A 48-year-old female presented with a 6-month history of pain and a 4-month history of an ulcerative lesion on the right side of her tongue. Examination revealed a 4cm x 3cm x 1cm tender ulcerative growth that bled on touch, consistent with early carcinoma of the tongue. Given her history of tobacco and betel nut chewing for 30 years, squamous cell carcinoma was considered the most likely diagnosis. Investigations including biopsy and imaging of the neck were planned to confirm diagnosis and assess spread, and right hemiglossectomy with neck dissection was proposed as treatment.
A presentation about an interesting case that came to the Radiology Department of Sebha Medical Center.
A 17 years old male, presented with a painful neck swelling, The swelling was first noticed 10 years ago and was small and painless then. In the last two months, the swelling increased in size and became painful and started to cause slight discomfort on swallowing.
The presentation contains 50 slides, and is divided into the following parts :
1 - The case
2 - Thyroglossal cysts
3 - Imaging Thyroglossal cysts
4 - Differential diagnoses
This presentation was prepared by me and I will present it today in sha Allah in the tutorials of the Radiology Department of Sebha Medical Center.
Examination of Swelling in a patient is always a task for MBBS students. This PPT provides the students, how to elicit a history & also the easy way to examine a swelling.
A presentation about an interesting case that came to the Radiology Department of Sebha Medical Center.
A 17 years old male, presented with a painful neck swelling, The swelling was first noticed 10 years ago and was small and painless then. In the last two months, the swelling increased in size and became painful and started to cause slight discomfort on swallowing.
The presentation contains 50 slides, and is divided into the following parts :
1 - The case
2 - Thyroglossal cysts
3 - Imaging Thyroglossal cysts
4 - Differential diagnoses
This presentation was prepared by me and I will present it today in sha Allah in the tutorials of the Radiology Department of Sebha Medical Center.
Examination of Swelling in a patient is always a task for MBBS students. This PPT provides the students, how to elicit a history & also the easy way to examine a swelling.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
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
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.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. Carcinoma Tongue
Dr. Aravind.K.R.
3rd yr Junior Resident
General Surgery
Rajendra Institute of Medical Sciences, Ranchi.
Prof. Dr. D. K. Sinha
Professor - Dept of General Surgery
Rajendra Institute of Medical Sciences, Ranchi.
3. Chief Complaints
• Mrs. X, 48 yr old housewife from
Dhanbad, Hindu by religion and of low
socio economic status presented to
the OPD with complaints of
1. Pain in the tongue for the past 6
months
2. Ulcer over the front part of right
side of tongue - for the past 4
months
3. Swelling in front of the ulcer - for
the past 3 months
4. History of Presenting Illness
• Pain
Insidious in onset, Non progressive in nature, Intermittent and burning type of
pain. Mild severity. Duration - 6 months.
Localized to the tongue, referred to right ear for 1 month
Aggravated while chewing and tongue movements.
Relieved on taking cold and sweet food
• Ulcer:
Insidious in onset, Progressive in nature
Duration - 4 months
Right lateral and front part of the tongue
Occured due to trauma following tongue bite
Associated with pain, discharge and occasional bleeding
which subsequently progressed to form a swelling in front of the ulcer (upper
part)for the past 3 months
swelling is associated with difficulty in chewing and prone to tongue bite.
No relieving factors
5. • H/O difficulty in speech for 2 months
• H/O excessive salivation present
• H/O loss of weight present due to reduction in food intake
• H/O bad odour from mouth present
• No H/O loss of taste sensation
• No history suggestive of complaints related to ear, nose and throat.
• No H/O neck swelling
• No H/O swelling or lumps in other parts of the body
• No H/O fever, jaundice, difficulty in breathing, recent onset bony
pain
• Known case of Hypertension for the the past 2 years on treatment
6. Past History
• H/O repeated trauma to the tongue due to mis directed tooth
for the past 6-7 years
• She was adviced for removal of her tooth (right 1st premolar),
but she apllied locally used topical medication with no
permanent relief and finally tooth extraction was done 2
weeks back.
• No H/O sexually transmitted disease
• No H/O any other surgical intervention
7. Personal History
• Non vegetarian by diet.
• H/O Tobacco chewing for the past 30 years
• H/O intake of betal nut and pan for the past 20 years.
• No H/O smoking, alcohol intake.
• Bladder and bowel habits normal.
• Family History - not significant
8. Obstetric and Menstrual
History
• She is married, having two live childen both by normal vaginal
delivery
• Attained menopause three years back.
