Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NV...Waleed Mahrous
This document provides guidelines from the European Society of Gastrointestinal Endoscopy (ESGE) for the diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). It recommends immediate assessment of patients' hemodynamic status and volume replacement if unstable. It also recommends early upper endoscopy within 24 hours of presentation to determine the source of bleeding and apply endoscopic hemostasis as needed. The guidelines provide recommendations on risk stratification, medication management, endoscopic diagnosis and treatment options for various bleeding lesions.
In patients with mild symptomatic microscopic colitis, which should be considered as first-line therapy for the induction of clinical remission?
In patients with mild symptomatic microscopic colitis, budesonide should be considered as first-line therapy for the induction of clinical remission?
Should we routinely administer erythromycin before endoscopy in patients with...Waleed Mahrous
Erythromycin is not routinely recommended prior to endoscopy for patients with upper gastrointestinal bleeding. While erythromycin may improve endoscopic visibility by reducing blood and clots in the stomach, studies have not shown it consistently improves clinical outcomes. Erythromycin could be considered for patients suspected of having large amounts of fresh blood or clots that could reduce diagnostic yield, but is not warranted for routine use in all patients with upper GI bleeding. Guidelines generally agree promotility agents should not be used routinely before endoscopy, but may be beneficial in selected cases to improve visualization.
This document provides guidelines on colonic stent placement for malignant large bowel obstruction. It recommends that colonic stenting be reserved for left-sided colon cancers with clinical and imaging evidence of obstruction without perforation. A CT scan is the primary diagnostic tool, and examination of the remaining colon should occur within 3 months after alleviating the obstruction. Colonic stenting by an experienced endoscopist using endoscopy and fluoroscopy combined is suggested. Covered and uncovered stents are equally effective but uncovered stents have higher tumor ingrowth rates. Stent placement may be an alternative to emergency surgery in a palliative setting.
Should we give a PPI IV before endoscopy in patients with upper GI bleeding?Waleed Mahrous
Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding - SIGN , BSG , NICE , ACG , AGA , ASGE Guidelines
Should we give a PPI IV before endoscopy in patients with upper GI bleeding?
Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NV...Waleed Mahrous
This document provides guidelines from the European Society of Gastrointestinal Endoscopy (ESGE) for the diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). It recommends immediate assessment of patients' hemodynamic status and volume replacement if unstable. It also recommends early upper endoscopy within 24 hours of presentation to determine the source of bleeding and apply endoscopic hemostasis as needed. The guidelines provide recommendations on risk stratification, medication management, endoscopic diagnosis and treatment options for various bleeding lesions.
In patients with mild symptomatic microscopic colitis, which should be considered as first-line therapy for the induction of clinical remission?
In patients with mild symptomatic microscopic colitis, budesonide should be considered as first-line therapy for the induction of clinical remission?
Should we routinely administer erythromycin before endoscopy in patients with...Waleed Mahrous
Erythromycin is not routinely recommended prior to endoscopy for patients with upper gastrointestinal bleeding. While erythromycin may improve endoscopic visibility by reducing blood and clots in the stomach, studies have not shown it consistently improves clinical outcomes. Erythromycin could be considered for patients suspected of having large amounts of fresh blood or clots that could reduce diagnostic yield, but is not warranted for routine use in all patients with upper GI bleeding. Guidelines generally agree promotility agents should not be used routinely before endoscopy, but may be beneficial in selected cases to improve visualization.
This document provides guidelines on colonic stent placement for malignant large bowel obstruction. It recommends that colonic stenting be reserved for left-sided colon cancers with clinical and imaging evidence of obstruction without perforation. A CT scan is the primary diagnostic tool, and examination of the remaining colon should occur within 3 months after alleviating the obstruction. Colonic stenting by an experienced endoscopist using endoscopy and fluoroscopy combined is suggested. Covered and uncovered stents are equally effective but uncovered stents have higher tumor ingrowth rates. Stent placement may be an alternative to emergency surgery in a palliative setting.
Should we give a PPI IV before endoscopy in patients with upper GI bleeding?Waleed Mahrous
Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding - SIGN , BSG , NICE , ACG , AGA , ASGE Guidelines
Should we give a PPI IV before endoscopy in patients with upper GI bleeding?
Treatment advances in achieving remission in mild to moderate ulcerative colitisWaleed Mahrous
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise boosts blood flow, releases endorphins, and promotes changes in the brain which help regulate emotions and stress levels.
Care of the treatment naive patient with hcv infection and mild liver diseaseWaleed Mahrous
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
Care of the treatment experienced patient who failed prior hcv therapyWaleed Mahrous
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
When a 5 asa agent no longer maintains remission in patients with ulcerative ...Waleed Mahrous
The goals of treatment for ulcerative colitis (UC) are to induce remission, maintain remission, and facilitate mucosal healing. Historically, a step-up approach has been used to accomplish these goals. Agents with the least toxicity are initially used, and agents are added or changed based on the treatment response or toxicity. The treatment of mild to moderate UC usually begins with 5-aminosalicylate acid (5-ASA), an anti-inflammatory agent. Corticosteroids may be used to reduce inflammation and to help induce disease remission when a flair of symptoms occurs. Other agents, such as thiopurine immunomodulator and biologic agents, are used to treat more severe disease, and surgery may be indicated if medical treatment fails.
