This document provides information on common complications, errors, and misunderstandings related to the Mini-Gastric Bypass (MGB) procedure, as well as guidelines for prevention and treatment. It discusses topics like anemia, staple line complications, leaks and bleeding, protein-calorie malnutrition from excessive weight loss, and management of these issues. The document emphasizes that widespread misunderstanding of the MGB procedure often leads to complications and errors in patient management, highlighting the need for standardization and recognition of surgeons with expertise in MGB.
Sleeve vs Mini-Gastric Bypass
IN EVERY STUDY, by every measure, the Mini-Gastric Bypass is equal to or better than every other form of bariatric surgery
The Mini-Gastric Bypass: Best Treatment Type 2 Diabetes Mellitus
Dr K S Kular
Kular Medical Education & Research Society ,
Kular Group of Institutes ,
drkskular@gmail.com
www.kularhospital.com
Why Consider the MGB?
With the Band/Sleeve/RNY available
Why even consider the Mini-Gastric Bypass?
6 yr study 29,820 BCBS plan members.
"Laparoscopic RNY and Lap Band both Fail to reduce overall health care costs in the long term."
Impact of Bariatric Surgery on Health Care Costs of Obese Persons, A 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data Jonathan P. Weiner, et al. JAMA Surg. 2013;148(6)
Mini Gastric Bypass: initial Experience
British Obesity Metabolic Surgery Society
4 th Annual Scientific Meeting
Jan 23-25, 2013 Glasgow
SPIRE Hospital Southampton
Department of Bariatric Surgery
M Van den Bossche, I Bailey, J Kelly
J Byrne, R Sutherland*
The Mini-Gastric Bypass:Best Treatment Type 2 Diabetes MellitusDr. Robert Rutledge
The Mini-Gastric Bypass:Best Treatment Type 2 Diabetes Mellitus
Dr K S Kular
Kular Medical Education & Research Society ,
Kular Group of Institutes ,
drkskular@gmail.com
www.kularhospital.com
Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hos...Dr. Robert Rutledge
Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
Sleeve
MGB
Kular Hospital
Sleeve v MGB (Hint: MGB Better)
Weight Loss Raw Data, Weight Loss Excluding SG Revisions v Age Wt matched MGBs, Resolution of Co-Morbidities, Patient Satisfaction, Dyspepsia/Bile Reflux
Conclusions
Safe and Effective Treatment of Obesity & Diabetes:Failure of the Band, Sleeve & RNYvsSuccess of the Mini-Gastric Bypass
Medical News: Bypass Surgery for Diabetes w Nonmorbid Obesity? Marlene Busko: Jun 04, 2013
BUT: Not metioned in the abstract:
22 serious complications in 60 RNY patients (36%);
2 most serious complications Anastomotic leaks (3.3%)
1 patient suffered anoxic brain injury.
RNY pts more likely to have Complications
Sleeve vs Mini-Gastric Bypass
IN EVERY STUDY, by every measure, the Mini-Gastric Bypass is equal to or better than every other form of bariatric surgery
The Mini-Gastric Bypass: Best Treatment Type 2 Diabetes Mellitus
Dr K S Kular
Kular Medical Education & Research Society ,
Kular Group of Institutes ,
drkskular@gmail.com
www.kularhospital.com
Why Consider the MGB?
With the Band/Sleeve/RNY available
Why even consider the Mini-Gastric Bypass?
6 yr study 29,820 BCBS plan members.
"Laparoscopic RNY and Lap Band both Fail to reduce overall health care costs in the long term."
Impact of Bariatric Surgery on Health Care Costs of Obese Persons, A 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data Jonathan P. Weiner, et al. JAMA Surg. 2013;148(6)
Mini Gastric Bypass: initial Experience
British Obesity Metabolic Surgery Society
4 th Annual Scientific Meeting
Jan 23-25, 2013 Glasgow
SPIRE Hospital Southampton
Department of Bariatric Surgery
M Van den Bossche, I Bailey, J Kelly
J Byrne, R Sutherland*
The Mini-Gastric Bypass:Best Treatment Type 2 Diabetes MellitusDr. Robert Rutledge
The Mini-Gastric Bypass:Best Treatment Type 2 Diabetes Mellitus
Dr K S Kular
Kular Medical Education & Research Society ,
Kular Group of Institutes ,
drkskular@gmail.com
www.kularhospital.com
Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hos...Dr. Robert Rutledge
Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
Sleeve
MGB
Kular Hospital
Sleeve v MGB (Hint: MGB Better)
Weight Loss Raw Data, Weight Loss Excluding SG Revisions v Age Wt matched MGBs, Resolution of Co-Morbidities, Patient Satisfaction, Dyspepsia/Bile Reflux
Conclusions
Safe and Effective Treatment of Obesity & Diabetes:Failure of the Band, Sleeve & RNYvsSuccess of the Mini-Gastric Bypass
Medical News: Bypass Surgery for Diabetes w Nonmorbid Obesity? Marlene Busko: Jun 04, 2013
BUT: Not metioned in the abstract:
22 serious complications in 60 RNY patients (36%);
2 most serious complications Anastomotic leaks (3.3%)
1 patient suffered anoxic brain injury.
