Fat emboli syndrome was first diagnosed in 1873 and involves the blockage of small blood vessels by fat globules, typically occurring 1-3 days after long bone fractures or pelvic fractures. It is characterized by a triad of hypoxemia, neurological abnormalities, and petechial rash. Treatment is supportive, with mechanical ventilation sometimes needed for respiratory failure and steroids proposed but controversial to prevent the inflammatory response. Prognosis is generally good with most neurological deficits being transient or reversible.
Rickets is a metabolic disease of growing bone that is unique to children.
It caused by a failure of mineralization of osteoid tissue in a developing skeleton, particularly at the growth plate.
Imperfect calcification typically resulting in soft bones and skeleton deformities.
CHEST INJURY- BLUNT/ Trauma Surgery
Dear viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on CHEST INJURY- BLUNT- an important topic in trauma. Even the blunt chest trauma can turn into penetrating one because of jagged edges of the broken ribs. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about pathophysiology, clinical approach, symptoms, signs, investigations, different individual types of Chest injuries and management of all the varieties of Chest injuries. My aim is, after watching this video all of you should be able to arrive at a correct working diagnosis of the type of chest injury and should also be able to institute immediate lifesaving treatment to the patients if there is a need. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
Rickets is a metabolic disease of growing bone that is unique to children.
It caused by a failure of mineralization of osteoid tissue in a developing skeleton, particularly at the growth plate.
Imperfect calcification typically resulting in soft bones and skeleton deformities.
CHEST INJURY- BLUNT/ Trauma Surgery
Dear viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on CHEST INJURY- BLUNT- an important topic in trauma. Even the blunt chest trauma can turn into penetrating one because of jagged edges of the broken ribs. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about pathophysiology, clinical approach, symptoms, signs, investigations, different individual types of Chest injuries and management of all the varieties of Chest injuries. My aim is, after watching this video all of you should be able to arrive at a correct working diagnosis of the type of chest injury and should also be able to institute immediate lifesaving treatment to the patients if there is a need. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
Cardiogenicshock by Dr.Afroza Prioty -140123092109-phpapp02Afroza Prioty
A small overview on cardiogenic shock which sometimes becomes a burning issue for the medical personnels and to combat the situation, the measures should be taken immediately and urgently.
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
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
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
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.
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
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.
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. HistoryHistory
First diagnosed in 1873 by Dr VonFirst diagnosed in 1873 by Dr Von
BergmannBergmann
1879 Fenger and Salisbury1879 Fenger and Salisbury
published description of FES.published description of FES.
3. FE vs. FESFE vs. FES
Fat emboli vs Fat emboli syndromeFat emboli vs Fat emboli syndrome
FE:FE: fat in the vascular circulation, can causefat in the vascular circulation, can cause
embolic phenomenon, more common 90% ptsembolic phenomenon, more common 90% pts
with traumatic injury (ECHO and BAL havewith traumatic injury (ECHO and BAL have
shown high incidence of FE after fractures andshown high incidence of FE after fractures and
orthopedic surgery)orthopedic surgery)
FES:FES: FE with pattern of sxs. Incidence 1-3%FE with pattern of sxs. Incidence 1-3%
femur fx, 5-10% if bilateral or multiple.femur fx, 5-10% if bilateral or multiple.
4. Fat Emboli SyndromeFat Emboli Syndrome
Mortality: 5-15%Mortality: 5-15%
Clinical diagnosis, No specific laboratory test isClinical diagnosis, No specific laboratory test is
diagnosticdiagnostic
Mostly associated with long bone and pelvic fxs,Mostly associated with long bone and pelvic fxs,
and more frequent in closed fracturesand more frequent in closed fractures
Single long bone fracture 1-3% chance ofSingle long bone fracture 1-3% chance of
developing FES, and increases with number ofdeveloping FES, and increases with number of
fxsfxs
Onset is 24-72 hours from initial insultOnset is 24-72 hours from initial insult
5.
6. Sickle Cell DiseaseSickle Cell Disease
FES can occur in SCFES can occur in SC
crisiscrisis
Bone marrow necrosis asBone marrow necrosis as
a result of hypoxia maya result of hypoxia may
release fatrelease fat
PLA2 has been seen toPLA2 has been seen to
increase 100x normal inincrease 100x normal in
SC crisis.SC crisis.
9. Pathogenesis- FEPathogenesis- FE
Direct entry of fat globules (fat entersDirect entry of fat globules (fat enters
torn venules)torn venules)
1.1. torn vesselstorn vessels
2.2. free fat presentfree fat present
3.3. temporary rise in marrow pressuretemporary rise in marrow pressure
above venous pressure.above venous pressure.
