This document discusses the evaluation of choledochal cysts using ultrasonography in pediatric patients. It presents 6 case studies demonstrating the use of ultrasonography to diagnose different types of choledochal cysts according to the Todani classification system. Ultrasonography was found to be 100% sensitive in diagnosing choledochal cysts and identifying the cyst type in 20 pediatric patients. It can also be used to detect complications and guide management such as surgical excision.
Pedunculated Lipoma of the Caecum Causing Colocolic Intussusception in an AdultKETAN VAGHOLKAR
Introduction: Colocolic intussusception in adults is uncommon and poses both a diagnostic
and therapeutic dilemma. The association of an underlying malignancy necessitates a preoperative
confirmation of diagnosis. The presenting features are variable. Hence contrast enhanced
computed tomography of the abdomen is pivotal for diagnosis. An en bloc resection
of the specimen in accordance with standard oncological principles is the mainstay of treatment.
Case report: A case of colocolic intussusception in an adult is presented to highlight the
difficulties in preoperative diagnosis and in selecting the best surgical option for treatment.
Conclusion: Adult bowel intussusception is a diagnostic dilemma with preoperative diagnosis
being the biggest challenge. CT scan of the abdomen is an excellent diagnostic modality with
high diagnostic accuracy. Explorative laparotomy with en bloc resection is mainstay of treatment
in adults.
Endometriosis is a disease restricted usually to the female genital tract. Involvement of the bowel by this disease can lead to a diagnostic dilemma due to the great variation in the symptomatology. Awareness of the pathophysiology, clinical features and diagnostic modalities is of utmost importance to decide the modality of treatment. Hormonal manipulation and surgical resection are the two modalities of treatment. The choice depends upon critical analysis of clinical and radiological findings and the desire to have pregnancy in cases associated with infertility.
Cholesterolosis of the gall bladder: a surgical dilemmaKETAN VAGHOLKAR
Cholesterolosis of the gall bladder or cholesterol polyps of the gall bladder have always been a contentious issue with respect to the role of prophylactic surgery in view of its asymptomatic state. Symptomatic cholesterol polyps behave similar to gall stones. There is therefore a need for a surgical algorithm to manage these lesions. A case of symptomatic cholesterol polyps of the gall bladder is reported to highlight the clinical presentation, imaging modalities and management strategies. Symptomatic cholesterol polyps of the gall bladder necessitate cholecystectomy. However, surgical intervention for asymptomatic polyps is guided by their size. Increased diameter is highly suspicious of a malignant potential requiring pre-operative staging and radical surgery.
The esophageal duplication cyst is a congenital defect of the digestive tract. It has an estimated prevalence of 0.012%, with higher predominance in males. Although it is a common fi nding in children, diagnosis of an esophageal duplication in adults is rare. Following ileal duplication, esophageal is the second most common duplication of the gastrointestinal tract, representing the 10-15% of all gastrointestinal duplication defects. For esophageal duplication, there are two main variants: cystic and tubular, the latter being the least common. They are usually developed during the third to fifth week of gestation due to failure of the vacuolar coalescence. Duplication cysts are commonly located in the distal third of the esophagus.Treatment should always be surgical, even at the asymptomatic stage
of disease, given the possibility of symptom development and complication appearance. Here we present a case of an adult patient presenting with an esophageal duplication cyst with a brief literature review.
ABSTRACT- Introduction- Gall bladder carcinoma is the most frequent carcinoma of the biliary tract. Pure mucinous adenocarcinoma as seen in breast, skin, and pancreas are very uncommon in the gall bladder. Mucinous adenocarcinoma of gall bladder is rarer variant of gall bladder carcinoma.
Methods- We were reported a case of 55 years old male presenting at department of surgery of LLR and Associated Hospital with nonspecific symptoms of diffuse pain abdomen with nausea and vomiting, generalized weakness, itching all over body, jaundice associated with anorexia and weight loss for last 4 to 5 months, ultrasonography revealed gross thickening of wall of gall bladder neck with ill define mass lesion and diagnosis was confirmed by USG guided FNAC, Histopathological examination and Immunohistochemistry (IHC).
RESULTS- Patient present with pain abdomen, icterus and anorexia, on USG guided FNAC cytological and Histopathological findings are suggestive of mucinous adenocarcinoma.
Conclusion- Mucinous adenocarcinoma is the rarest variant of adenocarcinoma gallbladder. Incidental diagnosis of mucinous adenocarcinoma of gall bladder was found by USG guided FNAC followed by the histopathological examination.