RNY pts more likely to have Complications
Understanding Weight Loss After Bariatric SurgeryUnderstanding the Bilio-Pancreatic Limb Length
Statistics, Random Distribution and Too Little or Too Much of a Good Thing
MGB is Great Look at the Data
MGB widespread persistent Confusion
Fear of Malnutrition
Need MGB Standardization Education Recognition of MGB Surgeons of Excellence
MGB Need for Standardization, Education & Recognition
DrR Rutledge MGB MRC Course Schedule Day One Introduction
1
9-9:50
Introduction
Welcome Goals
Welcome MGB Review Corporation Bronze Certification Course
Outline of Introduction
I. One Sentence Overview: Obesity & diabetes Growing Epidemic
II. Present forms of “Gold Standard” forms of Bariatric Surgery FAR from Perfect/adequate Solutions
III. Sleeve/RNY/Band/Distal Bypasses (BPD, SADI etc) All with Minor, Moderate, Serious & Deadly Complications
IV. MGB “Uniformly & Repeatedly, Around the World In Studies by “Experts”…
The MGB is Equal to or Better than Other Comparable forms of Bariatric Surgery”
V. But!
Despite numerous articles by MGB Experts showing Excellent Results
Growing Number of Articles of Non-Expert MGB Surgeons with Serious & Deadly Complications.
VI. Goals of the MGB Review Corporation
Rally MGB Experts (Collecting Expert MGB Surgeons to Leadership and Recognition)
Collaborate of Standardizing the MGB (Rutledge Technique)
Educate Interested/New MGB Surgeons (Bronze Certification) Course + Successful Completion of 300 question Exam (or Board of Governors Membership Approval)
Document Surgical Technique (Silver Certification) video Review of MGB Case Performance 5 + Cases
Document Excellence in Outcomes (Gold Certification) 20+ Consecutive Case Review with Contact Info and Permission
Recognition as a Leader to Teach MGB (Platinum/Diamond Certification)
VI. Goal Improved Patient Care and Recognition of MGB Surgeons of Excellence
MGB vs Sleeve, Meta-analysis
MGB BII Rx Diabetes
Sleeve/RNY/Band/Dbs (Distal Bypasses, BPD, SADI etc.)
Sleeve: Devastating Leak, Irreversible, => Failure, Weight Regain, GERD, Barrett’s & Esophageal Cancer
Popularity rise similar to the VBG and Lap Band
RNY: Complexity, Difficult to Revise, Failure, Bowel Obstruction, Late Severe Dangerous Hypoglycemia
Distal Bypasses; Malnutrition etc
Enhanced Recovery after Surgery its relevance - Evidence BasedDeep Goel
Enhanced recovery programs are evidence-based protocols designed to standardize medical care, improve outcomes, and lower health care costs. These protocols include evidence-based techniques to minimize surgical trauma and postoperative pain, reduce complications, improve outcomes, and decrease hospital length of stay, while expediting recovery following elective procedures.Protocols have been developed for colorectal surgery patients to reduce physiological stress and postoperative organ dysfunction through optimization of perioperative care and recovery
Surgical Management of Obesity درمان جراحی چاقی
انواع اعمال جراحی :
محدود کننده جذب :
گاسترینگ باندینگ قابل تنظیم لاپاراسکوپیک
گاسترکتومی آسینی
مختل کننده جذب مواد غذایی :
انحراف صفراوی پانکراسی
سوئیچ دئودنال
ترکیبی :
بای پس معده
گاستریک باندینگ قابل تنظیم لاپاراسکوپیکLAGB
قرار دادن یک نوار سیلیکونی بادشونده دور قسمت پروگزیمال معده که نوار به یک سیستم مخزنی که اجازه تنظیم سفتی نوار را فراهم می آورد متصل می شود. این سیستم مخزنی به وسیله یک پورت زیرجلدی قابل دسترس می شود.
