A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
A brief description on Cholangiocarcinoma, its classification and management. Contains management of Intrahepatic cholangiocarcinoma, Perihilar cholangiocarcinoma, Distal cholangiocarcinoma.
Cholangiocarcinomas (bile duct cancers) arise from the epithelial cells of the intrahepatic and extrahepatic bile ducts.
Please do not edit or rename.
Note it is only for academic purposes.
một trong những rối loạn vận động của thực quản, co thắt tâm vị không nguy hiểm tới tính mạng như các bệnh mãn tính không lây, hiểm nghèo, ... nhưng lại ảnh hưởng đáng kể đến sinh hoạt của cá nhân mang căn bệnh này ...
Choledocholithiasis is one of the main causes for Obstructive Jaundice.In this ppt presentation, I have discussed the etiology, clinical features, complications, investigations and management of Choledocholithiasis. I have also included a mindmap and 2 algorithms for Choledocholithiasis. I hope you will find it very useful and interesting.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
A brief description on Cholangiocarcinoma, its classification and management. Contains management of Intrahepatic cholangiocarcinoma, Perihilar cholangiocarcinoma, Distal cholangiocarcinoma.
Cholangiocarcinomas (bile duct cancers) arise from the epithelial cells of the intrahepatic and extrahepatic bile ducts.
Please do not edit or rename.
Note it is only for academic purposes.
một trong những rối loạn vận động của thực quản, co thắt tâm vị không nguy hiểm tới tính mạng như các bệnh mãn tính không lây, hiểm nghèo, ... nhưng lại ảnh hưởng đáng kể đến sinh hoạt của cá nhân mang căn bệnh này ...
Choledocholithiasis is one of the main causes for Obstructive Jaundice.In this ppt presentation, I have discussed the etiology, clinical features, complications, investigations and management of Choledocholithiasis. I have also included a mindmap and 2 algorithms for Choledocholithiasis. I hope you will find it very useful and interesting.
Acute kidney injury is important topic for students.
the presentation covers all aspects including guidelines from KDIGO, harrison 20th edition and relevant articles.
COURTSEY - DEPARTMENT OF CRITICAL CARE
ABVIMS & DR RML HOSPITAL NEW DELHI.
Similar to Fluid management in acute pancreatitis (20)
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
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
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
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!
2. Introduction
• Acute pancreatitis (AP) is acute inflammation of the
pancreas, and has high morbidity and mortality rates
• It has been estimated that about 10% to 20% of AP
patients develop the severe form, which has a 15% to
40% mortality rate
• A major factor complicating the appropriate
management of AP is the failure to discriminate its mild
and severe forms in the initial stages.
• Fluid resuscitation is the current cornerstone of early
management
4. The Pancreatic
Microcirculation
• From these large arteries arise the intralobular arteries, which run
within the pancreas, often parallel to the pancreatic ducts. The
intralobular arteries give rise to the pancreatic microcirculation
• The basic microscopic vascular unit consists of an exocrine lobular
plexus with multiple fine capillaries that receive one or more
vessels from the intralobular arteries
• The pancreatic islet cells receive the vast majority of the arterial
blood supply, up to 20 times more than the acinus
• The major goal of this autoregulation is to sustain a constant level
of pancreatic blood perfusion, with the lower limit of normal
being 40 mL/min per 100 gram of tissue
5. Microcirculatory Derangement
• Caused by:
- hypovolemia
-increasing capillary permeability
-hypercoagulability causing microthrombi
• In response to pancreatic acinar cell injury, multiple
proinflammatory cytokines and vasoactive mediators are
recruited to the pancreatic microcirculation and delivered to
the acinar cells increase the vascular permeability of the
capillaries decrease in endothelial tone causes significant
extravasation of both interstitial fluid acute edematous
changes around the acinus, and inflammatory cells further
perpetuates the degree of pancreatic damage
6. Other Theories
• Capillary vasoconstriction also has been implicated. In a study of rats
with sodium taurocholate– induced pancreatitis, arterial constriction
of up to 79% occurred within minutes of cellular injury.(Cuthbertson
CM, Christophi C. Disturbances of the microcirculation in acute
pancreatitis. Br J Surg 2006;93:518–530.)
