As presented at RMSGNA 2019: Of course, it's not about just avoiding nuts and seeds. However, do you know how many attacks you can endure before suggesting a resection? How to manage young or immunosuppressed patients with diverticulitis? How Eastern (asian)diverticulitis differs? The role of mesalamine in treatment? It's time to re-explore a disease that you thought you knew!
Celiac Disease: Beyond Bowes, Bone, & Blood Rev 2019Patricia Raymond
Celiac disease can cause iron deficiency anemia, osteoporosis, and malabsorption…but is that all? Nope. There are a huge number of other disease associations with celiac disease beyond just bowels, bone, and blood. Join us for this classic presentation of celiac comorbidities that may alert you to the presence of this woefully under-diagnosed condition.
Celiac disease. One in 132 Americans has it. We know about the malabsorption, the anemia, the osteoporosis associated with celiac disease. But what of associations with neurological disease, reproductive health, and other organ systems? What DON'T you know about this common condition?
Celiac Disease: Beyond Bowes, Bone, & Blood Rev 2019Patricia Raymond
Celiac disease can cause iron deficiency anemia, osteoporosis, and malabsorption…but is that all? Nope. There are a huge number of other disease associations with celiac disease beyond just bowels, bone, and blood. Join us for this classic presentation of celiac comorbidities that may alert you to the presence of this woefully under-diagnosed condition.
Celiac disease. One in 132 Americans has it. We know about the malabsorption, the anemia, the osteoporosis associated with celiac disease. But what of associations with neurological disease, reproductive health, and other organ systems? What DON'T you know about this common condition?
Slides From Hot Topics in NASH:New Strategies for the Diagnosis of NASH.2019hivlifeinfo
Slides From Hot Topics in NASH: New Strategies for the Diagnosis of NASH
xpert faculty present key data on current and emerging NASH treatment options for your patients.
Rita Basu, MD
Wing-Kin Syn, MBChB, PhD, FACP, FRCP
Format: Microsoft PowerPoint (.ppt)
File Size: 3.84 MB
Released: February 11, 2019
Management strategies in inflammatory bowel disease. https://youtu.be/ZVtMSTH...Yasser Abdel-Halim
https://youtu.be/ZVtMSTHb-JM
Modern strategies used in IBD (inflammatory bowel disease), (Crohn's disease & ulcerative colitis) with the most recent data from Network Meta-Analysis & AGA guidelines. We have one goal. Which is to block the structural bowel damage progression before it becomes irreversible, with the least possible side effects. & We have three clinical objectives, Early Remission, Maintaining Remission, De-escalation when Longstanding Remission. & To achieve objectives, we have four strategies. Early effective therapy for high-risk patient strategy, Treat to Target strategy, Tight Control strategy & Exit Strategy.
Primary sclerosing cholangitis (PSC) is a chronic, idiopathic, cholestatic liver disease characterized histologically by peribiliary inflammation and fibrosis.
It can lead to end stage cirrhosis and is a recognized risk factor for hepatobiliary cancers
Diverticulitis: Popular Misconceptions and New ManagementPatricia Raymond
Of course, it's not about just avoiding nuts and seeds. However, do you know how many attacks you can endure before suggesting a resection? How to manage young or immunosuppressed patients with diverticulitis? How Eastern (asian)diverticulitis differs? The role of mesalamine in treatment? It's time to re-explore a disease that you thought you knew!
Slides From Hot Topics in NASH:New Strategies for the Diagnosis of NASH.2019hivlifeinfo
Slides From Hot Topics in NASH: New Strategies for the Diagnosis of NASH
xpert faculty present key data on current and emerging NASH treatment options for your patients.