دونوع نوار برای این روش استفاده می شود :
lap-bandگاستریک باندینگ قابل تنظیم
گاستریک باندینگ قابل تنظیم سوئدی
این عمل جراحی بیشتر به صورت سرپایی انجام می شود وچون دستگاه گوارش مورد تهاجم قرار نمی گیرد خطر نسبی این عمل کمتر از اعمال دیگر است.
بیمارانی که برای کاهش وزن ناشکیبا هستند ، بی تحرک هستند ، قادر به ورزش نیستند و انتظار دارند که بتوانند به عادات غذایی قبلی خود بدون تغییر ادامه دهند کاندید خوبی برای این عمل نیستند.
تنظیمات باند و جلسات گروه حمایتی پس از عمل برای نتایج خوب بسیار مهم هستند.تنظیمات باند مانند بخشی از جراحی مهم است.
توافق کلی این است که کاهش کمتر از دو پوند در هفته اندیکاسیون افزایش محدودیت باند با اضافه کردن مایع است.
نتایج:
به طور میانگین 5تا7 سال بعد از عمل بیماران به ترتیب 60% و 58% از وزن اضافی را کم کردند.
هایپرتانسیون در 55% بیماران طی یک سال برطرف شده
آپنه انسدادی به 2%کاهش داشته
آسم و افسردگی بهبود داشته
در بیش از 50% موارد بهبودی داشته GERD
عوارض:
- پرولاپس: قسمت تحتانی معده به سمت بالا هل داده شده و در لومن باند گیر می کند.نیازبه جراحی دوباره دارد.
- سرخورردن
- صدمه بافتی به خاطر فرسودگی باند
- عوارض پورت و لوله هاَ
شکست در کاهش وزن بیشتر از اعمال دیگر رخ می دهد.
Duodenal Switch surgery is a very useful bariatric surgery for patients suffering from obesity. Approximately, the patients of DS lose around 60 to 80% of their surplus body weight and they experience nominal weight regain. For the patients of BMI greater than 50 this very surgery is very effective.
Kular Sleeve vs Mini-Gastric Bypass
IN EVERY STUDY, by every measure, the Mini-Gastric Bypass is equal to or better than every other form of bariatric surgery
Colonoscopic localisation accuracy for colorectal resectionsDamian Ianno
The Australasian Students’ Surgical Conference (ASSC) is the leading surgical conference for medical students in Australia and New Zealand. ASSC is designed to coincide yearly with the RACS Annual Scientific Conference and was held this year in Perth, Western Australia from 1-3 May 2015.
Comparison of Revision in Roux-en-Y vs Mini-Gastric BypassDr. Robert Rutledge
Comparison of Revision in
Roux-en-Y vs
Mini-Gastric Bypass
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
Understanding Weight Loss After Bariatric SurgeryUnderstanding the Bilio-Pancreatic Limb Length
Statistics, Random Distribution and Too Little or Too Much of a Good Thing
MGB is Great Look at the Data
MGB widespread persistent Confusion
Fear of Malnutrition
Need MGB Standardization Education Recognition of MGB Surgeons of Excellence
MGB Need for Standardization, Education & Recognition
DrR Rutledge MGB MRC Course Schedule Day One Introduction
1
9-9:50
Introduction
Welcome Goals
Welcome MGB Review Corporation Bronze Certification Course
Outline of Introduction
I. One Sentence Overview: Obesity & diabetes Growing Epidemic
II. Present forms of “Gold Standard” forms of Bariatric Surgery FAR from Perfect/adequate Solutions
III. Sleeve/RNY/Band/Distal Bypasses (BPD, SADI etc) All with Minor, Moderate, Serious & Deadly Complications
IV. MGB “Uniformly & Repeatedly, Around the World In Studies by “Experts”…
The MGB is Equal to or Better than Other Comparable forms of Bariatric Surgery”
V. But!
Despite numerous articles by MGB Experts showing Excellent Results
Growing Number of Articles of Non-Expert MGB Surgeons with Serious & Deadly Complications.