10. Pathogenesis- FEPathogenesis- FE
In orthopedic surgery echogenicIn orthopedic surgery echogenic
material can be seen inmaterial can be seen in R heartR heart
circulation.circulation.
Paradoxical embolism: fatParadoxical embolism: fat
embolism in arterial system, egembolism in arterial system, eg
PFOPFO
11. Pathogenesis- FESPathogenesis- FES
Production of toxic byproducts fromProduction of toxic byproducts from
TG/chylomicrons (lipase)TG/chylomicrons (lipase)
FES theorized to result fromFES theorized to result from degradation ofdegradation of
fat from FE to free fatty acidsfat from FE to free fatty acids causecause
vasculitis/ARDS). (inflammatory mediated).vasculitis/ARDS). (inflammatory mediated).
CRP also shown to be elevated in FE and causesCRP also shown to be elevated in FE and causes
fat agglutination.fat agglutination.
12. Pathogenesis of ARDS in FEPathogenesis of ARDS in FE
fat emboli obstructs lung vesselfat emboli obstructs lung vessel
(20 microns) platelets and fibrin(20 microns) platelets and fibrin
adhereadhere
Lipase creases FFALipase creases FFA
Inflammatory changesInflammatory changes
endothelial damage ARDSendothelial damage ARDS
13.
14. Triad of FESTriad of FES
HypoxemiaHypoxemia
Neurological abnormalitiesNeurological abnormalities
Petechial rashPetechial rash
16. PulmonaryPulmonary
Hypoxia, rales, pleural friction rubHypoxia, rales, pleural friction rub
ARDS may developARDS may develop
½ of pts with FES require mechanical½ of pts with FES require mechanical
ventilationventilation
CXR usually normal early on, later may showCXR usually normal early on, later may show
‘snowstorm’‘snowstorm’ pattern-pattern- diffuse bilateral infiltratesdiffuse bilateral infiltrates
CT chest:CT chest: ground glass opacification withground glass opacification with
interlobular septal thickeninginterlobular septal thickening
17. Neurological findingsNeurological findings
Usually occur after respiratory symptomsUsually occur after respiratory symptoms
Incidence 80% patients with FESIncidence 80% patients with FES
Minor global dysfunction most common, but rangesMinor global dysfunction most common, but ranges
from mild delirium to coma.from mild delirium to coma.
Seizures/focal deficits not common but can occurSeizures/focal deficits not common but can occur
Transient and reversible in most casesTransient and reversible in most cases
CT Head:CT Head: general edemageneral edema
MRI brain:MRI brain: Low density on T1, and high intensity T2Low density on T1, and high intensity T2
signal, correlates to degree of impairmentsignal, correlates to degree of impairment
18. RashRash
PetechialPetechial
Usually on conjuntiva, MM, neck, axillaeUsually on conjuntiva, MM, neck, axillae
Results from occlusion of dermal capillariesResults from occlusion of dermal capillaries
by fat globules and then extravasations ofby fat globules and then extravasations of
RBCRBC
Resolves in 5-7 daysResolves in 5-7 days
Pathognomonic, but only present inPathognomonic, but only present in 20-50%20-50% ofof
patientspatients
20. TreatmentTreatment
Supportive careSupportive care
Early immobilization of fx reducesEarly immobilization of fx reduces
incident of FESincident of FES
Conservative tx also reduces risk.Conservative tx also reduces risk.
Higher incidence when fixationHigher incidence when fixation
delayed greater than 24 hours.delayed greater than 24 hours.
21. SteroidsSteroids
Steroid prophylaxis is controversialSteroid prophylaxis is controversial
to prevent FESto prevent FES
Theorized blunting of inflammatoryTheorized blunting of inflammatory
response and complementresponse and complement
activationactivation
22. SteroidsSteroids
Few studies and small study size, soFew studies and small study size, so
remains controversial.remains controversial.
Prospective studies suggests prophylacticProspective studies suggests prophylactic
steroids benefit high risk patientssteroids benefit high risk patients
Once FES established, steroids have notOnce FES established, steroids have not
shown improved outcomes.shown improved outcomes.
23. Heparin and ASAHeparin and ASA
Have also been proposed for tx asHave also been proposed for tx as
they activate lipase and blockthey activate lipase and block
thromboxane respectively, but nothromboxane respectively, but no
evidence exists for either use inevidence exists for either use in
FES.FES.
24. Prevalence of PFO in the generalPrevalence of PFO in the general
population = 25%population = 25%