This document summarizes the case of a 47-year-old female patient presenting with a right neck mass. Imaging revealed bilateral carotid body tumors. Carotid body tumors are rare neuroendocrine tumors that typically arise from paraganglia near the carotid bifurcation. The patient's tumors were large and bilateral, presenting a surgical challenge. She underwent preoperative embolization followed by tumor resection via a transparotid approach, which resulted in temporary vocal cord paralysis. Her post-operative recovery required a PEG tube and vocal cord injections. Carotid body tumors are most often benign but can cause cranial nerve deficits if untreated or if the tumor is large.
this presentation deals with the real time diagnostic dilemmas of aspiration in in third world countries and suggest some remedies to counter the problems. this presentation also touch upon aspiration issues in children especially neonates and remedies to avoid it. obviously a presentation cannot substitute detail reading but it will help you have an outline of how to manage such cases.
this presentation deals with the real time diagnostic dilemmas of aspiration in in third world countries and suggest some remedies to counter the problems. this presentation also touch upon aspiration issues in children especially neonates and remedies to avoid it. obviously a presentation cannot substitute detail reading but it will help you have an outline of how to manage such cases.
Sinus tymapni shape and depth can influence surgical approach in cholesteatoma surgery. In the case of a shallower ST, an exclusive endoscopic exploration is chosen; while in the case of a deeper ST, a retrofacial approach is usually preferred.
thyroidectomy-surgical seminare, prepared by Dr. Siddharth JINDAL, third year resident in dept. of general surgery at P.D.U. Government Medical College and Civil Hospital, Rajkot, Gujarat.
Sinus tymapni shape and depth can influence surgical approach in cholesteatoma surgery. In the case of a shallower ST, an exclusive endoscopic exploration is chosen; while in the case of a deeper ST, a retrofacial approach is usually preferred.
thyroidectomy-surgical seminare, prepared by Dr. Siddharth JINDAL, third year resident in dept. of general surgery at P.D.U. Government Medical College and Civil Hospital, Rajkot, Gujarat.
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: January CasesSean M. Fox
Drs. Daniel Escobar, Angela Pikus, and Alex Blackwell are Emergency Medicine Residents and interested in medical education. Lauren Ramsey, PA-C works with the Sanger Heart & Vascular Institute. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Atrial Myxoma
- Cardiac Lymphoma
- Small Cell Lung Cancer
- Metastatic Cervical Squamous Carcinoma
- Spontaneous Pneumothorax
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: February CasesSean M. Fox
Drs. Potter and Richardson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Dr. Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology Topics including:
• Myocarditis
• Pulmonary Contusions
• Clavicle Fracture
• Pneumonia
• Acute Chest Syndrome
• Pleural Effusion
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...Sean M. Fox
Dr. Kelsey Lena is an Emergency Medicine Resident and Drs. Michael Avery and Joshua Davis are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s topics include:
• Splenic Rupture
• Obstructive jaundice
• Ovarian Torsion
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...Sean M. Fox
Drs. Angela Pikus, Alex Blackwell, Mark Baumgarten, Rosa Malloy-Post are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
• Naloxone-Associated Aspiration Pneumonitis & Pulmonary Edema
• Superior Vena Cava Syndrome
• Pulmonary Aspergillosis And The “Air Crescent Sign”
• Needle-Chest Decompression & Recent Pneumothorax Literature
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: May CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
Subcutaneous air
Osteopenia
Bronchiolitis
Constipation
Asthma exacerbation
Alveolar Rhabdomyosarcoma
Aspirated Foreign Bodies
Small Bowel Obstruction
Kyphoscoliosis
Pneumatocele
Cecal Volvulus
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: September CasesSean M. Fox
Drs. Breeanna Lorenzen and Travis Barlock are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
• Aortic Transection
• Hemothorax
• Innominate Artery Transection
• Dextrocardia
• Situs Inversus
• Pneumonia
• Complete Lung Consolidation
• Septic Pulmonary Emboli
• Pulmonary Metastases
• Pneumothorax
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
2. H&P
Background: 47 yo female who was referred to an outside ENT in August,
2014
CC: Right neck mass
HPI: Patient reported presence of neck mass for 9 years
Initially fluctuated in size but recently began growing steadily
Intermittent dull pain over right lateral neck sometimes extending to right year
No fluctuation of mass with eating; no facial weakness, numbness, dysphagia,
odynophagia or voice change
No tachycardia, diaphoresis, flushing or tachypnea
*Modified from documentation by Drs. Michael Baker, Kiran Kakarala and Paul Camarata
3. H&P
PMH: Anemia, headaches and seasonal allergies
PSH: Tonsillectomy and adenoidectomy
Meds/Allergies: Aspirin and Tylenol; allergic to sulfa
FH: Breast and uterine cancer in mother and sister
SH: ½ ppd smoker for 35 years; occasional alcohol use
ROS: + fatigue, hearing loss, tinnitus, palpitations, confusion, light-
headedness, headaches
*Modified from documentation by Drs. Michael Baker, Kiran Kakarala and Paul Camarata
4. H&P
Exam
Vitals: WNL
General: Well-developed, well-nourished
Ears: canals normal, TM intact and mobile; no evidence of fluid or infection
Nose: Normal nasal mucosa, no masses/lesions
Nasopharynx: No mass, lesion or drainage
Oral Cavity: Clear and without signs of infection
Pharynx: No mass or ulceration
Larynx: Vocal cords mobile, no visible lesions
Neck: Midline trachea without mass or lesion, large right side mass mobile (more horizontal than vertical) ,
firm, 4x5cm extending to the angle of mandible superiorly inferiorly to the level of cricoid, no TTP, non-
pulsatile
DDX: lymphadenopathy, branchial cleft cysts, salivary gland tumors, neurogenic
tumors, and aneurysms of the carotid artery.