VI. Goals of the MGB Review Corporation
Rally MGB Experts (Collecting Expert MGB Surgeons to Leadership and Recognition)
Collaborate of Standardizing the MGB (Rutledge Technique)
Educate Interested/New MGB Surgeons (Bronze Certification) Course + Successful Completion of 300 question Exam (or Board of Governors Membership Approval)
Document Surgical Technique (Silver Certification) video Review of MGB Case Performance 5 + Cases
Document Excellence in Outcomes (Gold Certification) 20+ Consecutive Case Review with Contact Info and Permission
Recognition as a Leader to Teach MGB (Platinum/Diamond Certification)
VI. Goal Improved Patient Care and Recognition of MGB Surgeons of Excellence
MGB vs Sleeve, Meta-analysis
MGB BII Rx Diabetes
Sleeve/RNY/Band/Dbs (Distal Bypasses, BPD, SADI etc.)
Sleeve: Devastating Leak, Irreversible, => Failure, Weight Regain, GERD, Barrett’s & Esophageal Cancer
Popularity rise similar to the VBG and Lap Band
RNY: Complexity, Difficult to Revise, Failure, Bowel Obstruction, Late Severe Dangerous Hypoglycemia
Distal Bypasses; Malnutrition etc
Enhanced Recovery after Surgery its relevance - Evidence BasedDeep Goel
Enhanced recovery programs are evidence-based protocols designed to standardize medical care, improve outcomes, and lower health care costs. These protocols include evidence-based techniques to minimize surgical trauma and postoperative pain, reduce complications, improve outcomes, and decrease hospital length of stay, while expediting recovery following elective procedures.Protocols have been developed for colorectal surgery patients to reduce physiological stress and postoperative organ dysfunction through optimization of perioperative care and recovery
Surgical Management of Obesity درمان جراحی چاقی
انواع اعمال جراحی :
محدود کننده جذب :
گاسترینگ باندینگ قابل تنظیم لاپاراسکوپیک
گاسترکتومی آسینی
مختل کننده جذب مواد غذایی :
انحراف صفراوی پانکراسی
سوئیچ دئودنال
ترکیبی :
بای پس معده
گاستریک باندینگ قابل تنظیم لاپاراسکوپیکLAGB
قرار دادن یک نوار سیلیکونی بادشونده دور قسمت پروگزیمال معده که نوار به یک سیستم مخزنی که اجازه تنظیم سفتی نوار را فراهم می آورد متصل می شود. این سیستم مخزنی به وسیله یک پورت زیرجلدی قابل دسترس می شود.
دونوع نوار برای این روش استفاده می شود :
lap-bandگاستریک باندینگ قابل تنظیم
گاستریک باندینگ قابل تنظیم سوئدی
این عمل جراحی بیشتر به صورت سرپایی انجام می شود وچون دستگاه گوارش مورد تهاجم قرار نمی گیرد خطر نسبی این عمل کمتر از اعمال دیگر است.
بیمارانی که برای کاهش وزن ناشکیبا هستند ، بی تحرک هستند ، قادر به ورزش نیستند و انتظار دارند که بتوانند به عادات غذایی قبلی خود بدون تغییر ادامه دهند کاندید خوبی برای این عمل نیستند.
تنظیمات باند و جلسات گروه حمایتی پس از عمل برای نتایج خوب بسیار مهم هستند.تنظیمات باند مانند بخشی از جراحی مهم است.
توافق کلی این است که کاهش کمتر از دو پوند در هفته اندیکاسیون افزایش محدودیت باند با اضافه کردن مایع است.
نتایج:
به طور میانگین 5تا7 سال بعد از عمل بیماران به ترتیب 60% و 58% از وزن اضافی را کم کردند.
هایپرتانسیون در 55% بیماران طی یک سال برطرف شده
آپنه انسدادی به 2%کاهش داشته
آسم و افسردگی بهبود داشته
در بیش از 50% موارد بهبودی داشته GERD
عوارض:
- پرولاپس: قسمت تحتانی معده به سمت بالا هل داده شده و در لومن باند گیر می کند.نیازبه جراحی دوباره دارد.
- سرخورردن
- صدمه بافتی به خاطر فرسودگی باند
- عوارض پورت و لوله هاَ
شکست در کاهش وزن بیشتر از اعمال دیگر رخ می دهد.
Duodenal Switch surgery is a very useful bariatric surgery for patients suffering from obesity. Approximately, the patients of DS lose around 60 to 80% of their surplus body weight and they experience nominal weight regain. For the patients of BMI greater than 50 this very surgery is very effective.
