite regulation. It also improves obesity-related conditions and quality of life. Close multidisciplinary support is needed
Surgical Management of Obesity درمان جراحی چاقی
انواع اعمال جراحی :
محدود کننده جذب :
گاسترینگ باندینگ قابل تنظیم لاپاراسکوپیک
گاسترکتومی آسینی
مختل کننده جذب مواد غذایی :
انحراف صفراوی پانکراسی
سوئیچ دئودنال
ترکیبی :
بای پس معده
گاستریک باندینگ قابل تنظیم لاپاراسکوپیکLAGB
قرار دادن یک نوار سیلیکونی بادشونده دور قسمت پروگزیمال معده که نوار به یک سیستم مخزنی که اجازه تنظیم سفتی نوار را فراهم می آورد متصل می شود. این سیستم مخزنی به وسیله یک پورت زیرجلدی قابل دسترس می شود.
دونوع نوار برای این روش استفاده می شود :
lap-bandگاستریک باندینگ قابل تنظیم
گاستریک باندینگ قابل تنظیم سوئدی
این عمل جراحی بیشتر به صورت سرپایی انجام می شود وچون دستگاه گوارش مورد تهاجم قرار نمی گیرد خطر نسبی این عمل کمتر از اعمال دیگر است.
بیمارانی که برای کاهش وزن ناشکیبا هستند ، بی تحرک هستند ، قادر به ورزش نیستند و انتظار دارند که بتوانند به عادات غذایی قبلی خود بدون تغییر ادامه دهند کاندید خوبی برای این عمل نیستند.
تنظیمات باند و جلسات گروه حمایتی پس از عمل برای نتایج خوب بسیار مهم هستند.تنظیمات باند مانند بخشی از جراحی مهم است.
توافق کلی این است که کاهش کمتر از دو پوند در هفته اندیکاسیون افزایش محدودیت باند با اضافه کردن مایع است.
نتایج:
به طور میانگین 5تا7 سال بعد از عمل بیماران به ترتیب 60% و 58% از وزن اضافی را کم کردند.
هایپرتانسیون در 55% بیماران طی یک سال برطرف شده
آپنه انسدادی به 2%کاهش داشته
آسم و افسردگی بهبود داشته
در بیش از 50% موارد بهبودی داشته GERD
عوارض:
- پرولاپس: قسمت تحتانی معده به سمت بالا هل داده شده و در لومن باند گیر می کند.نیازبه جراحی دوباره دارد.
- سرخورردن
- صدمه بافتی به خاطر فرسودگی باند
- عوارض پورت و لوله هاَ
شکست در کاهش وزن بیشتر از اعمال دیگر رخ می دهد.
Duodenal Switch surgery is a very useful bariatric surgery for patients suffering from obesity. Approximately, the patients of DS lose around 60 to 80% of their surplus body weight and they experience nominal weight regain. For the patients of BMI greater than 50 this very surgery is very effective.
As the rates of obesity increase, so do the medical problems caused and exacerbated by this physical state. For many, traditional methods of weight loss have proven ineffective for achieving and maintaining significant weight reduction. Bariatric surgery (ie, laparoscopic gastric banding, gastric bypass) offers these patients the opportunity to experience significant weight loss that can be maintained. The number of obese patients seeking bariatric surgery is steadily rising. But, unlike traditional diets for which risks are low and discontinuation can occur at any time, bariatric surgery has inherent risks and requires highly restrictive, long-term behavioral changes afterwards. Therefore, these patients typically are required to complete a thorough evaluation, including psychological assessment, to determine their appropriateness for surgery.
Surgical Management of Obesity درمان جراحی چاقی
انواع اعمال جراحی :
محدود کننده جذب :
گاسترینگ باندینگ قابل تنظیم لاپاراسکوپیک
گاسترکتومی آسینی
مختل کننده جذب مواد غذایی :
انحراف صفراوی پانکراسی
سوئیچ دئودنال
ترکیبی :
بای پس معده
گاستریک باندینگ قابل تنظیم لاپاراسکوپیکLAGB
قرار دادن یک نوار سیلیکونی بادشونده دور قسمت پروگزیمال معده که نوار به یک سیستم مخزنی که اجازه تنظیم سفتی نوار را فراهم می آورد متصل می شود. این سیستم مخزنی به وسیله یک پورت زیرجلدی قابل دسترس می شود.
دونوع نوار برای این روش استفاده می شود :
lap-bandگاستریک باندینگ قابل تنظیم
گاستریک باندینگ قابل تنظیم سوئدی
این عمل جراحی بیشتر به صورت سرپایی انجام می شود وچون دستگاه گوارش مورد تهاجم قرار نمی گیرد خطر نسبی این عمل کمتر از اعمال دیگر است.
