Coma is defined and the anatomy of consciousness explained. The various levels of arousal, AVPU scale and Glasgow Coma Scale described. The differential diagnosis of coma discussed are coma with & without focal deficits and the meningitis syndrome.
The various aspects of history discussed in details. The examination part includes the general examination, Brainstem reflexes, motor functions with the signs of lateralisation and meningeal irritation signs.
The basic lab investigations, Imaging and special investigations like CSF examination, EEG discussed.
Elevated intracranial pressure and its management explained.
این ارائه در کارگاه تخصصی تقلید و آپراکسی سرنخ هایی برای مداخلات مبتنی بر شواهد توسط دکتر هاشم فرهنگ دوست تدریس شده است.
برای مطالعه مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه کنید.
www.farvardin-group.com
ATAXIA IN CHILDREN -CAUSES, MANAGEMENT, INVESTIGATIONS, TYPES, COMMONEST ATAXIA IN CHILDREN IN DETAIL, HOW WILL YOU FIND OUT THE CAUSE FOR ATAXIA IN CHILDREN FLOWCHART, DEFINITION, TREATMENT
Coma is defined and the anatomy of consciousness explained. The various levels of arousal, AVPU scale and Glasgow Coma Scale described. The differential diagnosis of coma discussed are coma with & without focal deficits and the meningitis syndrome.
The various aspects of history discussed in details. The examination part includes the general examination, Brainstem reflexes, motor functions with the signs of lateralisation and meningeal irritation signs.
The basic lab investigations, Imaging and special investigations like CSF examination, EEG discussed.
Elevated intracranial pressure and its management explained.
این ارائه در کارگاه تخصصی تقلید و آپراکسی سرنخ هایی برای مداخلات مبتنی بر شواهد توسط دکتر هاشم فرهنگ دوست تدریس شده است.
برای مطالعه مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه کنید.
www.farvardin-group.com
ATAXIA IN CHILDREN -CAUSES, MANAGEMENT, INVESTIGATIONS, TYPES, COMMONEST ATAXIA IN CHILDREN IN DETAIL, HOW WILL YOU FIND OUT THE CAUSE FOR ATAXIA IN CHILDREN FLOWCHART, DEFINITION, TREATMENT
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
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
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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
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
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Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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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.
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3. Cerebral Palsy: Definition
Cerebral palsy is a static encephalopathy
Encephalopathy = Brain Injury that is non-
progressive disorder of posture and movement
Variable etiologies
Often associated with epilepsy, speech problems,
vision compromise, & cognitive dysfunction
4. LATEST DEFINITION OF CEREBRAL PALSY
“Cerebral palsy describes a group of permanent disorders of
the development of movement and posture causing activity
limitation that are attributed to non-progressive
disturbances that occurred in the developing fetal or infant
brain. The motor disorders of cerebral palsy are often
accompanied by disturbances of sensation, perception,
cognition, communication and behavior, by epilepsy, and by
secondary musculoskeletal disorders”
Rosenbaum P et al: Dev Med Child Neurol (Suppl.) 2007;109:8-14
7. Cerebral palsy
Classification
According to Pattern of involvement
Monoplegia : one limb / rare
Diplegia : both LL >> UL / good intelligence /
prematurity
Hemiplegia : unilateral usually UL > LL / 33 % seizures
50 % mentally retarded
Triplegia : rare / usually both LL + one UL
Quadriplegia : total body / often mentally retarded /
with seizures / severe hypoxia
Double hemiplegia : bilateral UL > LL
9. Gross motor functional classification system
Level Function
I Ambulatory in all settings
II Walks without aides but has
limitations in community settings
III Walks with aides
IV Mobility requires wheelchair or adult
assist
V Dependent for mobility
11. “ASPHYXIA” AND CP IN THE NCPP STUDY
2 3 C H IL D R E N
W IT H O T H E R R E A S O N S F O R C P
1 2 < 2 K G , 1 4 N O N -C N S A N O M A L Y
1 M IC R O C E P H A L Y , 7 P R E N A T A L R IS K
1 7 C H IL D R E N
"P U R E " A S P H Y X IA L D A M A G E
< 1 0 % O F A L L C P
1 P E R 2 ,7 0 0 B IR T H S
4 0 C H IL D R E N
W IT H A N Y A S P H Y X IA IN D IC A T O R
1 4 9 C H IL D R E N
W IT H N O A S P H Y X IA IN D IC A T O R
1 8 9 C H IL D R E N
W IT H C P
4 5 , 4 4 9
C H IL D R E N
12. All four criteria must be met:
Evidence of metabolic acidosis: umbilical artery pH<7 and base
deficit ≥12 mmol/L at delivery
Early onset of severe or moderate neonatal encephalopathy in
infants ≥34 weeks of gestation
Cerebral palsy of the spastic quadriplegic or dyskinetic type
Exclusion of other identifiable etiologies (eg, trauma, coagulation
disorders, infection, genetic disorders)
Task force on neonatal encephalopathy and cerebral palsy criteria for
Adapted from: Neonatal Encephalopathy and Cerebral Palsy: Executive Summ
13. A sentinel hypoxic event occurring immediately before or during
labor
A sudden and sustained fetal bradycardia or absence of fetal
heart rate variability in the presence of persistent late or
variable decelerations. This usually occurs after a hypoxic
sentinel event with a normal fetal heart rate pattern prior to the
event.