Kular Sleeve vs Mini-Gastric Bypass
IN EVERY STUDY, by every measure, the Mini-Gastric Bypass is equal to or better than every other form of bariatric surgery
Colonoscopic localisation accuracy for colorectal resectionsDamian Ianno
The Australasian Students’ Surgical Conference (ASSC) is the leading surgical conference for medical students in Australia and New Zealand. ASSC is designed to coincide yearly with the RACS Annual Scientific Conference and was held this year in Perth, Western Australia from 1-3 May 2015.
Comparison of Revision in Roux-en-Y vs Mini-Gastric BypassDr. Robert Rutledge
Comparison of Revision in
Roux-en-Y vs
Mini-Gastric Bypass
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
Dr Pravin John and Dr John Thanakumar, Anurag Hospital, Coimbatore present the differences between metabolic and obesity surgery - dept of advanced laparoscopy and obesity
Metabolic effects of bariatric surgery in patients with moderate obesity and ...Apollo Hospitals
Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes: Analysis of a randomized control trial comparing surgery with intensive medical treatment
The Mini-Gastric BypassDr Rutledge, DrR@CLOS.netFour Stories for Four Radical Ideas
20 minutes, 4 topics
5 minutes each
1. (Mis)Understanding the MGB Mechanism of action
2. MGB Paradox (Good MGB/Bad MGB)
3. MGB: BP Limb Length
4. MGB-OT to the new MGB2i
The Mystery of Bile or No Bile:“Elementary My Dear Watson!”
Why the two opposite studies of the MGB
1. Minimal Bile Reflux
2. Common Bile Reflux
Answer: 1. Skill and knowledge of the Surgeons & 2. Propper care and education of post op patients
Conclusion: Don't Do the MGB! If You Don't Know What You are Doing
Rx Lifestyle & Diet Plan
Simple Diet & Lifestyle Changes: Rx gut microbiome: Plain Yogurt / Curd / Fermented Dairy:1-2 tsps 3-6 x / Day.
Stop smoking, NSAIDs, Iron, “Supplements”, Vitamins & Medications
Before Meals, Stay upright after eating, Small meals, Limit fatty foods,
Avoid problem (junk) foods: soda, candy, fried foods, caffeinated and carbonated drinks, chocolate, citrus juices, vinegar dressings & mint, etc.
Limit or avoid alcohol, Eat slowly, small amounts, chew thoroughly and rest between bites,
Keep head up for 30-90 minutes post meals, relax for 30-90 minutes after meals.
The Billroth II is a good safe operation
Routinely used daily by General, Trauma and Cancer Surgeons Around the world
Studies show surgeons who are more fearful of Billroth II and cancer are the least knowledgeable about the scientific data on the Billroth II and Gastric Cancer
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
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
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.
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.
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.
STATEMENT OF NEED
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
2. Final Lecture:
Everything About the MGB
Common Errors & Misunderstandings in the MGB
Dx/Rx MGB Excess weight loss,
Malnutrition Prevention,
Management Protocol,
Revision & Techniques & Understanding
Use & Value of the Mini-Gastroplasty
7. UNIQUE POWER of MGB;
Tailor to Patient and Surgeon's Desires
UNDERSTANDING BP Limb Length Optional Decision of Surgeon
and Patient
Longer BP Limb => Greater Weight Loss
Risk of Excess Weight Loss 1%
Shorter BP Limb => Less Weight Loss
Risk of Excess Weight Loss 0.1%
8.
9.
10.
11.
12.
13. Start Pouch Below the Crow's Foot (Long Pouch)
Avoid “Bird's Beak” Deformity
Loose Pouch (Non Obstructive)
Avoid the EG junction
No Twist in the Pouch
Never dissect the hiatus for Hiatal Hernia or GERD
14. MGB Has Great Power!
(Conservative BP Limb length)
Length of the gut is constantly changing
% Bypass / Common Channel
NOT Better than Standard 150-200cm
Care in performance of GJ
WIDE GJ 3-5 cm (Not a RNY GJ)
Avoid Lateral Pouch Staple Line
16. The Mini-Gastric Bypass:
Complications
Risk, Identification & Management
“Mini-gastric bypass is a simpler, safer, and more
effective bariatric procedure than laparoscopic sleeve
gastrectomy“
Medicine (Baltimore). 2017 Dec; Comparison of safety and effectiveness between laparoscopic mini-
gastric bypass and laparoscopic sleeve gastrectomy:
A meta-analysis and systematic review.