بیمارانی که برای کاهش وزن ناشکیبا هستند ، بی تحرک هستند ، قادر به ورزش نیستند و انتظار دارند که بتوانند به عادات غذایی قبلی خود بدون تغییر ادامه دهند کاندید خوبی برای این عمل نیستند.
تنظیمات باند و جلسات گروه حمایتی پس از عمل برای نتایج خوب بسیار مهم هستند.تنظیمات باند مانند بخشی از جراحی مهم است.
توافق کلی این است که کاهش کمتر از دو پوند در هفته اندیکاسیون افزایش محدودیت باند با اضافه کردن مایع است.
نتایج:
به طور میانگین 5تا7 سال بعد از عمل بیماران به ترتیب 60% و 58% از وزن اضافی را کم کردند.
هایپرتانسیون در 55% بیماران طی یک سال برطرف شده
آپنه انسدادی به 2%کاهش داشته
آسم و افسردگی بهبود داشته
در بیش از 50% موارد بهبودی داشته GERD
عوارض:
- پرولاپس: قسمت تحتانی معده به سمت بالا هل داده شده و در لومن باند گیر می کند.نیازبه جراحی دوباره دارد.
- سرخورردن
- صدمه بافتی به خاطر فرسودگی باند
- عوارض پورت و لوله هاَ
شکست در کاهش وزن بیشتر از اعمال دیگر رخ می دهد.
Duodenal Switch surgery is a very useful bariatric surgery for patients suffering from obesity. Approximately, the patients of DS lose around 60 to 80% of their surplus body weight and they experience nominal weight regain. For the patients of BMI greater than 50 this very surgery is very effective.
As the rates of obesity increase, so do the medical problems caused and exacerbated by this physical state. For many, traditional methods of weight loss have proven ineffective for achieving and maintaining significant weight reduction. Bariatric surgery (ie, laparoscopic gastric banding, gastric bypass) offers these patients the opportunity to experience significant weight loss that can be maintained. The number of obese patients seeking bariatric surgery is steadily rising. But, unlike traditional diets for which risks are low and discontinuation can occur at any time, bariatric surgery has inherent risks and requires highly restrictive, long-term behavioral changes afterwards. Therefore, these patients typically are required to complete a thorough evaluation, including psychological assessment, to determine their appropriateness for surgery.
Rivision surgery after laparoscopic sleeve gastrectomyIbrahim Abunohaiah
Revision Surgery After Laparoscopic Sleeve Gastrectomy
Introduction to bariatric surgery
When to Revise a Weight Loss Surgery?
Options for redo surgery.
Laparoscopic Roux-en-Y gastric Bypass.
This is a presentation Dr. beck and Dr. Eakin give at the bariatric information sessions at Jordan Valley Medical Center, in Salt Lake City, Utah. It provides strategies fro medical weight loss, an it discusses the pros and cons of common bariatric operations.
Bariatric Surgery is rapidly gaining popularity. Knowing the right Indications and Contra Indications is paramount for Surgeons starting their career in Bariatric Surgery.
Background: Nonalcoholic Fatty Liver Disease (NAFLD) is the most common liver disease in the developed countries. Patients with Nonalcoholic Steatohepatitis (NASH), a subset of NAFLD, are at risk for progressive liver disease and in need of effective treatment options. There is a lack of data assessing sleeve gastrectomy and their effect on NAFLD.
Objective: To assess the effects of Sleeve Gastrectomy (SG) on NAFLD.
Methods: An online search of PubMed, Medline, and Google Scholar was independently carried out by two researchers using key words like Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steato-Hepatitis, Bariatric Surgery, Obesity Surgery, Sleeve Gastrectomy and Liver Biopsy, percutaneous liver biopsy, to identify all articles. Articles were also identified from references of relevant articles. All sleeve gastrectomies that had ntraoperative and postoperative liver biopsies were included.
Rivision surgery after laparoscopic sleeve gastrectomyIbrahim Abunohaiah
Revision Surgery After Laparoscopic Sleeve Gastrectomy
Introduction to bariatric surgery
When to Revise a Weight Loss Surgery?
Options for redo surgery.
Laparoscopic Roux-en-Y gastric Bypass.
This is a presentation Dr. beck and Dr. Eakin give at the bariatric information sessions at Jordan Valley Medical Center, in Salt Lake City, Utah. It provides strategies fro medical weight loss, an it discusses the pros and cons of common bariatric operations.
Bariatric Surgery is rapidly gaining popularity. Knowing the right Indications and Contra Indications is paramount for Surgeons starting their career in Bariatric Surgery.
Background: Nonalcoholic Fatty Liver Disease (NAFLD) is the most common liver disease in the developed countries. Patients with Nonalcoholic Steatohepatitis (NASH), a subset of NAFLD, are at risk for progressive liver disease and in need of effective treatment options. There is a lack of data assessing sleeve gastrectomy and their effect on NAFLD.