Apgar score of 0 to 5 after five minutes
Onset of multisystem involvement within 72 hours of birth
Early imaging studies showing evidence of an acute nonfocal
cerebral abnormality
Peripartum events that may be related to development of
cerebral palsy but which are not specifically asphyxial
insults
Adapted from: Neonatal Encephalopathy and Cerebral Palsy: Executive Summary. Obstet Gynecol 2004; 103:780.
14. Table 1
Mimics of cerebral palsy
disorder Clue
Familial spastic paraplegia Family history
Transient toe walking Normal deep
tendon reflexes
Muscular dystrophy Calf hypertrophy,
positive Gower’s
sign
Metabolic disorders Regression,
lethargy,
unusual vomiting
Sjogren-Larrson Ichthyosis
Lesch-Nyhan Severe self-
mutilation
Mitochondrial disorders Recurrent stroke,
cardiomyopathy,
15. Impaired movements
• 65% speech defects
• 50% are mentally retarded
• 50% ocular defects
• 25% hearing impairment
• 40% seizure disorders
• 20% seriously disabled
• 1.5 to 2.5 per 1,000 births
will result in severe to
moderately severe
17. Disorder Gross motor Fine motor Social language
Mental
retardation
Delay + + to + + + ++ t+++ +++
Cerebral palsy Delay +++ ++ + +
CP with MR +++ +++ +++ +++
Hearing
impairment
No No No +++
Impaired
vision
++ +
Spinal
muscular
atrophy
++ + + to ++ No Expressive
may be
delayed
18. Levine ( poster) criteria
P- Posturing/ abnormal movement
O- oropharyngeal problems (normality
tongue thrust and swallowing abnormality
S- strabismus
T – tone ( hyper to hypo)
E- Evolutional maldevlopment ( persistent primitive
reflexex or protective / equilibrium reflexes fail to
devlop ( parachute reflex)
R – reflexes ( increased deep tendon/ persistent
babinski
19. Difficulty to diagnose CP during
the 1st
year of life
1. Hypotonia more common then hypertonia in 1st
yr
2. early abundance of primitive reflexes may confuse
3. limited variety of volitional movement for
evolution
4 subtantioal myelination takes months to evovle
5 most instace of CP doesn’t have substancial risk fac
20. What behaviour symptoms
during 1st
year arouse suspicion
of CP
1. excessive irritablity, crying , sleep difficulties
2. early feeding difficulties ( Co-ordination of sucking
and swallowing)
3. Jitter or jerky behavoiur
4. easily startle behaviour
5. Stiffness during dressing , diaper, hand washimg
6. paradoxical precocious devlopment
a , early rolling ( actually sudden reflex roll rathe
then volitional
Stiff leg standing
21. Feature suggestive of
progressive rather then CP
1. Abnorma increase in heaad circumference
Eye abnormalities
Skin abnormalty
Hepatomegaly and / or spleenomegaly
Decrease or absent deep tendon reflex
Sensory abnormalities
Devlopmental regression ( Rett syndrome )
22. Head and Neck Findings
• 24% inability to chew
• 20% inability to swallow easily
• 20% frequent dental caries
• High rate of temporo-mandibular
disorders
23. Positive signs of spastic CP include:
Spastic hypertonia
Hyperreflexia caused by
hyperexcitability of the stretch reflex
Extensor plantar responses
Clonus
24. Negative signs of spastic CP include:
Slow effortful voluntary movements
Impaired fine-motor function
Difficulty in isolating individual
movements
Fatiguability
26. ASSOCIATED DISORDERS
Intellectual disability
Children with spastic quadriplegia are typically the most severely
affected, while cognitive function usually is better with dyskinetic
CP that is mainly athetoid
Psychiatric disorders
including emotional lability, poor attention and vigilance, and
obsessive-compulsive traits
Epilepsy
most common in patients with spastic quadriplegia and
acquired hemiplegia, and less common in mild symmetric
spastic diplegia and CP that is mainly athetoid
27. Visual disorders
strabismus and clinically significant refractive errors each
occurred in 50 percent, and amblyopia and visual field defects
each
Speech impairment
including aphasia and dysarthria, occur in about 38 percent of
children with CP
Hearing impairment
most common in those with very low birthweight or severe
hypoxic-ischemic insults
Pulmonary disease
a leading cause of death among patients with severe CP
Growth failure Urinary disorders Orthopedic disorders
Osteopenia
28. DIAGNOSIS
The diagnosis of CP depends upon a combination of findings, including motor delay,
neurologic signs, persistence of primitive reflexes, and abnormal postural reactions
Neurobehavioral signs
Motor abnormalities
Developmental reflexes
Laboratory studies
serum concentrations of glucose, thyroid, ammonia, lactate and pyruvate, plasma
amino acid analysis, urine organic acid analysis, and arterial acid-base status,
should be obtained to exclude a metabolic disorder
29. NEUROIMAGING FOR CP
[Bax et al JAMA 2006;296:1602]
Emerging imaging modalities will likely provide further insight
into the etiology of CP by making imaging easier in children
(PROPELLAR) and by mapping white matter tracts (DTI).