Wang FG, Yu ZP, Yan WM, Yan M, Song MM
17. MGB Better than Sleeve
A meta-analysis and systematic review
“Mini-gastric bypass is a simpler, safer, and more effective bariatric procedure
than laparoscopic sleeve gastrectomy“
Medicine (Baltimore). 2017 Dec; Comparison of safety and effectiveness between
laparoscopic mini-gastric bypass and laparoscopic sleeve gastrectomy:
A meta-analysis and systematic review.
Wang FG, Yu ZP, Yan WM, Yan M, Song MM
18. MGB vs sleeve gastrectomy for type 2 diabetes:
Prospective randomized controlled trial.
Remission of T2DM was achieved by
93% MGB vs. 47% in sleeve gastrectomy group
(P = .02).
MGB lost more weight, achieved a lower waist circumference, and had lower glucose,
HbA(1c), and blood lipid levels than the sleeve gastrectomy group.
No serious complications occurred in either group.
19. MGB vs Sleeve
A meta-analysis and systematic review
“Patients receiving mini-gastric bypass had a lot of advantageous indexes than patients
receiving sleeve gastrectomy,
such as higher 1-year EWL% (excess weight loss),
higher 5-year EWL%, higher T2DM remission rate, higher hypertension remission rate,
higher obstructive sleep apnea (OSA) remission rate,
Lower leakage rate,
Lower overall late complications rate,
Lower gastroesophageal reflux disease (GERD) rate,
Shorter hospital stay and
Lower revision rate.”
Medicine (Baltimore). 2017 Dec; Comparison of safety and effectiveness between laparoscopic mini-gastric bypass and laparoscopic sleeve
gastrectomy: A meta-analysis and systematic review. Wang FG, Yu ZP, Yan WM, Yan M, Song MM
20. 15-year experience of (mini-) gastric bypass: comparison
with other bariatric procedures.
WJ Lee; Surg Endosc. 2018
The 30-day post-operative major complication occurred in
1.7% of MGB, 2.0% RNY & 1.4% Sleeve
MGB had a higher weight loss
LSG had a lower remission rates comparing to MGB and LRYGB.
15 yr Revision rate MGB 4%: Lower than 5% RnY & 5.2% in Sleeve
CONCLUSION:
MGB is an effective procedure for treating morbid obesity and metabolic
disorders, which results in sustained weight loss and a high resolution of
comorbidities.
21. Rutledge Outcomes and Complications After Mini-Gastric
Bypass
6,185 consecutive patients
85% females with a mean age of 39 years
The mean operating time was 42 minutes
Median Hospital Stay 1 day
22. Mini-Gastric Bypass outperforms RNY
as measured by Length of Stay
A shorter Length of Stay (LOS) usually is associated with a better outcome.
Length of Stay is often an indicator of more efficient and effective care.
Shorter LOS means that the patient is able to return home earlier, providing the
opportunity to recuperate in a familiar surrounding free from potential
complications that result from the hospital environment.
23. Comparison the LOS in MGB vs RNY in
Three Large National Databases
Results: Analysis of LOS for RNY was recently published. (Wolfe et al); Wolfe reported on review of LOS analyses:
1. Nationwide Inpatient Sample (NIS), an AHRQ data source on 7 million RNY's;
2. Bariatric Outcomes Longitudinal Database (BOLD) data over 250,000 RNY's,
3. University Health System Consortium (UHC), 113 academic medical centers and 254 affiliated hospitals (90% of the
nation's non-profit academic medical centers)
24. MGB v RNY
Nationwide Inpatient Sample (NIS)
median LOS 2.7 d, less than 1% had 1 day LOS
Bariatric Outcomes Longitudinal Database (BOLD)
mean LOS 2.4 d, < 1% had 1 day LOS;
University Health Consortium database only 8.3% in leading US hospitals had a LOS of 1 d or less.
“Given these data only a small minority of RNY patients could safely meet 1 day LOS goal.”
MGB: **median LOS was 1 day**, mean of 1.2 days.
25. Analysis of Complications After Mini-Gastric Bypass
31.6% of patients reported a complication:
Minor in 22.7%,
Moderate in 3.7%,
Severe -> Hospitalization in 5.2%
26. MGB: Most Frequent Complications
5%:
Dyspepsia/Ulcer/Gastritis (? Not Bile ?)
