Cardiac MRI can be used to evaluate ischemic heart disease in several ways:
1. Perfusion imaging with contrast can identify areas of reduced blood flow to the heart muscle during stress testing to detect blockages.
2. Late gadolinium enhancement reveals areas of injured or dead heart muscle through enhanced areas on imaging. This can help assess viability after heart attacks.
3. Functional imaging sequences like cine can evaluate the heart's structure, motion, and pumping ability to see effects of heart disease like reduced ejection fraction or wall thinning.
Its important to recognise the myelination pattern in neonates and infants. This presentation talks about the myelination pattern and imaging of white matter diseases in children.
Its important to recognise the myelination pattern in neonates and infants. This presentation talks about the myelination pattern and imaging of white matter diseases in children.
A detailed description of ct coronary angiography and calcium scoring with various aspects regarding the preparation, procedure, limitations and a short review regarding post CABG imaging.
Presentation given at Arab Health congress on Jan. 29th 2013, with information about (dual source) Cardiac CT of the coronary arteries with technical & practical information and some clinical use cases
Unlike other modalities, MRI offers the capability to modulate both the emitted and received signals so that a multitude of tissue characteristics can be examined and differentiated without the need to change scanner hardware.
As a result, from a single imaging session, one could obtain a wealth of information regarding
cardiac function and morphology,
myocardial perfusion & viability,
hemodynamics,
large vessel anatomy.
CMR is now considered the gold standard for the assessment of regional and global systolic function, myocardial infarction (MI) and viability, and the assessment of congenital heart disease.
A detailed description of ct coronary angiography and calcium scoring with various aspects regarding the preparation, procedure, limitations and a short review regarding post CABG imaging.
Presentation given at Arab Health congress on Jan. 29th 2013, with information about (dual source) Cardiac CT of the coronary arteries with technical & practical information and some clinical use cases
Unlike other modalities, MRI offers the capability to modulate both the emitted and received signals so that a multitude of tissue characteristics can be examined and differentiated without the need to change scanner hardware.
As a result, from a single imaging session, one could obtain a wealth of information regarding
cardiac function and morphology,
myocardial perfusion & viability,
hemodynamics,
large vessel anatomy.
CMR is now considered the gold standard for the assessment of regional and global systolic function, myocardial infarction (MI) and viability, and the assessment of congenital heart disease.
FOR RADIOLOGY
USEFULL FOR NEW RADIOLOGY RESIDENTS TO INDENTIFY NORMAL ANATOMY AND ABNORMAL FINDINGS IN BRAIN CT AND MRI SCANS.
IN EMERGANCY CASES AND IN ROUTINE OPD IPD PATIENDS
d/t types of ischemic strokes, imaging modalities, imaging features on different imaging modalities. differential diagnosis of different imaging findings.
will help you in understanding myocardial infarction in more detail with its management and therapy with complications and with graphical knowledge you can understand it better and some laboratry test are also included in it .
"Navigating Cortical Cerebral Venous Thrombosis (CVT) Management with Dr. Ganesh"
🌟 Hello, everyone! Dr. Ganesh here, and today, we're delving into a critical topic in neurology: the management of Cortical Cerebral Venous Thrombosis (CVT). Whether you're a healthcare professional, a patient, or simply interested in understanding the complexities of cerebrovascular health, this discussion is crafted to provide valuable insights.
CEREBRAL INFARCTS
Pathophysiology
Significantly diminished blood supply to all parts(global ischemia) or selected areas(regional or focal ischemia) of the brain
Focal ischemia- cerebral infarction
Global ischemia-hypoxic ischemic encephalopathy(HIE), hypotensive cerebral infarction
Infarct vs pneumbra
In the central core of the infarct, the severity of hypoperfusion results in irreversible cellular damage
Around this core, there is a region of decreased flow in which either:
The critical flow threshold for cell death has not reached
Or the duration of ischemia has been insufficient to cause irreversible damage.