*Modified from documentation by Drs. Michael Baker, Kiran Kakarala and Paul Camarata
5. Workup
CT Neck with Contrast ordered by outside
ENT before referral to KU
In the area of the carotid bifurcations there
are large enhancing masses bilaterally
Right: 8x4x3 cm
Left: 6x4 cm
Masses compress but do not invade IJ
Unremarkable parotid and submandibular
glands
Diagnosis: Bilateral Carotid Body Tumors
Definitive diagnosis would require histologic
verification
Labs: Plasma-free metanephrines and 24-
hour urine metanephrines WNL
6. Carotid Body Tumors
Type of paraganglioma, rare neuroendocrine tumors arising from extra-adrenal autonomic
paraganglia
Parasympathetic derived
Head and neck paragangliomas are less likely to be secretory (5%)1
Most are sporadic but hereditary paragangliomas have been linked to mutations in the
succinate dehydrogenase (SDH) enzyme complex 2
Sporadic tumors more common in women; hereditary tumors are equally distributed 3
Mean age at diagnosis was 47 in a study of 236 patients 4
Vast majority are benign; malignancy is only confirmed by presence of paraganglioma in
lymph nodes 1
7. Carotid Body Tumors
Bilateral in approximately 10% of cases 5
Fontaine’s sign: Exam finding in which mass is more
mobile in horizontal plane than vertical plane 6
Lyre sign on angiography: splaying of the internal and
external carotid arteries by the mass 8
Consider vagal paraganglioma if carotids are displaced
anteriomedially without splaying
Salt and pepper appearance on MRI 8
8. Treatment
Surgery remains the only definitive treatment with low
vascular morbidity 7
If untreated, complications include dysphagia, deficits of
cranial nerves VII, IX, X, XI and XII, and hoarseness or a
Horner's syndrome may result from pressure on the vagus
or sympathetic nerves
Shamblin III tumor and tumor size >3.2cm emerged as
predictive factors for early postoperative peripheral
neurological complications 7
Post-operative nerve deficit is common (56%) but often
temporary (17% at 18 months)
7
Shamblin Classification
9. Course
Patient saw surgeons prior to operation
Underwent preoperative right carotid body tumor embolization
Controversial with some studies reporting no benefit and others reporting
reduction in intraoperative blood loss and associated morbidity
Right pre-auricular transparotid and transcervical approach to
parapharyngeal space tumor
Failed swallow with evidence of right vocal cord paralysis
PEG tube placed
Underwent Vocal Cord Injection three days after resection
Discharged with nectar-thick liquids and post-op swallow appointment
10. References
1: Johnson, Jonas T., Clark A. Rosen, and Byron J. Bailey. Bailey's Head and Neck Surgery--otolaryngology.
Philadelphia: Wolters Kluwer Health /Lippincott Williams & Wilkins, 2014
2: Dannenberg H, Dinjens WN, Abbou M, et al. Frequent germ-line succinate dehydrogenase subunit D gene
mutations in patients with apparently sporadic parasympathetic paraganglioma. Clin Cancer Res 2002; 8:2061.
3: Lin D, Carty S, Young WF Jr. Paragangliomas: Epidemiology, clinical presentation, diagnosis, and histology.
UpToDate. 2015.
4: Erickson D, Kudva YC, Ebersold MJ, Thompson GB, Grant CS, van Heerden JA, Young WF Jr. Benign
paragangliomas: clinical presentation and treatment outcomes in 236 patients. J Clin Endocrinol Metab.
2001;86(11):5210.
5: Davidovic LB, Djukic VB, Vasic DM et-al. Diagnosis and treatment of carotid body paraganglioma: 21 years of
experience at a clinical center of Serbia. World J Surg Oncol. 2005;3 (1): 10
6 :Boedeker CC, Ridder GJ, Schipper J. Paragangliomas of the head and neck: diagnosis and treatment. Fam Cancer.
2005;4(1):55.
7: Lamblin, E., I. Atallah, E. Reyt, S. Schmerber, J.-L. Magne, and C.a. Righini. "Neurovascular Complications following
Carotid Body Paraganglioma Resection." European Annals of Otorhinolaryngology, Head and Neck Diseases (2016)
8: Lee, K. J. Essential Otolaryngology: Head and Neck Surgery. Norwalk, CT: Appleton & Lange, 2012.