Key-words- Mucinous Adenocarcinoma, Gall bladder, FNAC, Mucin
Pedunculated Lipoma of the Caecum Causing Colocolic Intussusception in an AdultKETAN VAGHOLKAR
Introduction: Colocolic intussusception in adults is uncommon and poses both a diagnostic
and therapeutic dilemma. The association of an underlying malignancy necessitates a preoperative
confirmation of diagnosis. The presenting features are variable. Hence contrast enhanced
computed tomography of the abdomen is pivotal for diagnosis. An en bloc resection
of the specimen in accordance with standard oncological principles is the mainstay of treatment.
Case report: A case of colocolic intussusception in an adult is presented to highlight the
difficulties in preoperative diagnosis and in selecting the best surgical option for treatment.
Conclusion: Adult bowel intussusception is a diagnostic dilemma with preoperative diagnosis
being the biggest challenge. CT scan of the abdomen is an excellent diagnostic modality with
high diagnostic accuracy. Explorative laparotomy with en bloc resection is mainstay of treatment
in adults.
Endometriosis is a disease restricted usually to the female genital tract. Involvement of the bowel by this disease can lead to a diagnostic dilemma due to the great variation in the symptomatology. Awareness of the pathophysiology, clinical features and diagnostic modalities is of utmost importance to decide the modality of treatment. Hormonal manipulation and surgical resection are the two modalities of treatment. The choice depends upon critical analysis of clinical and radiological findings and the desire to have pregnancy in cases associated with infertility.
Cholesterolosis of the gall bladder: a surgical dilemmaKETAN VAGHOLKAR
Cholesterolosis of the gall bladder or cholesterol polyps of the gall bladder have always been a contentious issue with respect to the role of prophylactic surgery in view of its asymptomatic state. Symptomatic cholesterol polyps behave similar to gall stones. There is therefore a need for a surgical algorithm to manage these lesions. A case of symptomatic cholesterol polyps of the gall bladder is reported to highlight the clinical presentation, imaging modalities and management strategies. Symptomatic cholesterol polyps of the gall bladder necessitate cholecystectomy. However, surgical intervention for asymptomatic polyps is guided by their size. Increased diameter is highly suspicious of a malignant potential requiring pre-operative staging and radical surgery.
The esophageal duplication cyst is a congenital defect of the digestive tract. It has an estimated prevalence of 0.012%, with higher predominance in males. Although it is a common fi nding in children, diagnosis of an esophageal duplication in adults is rare. Following ileal duplication, esophageal is the second most common duplication of the gastrointestinal tract, representing the 10-15% of all gastrointestinal duplication defects. For esophageal duplication, there are two main variants: cystic and tubular, the latter being the least common. They are usually developed during the third to fifth week of gestation due to failure of the vacuolar coalescence. Duplication cysts are commonly located in the distal third of the esophagus.Treatment should always be surgical, even at the asymptomatic stage
of disease, given the possibility of symptom development and complication appearance. Here we present a case of an adult patient presenting with an esophageal duplication cyst with a brief literature review.
ABSTRACT- Introduction- Gall bladder carcinoma is the most frequent carcinoma of the biliary tract. Pure mucinous adenocarcinoma as seen in breast, skin, and pancreas are very uncommon in the gall bladder. Mucinous adenocarcinoma of gall bladder is rarer variant of gall bladder carcinoma.
Methods- We were reported a case of 55 years old male presenting at department of surgery of LLR and Associated Hospital with nonspecific symptoms of diffuse pain abdomen with nausea and vomiting, generalized weakness, itching all over body, jaundice associated with anorexia and weight loss for last 4 to 5 months, ultrasonography revealed gross thickening of wall of gall bladder neck with ill define mass lesion and diagnosis was confirmed by USG guided FNAC, Histopathological examination and Immunohistochemistry (IHC).
RESULTS- Patient present with pain abdomen, icterus and anorexia, on USG guided FNAC cytological and Histopathological findings are suggestive of mucinous adenocarcinoma.
Conclusion- Mucinous adenocarcinoma is the rarest variant of adenocarcinoma gallbladder. Incidental diagnosis of mucinous adenocarcinoma of gall bladder was found by USG guided FNAC followed by the histopathological examination.