9. General Examination
• Patient is conscious, co-operative, oriented to time, place and
person, afebrile.
• Average built and nourished.
• Mild pallor +, not icteric, no clubbing, no cyanosis, no pedal edema,
no generalized lymphadenopathy.
• Hydration adequate
• Karnofsky Performance Status - 80
• ECOG Performance status - Grade 1
• Vitals:
• BP: 124/80mmHg(arm) in sitting posture
• Pulse Rate: 84/min, normal volume, regular rhythm, no radioradial
& no radiofemoral delay.
• RR: 16/min, thoraco abdominal type.
• BMI: 22.5kg/m2
10. After getting informed consent, the patient is
examined in a well lit room in sitting posture
11. Local Examination
• Inspection:
• No facial deformity
• Mouth opening - Adequate.
• Staining of teeth present
• Tongue: Normal in size and shape. Pinkish red in colour.
Movement present in all directions.
No fibrillation. Undersurface and Posterior 1/3rd – Normal
Anterior 2/3rd tongue: A single ulcero-proliferative growth of size
approx. 3cmX3cmX1cm from about 2cm lateral to tip of the tongue extending
posteriorly on the right side upto 2 cm anterior to the sulcus terminalis, which
is almost oval in shape, pink in colour, irregular surface, anteriorly well defined
and posteriorly ill defined margins.
An ulcer of size approx 2cmX1cm present over posterior part of the swelling
with everted and rolled out edges, floor contains pale granulation tissue and
yellowish white slough
Surrounding area – looks normal.
• Retromolar trigone and other areas in oral cavity – Normal
12.
13. Palpation
• Tenderness present over the ulcerated surface.
• A single oval ulcero proliferative growth of size 4cmX3cmX1cm
in the right lateral part of the tongue extending 2.5cm lateral to
tip of tongue upto 2cm anterior to sulcus terminalis, irregular
and rough surface, firm in consistency, anteriorly well defined
margins and posteriorly ill defined and do not cross midline. The
ulcer of size 2cmX1cm is present over the growth posteriorly
with everted and rolled out edges, irregular margins, base is
indurated.
• Floor has pale granulation tissue with yellowish white slough at
places. It bleeds on touch.
• No extension into floor of mouth, alveolar region and retro molar
region
• Tonsilar region, Posterior pharyngeal wall - Normal
14. • Inspection of Neck - Normal
• Cervical lymph node Examination – Not palpable.
15. Other system examination
• Ear Nose and Throat examination - within normal limits
Indirect laryngoscopy:
Posterior 1/3rd tongue, posterior most part of tongue,
Hypopharynx Epiglottis, pyriform fossa - Normal (No
growth/ulceration)
Vocal cord - mobility present; no growth or ulceration
• Cardio vascular system, Respiratory system, Central Nervous
sytem, Abdominal examination – within normal limit.
16. Summary
A 48 year old female presented with history of pain for 6 months
and ulcero proliferative lesion over the right antero-lateral
aspect of the anterior 2/3rd tongue for last 4 months with
history of tobacco and betal nut chewing for about 30 years. On
examination, a tender ulceroproliferative growth of size
4cmx3cmx1cm with everted and rolled out edges, indurated
base was felt which bleeds on touch. Hence.....
Provisional Diagnosis:
Right side Early Carcinoma Tongue -
Anterior 2/3rd
Stage – T2 N0 Mx
17. Differential Diagnosis
• Squamous Cell Carcinoma – Most common
• Verrucous Carcinoma
• Undifferentiated Carcinoma
• Small cell neuro-endocrine tumor
• Adenocarcinoma of minor salivary glands
• Lymphoepithelioma
18. Investigations
• Confirmation of Diagnosis:
• Wedge biopsy of Growth and Histopathological examination
• CECT of Head and Neck from skull base to upper chest -
To see for bony infiltration (cortical bone abutment) into
mandible, pterygoid plates and for occult metastasis to cervical
lymph nodes
• MRI Tongue - To check for infiltration to extrinsic and intrinsic
muscles of tongue, nerves and vessels.
• Routine blood investigations and Chest Xray
• Orthopantomogram
19. Treatment
• Surgery:
• Right sided Hemi-glossectomy with right side Elective Supra-
omohyoid neck dissection.
• Post Operative follow up:
• Clinical examination every 3 monthly in 1st year, then every 4
monthly in 2nd year, every 6 monthly upto 4th year and then
once in a year.
20. • This slide presentation was awarded 1st prize in Regional
Refresher Course (Zonal) of ASI in 2020.