Rita Basu, MD
Wing-Kin Syn, MBChB, PhD, FACP, FRCP
Format: Microsoft PowerPoint (.ppt)
File Size: 3.84 MB
Released: February 11, 2019
Management strategies in inflammatory bowel disease. https://youtu.be/ZVtMSTH...Yasser Abdel-Halim
https://youtu.be/ZVtMSTHb-JM
Modern strategies used in IBD (inflammatory bowel disease), (Crohn's disease & ulcerative colitis) with the most recent data from Network Meta-Analysis & AGA guidelines. We have one goal. Which is to block the structural bowel damage progression before it becomes irreversible, with the least possible side effects. & We have three clinical objectives, Early Remission, Maintaining Remission, De-escalation when Longstanding Remission. & To achieve objectives, we have four strategies. Early effective therapy for high-risk patient strategy, Treat to Target strategy, Tight Control strategy & Exit Strategy.
Primary sclerosing cholangitis (PSC) is a chronic, idiopathic, cholestatic liver disease characterized histologically by peribiliary inflammation and fibrosis.
It can lead to end stage cirrhosis and is a recognized risk factor for hepatobiliary cancers
Diverticulitis: Popular Misconceptions and New ManagementPatricia Raymond
Of course, it's not about just avoiding nuts and seeds. However, do you know how many attacks you can endure before suggesting a resection? How to manage young or immunosuppressed patients with diverticulitis? How Eastern (asian)diverticulitis differs? The role of mesalamine in treatment? It's time to re-explore a disease that you thought you knew!
Complicated diverticular disease
Diverticulitis is the most usual clinical complication of
diverticular disease, affecting 10–25% of patients with
diverticular.
The process by which diverticulitis arises has been likened to that of appendicitis, with a diverticulum becoming obstructed by inspissated stool in its neck.
This faecalith abrades the mucosa of the sac, causing inflammation and expansion of usual bacterial flora, with
diminished venous outflow and localised ischaemia.
Bacteria may breach the mucosa and extend the process
through the full wall thickness, ultimately leading to
perforation.
What are the correct probiotics to advise your ill patients to take? Should your well patients be on probiotic supplements? What doses are appropriate? Can they cause harm?
Do you know how to choose and use a probiotic properly?
Marketing has gotten out of hand, and gastroenterology professionals need to understand the oftentimes scanty data that exists on probiotic usage. Join us and learn to use this age old tool made new again.
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.
Rarely Seen Duodenal Varices Merit Vigilant EndoscopyJohnJulie1
We present a thirty year old female who was diagnosed recently to be suffering from cryptogenic related compensated chronic liver disease. She had no history of ascites, pedal edema, upper or lower gastrointestinal bleed or Porto systemic encephalopathy. On evaluation her complete haemogram revealed mild anemia and thrombocytopenia, liver function were mildly deranged with slight increase in serum bilirubin, transaminases and mild coagulopathy as evidenced by International Normalized Ratio (INR) level of 1.3. The renal function test, thyroid profile, blood sugar, serum electrolytes,
Similar to Diverticulitis: Popular Misconceptions & New Management rev 2019 (20)
Hash It Out: The Role of Medical Marijuana in GIPatricia Raymond
Marijuana's side effect of Cannabinoid Hyperemesis Syndrome is well known to us, as is use of Marinol to enhance appetite in the chronically ill, but are there other high points in the use of medical marijuana? What about the possible use of CBD oil for chronic pancreatitis or intractable abdominal pain?
Studies have shown cannabis' effect on GI motility, inflammation and immunity, intestinal and gastric acid secretion, nociception and emesis pathways, and appetite. Let's weed through the available data on the medical use and side effects of medicinal cannabis in gastroenterology.
Evolving diets in GI Disease 2019 Raymond/GallagherPatricia Raymond
As presented 09/2019 at RMSGNA: In the 50's , doctors recommended smoking for your health. More recently gastroenterologists told patients with ulcers to drink milk and eat bread to heal.
Are you using new science based dietary information for your patients? It's time to update your timeworn dietary strategies and handouts. Join us and review the science on recent advances in dietary management for gastrointestinal disorders: Fatty liver, IBS, IBD, Gastroparesis, Post gastric bypass, Diverticulosis, Cirrhosis, and more!