• Hypercoagulability leading to microthrombi formation also
contributes to pancreatic ischemia and subsequent necrosis.Levels of
procoagulant factors such as fibrinogen, D-dimer, and platelets all are
increased in acute pancreatitis, likely triggered by inflammatory
mediators
• There also are profound disturbances in the larger pancreatic vessels
that can lead to downstream effects on the pancreatic
microcirculation. Often this disturbance is secondary to arterial
vasospasm, causing decreased perfusion of the pancreatic capillary
bed
8. Organ dysfuntion
• Organ dysfunction usually occurs quite early in
the course of severe AP, usually the first four
days,
• Mortality in about 50% of cases within the first
week of its manifestation.
• The first five days after the onset of acute
disease are considered as the “therapeutic
interventional window”
• correct the third space losses and increase tissue
perfusion.
• SIRS may be averted with prevention of multiple
organ failure and/or pancreatic necrosis
9. The revised Atlanta Classification
for severity of Ac. Pancreatitis
• Mild AP—characterized by the absence of organ
failure or local complications
• Moderately severe AP—defined by the presence
of transient organ failure (resolving within 48
hours) or local complications developing in the
absence of organ failure
• Severe AP—defined by the presence of
persistent organ failure (>48 hours) with or
without local complications
12. APACHE-II Scores-
Acute Physiology And Chronic
Health Evaluation II
The 12 variables are
• temperature
• heart rate
• respiratory rate
• mean arterial blood pressure
• oxygenation
• arterial pH
• serum potassium, sodium, and creatinine;
• hematocrit; white blood cell (WBC)
• Glasgow Coma Scale
13. Scoring system –BISAP- Bedside Index of
Severity in Acute Pancreatitis
BISAP assesses 5 criteria with each one of score 1 :
• blood urea nitrogen (BUN) > 25 mg/dl
• age > 60 years
• impaired mental status
• SIRS
• pleural effusion.
A score of 0-2 is low mortality of less than 2%.
A score of 3-5 is associated with a higher mortality of more
than 15%.
14. HAPS- Harmless Acute
Pancreatic Score
• Criteria – each score 1 :
• Absence of rebound tenderness/guarding
• Normal serum creatinine level
• Normal hematocrit level
a harmless course was defined as the absence of pancreatic
necrosis (Balthazar score, 0–4 points), no need for dialysis or
artificial ventilation, and no fatal outcome
15. RATIONALE FOR FLUID
RESUSCITATION
• Based on the need to resolve the hypovolemia that occurs secondary
to vomiting, reduced oral intake, third space extravasation,
respiratory losses and diaphoresis.
• A hematocrit of ≥ 44%-47% on admission combined with failure of a
decrease in the hematocrit at 24 h was reported as the best risk
factor for development of necrosis (Wu et al 2010)
• Thus, the purpose of effective fluid resuscitation in severe AP is not
only to replenish the blood volume but also to stabilize the capillary
permeability, modulate the inflammatory reaction, and sustain
intestinal barrier function
• signs of splanchnic hypoperfusion could be prevented with fluid
resuscitation.
16. Which patients require fluid
resuscitation?
• Patients with moderate and severe AP require observation for
organ failure and local or systemic complications, and should
be started on fluid therapy
17. Choice of fluid –colloids
• Commonly used colloids are various formulations of dextran,
hetastarch and albumin. Colloids are considered superior to
crystalloids in of the hemodynamic response
• They also have better retention in the intravascular
compartment because of their larger size
• contribute to the correction of hypovolemia because of their
osmotic effect in drawing fluid from the interstitium to the
vascular compartment
• Side effect: colloids can cause intravascular volume overload,
hyperoncotic renal impairment, coagulopathy, and
anaphylactic reaction
18. Crystalloids
• crystalloids are normal saline (NS), lactated Ringer’s (RL) and
Ringer’s ethyl pyruvate, with hypertonic saline being the so-
called “new kid on the block”.
• Crystalloids are distributed in both the plasma and the
interstitial compartments, and large spaces are therefore
required to restore the circulation.
• Side effect : Infusion of large amounts of crystalloids
pulmonary edema.
• Hypertonic saline effectively reduces the volume of isotonic
fluid resuscitation, thereby reducing the risk of pulmonary
edema. However, there is a potential risk of central pontine
myelinolysis with aggressive hypertonic saline therapy
19. Colloids vs Crystalloids
• Points in favor of colloids
• they are not as permeable to leakage in pancreatic
microcirculation as crystalloids
• By remaining in the lumen, circulatory blood flow is better
maintained and inflammatory mediators are less likely to
reach the acinus when colloids are used
• Hydroxyethyl starch (HES) is another colloid fluid that can
preserve systemic oxygenation in patients with capillary leak
• While it has been shown to reduce the risk of intra-abdominal
hypertension in severe AP
20. Colloids vs Crystalloids
• Favor of crystalloids
• practice are shifting toward the use of lactated Ringer's.