Key-words- Mucinous Adenocarcinoma, Gall bladder, FNAC, Mucin
Abdominal Splenosiscausing Hydronephrosis- A Case Reportsemualkaira
Splenosis is anuncommenprocess ofintra abdominal or extra abdominal splenic tissue seeding, mostly post traumatic.The issueof splenosismostly comesupinpatientspresentingwith suspicious nodules inthe abdominal or chest cavity. It is exactly these patients with a history of blunt abdominal trauma who should be considered as candidates for having splenosis and should be screened with a proper medical history and with the use of novel non invasive imaging modalities thus sparing the patients unnecessary and potentially dangerous procedures.
Abdominal Splenosiscausing Hydronephrosis- A Case Reportsuppubs1pubs1
Splenosis is anuncommenprocess ofintra abdominal or extra abdominal splenic tissue seeding, mostly post traumatic.The issueof splenosismostly comesupinpatientspresentingwith suspicious nodules inthe abdominal or chest cavity. It is exactly these patients with a history of blunt abdominal trauma who should be considered as candidates for having splenosis and should be screened with a proper medical history and with the use of novel non invasive imaging modalities thus sparing the patients unnecessary and potentially dangerous procedures.
Intussusception in adult population is quite uncommon. It is usually seen in the pediatric age group. A wide range of causes can predispose to intussusception in adults. Majority of them are benign especially in cases of small bowel intussusception. However malignancy is quite often encountered in cases of colonic intussusception. Diagnosis in adults is difficult due to vague symptoms and intermittent nature. Computerized tomography is diagnostic. However majority of cases in adults are diagnosed at laparotomy. Surgical resection assuming the lesion to be malignant is the treatment of choice.
Management of Perforated Duodenal Diverticulum: Case Reportasclepiuspdfs
It has been reported that duodenal diverticula are common but perforated duodenal diverticulum is a rare entity. At this time, there is no standardized management for perforated duodenal diverticulum. In these cases, patients usually complain of vague abdominal pain and computed tomography scan is mostly ordered used as an important diagnostic method. Diagnosis and the severity of the disease need to be assessed before any intervention. Essentially, the perforated small bowel is treated with surgical intervention. However, conservative treatment with broad-spectrum antibiotics and strict nil per os has been offered in the past for stable patients. Below, we report one case of perforated duodenal diverticulum that we managed with conservative treatment.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Austin Journal of Clinical Case Reports is an open access scholarly journal. The goal of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments by publishing case reports in all aspects of Clinical Medicine. Case Reports is an open access journals. The goal of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments by publishing case reports in all aspects of Clinical Medicine.
The aim of this open access journal is to offer service for scientists and academicians to promote, share, and discuss various new issues and developments by publishing clinical case reports in all aspects.
Austin Journal of case repots are a reflective analysis of one, two, or three clinical cases. All clinical case reports submitted must have been approved by an ethics committee or institutional review board.
Austin Journal of Clinical Case Reports is an open access scholarly journal. The goal of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments by publishing case reports in all aspects of Clinical Medicine. Case Reports is an open access journals. The goal of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments by publishing case reports in all aspects of Clinical Medicine.
Abstract
This case report describes the diagnosis and management of a large mesenteric cyst in a 55 year old lady who presented with abdominal distension & with mass in the left upper quadrant. Mesenteric cysts are rare, benign, abdominal tumors to which <1000 cases have been reported in the literature. While 40% of cases are incidental findings found either through physical examination or imaging, they can cause non-specific abdominal symptoms including pain, altered bowel habits, nausea/vomiting or anorexia. Less commonly, 10% of cases can present with bowel obstruction, volvulus, torsion or shock. In general, the lack of characteristic clinical and radiological features presents as a diagnostic difficulty.
The mainstay in imaging is computerized tomography (CT). CT identifies and helps aid the decision to pursue a laparoscopic or open laparotomy approach, where complete surgical resection is the ultimate goal. In our patient a CT Abdomen & Pelvis showed a large, loculated cystic mass measuring 30cm in cranio-caudal length and 16cm in the transverse and anterior/posterior diameter. While different approaches have been described in the literature to surgically resect such cysts, our approach was largely reflective of size and adherence to surrounding structures in this case. A laparotomy was performed using an upper mid-line 7 cm incision; 4500cc of fluid was aspirated from the cyst which was found to originate from the small bowel mesentery. A complete resection of the multi-loculated cystic sac was done that included the resection of the middle mesenteric vein. The post-operative period was uneventful. The patient was discharged on post-operative day 2. The Histopathology identified the mass as a multi-loculated peritoneal inclusion-type cyst.