Examine historical misinformation in dietary management of gastrointestinal disorders
Describe the emerging evidence supporting the primary role of dietary therapies in digestive disease including Irritable Bowel Syndrome, Inflammatory Bowel Disease, Small Intestinal Bacterial Overgrowth, Non-Alcoholic Fatty Liver Disease, Gastroparesis, Pancreatitis, Post-Gastric Bypass, and Diverticulitis.
Identify the role of the Registered Dietitian and the importance of a multi-disciplinary approach to the management of digestives diseases
Know GI Inside & Out? Recognizing Skin Lesions of GI DisordersPatricia Raymond
Skin lesions seen with disorders of the digestive tract are not rare; would you recognize and correctly correlate erythema nodosum, dermatitis herpetiformis, pyoderma gangrenosum? Those were easy-- how about pyoderma vegetans, pyostomatitis vegetans, sweet’s syndrome, xanthomas, tripe palms, palmoplantar keratoderma, or trichilemmomas? Stumped?
Join us and learn the art of GI diagnosis without resorting to our endoscopes.
Fun Functional Gallbladder Disorders: Update on Hypo and Hyperkinetic Gallbla...Patricia Raymond
Functional gallbladder disorder is biliary pain from motility disturbance in the absence of gallstones, sludge, or microcrystal disease. In patients with biliary-type pain and a normal US, the prevalence is 8% men and 21% women. We will review the clinical manifestations, diagnosis, and management of patients with suspected functional gallbladder disorder, and also address current evaluation and management of sphincter of Oddi dysfunction.
Cyst Assist: Pancreatic Cyst Evaluation & ManagementPatricia Raymond
Explore the clinical approach to cystic pancreatic lesions, and review recent guidelines directing observation, endoscopic evaluation, and surgical referral for patients with pancreatic cystic neoplasms. Much of our focus will be to understand the natural history and management of the four subtypes of pancreatic cystic neoplasms (PCNs): Serous cystic tumors (SCTs), Mucinous cystic neoplasms (MCNs), Intraductal papillary mucinous neoplasms (IPMNs), and Solid pseudopapillary neoplasms (SPNs). Pseudocyst management will be included in this review of these increasingly frequent and often incidental and asymptomatic CT and MRI findings.
Kudos To You: Learning your Kudo Pit Patterns and Paris Polyp ClassificationsPatricia Raymond
We've told patients that we won't know about their polyps until after the pathology report is back; turns out that's not precisely true. Today's excellence in optics provides an accurate instantaneous assessment of the histology of colon polyps which may help in decision making during colonoscopy.
Did you know that if a polyp has a type 5 Kudo pit pattern, 50% were invasive cancers to the submucosal layer? What is it about that scary polyp that raises your hackles? Join us in this highly interactive session where we'll learn Kudo pit patterns as well as Paris polyp classifications to elevate your GI procedure reporting and your patient care.
Describe the emerging evidence supporting the primary role of Kudo Pit Patterns in visual inspection of in situ polyps, and demonstrate your ability to identify the patterns
Authentication of Kudo Pits
Pits and their risks
Images of Kudo pits
Quiz of Kudo Pits
Discuss the potential and shortcomings of the Paris Polyp Classification, and demonstrate an ability to classify the polyp shape
Polyp shapes and and their risks (pedunculated, elevated, depressed)
Images of polyps for Paris classification
Polyps and their risks
Quiz of polyp shapes
Concerns regarding interobserver variability
Familial Adenomatous Polyposis affects 1 in 10,000 to 30,000 Americans who experience 100% risk of colon cancer, and FAP doesn't end with a total colectomy for removal of their hundreds of polyps.
Follow this journey of two real FAP patients through pancreatitis from symptomatic ampulla polyps, surgical resection of giant small bowel polyps, bowel obstruction from abdominal desmoid tumors, and Wilm's tumor of the kidney. How do we diagnose, monitor and support our FAP patients? Can pharmacotherapy reduce risk of polyp growth in FAP? What are the extracolonic manifestations of the APC gene mutation? Our responsibility doesn't end when the colon does.