Dysphagia Lusoria Caused by Kommerell’s Diverticulum of the Aberrant Left Sub...Waleed Mahrous
A 64-year-old man presented with dysphagia caused by an aberrant left subclavian artery and associated Kommerell's diverticulum. Imaging revealed the aberrant left subclavian artery originating from the descending aorta above the left main bronchus, with an associated saccular outpouching known as Kommerell's diverticulum. The patient underwent surgical division and reimplantation of the aberrant vessel to relieve compression of the esophagus and resolve his dysphagia symptoms.
The Changing Role of Beta-Blocker Therapy in Patients with Cirrhosis 2014Waleed Mahrous
Beta-blockers were traditionally used to prevent variceal bleeding in patients with cirrhosis but recent studies have questioned their effectiveness and safety. This review article discusses the changing role of beta-blockers in light of new evidence suggesting they may not reduce mortality and could worsen other complications like spontaneous bacterial peritonitis. The authors conclude that while beta-blockers remain the standard of care for primary prophylaxis of variceal bleeding, their use requires careful consideration of risks and benefits for each individual patient.
- The patient is a 29-year-old Cambodian woman in her first trimester of pregnancy who was found to have chronic hepatitis B virus (HBV) infection. Her liver tests are normal. She is HBsAg+, HBeAg+ with an HBV DNA level of 50,000 IU/ml.
- It is recommended that the patient receive antiviral therapy during pregnancy to reduce the risk of mother-to-child transmission of HBV. Close monitoring of the infant after delivery for prophylaxis is also advised. Counseling on lifestyle modifications and vaccination of household members should be provided.
This case presentation discusses a 47-year old male patient who was referred for abdominal pain, nausea, vomiting and significant weight loss. Investigations revealed jejunization of the ileum on CT scan and villous atrophy on biopsy. The patient was initially treated for Crohn's disease but did not improve. Further histopathology found a thick collagenous band suggestive of collagenous sprue. The patient was started on a gluten-free diet, steroids, total parenteral nutrition, and anti-TNF therapy, leading to improved symptoms. Collagenous sprue is a rare malabsorptive disorder characterized by villous atrophy and thick subepithelial collagen deposits. Treatment is challenging but may include steroids
The document discusses the use of percutaneous endoscopic gastrostomy (PEG) tubes. It notes that PEG tubes are often overused and placed for inappropriate reasons to avoid difficult conversations. PEG tubes only have a limited role in a few conditions and their benefits over other methods are questionable. The mortality rate after PEG placement is high due to underlying illnesses. Several conditions like advanced dementia and late-stage cancers show little benefit from PEG tubes. Guidelines recommend considering PEG only for specific conditions and not using them for situations like aspiration or short life expectancy. Hospitals need guidelines and education to reduce inappropriate PEG placements.
Mahrous Recommendation - 1 - AGA Introduces New Guideline for Crohn’s Disease...Waleed Mahrous
The document summarizes new guidelines from the American Gastroenterological Association (AGA) for treating Crohn's disease. It recommends using anti-TNF-α drugs to induce remission in patients with moderately severe Crohn's disease. It also recommends anti-TNF-α drugs or thiopurines to maintain remission and suggests various combination therapies based on the severity of symptoms and type of remission.
This document describes a case scenario of a 59-year-old woman who presented with nausea, epigastric pain, and hypotension. Blood tests showed abnormal liver function and imaging found gas in her liver parenchyma and portal veins. She was diagnosed with emphysematous hepatitis, a rare condition where gas forms in the liver due to infection, usually with fatal consequences. Risk factors in this case included diabetes, possible thrombus or embolism, and Klebsiella pneumoniae bacteria. The pathogenesis of emphysematous hepatitis remains unclear but involves gas-forming infection and alterations of the bowel wall or portal system allowing gas into the liver.
Evidence Based Treatment of Acute Pancreatitis 2013Waleed Mahrous
The document summarizes guidelines for the diagnosis and management of acute pancreatitis. It addresses criteria for diagnosis, risk stratification based on severity (mild, moderately severe, severe), initial assessment including fluid resuscitation goals, nutritional support, and recommendations for enteral versus parenteral nutrition based on severity. The guidelines emphasize early aggressive fluid resuscitation, monitoring for organ failure, and initiating enteral nutrition in severe cases to prevent infectious complications while avoiding parenteral nutrition.
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.
Treatment advances in achieving remission in mild to moderate ulcerative colitisWaleed Mahrous
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise boosts blood flow, releases endorphins, and promotes changes in the brain which help regulate emotions and stress levels.