Current therapies attempt to rescue these ‘at risk’ cells
Goal of imaging
Exclude hemorrhage
Identify the presence of an underlying structural lesion such as tumour , vascular malformation, subdural hematoma that can mimic stroke
Identify stenosis or occlusion of major extra- and intracranial arteries
Differentiate between irreversibly affected brain tissue and reversibly impaired tissue (dead tissue versus tissue at risk)
Imaging modalities
CT
MRI
Diffusion weighted imaging
MRA
MRS
CT angiography
CT perfusion imaging
Perfusion-weighted MR Imaging
Trans cranial doppler
Cerebral angiography
Classification
Hyper acute infarct (<12 hours)
Acute infarct (12 to 48 hours)
Subacute infarct (2 to 14 days)
Chronic infarct (>2 weeks)
Old infarct (> 8 to 10 weeks)
CT-Hyperacute infarct
Normal in 50 – 60%
Hyperdense MCA sign-acute intraluminal thrombus
Obscuration of lentiform nulei
Dot sign-occluded MCA branch in sylvian fissure
Insular ribbon sign –grey white interface loss along the lateral insula
Hyperdense MCA sign
Obscuration of lentiform nuclei
Insular ribbon sign
Insular ribbon sign
MRI –Hyperacute infarct
Absence of normal flow void with intra vascular arterial enhancement
Anatomic changes in T1WI
Sulcal effacement,
Gyral edema,
Loss of grey white interface
Sulcal effacement
CT- Acute infarct
Low density basal ganglia
Sulcal effacement
Wedge shaphed parenchymal hypo density area that involves both grey and white matter
Increasing mass effect
Hemorrhagic transformation may occur -15 to 45% ( basal ganglia and cortex common site) in 24 to 48 hours
Sulcal effacement
MRI –Acute infarct
T2WI-hyperintensity in affected area
Meningeal enhancement adjacent to infarct(12 to 24 hours)
Early parenchymal enhancement
Hemorrhagic transformation becomes evident
MRI –Acute infarct
MRI –Acute infarct
CT – sub acute infarct
NECT
Wedge-shaped area of decreased attenuation involving gray/white matter in typical vascular distribution
Mass effect initially increases, then begins to
diminish by 7-10 days
HT of initially ischemic infarction occurs in 15-20% of MCA occlusions, usually by 48-72 hrs
CECT
Enhancement patterns typically patchy or gyral
May appear as early as 2-3 days after ictus, persisting up to 8-10 weeks
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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
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
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.
2. • INTRODUCTION: Leading cause of mortality and morbidity in developed
counteries. Estimated will be leading cause of death till end of this decade.
First attack> high risk of death d/t complication related.
• Emerging imaging modalities CCT and CMR for IHD and coronary heart ds.
• PATHOPHYSIOLOGY:
- CAD (A.plaque) mcc >IHD
- Chronic stable : slow plaque obcstruction
- If plaque ruptures > thrombus > acute coronary syndrome (fig)
- Therapeutic current: PCI and thrombolysis t/t
- Myocardial infarctions are usually classified by (a)location (anterior, inferior,
lateral), (b) size (focal necrosis,small (<10%), moderate (10–30%) and large
(>30%of LV myocardium) and (c) temporally as evolving (<6 h),acute (6 h–7
days), healing (7–28 days) and healed (>28days).
- healing process can result to thinning of the wall resulting to remodelling and
finally causing dilated type cardiomyopathy.
- Stunned vs hibernating myocardium? > acute reperfusion injury (generally
occurs within hours of reperfusion) causing contractility dysfunction which
takes days to become normal – stunned. Takes years (chronic form) to regain
normal function – hibernating m.
3.
4.
5.
6. CORONARY ANGIOGRAPHY
• Coronary MR angiography is at present still not
incorporated in daily clinical care, mainly
because of long acquisition times, unreliable
image quality and the availability and ease of
use of CCT. However, clinically interesting
indications for coronary MR angiography are
imaging of congenital anomalies of the coronary
arteries, coronary artery imaging in
(postoperative) patients with congenital heart
disease and diagnosis (and follow-up) of patients
with coronary aneurysms in Kawasaki’s disease
7.
8.
9. FUNCTIONAL IMAGING
- imp for the IHD workup
esp. for post MI with
remodelling changes.
Includes: echo, CMRI, CCT,
nuclear study, SPECT and
angiographic studies.
10. White blood Imaging
• gradient echo sequences and steady-state free precession MRI (SSFP).
• The main advantage of white blood imaging is its fast acquisition. It can obtain movement
sequences and allows studying cardiac function and movement. CINE can find volumes in
chambers.
PERFUSION STUDY:
- Using contrast like gadolinium. perfusion across the myocardium is studied. (STRESS TEST can be
usde in perfusion detection where adenosine <beta agonist> is given for the stress on myocardium). Its
first pass contrast.
LGE is late gadolinium enhancement. done after 10-25min of the contrast administration.