PowerPoint presentation on Choledochal Cysts, also known as biliary cyst, uploaded by Dr. Vaskar Humagain, first presented in 31st December, 2013. This presentation contains all the information about Choledochal Cysts, the original and revised Todani classification of choledochal cysts, pathogenesis, other associated congenital anomalies, clinical features in infant and adult, management of choledochal cysts. Comments are highly welcome :)
Abdominal Splenosiscausing Hydronephrosis- A Case Reportsemualkaira
Splenosis is anuncommenprocess ofintra abdominal or extra abdominal splenic tissue seeding, mostly post traumatic.The issueof splenosismostly comesupinpatientspresentingwith suspicious nodules inthe abdominal or chest cavity. It is exactly these patients with a history of blunt abdominal trauma who should be considered as candidates for having splenosis and should be screened with a proper medical history and with the use of novel non invasive imaging modalities thus sparing the patients unnecessary and potentially dangerous procedures.
Abdominal Splenosiscausing Hydronephrosis- A Case Reportsuppubs1pubs1
Splenosis is anuncommenprocess ofintra abdominal or extra abdominal splenic tissue seeding, mostly post traumatic.The issueof splenosismostly comesupinpatientspresentingwith suspicious nodules inthe abdominal or chest cavity. It is exactly these patients with a history of blunt abdominal trauma who should be considered as candidates for having splenosis and should be screened with a proper medical history and with the use of novel non invasive imaging modalities thus sparing the patients unnecessary and potentially dangerous procedures.
Intussusception in adult population is quite uncommon. It is usually seen in the pediatric age group. A wide range of causes can predispose to intussusception in adults. Majority of them are benign especially in cases of small bowel intussusception. However malignancy is quite often encountered in cases of colonic intussusception. Diagnosis in adults is difficult due to vague symptoms and intermittent nature. Computerized tomography is diagnostic. However majority of cases in adults are diagnosed at laparotomy. Surgical resection assuming the lesion to be malignant is the treatment of choice.
Management of Perforated Duodenal Diverticulum: Case Reportasclepiuspdfs
It has been reported that duodenal diverticula are common but perforated duodenal diverticulum is a rare entity. At this time, there is no standardized management for perforated duodenal diverticulum. In these cases, patients usually complain of vague abdominal pain and computed tomography scan is mostly ordered used as an important diagnostic method. Diagnosis and the severity of the disease need to be assessed before any intervention. Essentially, the perforated small bowel is treated with surgical intervention. However, conservative treatment with broad-spectrum antibiotics and strict nil per os has been offered in the past for stable patients. Below, we report one case of perforated duodenal diverticulum that we managed with conservative treatment.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Austin Journal of Clinical Case Reports is an open access scholarly journal. The goal of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments by publishing case reports in all aspects of Clinical Medicine. Case Reports is an open access journals. The goal of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments by publishing case reports in all aspects of Clinical Medicine.
The aim of this open access journal is to offer service for scientists and academicians to promote, share, and discuss various new issues and developments by publishing clinical case reports in all aspects.
Austin Journal of case repots are a reflective analysis of one, two, or three clinical cases. All clinical case reports submitted must have been approved by an ethics committee or institutional review board.
Austin Journal of Clinical Case Reports is an open access scholarly journal. The goal of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments by publishing case reports in all aspects of Clinical Medicine. Case Reports is an open access journals. The goal of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments by publishing case reports in all aspects of Clinical Medicine.
Abstract
This case report describes the diagnosis and management of a large mesenteric cyst in a 55 year old lady who presented with abdominal distension & with mass in the left upper quadrant. Mesenteric cysts are rare, benign, abdominal tumors to which <1000 cases have been reported in the literature. While 40% of cases are incidental findings found either through physical examination or imaging, they can cause non-specific abdominal symptoms including pain, altered bowel habits, nausea/vomiting or anorexia. Less commonly, 10% of cases can present with bowel obstruction, volvulus, torsion or shock. In general, the lack of characteristic clinical and radiological features presents as a diagnostic difficulty.
