Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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.
2. Definition
Cholecystitis is defined as inflammation of the
gallbladder that occurs most commonly because of
an obstruction of the cystic duct from
cholelithiasis. Ninety percent of cases involve
stones in the cystic duct (ie, calculous cholecystitis),
with the other 10% of cases representing
acalculous cholecystitis.
http://mbbshelp.com
3. Etiology
Bacterial infection
From:upper airway infection, urogenital inf, infect
dis of intestine, viral hepatitis
Transmission of inf to GB:
Hematogenous on the liver arteries
Ascending from intestine due to Oddi's sphincter
failure, gastric hypo secretion
Lymphogenous
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5. Predisposing factors
1. Cholestasis due to
bile-excreting ductus dyskinesis
Obesity, pregnancy due to ↑intra-abdominal
pressure and bile-excreting difficulty
Stress due to bile-excreting ductus dyskinesis
dietary habits disturbance- rare eating promote
cholestasis, fatty and fried food provoke Oddi's
sphincter spasm
If little use cellulose, appears bed dilution of bile
Hypokinesis
Congenital GB anomalies
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6. Due to inflam GITD – reflexes way
Dysbacteriosis
Dysbolism
Promote phys-chem behaviour of bile
Heredidy problem
Bile is bactericidal.
Inflamation developed if
bacteria+discholia+↓immunity+ GB wall pr
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7. Patogenetic factors:
Neurodistrophic changes of GB wall
Neuroendocrine abnormalities
↑Symp s-m and hormone (cholecyctokinine, pancreasimine,
hastrine, glucagon, insulin, secretin): provoke weakening of
GB and ↑tone of Oddi's sphincter, after accumulate GB
Parasymp s-m and hormone (neurotensine, enkefaline,
thyreoid h, anticholecyctokinin): spastic contraction of GB,
weakening Oddi's sphincter and bile evacuated
Cholestasis and Discholia
GB wall pr
Allergy
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9. Clinical current
Rare recidiving
Rarely recidiving
Permanent
Atypical
Phase of D
Exacerbation or decompensation
subcompensation
compensation
Severity
Light
Moderate
severe
Complication
Reactivity
pancreatitis
Reactivity
hepatitis
Pericholecyctitis
Duodenitis
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10. CP
Pain
pain begins in the epigastric region and then localizes
to the right upper quadrant (RUQ).
Although the pain may initially be described as
colicky
radiating to the tip of the right scapula, clavicle,
shoulder.
↑pain after plentiful eating, fatty, spice, fried, hot,
cold food, aerated water, alcohol, stress, phys activity
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11. Dyspepsia
(↓appet, vomit, belching, to feel bitterness,
meteorism, diarrhea)
Itchy skin or biliary pruritus due to
irritation of skin’s nerve endings by bile
acid
Fever
Psychological disturbance (depression,
fatigue, emotional lability, irritability,
fatiguability)
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12. Physical
Jaundice may be noted in approximately 15% of
patients.
Kera s-m: local soreness in the GB projection
Murphy sign, which is specific but not sensitive for
cholecystitis, is described as tenderness and an
inspiratory pause elicited during palpation of the
RUQ.
Physical examination may reveal fever,
tachycardia, and tenderness in the RUQ or
epigastric region, often with guarding or rebound.
A palpable gallbladder or fullness of the RUQ is
present in 30-40% of cases.
