Epistaxis, or nosebleed, is bleeding from inside the nose. It is common and can occur in people of all ages. The nose has a rich blood supply from both the internal and external carotid arteries, making it susceptible to bleeding. The most common site of bleeding is Kiesselbach's plexus in the anterior nasal septum. Epistaxis can be classified as anterior or posterior depending on the location and direction of bleeding. Causes include local trauma, infections, vascular abnormalities, and medications. Management involves first aid measures, cauterization, nasal packing, surgery, or ligation of vessels supplying the nose.
Epistaxis is the medical term for "nasal bleeding".
This ppt is more of use for medical students ....a compilation of all the required knowledge about epistaxis.
Epistaxis is the medical term for "nasal bleeding".
This ppt is more of use for medical students ....a compilation of all the required knowledge about epistaxis.
Epistaxis (nosebleed) is one of the most common ear, nose, and throat (ENT) emergencies that present to the emergency room or primary care. There are two types of nosebleeds: anterior (more common), and posterior (less common, but more likely to require medical attention).
Epistaxis (nosebleed) is one of the most common ear, nose, and throat (ENT) emergencies that present to the emergency room or primary care. There are two types of nosebleeds: anterior (more common), and posterior (less common, but more likely to require medical attention).
Bleeding from inside the nose is called epistaxis
Fairly common and is seen in all age groups.
“Epistaxis refers to nose bleed or hemorrhage from the nose”.
It‘s mostly commonly originates in the anterior portion of the nasal cavity.
A hemorrhage from the nose, referred to as epistaxis, is caused by the rupture of tiny, distended vessels in the mucous membrane of any area of the nose.
Most commonly, the site is the anterior septum, where three major blood vessels enter the nasal cavity:
(1) the anterior ethmoidal artery on the forward part of the roof (Kesselbach’s plexus)
(2) the sphenopalatine artery in the posterosuperior region, and
(3) the internal maxillary branches (the plexus of veins located at the back of the lateral wall under the inferior turbinate).
Pleural effusion may be defined figuratively as the juice, oozing from the leaky lingerie of the lung. However the text book definition is the abnormal accumulation of fluid in the pleural space due to disturbances in the forces that keep the pleural fluid economy in equilibrium...
- 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
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- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
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).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
4. Introduction
• It is fairly common.
• It is seen in all age groups : children,
adults and older people.
• It often presents as an emergency.
• Epistaxis is a sign and not a disease.
5. Introduction
Why Nose?
• Situated in a vulnerable position as
it protrudes on the face.
• Has a very rich blood supply.
• Supplied by both internal and
external carotid system.
• Various anastomoses between
arteries and veins.
• Vasculature runs just under the mucosa.
• Exposed to the drying effect of inspiratory current.
6. Introduction
Epidemiology
• Lifelong incidence of epistaxis in general population is about 60%.
• Fewer than 60% seek medical attention.
• Peaks in young children (2 – 10 y) and older individuals (50 – 80 y)
• occur in males more than females.
8. • Nose is richly supplied by both the external and internal carotid systems.
Superior part of the nose (Internal carotid artery):
• Ophthalmic artery
- Anterior ethmoidal artery
- Posterior ethmoidal artery
Inferior part of the nose (External carotid artery):
• Maxillary artery
- Greater palatine artery
- Sphenopalatine artery
• Facial artery
- Superior labial artery vestibule of the nose
9. Kiesselbach’s plexus (Little’s area)
• In anterior inferior part of nasal septum.
• Most common site for epistaxis.
• Mainly anterior epistaxis.
• Four arteries:
1. Septal branch of sphenopalatine artery
2. Anterior ethmoidal artery
3. Septal branch of labial artery
4. Greater palatine artery
10. Woodruff’s Plexus
• Posterior end of middle turbinate.
• Most common site for posterior epistaxis.
• It is anastomoses of two arteries:
1. Sphenopalatine artery
2. posterior pharyngeal artery
11. Reterocolumellar Veins
• Runs vertically downwards just behind columella.
• Crosses the floor of nose and joints venus plexus on lateral nasal wall.
• Common site for venous bleed in young patient.
15. Anterior Epistaxis
Blood flow out from front nose with patient
in sitting position.
•Incidence: More common.
• Site: Mostly from Little’s area or anterior
part of lateral wall.
• Age: Mostly occurs in children or young adults.
• Cause: Mostly trauma.
• Bleeding: Usually mild, can be easily controlled
by local pressure or anterior pack.
16. Posterior Epistaxis
Blood flow back into the throat.
• Incidence: Less common.
• Site: Mostly from posterosuperior part of nasal
cavity; often difficult to localize the bleeding point.