The mainstay in imaging is computerized tomography (CT). CT identifies and helps aid the decision to pursue a laparoscopic or open laparotomy approach, where complete surgical resection is the ultimate goal. In our patient a CT Abdomen & Pelvis showed a large, loculated cystic mass measuring 30cm in cranio-caudal length and 16cm in the transverse and anterior/posterior diameter. While different approaches have been described in the literature to surgically resect such cysts, our approach was largely reflective of size and adherence to surrounding structures in this case. A laparotomy was performed using an upper mid-line 7 cm incision; 4500cc of fluid was aspirated from the cyst which was found to originate from the small bowel mesentery. A complete resection of the multi-loculated cystic sac was done that included the resection of the middle mesenteric vein. The post-operative period was uneventful. The patient was discharged on post-operative day 2. The Histopathology identified the mass as a multi-loculated peritoneal inclusion-type cyst.
PowerPoint presentation on Choledochal Cysts, also known as biliary cyst, uploaded by Dr. Vaskar Humagain, first presented in 31st December, 2013. This presentation contains all the information about Choledochal Cysts, the original and revised Todani classification of choledochal cysts, pathogenesis, other associated congenital anomalies, clinical features in infant and adult, management of choledochal cysts. Comments are highly welcome :)
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
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
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.
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
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.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
1. TITLE: EVALUATION OF CHOLEDOCHAL
CYSTS USING ULTRASONOGRAPHY IN A
SPECTRUM OF CASES
GUIDE :
DR. ALKA AGRAWAL
HEAD OF DEPARTMENT
DEPARTMENT OF RADIODIAGNOSIS
MGMMC INDORE
COGUIDE :
DR. GAURAV BHANDARI
ASSISTANT PROFESSOR
DEPARTMENT OF
RADIODIAGNOSIS
MGMMC INDORE
PRESENTER :
DR. SUDHA CHANDANA
PG RESIDENT
DEPARTMENT OF RADIODIAGNOSIS
MGMMC INDORE
2. INTRODUCTION
Choledochal cysts are cystic dilatation of the biliary tree, with an incidence of
1:100,000-150,000, an uncommon but serious condition that requires surgical
treatment. (1)
Although choledochal cysts are generally considered a disorder of childhood and
infancy, the ages in reported cases have ranged from newly born to 80 years.
however, 60% of such cysts are diagnosed in patients less than 10 years old . (1)
PATHOGENESIS:
Close association with the anomalous formation of the pancreaticobiliary ductal
junction is reported in some subtypes .(2)
3. CLASSIFICATION
Commonly accepted classification is one devised by Todani et al. (3)
There are five main and several subtypes
type I: most common, accounting for 80-90% ( can present in utero)
Ia: dilatation of extrahepatic bile duct (entire)
Ib: dilatation of extrahepatic bile duct (focal segment)
Ic: dilatation of the CBD portion of extrahepatic bile duct
type II: true diverticulum from extrahepatic bile duct
type III: dilatation of extrahepatic bile duct within the duodenal wall (choledochocoele)
type IV: next most common
IVa: cysts involving both intra and extrahepatic ducts
IVb: multiple dilatations/cysts of extrahepatic ducts only
type V: multiple dilatations/cysts of intrahepatic ducts only (Caroli disease)
Recently a type VI cyst as been identified as cystic dilatation involving cystic duct (only a
few case reports are available in literature). (4)
4. IMAGING
MODALITIES
USG CT MRCP
key to diagnosis is a dilated cystic
lesion which communicates with
the bile duct and is separate from
the gall bladder
• greater ability to demonstrate intrahepatic cysts
• conclusively demonstrates continuity with the
biliary tree
GB
CDC
MDCT
demonstratin
g intrahepatic
cysts
USG shows
CDC
separate
From GB
5. MATERIALS AND METHODS
Ultrasonography was done using convex( 2-5MHz) and linear (3-9MHz) probe in patients presenting with
a spectrum of symptoms like neonatal cholestasis, jaundice, pain abdomen and or palpable abdominal
mass.
Study was done in a total of 20 pediatric patients who were given a provisional diagnosis of choledochal
cyst on ultrasonography.
The patients were followed up for a variable period of time and USG findings were evaluated using
MRCP, MDCT and/or per operative and histopathology findings as and when applicable.
USG was done to make a diagnosis of choledochal cyst, determining the type of cyst as per Todani’s
classification and also evaluating complications.
DISCUSSION
Ultrasonography was found 100 % sensitive in making a diagnosis of choledochal cyst (confirmed per
operatively/MRCP/MDCT/histopathologically )
16 (80%) out of the 20 cases of choledochal cysts included in our study were found to be of type 1 , which
is also the most common type as per Todani et al. (3)
There were 3 cases of type IV a , and a single case of type V choledochal cyst.