Objective: To assess the effects of Sleeve Gastrectomy (SG) on NAFLD.
Methods: An online search of PubMed, Medline, and Google Scholar was independently carried out by two researchers using key words like Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steato-Hepatitis, Bariatric Surgery, Obesity Surgery, Sleeve Gastrectomy and Liver Biopsy, percutaneous liver biopsy, to identify all articles. Articles were also identified from references of relevant articles. All sleeve gastrectomies that had ntraoperative and postoperative liver biopsies were included.
Stop hunger, slow down diabetes with bariatric surgery.Jia Maheshwari
It sounds like a magic wand but the expertise of a bariatric surgeon can help many diabetics live fulfilling lives with controlled sugar levels and lowering the risks and complications associated with diabetes.
Weight Loss Solutions at Nova helps many lose weight safely and successfully.
Reduces blood pressure, diabetic and coronary conditions while improving mobility.
Uncoiling the Tightening Obesity Spiralasclepiuspdfs
While an underweight prevalence was once more than twice that of obesity, now more people are obese than underweight. Obesity is one of the leading causes of preventable death in the world. There are an estimated 2,100,000,000 obese people worldwide and that number is forecast to grow to 51% of the world’s population by 2030. Escalating obesity-related disease costs threaten to bankrupt the world’s health-care systems.
Managment of Diabesity (Obesity in diabetes mellitus) Tarek Al 3reeny
This presentation summaries state of the art management of obesity in diabetes mellitus (diabesity) including definition and classifications of both obesity and diabetes. Multidisciplinary approach , pharmacotherapy & bariatric surgery
India has been declared the ‘diabetic capital’ of the world and it is estimated that by the year 2025, it will be home to more than 80 million diabetics with most of them being type 2 diabetics. A laparoscopic operation called Ileal Transposition Operation was devised in order to control diabetes and avoid future diabetic complications.
Confronted with a rising incidence of increasingly overweight and frankly obese individuals, many interventions have continued to be sought for by the scientific community to address this.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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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.
1. Presentor – Dr. Bharat Chaudhary
PG resident
Dept. of General Surgery
2. Obesity is becoming the plague of the 21st century. With
overweight becoming the norm in most western countries
and newly resource-rich countries, two-thirds of adults are
overweight or obese.
Obesity and lack of physical activity have the second largest
public health impact after smoking. Severe obesity increases
the risk of cancer, is associated with multiple other diseases,
affects quality of life and reduces life expectancy by 5–20
years.
3. Obesity runs in families and social networks
and very few obese people have an identifiable
genetic, hormonal basis such as Prader–Willi
syndrome.
Surgeons encounter the problem of obesity on
a daily basis as it affects the treatment of
nearly every abdominal pathology in terms of
approach and outcomes.
Dieting, increasing energy expenditure
through exercise, and intensive lifestyle
intervention, are successful for most obese
people in helping them lose 6–8% body weight
in the short term, up to 1–3 years.
4. Currently there is no available pharmacotherapy
that is safe and clinically or cost-effective in the
long term, and there is none on the horizon
remotely as effective as bariatric surgery.
Bariatric surgery is the branch of surgery
involving manipulation of the stomach and/or
small bowel to aid weight loss. Severe and
complex obesity is a phrase commonly used for
patients with body mass index (BMI) ≥35 and
obesity-related disease, or BMI ≥40 by itself .
5.
6.
7.
8. Due to the tendency for basal metabolic rate to decrease
with dieting, most people will regain all their weight,
returning to the previous homeostatic set point.
Bariatric surgery appears to alter this mechanism and
‘reset’ this point, with 15–25% weight loss maintenance up
to 20 years .
Bariatric surgery leads to long-term survival benefit and
improves obesity-related disease and quality of life.
9. Metabolic’ or ‘diabetes’ surgery is increasingly being used
in conjunction with, or instead of, ‘bariatric surgery’ due to
the highly effective way surgery improves the metabolic
syndrome, with weight loss being a welcomed additional
effect. Type 2 diabetes is part of the ‘metabolic syndrome’
that includes high blood pressure, dyslipidaemia and
polycystic ovary syndrome.
The term refers to the marked effects of some operations
on diabetes and the metabolic syndrome, which may have
an impact more important than weight loss itself.
10. The improvement in type 2 diabetes may be additional to
the weight loss.
Surgery is very cost effective since medications reduce or
stop as glycaemic control improves.
11. Bariatric surgery is a treatment option for anyone with a
BMI ≥40.
Offer an expedited assessment for people with a BMI ≥35
with onset of type 2 diabetes in the past 10 years.
Consider an assessment for people with a BMI of 30–34.9
with onset of type 2 diabetes within 10 years.
12. Consider an assessment for people of Asian origin with onset of
type 2 diabetes at a lower BMI than other populations.