• Age: After 40 years of age.
• Cause: Spontaneous; often
due to hypertension or arteriosclerosis.
• Bleeding: severe,
requires hospitalization; postnasal pack
often required.
18. 1. Little’s area: 90% of cases.
2. Above level of middle turbinate: anterior and posterior ethmoidal artery.
3. Below level of middle turbinate: from branch of sphenopalatine artery.
4. Posterior part of nasal cavity: blood to pharynx.
5. Diffuse: from septum and lateral nasal wall.
6. Nasopharynx.
20. 1. Local (nose or nasopharynx).
2. General.
3. Idiopathic.
21. Local Causes
Trauma:
• Finger nail trauma
• Injury of nose
• Intranasal surgery
• Fracture of middle third of face and base of skull
• Hard blowing of nose
• Violent sneeze
Infection:
• Acute: viral rhinitis, acute sinusitis, nasal diphtheria
• Chronic: Crust forming Disease(rhinitis sicca, tuberculosis); Granulamatous lesion of nose(rhinosporidosis)
22. Local Causes
Foreign bodies:
• Nonliving: any neglected foreign body
• Living: Maggots, leeches
Neoplasms:
• Benign: Hemangioma, papilloma
• Malignant: Carcinoma, sarcoma
Atmospheric changes:
high altitudes, sudden decompression, Casisson disease.
Deviation of nasal septum.
23. General Causes
Cardiovascular System:
• Hypertension
• Arteriosclerosis
• Mitral stenosis
• Pregnancy (hypertension and hormonal)
Disorders of blood and blood vessels:
• Aplastic anemia
• Leukemia
• Thrombocytopenia
• Vascular purpura
24. General Causes
Liver: Hepatic cirrhosis.
Kidney: Chronic nephritis.
Mediastinal compression: tumor causing raised venous pressure.
Acute general infection: influenza, measules, whooping cough.
Vicarious menstruation.
Drug:
• Excessive use of salicylates and other analgesics.
• Anticoagulant therapy
26. First Aid
Bleeding from Little’s area can be stopped by pinching the nose for 5 min.
Trotter’s method:
1. Patient is made to sit
2. Leaning a little forward
3. Breath quietly from the mouth
4. Cold compression is applied(vasoconstriction)
27. Cauterization
• Useful in anterior epistaxis when bleeding point has been located
• Topically anaesthetized
• Bleeding point cauterization with bead of
silver nitrate or
coagulated with electrocautery
28. Anterior Nasal Packing
• Done if localized bleeding is profuse or bleeding point is not localize
• Use of a ribbon gauze soaked with liquid paraffin(1 m gauze; 2.5 cm
gauze in adult and 12 mm in children)
• Can be done with vertical layer and horizontal layer
• Can be removed with 24 hour and can be kept upto 2-3 days
• Systemic antibiotic should be given to prevent sinus infection
and toxic shock syndrome
29. Posterior Nasal Packing
• For posterior nasal bleed
• Can be carried through different instrument:
1. Gauze
2. Foley’s Catheterization
3. Nasal balloon
Nasal packing by Gauze
Nasal packing by Foley’s catheterNasal Balloon
30. Elevation of Mucoperichondrial Flap and Submucous Resection(SMR)
Operation:
• For persistant or recurrent bleeds from septum
• Elevation of mucoperichondrial flap
• Reposining flap back help to cause fibrosis and constrict blood vessel
Endoscopic Cauterization
• Topical or general anesthesia, bleeding point is localized
• with rigid endoscopy and cauterized
• Procedure is effective with less morbidity and decreased stay
• With profuse bleeding it is very difficult to localize so this
• procedure can’t be carried out
31. Ligation of Vessels
Ligation can be done to
• External Carotid (ligation on origin of superior thyroid artery)
• Maxillary artery
• Ethmoidal artery
33. General Measures in Epistaxis
• Making patient sit up with back rest and record any blood loss taking place through spitting or vomiting
• Mild sedation should be given
• Checking pulse, BP and respiration
• Maintenance of hemodynamics (Blood transfusion may required)
• Antibiotics can be given to prevent sinusitis, if pack is to be kept beyond 24 hours
• Intermittent oxygen may be required in patients with bilateral packs because of increased pulmonary
resistance from nasopharynx reflex
• Investigation and treatment for any underlying local or general cause
34. References
• Disease of Ear, Nose and
Throat and head and neck
surgery. Dhingra PL,
Dhingra S. 6th ed.
Epistaxis.
• Disease of Ear, Nose and
Throat. Bhansal M. 1st ed.
Nose and Paranasal
Sinuses. =