The most common presentation was that of abdominal pain and jaundice. 6 of them were large enough to
present as palpable abdominal mass.
11 of the 20 cases underwent cyst excision and hepaticojejunostomy under GA for curative management
which is the recommended form of treatment . (5)
9 out of 20 had confirmation of USG diagnosis by either MRCP or MDCT abdomen
6. TYPE 1 : THE MOST COMMON TYPE
CASE 1: 11 yr female, with on off pain abdomen ,
USG shows mild dilatation of CBD measuring
11mm , s/o type 1A CDC, confirmed on MRCP.
CASE 2 : 4 mon male, with
antenatally detected large
abdominal cystic mass
lesion, USG, CT and
MRCP clearly demonstrate
the continuity of a large
cystic lesion with the biliary
tree. s/o type 1A CDC
CASE 3 : 5yr male, with pain abdomen , shows a
cystic anechoic lesion on USG, separate from GB,
with definite continuity with biliary tree, further
confirmed as type 1A CDC on MRCP
7. TYPE IV A : SECOND MOST COMMON TYPE
CASE 4 : 7 mon male, with abdominal distension and jaundice since birth. USG (fig 1,2&3) shows a large
extra hepatic anechoic cystic lesion showing continuity with the biliary tree along with multiple
intrahepatic cystic dilatations involving the intrahepatic biliary tree, showing no flow on colour Doppler.
Findings s/o type IVa choledochal cyst confirmed on MDCT(fig 4&5) and intraoperatively.
FIG 1 FIG 2
FIG 4 FIG 5
FIG 3
8. TYPE IV A
FIG 1 FIG 2 FIG 3 FIG 4
FIG 5 FIG 6
CASE 5 : 2yr female, with abdominal mass and jaundice,
USG (fig 1 & 2) shows a large anechoic cystic lesion seen in
continuity with the biliary tree along with multiple
intrahepatic cystic dilatations. MDCT abdomen in axial,
sagittal and coronal planes confirm the findings of USG,
clearly demonstrating a large cystic lesion separate from
GB( yellow arrow), replacing the normal extrahepatic
biliary tree, along with multiple cystic dilatations of the
intrahepatic biliary tree s/o TYPE 4A choledochal cyst.(fig
3,4 ,5&6 )
9. TYPE 5 CAROLI’S WITH
INFANTILE POLYCYSTIC KIDNEY
DISEASE
CASE 6 : 2.5 Y old, with abdominal pain , jaundice and failure to thrive since birth. USG
abdomen reveals multiple intrahepatic cystic lesions showing communication with biliary tree
and showing the classical central dot sign ( yellow arrows) on CT s/o Caroli’s disease .
Bilateral kidneys are enlarged, echogenic and shows multiple non communicating cysts s/o
infantile variety of polycystic kidney disease .
COMPLICATIONS OF
CHOLEDOCHAL CYSTS
CASE 8
CASE 7
CASE 7 shows a fusiform dilatation of CBD
with multiple echogenic foci within s/o calculi
Case 8 in another patient, shows echogenic
sludge within the lumen of a choledochal cyst.
10. CONCLUSION
Ultrasonography is an excellent modality for initial evaluation of pediatric patients with
choledochal cysts. It not only helps establish a provisional diagnosis of choledochal cyst, but
also helps us decide the subtype of cyst, presence of complications and other syndromic
associations. MR is mostly used for confirmation of diagnosis in complex cases and also for
pre-operative evaluation for ductal anatomy.
REFERENCES :
1: Kim OH, Chung HJ, Choi BG. Imaging of the choledochal cyst. Radiographics. 1995;15 (1): 69-88.
2: Babbitt DP. Congenital choledochal cyst: New etiologic concept based on anomalous relationships of common bile duct and
pancreatic bulb. Ann Radiol 1969; 12:231-40
3: Todani T, Watanabe Y, Narusue M, et al. Congenital bile duct cysts. Am J Surg 1977; 134:263-69
4: Bode WE, Aust JB. Isolated cystic dilatation of the cystic duct. Am J Surg. 1983;145:828–9.
5: Liu CL, Fan ST, Lo CM, Lam CM, Poon RT, Wang J. Choledochal cysts in adults. Arch Surg.2002;137:465–468