Care of the treatment naive patient with hcv infection and mild liver diseaseWaleed Mahrous
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
Care of the treatment experienced patient who failed prior hcv therapyWaleed Mahrous
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
When a 5 asa agent no longer maintains remission in patients with ulcerative ...Waleed Mahrous
The goals of treatment for ulcerative colitis (UC) are to induce remission, maintain remission, and facilitate mucosal healing. Historically, a step-up approach has been used to accomplish these goals. Agents with the least toxicity are initially used, and agents are added or changed based on the treatment response or toxicity. The treatment of mild to moderate UC usually begins with 5-aminosalicylate acid (5-ASA), an anti-inflammatory agent. Corticosteroids may be used to reduce inflammation and to help induce disease remission when a flair of symptoms occurs. Other agents, such as thiopurine immunomodulator and biologic agents, are used to treat more severe disease, and surgery may be indicated if medical treatment fails.
Dysphagia Lusoria Caused by Kommerell’s Diverticulum of the Aberrant Left Sub...Waleed Mahrous
A 64-year-old man presented with dysphagia caused by an aberrant left subclavian artery and associated Kommerell's diverticulum. Imaging revealed the aberrant left subclavian artery originating from the descending aorta above the left main bronchus, with an associated saccular outpouching known as Kommerell's diverticulum. The patient underwent surgical division and reimplantation of the aberrant vessel to relieve compression of the esophagus and resolve his dysphagia symptoms.
The Changing Role of Beta-Blocker Therapy in Patients with Cirrhosis 2014Waleed Mahrous
Beta-blockers were traditionally used to prevent variceal bleeding in patients with cirrhosis but recent studies have questioned their effectiveness and safety. This review article discusses the changing role of beta-blockers in light of new evidence suggesting they may not reduce mortality and could worsen other complications like spontaneous bacterial peritonitis. The authors conclude that while beta-blockers remain the standard of care for primary prophylaxis of variceal bleeding, their use requires careful consideration of risks and benefits for each individual patient.
- The patient is a 29-year-old Cambodian woman in her first trimester of pregnancy who was found to have chronic hepatitis B virus (HBV) infection. Her liver tests are normal. She is HBsAg+, HBeAg+ with an HBV DNA level of 50,000 IU/ml.
- It is recommended that the patient receive antiviral therapy during pregnancy to reduce the risk of mother-to-child transmission of HBV. Close monitoring of the infant after delivery for prophylaxis is also advised. Counseling on lifestyle modifications and vaccination of household members should be provided.
This case presentation discusses a 47-year old male patient who was referred for abdominal pain, nausea, vomiting and significant weight loss. Investigations revealed jejunization of the ileum on CT scan and villous atrophy on biopsy. The patient was initially treated for Crohn's disease but did not improve. Further histopathology found a thick collagenous band suggestive of collagenous sprue. The patient was started on a gluten-free diet, steroids, total parenteral nutrition, and anti-TNF therapy, leading to improved symptoms. Collagenous sprue is a rare malabsorptive disorder characterized by villous atrophy and thick subepithelial collagen deposits. Treatment is challenging but may include steroids
The document discusses the use of percutaneous endoscopic gastrostomy (PEG) tubes. It notes that PEG tubes are often overused and placed for inappropriate reasons to avoid difficult conversations. PEG tubes only have a limited role in a few conditions and their benefits over other methods are questionable. The mortality rate after PEG placement is high due to underlying illnesses. Several conditions like advanced dementia and late-stage cancers show little benefit from PEG tubes. Guidelines recommend considering PEG only for specific conditions and not using them for situations like aspiration or short life expectancy. Hospitals need guidelines and education to reduce inappropriate PEG placements.
Mahrous Recommendation - 1 - AGA Introduces New Guideline for Crohn’s Disease...Waleed Mahrous
The document summarizes new guidelines from the American Gastroenterological Association (AGA) for treating Crohn's disease. It recommends using anti-TNF-α drugs to induce remission in patients with moderately severe Crohn's disease. It also recommends anti-TNF-α drugs or thiopurines to maintain remission and suggests various combination therapies based on the severity of symptoms and type of remission.
This document describes a case scenario of a 59-year-old woman who presented with nausea, epigastric pain, and hypotension. Blood tests showed abnormal liver function and imaging found gas in her liver parenchyma and portal veins. She was diagnosed with emphysematous hepatitis, a rare condition where gas forms in the liver due to infection, usually with fatal consequences. Risk factors in this case included diabetes, possible thrombus or embolism, and Klebsiella pneumoniae bacteria. The pathogenesis of emphysematous hepatitis remains unclear but involves gas-forming infection and alterations of the bowel wall or portal system allowing gas into the liver.
Evidence Based Treatment of Acute Pancreatitis 2013Waleed Mahrous
The document summarizes guidelines for the diagnosis and management of acute pancreatitis. It addresses criteria for diagnosis, risk stratification based on severity (mild, moderately severe, severe), initial assessment including fluid resuscitation goals, nutritional support, and recommendations for enteral versus parenteral nutrition based on severity. The guidelines emphasize early aggressive fluid resuscitation, monitoring for organ failure, and initiating enteral nutrition in severe cases to prevent infectious complications while avoiding parenteral nutrition.
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.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html