Bariatric surgery is the option of choice for adults with BMI
>50 when other interventions have not been effective.
People fitting the above criteria are also required to be
receiving, or to receive, assessment in a specialist weight-
management service before referral to a surgical team.
13. NICE-accredited guidance on the make-up of the medical
and surgical bariatric multidisciplinary team.
Bariatric physician in primary (can be the general practitioner) or
secondary care (usually a diabetologist).
Dietitian
Specialist nurse
Appropriately trained mental health professional Bariatric
surgeon
15. Multidisciplinary assessment
Every patient should be assessed and managed by a coherent and
well-functioning team of healthcare professionals with a varied
background and expertise.
Improved outcomes are usually achieved in high-volume,
specialised units.
Data collection and submission to national registries are
recommended to provide quality assurance and long-term
outcome data
16. An international survey by IFSO ( International Federation
for Surgery of Obesity) in 2013 indicated that there were
nearly 5,00,000 procedures done annually. Gastric bypass
comprised 45%, sleeve gastrectomy 37%, gastric banding
10% and biliopancreatic diversion/duodenal switch (BPD/
DS) 1.5%.
The variety of procedures usually reflects surgeon expertise
and surgeon and patient preference.
Sleeve gastrectomy is rapidly gaining popularity at the
expense of gastric banding and to a lesser extent gastric
bypass.
17. Although adjustable gastric banding is declining in the UK
and elsewhere, it did boost the popularity of bariatric
surgery due to the perioperative safety, the lack of
nutritional complications and its relative ease and
availability.
The pars flaccida technique (through the window of the
lesser omentum) is now standard practice with a band
placed just below the oesophagogastric junction, making a
small ‘virtual’ gastric pouch .
The band is sutured into place anteriorly with
gastrogastric tunneling sutures to reduce slippage.
18.
19. The access port is routinely sutured to the rectus sheath in the
upper abdomen for ease of access by a non-coring, Huber needle
for band adjustments.
The initial surgical placement is only the beginning of the
treatment. Specialist nurses, physicians and surgeons do
‘band consultations’ to assess eating habits and then perform an
adjustment with injection or aspiration of saline if indicated.
Follow-up should be monthly to begin with as needed during
the first year, with full MDT support to help patients get the
best use out of their bands.
20.
21. This operation is less challenging to perform than gastric
bypass.
The lesser curve-based gastric tube is constructed over a size
32–36 Fr bougie, although some advocate that even larger
sizes reduce the risk of staple line leakage.
Linear stapling devices are used and again there is variation in
the different techniques between how wide the staplers should
be and whether reinforcement strips should be used.
However, the sleeve is considered to be associated with lower
perioperative risk and similar weight-loss outcomes to gastric
bypass up to 3 or more years.
22.
23. BPD, described by Scopinaro in Naples, produces greater
weight loss than other procedures, but is associated with a
higher nutritional complication rate.
The mechanism of action appears to be mainly
malabsorption of calories.
The DS is a variant of the BPD
24. A sleeve gastrectomy is followed
by division of the duodenum just
distally to the pylorus. The ileum
is divided with a linear stapler,
followed by a duodenoileostomy
and ileoileostomy with the
objective to create a common
channel of 75–125 cm and an
alimentary channel of 100–250
cm.
25. Single anastomosis duodenoileal bypass with sleeve
gastrectomy (SADI-S) is a novel procedure based on the BPD-
DS.
A sleeve gastrectomy is followed by an end-to-side duodenoileal
anastomosis.
The length of the common channel–alimentary limb is 200 cm.
Potential advantages include the preservation of the pylorus,
elimination of one anastomosis compared to the DS, reduced
operating time and reduced risk of perioperative complications.
26.
27. Shared-care arrangements with surgeons/physicians and
primary care need to be in place so that diabetes and
hypertension medications and dosage can be appropriately
reduced as weight is lost.
Every diabetic needs at least an annual review. Although
gastric banding, gastric bypass and sleeve gastrectomy do not
cause protein–calorie malabsorption, bariatric surgery can
cause severe vitamin and mineral deficiencies, amplifying
pre-existing deficiencies caused by being obese.
28. All patients should have routine metabolic and nutritional
monitoring lifelong . Patients need regular multivitamins/trace
element supplements. The minimum frequency of assessment
is 3–6 monthly in the first postoperative year, 6–12 monthly in
the second year and at least annually thereafter.
Folic acid supplementation should be considered in all sexually
active women of child- bearing age, due to the risk of neural
tube defects. This is especially important as fertility often
improves after surgery.
The MDT also needs to support the small number of patients
who develop severe mental health issues after surgery, as
there is a slightly increased risk of suicide after gastric bypass.
29. Bailey & Love’s short practice of surgery ( 27th edition)