Bored with Barretts: Diagnosing Gastric Intestinal Metaplasia, Meckels, & Pa...Patricia Raymond
We all know what to do with the border disorder that is Barretts, but what about other mucosal heterotopia: intestinal mucosa in the stomach, stomach mucosa in the intestine, pancreas mucosa in the stomach...what's going on with all this meandering mucosa? Join us for a discussion about how to diagnose and manage various misplaced gastrointestinal mucosa.
Discuss the natural history of Gastric Intestinal Metaplasia and construct proper endoscopic surveillance and mapping guidelines
Epidemiology and risk factors
Complete and incomplete, types I-III based on mucin expression
Risk of progression to cancer
Proper surveillance and endoscopic mapping
Management
35 min
Meckels
Describe the presumed anatomical development of Meckel's Diverticulum, summarize the 'Rule Of Twos', formulate management of a Meckel's associated cryptic bleed
Who was Meckel
Epidemiology and risk factors
Rule of twos
Risk of bleed
Management
10 min
Pancreatic Rests
Discuss the natural history of Gastric Intestinal Metaplasia and construct proper endoscopic surveillance and mapping guidelines
Review the endoscopic appearance of the Pancreatic Rest, discuss rare symptoms attributable to the finding and current endoscopic evaluation and management
Endoscopic appearance
Anatomic development
Risks for pancreatitis, cancer, obstruction
Endoscopic and surgical management
10 min
Do You Believe in Reflux: Idiopathic Pulmonary FibrosisPatricia Raymond
Recent studies suggest that if you have IPF (idiopathic pulmonary fibrosis), that you may not perceive the GERD (reflux) that you have, and that this acid reflux may cause the fibrosis to progress. Ask for proper testing and treatment to see if you are one of the almost 80% of IPF patients who have reflux, often silent reflux.
Hospitals have become unfriendly places for patients to be in…rushed, harried staff simply doesn’t have the time to provide the personal touch anymore…or can we? Delighted patients refer their friends and return for repeat procedures.
The ‘Spa Hospital’ addresses our patients’ needs with low or no cost techniques adapted from those used at spas. Attention will also be given to reception and departure from unit, patient privacy concerns, and their lasting impression with reviews of medical literature supporting these techniques.
What Their Poo Can Tell You: How FIT (iFOBT) Fits Your Colorectal Cancer Algo...Patricia Raymond
Everyone needs a colonoscopy at 50 for colorectal cancer prevention, but what if…they simply refuse? They can’t afford it due to insurance issues? We seem to have forgotten that the updated ACG guidelines of 2009 for first time recommend use of annual stool FIT testing as “the preferred cancer detection test” if colonoscopy was not available or refused. How does FIT differ from our venerable stool guaiac testing? And is it finally time to discard gFOBT (AKA guaiac testing) as an insensitive and nonspecific diagnostic tool? Join our conversation and see how FIT testing fits our current screening guidelines, your patients’ financial limitations, and your excellent medical care.
Kiss Your Hemorrhoids Goodbye: Surgical and Non-Surgical Management OptionsPatricia Raymond
Kiss Your Hemorrhoids Goodbye: Surgical and Non-Surgical Management Options
Patricia L. Raymond MD FACG, Rx For Sanity
There seem to be many options to manage our patients' hemorrhoids: hemorrhoidectomy, banding, sclerotherapy, laser photocoagulation, topical medications. Which option is the best for your patient? The physiology and management of the bitter end of the gastrointestinal tract.
Objectives: The participant will…
Distinguish between internal and external hemorrhoids, review the anorectal anatomy and understand the grading system for internal hemorrhoids.
Categorize the differential diagnosis of hemorrhoids, including proctalgia fugax, anal fissure, perianal crohns disease, anal cancer, condyloma, skin tags and rectal prolapse
Examine specific medical, endoscopic, office, and surgical treatment options for hemorrhoids and their stated efficacy
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
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
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!
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.
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
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.
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.
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.
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
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.
7. Nut and seed concerns are so yesterday…
• Nut, corn, and popcorn consumption are NOT associated with an increase
in risk of diverticulosis, diverticulitis or diverticular bleeding.