• Dark blood Imaging- on spin echo or steady-state free precession sequences -These can be
T1, T2, or proton density weighted sequences - T1 weighted sequences achieve better
anatomic definition and T2 and PD weighted sequences reach better tissue characterization
MYOCARDIAL INFARCTION IMAGING
CASES:
11. 73/F Cine stress MRI shows perfusion defect along anterolateral myocardial wall predominantly in
subendocardial region. On cartherization 70% stenosis was noted then PCI was done.
Importance of stress MRI which
find out the perfusion defect
region suggesting chronic stable
CAD.
microvascular obstruction (MVO) –
lack of tissue perfusions (its seen
inearly post contrast) as contrast not
diffused.
12. rest can be normal, here on stress MRI showing persisent myodcardial perfusion defect. it was post
CABG case in 70m post x increasing chest pain non relieved on medicines. surgical intervention was
planned.
13. T2 SA HLA bright – edema
(excess water content or in
short myocardium at risk). T
with STIR is commonly done
to find out the edema
LGE corresponds to edema
suggests irreversible damage
to the tissue. (non salvagable)
Lcx branch.
15. LGE is not reliable indicator of necrosis in acute setting.
16. T2 shows bright-edema
with central dark core.
first pass contrast shows
main microvascular
obstruction (MVO) – lack
of tissue perfusions (its
seen inearly post
contrast) as contrast not
diffused.
on early and late contrast
the darker area appear
reduced suggesting the
diffusion of GD into the
necrotic part.
on cine (end diastolic and
end systolic) shows
inferolateral wall shows
impaired contraction.
additional now T2 dark
could reflect the
hemorrhage. Cine even
shows bright signal
pericardium s/o effusion/
inflammation. the blood in
T2 will be heterogenous
ie peripheral hyperintense
rim
17. MYOCARDIAL VIABILITY IMAGING
Post contrast enhancement with occlusion. CINE end systolic early and late (6month) shows mardked
thinning of the myocardium.
following such remodelling revascularition can help. but revascularition would only help in viable, stunned
and hybernated myocardium and not necrotic/scarred myocardium. here comes role of CMR to find out the
viable myocardium
18. Viability imaging in 57-year-
old patient presenting
ischaemic cardiomyopathy
and increasing dyspnoea
CINE showing increased
volume, reduced EF, severe
thinning. LGE shows
transmural enhancment
suggesting healed
myocardial infarction (non
viable)
thinning of <6mm even has
low chances of reversibility
(done in end diaslolic)
transmural enhancement in
the inferolateral wall
reflecting a healed
extensive
inferolateral myocardial
infarction - irreversible
damage
19. CINE image shows posterior
myocardial wall shows
thinning with reduced EF
and increased chamber
volume.
On LGE shows transmural
enhancement suggesting
MI. on confirmation by
angiography shows RCA
occlusion.
20. POST MI COMPLICATIONS
- Ventricular thrombus common complication associated with ischemic dilated cardimyopathy. common
after anterior wall MI.
- actually contrast study for CMR is bonus thing as we do it for the detection of MI so can incidentally find i
- to differentiate between the myocardial occlusion and intraluminal - for intramyocardial there will be no
reflow on late contrast images.
- CMR also shows incidentally the presence of pericardial inflammation (this are common association
with transmural type of infarction) as we seen in earlier cases could be pericardiatis or pericardial
effusion.
- aneurysms
21. first pass post contrast
(inversioin images)
shows transmuaral non
enhancement. but on
LGE shows endocardial
non late enhancement
with altered signal and
looking at VLA view
shows altered signal
suggesting presence of
mural thrombus in
presence of MI
22. CINE - myocardial hypo and thinnin. on early and late contrast shows transmural enhancement and hypointense
thrombus with apex aneurysm
23. CMR at 1 wk and after 4months – shows edema them thinning. Subendocardial no reflow and transmural
enhancment. Papillary muscles shows no reflow.
24. DIFFERENTIAL SIMILAR TO MI on imaging
T2 edema. post contrast in all view shows epicardial and subepicardial enhancement suggesting acute
pericarditis. this was case of 17 F with retrosternal pain on BX pericardium lyphohistiocytic infiltrates were noted.
25. T2 WI shows edema in left lateral wall. On LGE enhancement noted mainly in subepicardial region. Its acute
myocarditis in 18yr female.
CINE and T1 shows hyperintense mass. on LGE shows non enhancing mass with myocardial wall enhancement
hyper on T1 and hypo LGE suggests myocaradial hematoma with scarring of the adjacent myocardium - case of
post traum to chest in 71m