Anemia
2%:
Gas-Cramps,
Nausea/Vomiting,
27. Less Frequent MGB Complications
1%:
Diarrhea,
Leak,
Dehydration,
Regained Weight,
Hernia,
Minor Bleeding
Less Than 1%
Renal Stones, Gall Bladder Removal, Stricture,
Minor Eating-Complaints, Malnutrition, Re-Exploration,
Poor Wt Loss, Hair Loss,
Low Ca., Pneumonia-Minor, Perforated Ulcer, Hypoglycemia,
Thiamine Deficiency, Potassium Deficiency, Revision, Gout.
28. Management of MGB Complications:
How to &
How NOT To
Excessive Weight Loss
29. Revision Of Mini-Gastric Bypass For Excess Weight Loss
(Rutledge)
Excessive wt. loss and malnutrition revision in 55 patients (0.9%)
Revision Operative time 47 min
No mortality, major morbidity was 7%, mean length of stay 3 days and the
median was 2 days
RNY Revision report Patel, et al "difficult, dangerous and potentially deadly"
Revision of the MGB for excess weight loss is
technically simple, low risk procedure that takes just under an hour
30. Surg Obes Relat Dis. 2017
Roux-en-Y gastric bypass for the treatment of severe complications after
omega-loop gastric bypass
OLGB conversion to Roux-en-Y gastric bypass (RYGB) to treat complications.
Seventeen patients underwent OLGB conversion to RYGB.
Before conversion, 10 patients (58.8%) received nutritional support for
undernutrition
Average weight 52 kg, BMI 18 kg/m², %EWL 149%
41% major adverse events <90 d
Commentary: No, No, No! Do Not do a Weight Loss Surgery (RNY) for
Excessive Weight Loss.
31. Rx Excessive Weight Loss Post MGB
Experienced MGB Surgeons vs Experiened NON-MGB Surgeons
Experienced MGB Surgeon
Immediate Revision
=> Major Morbidity 7% <=
Experienced NON-MGB Surgeons
(More Recent Study)
TPN + RNY
=> Major Morbidity 41% <=
37. Anemia
Confusion and Mismanagement
Often see aggesive encouragement of oral iron
supplements (can cause dyspepsia d constipation)
with limited effectiveness
Fall back to IV iron use
Ignore the primary problem
38. Anemia
Confusion and Mismanagement
The primary problem
Anemia almost never occurs in Men
The Primary Cause is:
Menstrual Blood Loss
Primary Rx => Decrease Menstrual Blood Loss
39. Complications of staple line and anastomoses following
laparoscopic bariatric surgery
Gianfranco Silecchia and Angelo Iossa, Ann Gastroenterol. 2018 Jan-Feb; 31(1): 56–64
40. Many Other Examples of Failed Understanding Leading to
Errors in Mangement and Patient Harm
Time is limited
1 Recent Tragic Example
2 years ago Kular, Rutledge and Deitel wrote a warning letter to Editor
a surgical group perfoming an “Omega Loop”
Quoting my paper as the technque being used (prager)
41. Many Other Examples of Failed Understanding Leading to
Errors in Mangement and Patient Harm
We warned that the very high %Excess Weight Loss of their cases (Misjudging BP Limb) would lead to
dangerous and deadly consequences
Jan 2018 they reported on 10 patients Median %excess weight loss at that time was 110.6%
Treatment: (?) In eight patients, lengthening of the alimentary/common limb
In one patient, liver transplantation was required, one patient DEATH due to liver failure
42. Understanding the Obvious
• First: If you do not understand an operation (MGB)
• Do Not Use the Operation
• In Short This Presentation in Summary:
• Widespread and Persistent Misunderstanding of MGB
• Often Leading to Complications and Even Death
• Needed: Standardization of MGB and Recognition of
Surgeons Knowledgeable and Skilled in its use
43. Confusion By Surgeons Who Do Not
Understand the MGB
Some Examples of Confusion
The Pouch is Too Big & Pts Will Not Loose Weight
Short Gastric Pouch (MGB = OldMason Loop)
Dissection EG Junction and crural Repair
MGB with a “Ring”
Irrational Fear of Bile Reflux
Confused About Risk Gastric Cancer
Fear of Malnutrition
Management of MGB Complications
And More...
44. Needed: Standardization of MGB and Recognition of Surgeons
Knowledgeable and Skilled in its use
Standardize, Educate, Recognize
The Best in MGB
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MGBReviewCorp.com