• Health Professionals Follow-up Study
> 47,228 men between the ages of 40 and 75 years
> Inverse association between the amount of nut and popcorn consumption and
the risk of diverticulitis (HR nuts 0.8, 95% CI 0.63-1.01; HR popcorn 0.72, 95%
CI 0.56-0.92)
> No association between consumption of corn and diverticulitis
> No association between nut, popcorn, or corn consumption and diverticular
bleeding or uncomplicated diverticulosis.
Strate LL, Liu YL, Syngal S, et al.
Nut, corn, and popcorn consumption
and the incidence of diverticular disease.
JAMA 2008; 300:907.
7
12. What percent of your screening
colonoscopy patients have
diverticulosis?
12
13. Prevalence
<20% @ 40 years
60% @ 60 years
• Western and
industrialized nations
have prevalence rates
of 5 to 45 %
• Diverticulosis is
ASYMPTOMATIC!
13
14. 95 % of patients with diverticula have sigmoid diverticula
65%
24%
7%4%
Only in sigmoid colon
Mainly in sigmoid colon
Thoughout colon
Not sigmoid colon
14
15. It’s about the taenia!
• The taenia coli run the
length of the large
intestine.
• The taenia coli are
shorter than the the
colon
> Gathers (“becomes
sacculated”) forming the
haustra of the colon
— shelf-like intraluminal
projections.
http://salerno.uni-muenster.de/data/bl/sobotta/pics_big/0960.jpg
15
17. Wall weakness + pressure =
diverticulosis
• Weakness in wall where the vasa recta penetrate the
circular muscle layer of the colon.
• Abnormal colonic motility
> Exaggerated segmentation contractions in which
segmental muscular contractions separate the
lumen into chambers.
> Increase in intraluminal pressure predisposes to
herniation of mucosa and submucosa.
17
18. Sigmoid colon location
> Laplace’s law according to which pressure (P) is proportional to wall tension (T)
and inversely proportional to bowel radius (R), where k is a conversion factor
(P = kT/R).
— Sigmoid colon is the segment of the colon with the smallest diameter
(R), it is the site of the highest pressure during segmentation of the
colon
18
21. Asian (Right sided) diverticulosis
• Prevalence between <1
and 5 per million population
• Predominantly right-sided
• Increased prevalence with
adoption of more Western
lifestyle.
> Japan has experienced an
increase in the prevalence of
right-sided diverticulosis
similar to the increase in left-
sided diverticula in
westernized countries.
http://wholelifefengshui.com/home/attachment/the-entrance-to-an-asian-temple
22
23. • Proposed by Hinchey et al. in 1978
• Classifies colonic perforation due to diverticular disease for surgeons.
> Hinchey I - localized abscess (para-colonic)
> Hinchey II - pelvic abscess
> Hinchey III - purulent peritonitis (pus in the abdominal cavity)
> Hinchey IV - feculent peritonitis.
Side Bar: there is NO classification system
for uncomplicated diverticulosis;
the ‘Mild’, ‘Moderate’, ‘Severe’ descriptions
we use endoscopically are not quantitative.
Grading diverticulitis- Hinchey classification
24
26. Symptomatic uncomplicated diverticular disease (SUDD)
• Persistent abdominal pain
attributed to diverticula in
the absence of
macroscopically overt
colitis or diverticulitis.
• ‘Smouldering diverticulitis’
• Wall thickening is present
in the absence of
inflammatory changes on
computed tomography
(CT).
• Symptoms overlap with IBS
> Chronic colicky/Constant
lower abdominal pain
> Pain relieved with defecation,
passage of flatus
> Bloating, distension,
flatulence
> Associated alteration in bowel
habit
• No signs of inflammation (fever,
leukocytosis)
27
27. Segmental colitis associated with diverticula (SCAD)
> “Diverticular colitis”
> Characterized by
inflammation in the
interdiverticular mucosa
without involvement of
the diverticular orifices.
