Acute type A dissection, is on of the highest mortality cases in cardiovascular surgery. It doubled it incident with concomitant complication such as malperfusion or pericardial tamponade. In this presentation, the patient have both coronary malperfusion and pericardial tamponade
bentall, and 'old' procedures that still valid until present. Bail out for valve sparring & the patology of indonesian most present were best in this procedures
bentall, and 'old' procedures that still valid until present. Bail out for valve sparring & the patology of indonesian most present were best in this procedures
Complication on avf play significant number of hospitalization & morbidity. Despite fistula first campaign are still beneficial for most patient, gathering knowlege to prevent complication are important.
my aortic surgery presentation in Solo as an introduction for general practitioner and cardiology resident
Cover the basic diagram of surgical procedures of aorta.
definitely not for surgeon.
Complication on avf play significant number of hospitalization & morbidity. Despite fistula first campaign are still beneficial for most patient, gathering knowlege to prevent complication are important.
my aortic surgery presentation in Solo as an introduction for general practitioner and cardiology resident
Cover the basic diagram of surgical procedures of aorta.
definitely not for surgeon.
Cardiac arrest an overview of defibrillation vs cardioversionUmair Sheikh
Describes the difference between cardioversion and defibrillation.
Management of Cardiac arrest. Approach to a patient with hemodynamic compromise. How to operate a defibrillator device.
Brief about ACLS and BLS.
Post cardiac arrest care.
Dr Priya Nair is a senior intensive care specialist at Sydney's St Vincent's Hospital and an expert in managing patients with cardiac assist devices. In this talk she takes us through the key issues encountered when on managing patients with left ventricular assist devices. As LVADs are becoming more widespread, this inside know-how is invaluable to all of us. They physiology and technology involved with these devices is pretty amazing.
This is the second of two talks at the recent Sydney Intensive Network Meeting. The first talk was by Cardiologist Chris Hayward here.
simple word for future doctor. writing & drawing in pure white paper is always fun & feels like nothing to loose even if we knew that it will last almost forever
in endo era. aortic is one of the industrial driven medical proedure & one of the most expensive. Its morbidity are quoet acceptable, but......... surgeon if the best deal behind this awsome techno
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
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
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
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
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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!
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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.
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.
Role of Mukta Pishti in the Management of Hyperthyroidism
Dicky stnf a_complic
1. Fatal Complication of
Type A Aortic Dissection
Pericardial Tamponade and Coronary Malperfusion
Case Report
Dicky Aligheri, MD
National Cardiovascular Centre Harapan Kita,
Jakarta Indonesia 2014
3. History
• 46 yo female
• History of uncontrole hypertension
and active smoking (>10 /d)
• Abrupt onset (4 hours before admission)
– Chest pain
– Unstable hemodynamic
• BP 88/35, HR 125 t/min, CVP 22
• ECG : st elevation in lead II, III, aVF
• Lab : elevated D dimer level
• Echo : RV hypokinetic, RA RV compression, Severe AI,
pericardial effusions
15. Acute type A aortic dissection
• The incidence of aortic dissection 5 to 30 cases per million
people per year,
• requires immediate surgical intervention
• can be complicated by pericardial tamponade and malperfusion
(coronary, cerebral, renal, limb)
• the overall mortality in type A dissection was almost 3 times higher
in the group with malperfusion (45- 66%) than with no
malperfusion (15 – 22%%).
Ann Cardiothorac Surg 2013;2(2):205-211
J Emerg Trauma Shock. 2011 Apr-Jun; 4(2): 273–278
Circulation. 2004;90:2375-2378
Discussions
20. Pericardial Tamponade
• cardiac tamponade complicating acute aortic dissection is
associated with a high early mortality
• Performing pericardiocentesis may instead precipitate
hemodynamic collapse and death
• it should be considered a surgical emergency, and
pericardiocentesis should be avoided while every effort is
be made to proceed as urgently as possible to the
operating room
JAMA. 2000 Feb. 16;283(7):897–903. PMID 10685714
.Thorac. Cardiovasc. Surg. 2001 Mar.;121(3):552–560. PMID 11241091
Am. J. Cardiol. 2009 Apr. 1;103(7):1029–1031. PMID 19327436
Circulation. 2012 Sep 11;126(11 Suppl 1):S97-S101.
Postgrad Med J. 2012;88(1046):729-730.
21. Coronary Malperfusions
Neri E, Toscano T, Papalia U, Frati G, Massetti M, Capannini G, et al.
Proximal aortic dissection with coronary malperfusion: presentation,
management, and outcome. J. Thorac. Cardiovasc. Surg. 2001
Mar.;121(3):552–560
23. CONCLUSION
•Acute type A aortic dissection complicated with pericardial
tamponade and coronary malperfusion is a devastating event. It is
associated with a high early mortality and extremely high mortality
rate over the first 24 to 48 hours
•In tamponade, pericardiocentesis should be avoided
•In patients with coronary malperfusion, most patients received CABG
and ascending / root aortic replacement because of its simplicity
Tearing chest painPresentation of shock… CV line for resusitaion
Realize RV prob.. Echo..ct… OR
Dissect from root to inominate, to prox coeliac
Multiple entru tear at the arch
RCA osteal obstruction… surgical consult was made
Pericardial effusion
Alasan tiap segmen.. Fasilitasi tevar.. Bentall spy cepat
Bicaval u retro kr pengalaman, Masalah di retro tdk efektif even direct..
planning
Alasan tiap segmen.. Fasilitasi tevar.. Bentall spy cepat
Bicaval u retro kr pengalaman, Masalah di retro tdk efektif even direct..
Cpg failre.. Buka aoscenden.. No flow di RCA n minimal di LCA
Retro jadi osteal
Cpg jd svg lad
Masalah di ascp krn ketendang..
Proble intra op.. Koagulo sls dg lokal hemostatik, glue dsb, ffp, fresh blood, lots pericardial reinforced
Cpb weaning, ga bisa.. RV hmpir ga gerak.. Flow meter LAD n RCA 1.7 n 1.6
Extra graft Lcx, flow 2
Problem prox anat ke graft
Bisa ke icu dg 2 digit. 80/55 100x/min on beat cvp 12
Ecmo was all accu,.. No optio
Pmi.. Ecmo n CVVH… expensive
Renc graft revision… develop u responsive VF.. Died 18 hrs post op after 1 hurs ressusittion
.
The severity and consequences of adissection are related to the physical characteristics and anatomic location of the tear as well asthe underlying patient physiology
and is associated with a significant surgical morbidity and mortality (fatal)
Indo 200mill so.. Mor than 2000 cases
Experience all. Complic.. But tjis pts is the worst
Type2… yg plg sering.. Strategy umum.. Komplikasi malperfusi.. Retro type A
Standart deep… and then moderate
But for complicated.. Deeppp w scp.. No nirs so blindly use the scp… rscp only for “bad” arch
Act… pts ini 340 after double doses.. Confident ??
One of most co cod
Even percin efecyive for other. But……
Pea.. death
anatomic reconstruction of the coronary artery ostia, avoidance of complete graft-dependent perfusion of large areas of the myocardium, and preservation of antegrade flow in the coronary trees, thus avoiding the risk of competitive flow and coronary redissection.[27,54] However, mobilization and repair of acutely dissected coronary arteries is potentially dangerous and problematic.