• Wu et a lcompared NS vs RL as resuscitation fluid in AP and
reported dampening of systemic inflammation after 24 h with
RL
• Experimental studies show that zymogens may be activated by
low pH. Furthermore, low pH may also adversely impact
acinar cells and make them more vulnerable to injury, thereby
contributing to the increase in severity of AP
• A significant reduction in the prevalence of SIRS and levels of
C-reactive protein was found in the RL group as compared to
the NS group
• Lactate has a direct anti-inflammatory effect via the GPR81
receptor and the cellular inflammasome
21. Volume and rate of fluid
resuscitation:
• 15 mL/kg per hour infusion as aggressive resuscitation, as
compared to controlled resuscitation, which they defined as 5-
10 ml/kg per hour
• Aggressive resuscitation restores the intravascular
compartment depleted by “third spacing” and results in more
effective end-organ tissue perfusion and reverses pancreatic
ischemia
22. Controlled hydration
• Non-aggressive hydration suggest that by the time we
intervene in patients with AP, pancreatic necrosis is already
non-reversible and aggressive fluid therapy will only lead to
respiratory failure and increased intra-abdominal pressure
• A “controlled” resuscitation aimed at reversing hypotension,
and being able to maintain effective mean arterial pressure
(MAP) and urine output > 0.5 mL/kg,
23. How much fluid is
sequestrated?
• The median fluid sequestration in the first 48 h after
hospitalization was 3.2 L (1.4-5 L), 6.4 L (3.6-9.5 L) in those
without necrosis and those with necrosis, and 7.5 L (4.4-12 L)
in those with persistent organ failure(de-Madaria et al)
• patients who develop local complications after admission are
prone to more fluid sequestration, so they require more fluids.
• They suggest that fluid resuscitation and its replacement is a
dynamic process and patients with local complications should
receive heightened fluid intake on the second and third days
of admission
24. RESUSCITATION GOALS
• . A drop in hematocrit and BUN has often been recommended
as a marker of hemoconcentration correction
• At 8-12 h after of the start of resuscitation, if the BUN level
remained unchanged or increased from its previous value,
participants were considered refractory
• The classic static parameters for monitoring are central venous
pressure (CVP), pulmonary artery occlusion pressure (PAOP)
and MAP
• A high CVP in patients with severe AP may indicate
intravascular repletion when the intracellular compartment is
actually under-resuscitated
• Adequate urine output confirms adequate intravascular
repletion. urine output of > 0.5 ml/kg per hour is considered
as the end point of fluid resuscitation
This issue is critical, as about half of the patients with severe AP die within the first week due to the development of organ failure; the incidence of organ failure is maximal (17%) on the first day
The intralobular arteries give rise to the pancreatic microcirculation, a vast network of capillaries and venules that supply the pancreatic acinus with a rich blood supply
In fact, disturbed pancreatic microcirculation is an important step in the transformation from acute self-limited (interstitial edematous) pancreatitis to severe, necrotizing pancreatitisThis alteration in microcirculation significantly increases the degree of pancreatic ischemia, irrespective of etiology, thus exacerbating the systemic inflammatory response syndrome and leading to multisystem organ failure
In response to pancreatic acinar cell injury, multiple proinflammatory cytokines and vasoactive mediators, including tumor necrosis factor , histamine, bradykinin, interleukin (IL)-1, IL-2, IL-6, platelet-activating factor, and endothelin-1 are recruited to the pancreatic microcirculation and delivered to the acinar cells . Once this damage to the pancreatic microcirculation has been initiated, it is very difficult to reverse the process, with, for example, aggressive fluid resuscitation
. Vasoconstriction thus appears to be an early event in acute pancreatitis, and there does not appear to be a correlation between total pancreatic blood flow and regional pancreatic perfusion
25 represents a predicted mortality of 50% and a score of
over 35 represents a predicted mortality of 80%.
Total APACHE II = A+B+C
• A → APS points
• B → Age points
• C → Chronic Health points
well-recognized proinflammatory
effect of normal saline and the unintended consequences
of hyperchloremic metabolic acidosis when large
volumes of saline are used in resuscitation