28
28. Mesalamine for SUDD & prevent -itis
29
Mesalazine for the Treatment of Symptomatic Uncomplicated Diverticular Disease of the Colon and
Picchio M Elisei W Brandimarte G et al 2016 Oct;50 Suppl 1:S64-9. doi: 1
29. SCAD as IBD variant?
• Prevalence varies between 1.15% and 11.4%
amongst those with diverticulosis
• Slightly more common in males
• Usually presents in the sixth decade
• Four subtypes
30
Segmental colitis associated with diverticulosis: is it the coexistence of colonic diverticulosis and infla
30. SCAD as IBD variant?
31
Segmental colitis associated with diverticulosis: is it the coexistence of colonic diverticulosis and infla
32. What percent of your diverticulosis
patients get diverticulitis?
• How often do people under 50 get
diverticulitis?
• Who gets more diverticulitis, men or
women?
33
33. Diverticulitis— what’s my risk?
4 to 25 % with diverticulosis develop diverticulitis.
• Diverticulitis increases with age
> The mean age at admission for acute diverticulitis is 63 years.
> 16 percent of admissions for acute diverticulitis are in patients under 45
years of age.
— right-sided diverticulitis in only 1.5 percent of cases
• Increased incidence of diverticulitis
> Increase in admissions for acute diverticulitis by 26 percent from 1998 to
2005.
> The largest increase was in patients aged 18 to 44 years (82 percent).
34
34. Under age 50 years
Diverticulitis is more common in men
35
36. Young obese males & diverticulosis
Virulent diverticular disease in young obese men.
Schauer PR, Ramos R, Ghiatas AA, Sirinek KR Am J Surg. 1992;164(5):443.
• During a 9-year period ending in December 1990, 61 of 238 patients
treated for acute diverticulitis were 40 years of age or younger.
> Primarily obese Hispanic males in whom the correct diagnosis was
frequently missed.
> Younger patients more frequently required an operation on an urgent basis
for complications of diverticulitis during the initial hospitalization.
> The most common indication for operation in young patients was
perforation compared with recurrent disease for the older age group.
> Sevenfold incidence of enteric fistulas complicating their acute episode of
diverticulitis.
37
37. Between the ages of 50 and 70
Slight female preponderance of diverticulitis
38
40. Diverticulitis from fecalith? Not.
• Diverticulitis from
micro- or macroscopic
perforation of a
diverticulum.
> Erosion of the
diverticular wall by
increased intraluminal
pressure or inspissated
mucous or food
particles—Not a fecalith.
41
42. Treatment of acute diverticulitis
• Bowel rest
• Antibiotics (?) 10-14
days
> Cipro/Flagyl
> Cipro/Clindamycin
• No colonoscopy x 6
weeks
> Perforation risk
• 20-40% will have
recurrent attacks
> Similar to first attack, not
worse
• 5-20% will get SUDD
(symptomatic uncomplicated
diverticular disease)
AKA “smoldering
diverticulitis”
• Unknown percentage
with SCAD
43
44. Acute diverticulitis complications in 25%
• Abscess —17% of patients
hospitalized with acute
diverticulitis
• Fistula —between the colon and
adjacent viscera. Fistulas occur
in approximately 20% of patients
with surgically treated
diverticulitis and most commonly
involve the bladder.
• Perforation —1 to 2 percent of
patients with acute diverticulitis
have a perforation with purulent
or fecal peritonitis
> Mortality rates approach 20 %
http://radiology.med.sc.edu/diverticularabscess.htm
45
46. Antibiotics in question for diverticulitis, 2012
• Multicenter randomized trial of 623 patients
> CT-scan uncomplicated diverticulitis
• No statistical difference in complication rates based upon use of
antibiotics
• No difference in rate of bowel perforation
• Similar rate of recurrent diverticulitis (16.2 versus 15.8 percent).
> 3 patients randomized no antibiotics - intra-abdominal abscess
• If additional studies support, selected patients who are diagnosed with
uncomplicated diverticulitis may be safely managed with close
observation without antibiotic therapy
47
48. What percent of your diverticulosis patients bleed?
• What side bleeds?
• How many need intervention to stop?
• What’s the risk of rebleed?