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14. Phys s-m of GB
There are 3 group s-ms
1. Segmentary reflexity s-s showed
exacerbation of diseases
2. Reflexity points showed expansion of
irritation beyond segmentary innervation
3. S-s of irritation GB
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15. Segmentary reflexity s-s showed exacerbation of diseases
assesment when pressing
Makkensi’s soreness point - at the
intersection of lateral border of abdomen
straight muscle and right rib arch
Boas’s soreness point level of Th X-XI on
paravertebral line
Zaharina Geda’s zone – zones of soreness
and hypersensitivity from upper 2 point
expansion
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16. Reflexity points showed expansion of irritation beyond
segmentary innervation showed recidiving processes
Appears soreness in palpation this points
Bergman’s point- intraupper border of orbita
Ionash’s Occipital point
Mussi-georgievsk’s point-between right sterncl
mast branches
Chariton’s intrascapular p – centre of horizontal
line over the centreof right scapula
Lapinsk’s femoral p – centre of internal border
right femor
Right poplitea p
Plantar p – back of right foot
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17. S-s of irritation GB
Kera’s s-m: local soreness when deep palpation of GB
Murphy’s sign - tenderness and an inspiratory pause
elicited during palpation
Gausman’s s-m- appears soreness when blow on right
hypochondrium in inspiration
Ortner’s s-m- soreness when tapotement on the right rib
arch
Aisenberg’s s-m – in standing position pts to rise on one's
toes, after that get down appears soreness
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18. Investigation
Normal Ultrasound parameters of GB:
pear-shaped, ovoid or cilindrical configuration
N size- L=6-9.5cm x 3-3.5cm
Wall – homogeneous, thin line, with moderate, ↑echogenicity
Wall thickness = 2mm
Contour is uniform, accurate
Before U
12h no eating
Before 1-2h no eat black bred, pea, bean, milk, sauerkraut, grapes
Enzyme drugs 1-2 x 3 pd, activated carbon before sleep
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19. Ultrasound parameters of CH CHol:
Thickening of GB wall
Consolidation of GB wall
Deformation and uneven contour of GB
No mowing GB in breathing
No homogenous contents of GB
Soreness when pressing with by US sensor
↑or ↓ size of GB
↓stretchability of GB
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21. Severity
Light – 1-2t per year execerb, 2-3 weeks,
no intensive pain, liver function normally,
no complic
Moderate - 5-6t per year execerb, more 2-
3 weeks, intensive pain, liver function
abnormalities, complic
Severe - 1-2t per mounth execerb,
prolonged, intensive pain, liver function
abnormalities, complic
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23. Etiology
Inflammatory processes of HB system
Metabolic changes of cholesterol and bilirubine (DM,
HLipidemia, gout, obesity)
Genetic
Malnutrition – more fatty food, purified carbohydrates
(promote acid reaction of bile,that ↓dilution of cholesterol)
A hypovitaminosis
Female sex
Certain ethnic groups
Drugs (especially hormonal therapy in women)
Pregnancy
Increasing age
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25. Treatment
Diet
Acute exacerb: 1-2 day warm drinking
(tea, juice etc) 3-6 glasses per day
cracker
After , grinded foot (soup, semolina,
boiled rice, porridge, kissel,
After curd, boiled fish, milled meat
5-6 times per day
;
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26. Recommended fasting days
Curd-kefir days 900gr kefir, 300gr curds
Rice- stewed fruit – 1/5l compote, boiled
rice (50gr rice)
Watermelon or grapes – 2kg
Fruit 1.5-2 kg apple
No use meat broth, adipose, yolk, spicy,
fried, broiled foot
,
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27. Treatment
Arresting pain (platiphillin, papaverin,
NTG, analgin, baralgin, promedol, droperidol
i/v
Antibacter treatment: eritromycin,
oxacillin, rifampicine, ampicillin,
tetracyclin, furosolidon, wefalosporin,
aminoglicosids
Choleretics: chologon 0.2 1-2 tbx3,
Decholin 5-10 ml x 1 pd, allochol 1-2 tb x
3-4, festal 1-2 tb x 3-4,
Cholekinetiks: kcilit 50-100 ml 2-3pd,
corbit 50-100 ml
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29. Treatment
For acute cholecystitis, initial treatment includes bowel rest, intravenous
hydration, analgesia, and intravenous antibiotics. For mild cases of acute
cholecystitis, antibiotic therapy with a single broad-spectrum antibiotic is
adequate. Some options include the following:
The current Sanford guide recommendations include piperacillin/tazobactam
(Zosyn, 3.375 g IV q6h or 4.5 g IV q8h), ampicillin/sulbactam (Unasyn, 3 g IV
q6h), or meropenem (Merrem, 1 g IV q8h). In severe life-threatening cases, the
Sanford Guide recommends imipenem (500 mg IV q6h).
Alternative regimens include a third-generation cephalosporin plus Flagyl (1 g IV
loading dose followed by 500 mg IV q6h).
Bacteria that are commonly associated with cholecystitis include E coli and
Bacteroides fragilis and Klebsiella, Enterococcus, and Pseudomonas species.
Emesis can be treated with antiemetics and nasogastric suction.
Because of the rapid progression of acute acalculous cholecystitis to gangrene
and perforation, early recognition and intervention are required.
Supportive medical care should include restoration of hemodynamic stability and
antibiotic coverage for gram-negative enteric flora and anaerobes if biliary tract
infection is suspected.
Daily stimulation of gallbladder contraction with intravenous CCK has been
shown by some to effectively prevent the formation of gallbladder sludge in
patients receiving TPN.
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