The American Academy of
Neurology now recommends
that all cases of cerebral palsy of
unknown origin undergo
neuroimaging
Most children with cerebral palsy
have abnormal neuroradiological
findings, white matter damage
being the most common.
30. lgorithm for the evaluation of the child with cerebral palsy (CP)
31. Cerebral palsy
Clinical Assessment
Goals of Physical Examination
Determine grades of muscle strength and selective
control.
Evaluate muscle tone and determine type.
Evaluate degree of deformity / contracture at each
joint.
Assess linear, angular and torsional deformities of
spine, long bones, hands and feet.
Appraise balance, equilibrium and standing / walking
posture.
32. Cerebral palsy
Goals of Management
(Treatment)
Turn focus of parents from the disease to the goal-
oriented approach
needs time and a lot of
discussion
Physician and Physiotherapist must have the same
perspective
33. Cerebral palsy
Types of Management
(Treatment)
Physical therapy
Orthotics
Control of spasticity
Orthopedic surgery
35. Cerebral palsy
Selective Dorsal Rhizotomy
Cut 30 – 50 % of abnormal dorsal rootlets L2 - S1
Followed by intensive physiotherapy
Results encouraging
May cause hyperlordosis / hip subluxation
Best for : spastic diplegia, 4-8 yrs, no previous surgery,
no contractures, no extra pyramidal signs
? Not enough alone
Orthopedic procedures obtain similar results
36. Cerebral palsy
Baclofen
GABA agonist – inhibits release of excitatory
neurotransmitter at level of spinal cord
Oral : mixed reports/ side effects/ not selective
Continuous intrathecal – implantable pump
Good results in releasing spasticity, and improving
function
Complications of pump and catheter
Needs specialized centers
37. Cerebral palsy
Botulinum-A toxin
Acts at myo-neural junctions
Inhibits exocytosis of Acetylcholine
Inject selected muscles at multiple sites
Spasticity reduction may last up to 6 months
Reversible , painless , minimal side effects
Most patients still require lengthening for
permanent correction
Role : - Facilitates physiotherapy and
mobilization
- Delays surgical management
- Trial to determine effects of specific
proposed surgical treatment
39. Cerebral palsy
Physical Therapy
There is no evidence that any type of physical therapy can
have a beneficial lasting effect on motor function
beyond early to middle childhood (age 4-8 years).
Thomas S. Renshaw
( Lovell & Winter’s Pediatric Orthop.)
40. Cerebral palsy
Orthotics
Immobilization may cause atrophy
Night splints :
- Do not prevent nor reduce deformity
- may cause irritation, pain or stimulate reflexes in
spastic muscles and relaxes the weaker apponents –
thus may increase deformity rather than reduce it !
May be useful only in Athetoid
41. Cerebral palsy
Prerequisites foreffective
surgery
Type : spastic
Extent : hemiplegics / diplegics : good results
quadriplegics : minimal
improvement
Age : 3- 12 years
IQ : good
Good upper limb function : for walking
Underlying muscle power : not weak
Walker / non-walker :
surgery hardly changes state but improves gait
42. Cerebral palsy
Prerequisites foreffective
surgery
Type : spastic
Extent : hemiplegics / diplegics : good results
quadriplegics : minimal
improvement
Age : 3- 12 years
IQ : good
Good upper limb function : for walking
Underlying muscle power : not weak
Walker / non-walker :
surgery hardly changes state but improves gait
43. Cerebral palsy
Timing For Orthop Surgery
For structural changes : Early
e.g. Hip subluxation , usually <5 years
To improve function ( gait ) :
defer until walking ( independently / with aids )
until gait pattern develops and could be
assessed
walking : 18 – 21 months in hemiplegia
3 – 4 years in spastic diplegia
Optimum time of lower extremity surgery
5 – 7 years: can analyze and observe gait pattern
44. The ‘‘Birthday Syndrome’’
One group of complications related to a
chain of operations over the years is social
isolation, loss of motivation, frustration, and
psychosocial problems termed the birthday
syndrome.31