49
49. Diverticular bleeding—it’s about the Vasa Recta
• The responsible vasa recta drapes over the dome of the
diverticulum
> Covered only with mucosa
> Over time, becomes injured
> Ruptures into lumen, with bleeding
• Diverticular bleeding typically occurs in the absence of
diverticulitis.
50
51. Diverticular bleeding
• 5 to 15 percent with
diverticulosis
> Massive in a third of
patients
> The right colon is the
source of colonic
diverticular bleeding in
50 to 90 percent of
patients.
http://www.endoatlas.com/jpeg/co_ge_19.jpg
http://www.drvergilio.com/new_page_6.htm
52
53. “Will I bleed again from my diverticula?”
• Bleeding stops spontaneously in
75 percent of patients overall
> 99 % transfused < four units/day
• Risk of rebleeding 14 to 38%
• After 2nd bleed, risk of further
bleed rises to 21 to 50%
• Morbidity and mortality rates from
diverticular bleeding 10 to 20 %
http://www.endoatlas.org/assets/media/img/xl/weo_colon_diverticulum_active_bleeding_brugge.jpg
54
54. Management of diverticular bleed
• Colonoscopy
• Scintigraphy
• Angiography
• Surgery
http://www.healio.com/gastroenterology/curbside-consultation/%7Bb6e2c2ea-9e74-499c-b26a-4f79166f6849%7D/when-do-i-need-to-refer-
55
56. Endoscopic management of diverticular hemorrhage
48 patients with hematochezia and known diverticulosis
• A definite diverticular bleeding source (defined by
active bleeding from a diverticulum, a nonbleeding
visible vessel, or an adherent clot)
> Identified in 10 patients (21 %)
> Successful treatment with endoscopic therapy
57
58. Endoscopic management of diverticular hemorrhage
48 patients with hematochezia and known diverticulosis
> Treatment included four-quadrant submucosal injection of
epinephrine (1 to 2 mL aliquots, dilution 1:20,000) or
endoscopic tamponade.
— Visualized non-bleeding diverticular vessel, the vessel was
treated with bipolar coagulation at a setting of 10 to 15
Watts of power with moderate pressure directly on the
vessel using one-second pulses until good coagulation and
flattening of the vessel were achieved .
— Nonbleeding adherent clots were injected with epinephrine
and shaved down to 3 to 4 mm above the attachment with
a cold polypectomy snare (without coagulation). The
underlying stigmata (usually visible vessels) were then
coagulated with a bipolar probe.
59
59. • No episodes of recurrent bleeding
> Median follow-up of 30 months
• No patient required emergency surgery
• In a separate group of 17 patients with definite diverticular bleeding who did
NOT receive endoscopic therapy, persistent bleeding after colonoscopy
occurred in nine (53 percent).
• Six with persistent bleeding underwent surgery, and two suffered
complications following surgery.
• EBL and hemoclips are being studied for diverticular bleeding
60
60. 61
How do we prevent these things from happening?
63. What lifestyle modifications have been
proved to help diverticulosis?
• We know about nuts and seeds, but…
• High fiber diet?
• Reduce animal fat and meat?
• Vigorous exercise?
• Weight management?
• Stop smoking?
• Reduce caffeine?
• Stop drinking alcohol?
65
65. Dietary Fiber- unclear, but good maintenance
• CAUSE: Low dietary fiber predisposes to the development of
diverticular disease- conflicting results
• TREATMENT of Symptomatic: Reduction symptoms in patients with
symptomatic uncomplicated diverticular disease (SUDD) –NO
• PREVENTION of Attacks: Reduction the incidence of symptomatic
diverticular disease –Yes
> By decreasing intestinal inflammation and altering the intestinal microbiota
— Study > 47,000 men
— Adjustment for age, energy-adjusted total fat intake, and physical activity
— Total dietary fiber intake was inversely associated with the risk of
symptomatic diverticular disease (RR 0.58 highest quintile versus lowest
quintile for fiber intake).
67
67. Fat and Red Meat—Bad for your diverticula
> Same cohort study as fiber
• High-total-fat, low-fiber diet
the RR 2.35 (95% CI 1.38,
3.98) verses low-total-fat,
high-fiber diet
• High-red-meat, low-fiber
diet RR 3.32 (95% CI 1.46,
7.53) verses low-red-meat,
high-fiber diet.
69
69. Sedentary lifestyle and Obesity- Bad for your tics
• Vigorous physical activity= reduction in risk of diverticulitis and
diverticular bleeding.
> 8,000 men aged 40 - 75
> Risk of developing symptomatic diverticular disease was inversely related
to overall physical activity (RR 0.63 for highest versus lowest extremes)
after adjustment for age and dietary fat and fiber
> Most of the decrease in risk was associated with vigorous activity such as
jogging and running.
• Obesity = increased risk of diverticulitis and diverticular bleeding.
> 47,228 male health professionals
> 801 incident cases of diverticulitis and 383 cases of diverticular bleeding
during 18 years of follow-up
> Risk of diverticulitis and diverticular bleeding was significantly higher in
those with the highest quintile of waist circumference as compared with the
lowest (RR diverticulitis 1.56, 95% CI 1.18-2.07; RR diverticular bleeding
1.96, 95% CI 1.30-2.97).
71
70. Cigs- NO, Caffeine and alcohol OK
• Current smokers at
increased risk for
perforated diverticulitis and
a diverticular abscess as
compared with nonsmokers
(OR 1.89, 95% CI 1.15-
3.10)
• Caffeine and alcohol are
not associated with an
increased risk for
symptomatic diverticular
disease
72
72. DIVA Trial Mesalamine (2013)
• 1-year double-blind, randomized, placebo-controlled study
> CT-scan confirmed acute diverticulitis
> placebo, mesalamine, or mesalamine+Bifidobacterium infantis 35624
(Align) for 12 weeks and followed for 9 additional months.
• Global symptom score (GSS) of 10 symptoms (abdominal pain,
abdominal tenderness, nausea/vomiting, bloating, constipation,
diarrhea, mucus, urgency, painful straining, and dysuria). Patients
were required to have a GSS≥12 at baseline, including an abdominal
pain score>2.
• One hundred seventeen patients (placebo, 41; mesalamine, 40;
mesalamine+probiotic, 36)
75
73. DIVA Trial Mesalamine (2013)
• GSS decreased in all groups during treatment without a statistically
significant difference between mesalamine and placebo, however;
scores were consistently lower for mesalamine at all time points.
• The rate of complete response (GSS=0) was significantly higher with
mesalamine than placebo at weeks 6 and 52 (P<0.05), and was
particularly high for rectosigmoid symptoms at weeks 6, 12, 26, and
52.
• Recurrence of diverticulitis was low and comparable across groups.
• Probiotic in combination with mesalamine did not provide additional
efficacy.
• CONCLUSIONS:
• Mesalamine demonstrated a consistent trend in reducing symptoms.
• Addition of probiotic did not increase mesalamine efficacy.
76
76. So you feel your left side achin’
Lower belly starts makin’
Crampy pain, and B-Ms are narrow.
You have low grade fever
And then shakes that make you quweever
And wow, you ache to the marrow.
80
The ER doc is right on time
The lab draws tubes times nine
And they shoot some belly X-rays
And tho you’re far from overjoyed
With the stat results deployed
Tune in to what the doc says!
You’ve got DIVERTICULITIS, yes it bites!
Diverticulitis, sigmoid site—
Diverticulitis, liquid diet.
Diverticulitis from a microperfori
Bowel leak!
If your family is Asian
Look to a strange location
Cause tics occur in the right colon!
And if you’re a husky boy
Weight loss you should employ
Your tics will more likely get a hole-in!
If blood it starts to run
With red clots out of your bum
The bleeding stops in most in a day.
If pesky seeds you do avoid
That infos null and void
Our studies prove that nuts are OK.
You’ve got DIVERTICULOSIS, me-o-my!
Mini hernias due to vasa recti
Diverticulosis, it’s benign.
Diverticulosis, and nuts & seeds are fine.
Munch out!