Omphalocele and gastroschisis are abdominal wall defects occurring in around 1 in 5000 births. Omphalocele involves intestines and other organs protruding through the umbilical cord, covered by a membrane. Gastroschisis involves intestines protruding through an opening beside the umbilical cord without a membrane. Associated anomalies are more common with omphalocele. Prenatal diagnosis involves ultrasound and alpha-fetoprotein levels. Perioperative care focuses on fluid replacement and ventilation support given fluid losses from exposed organs. Primary closure is done if intragastric pressure is low, otherwise a delayed closure technique is used. Postoperative complications can include hypertension and edema.
seminar (Undescended testes)
Define the undescended testes.
Differentiate between the undescended testes , retractile testes .
Etiology and complication of the undescended testes.
Work up and management plan for the undescended testes .
Define the undescended testes.
Differentiate between the undescended testes , retractile testes .
Etiology and complication of the undescended testes.
Work up and management plan for the undescended testes .
Define the undescended testes.
Differentiate between the undescended testes , retractile testes .
Etiology and complication of the undescended testes.
Work up and management plan for the undescended testes .
Define the undescended testes.
Differentiate between the undescended testes , retractile testes .
Etiology and complication of the undescended testes.
Work up and management plan for the undescended testes Majmaah University
Intussusception is the most common acute abdominal disorder of early childhood. In this lecture, we describe the manifests of Intussusception, the diagnosis, and the treatment of this disease.
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
seminar (Undescended testes)
Define the undescended testes.
Differentiate between the undescended testes , retractile testes .
Etiology and complication of the undescended testes.
Work up and management plan for the undescended testes .
Define the undescended testes.
Differentiate between the undescended testes , retractile testes .
Etiology and complication of the undescended testes.
Work up and management plan for the undescended testes .
Define the undescended testes.
Differentiate between the undescended testes , retractile testes .
Etiology and complication of the undescended testes.
Work up and management plan for the undescended testes .
Define the undescended testes.
Differentiate between the undescended testes , retractile testes .
Etiology and complication of the undescended testes.
Work up and management plan for the undescended testes Majmaah University
Intussusception is the most common acute abdominal disorder of early childhood. In this lecture, we describe the manifests of Intussusception, the diagnosis, and the treatment of this disease.
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
This is a detailed lecture about different complications of Hernia and their management. Including; Irreducible, obstructed, strangulated, incarcerated hernia.
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.
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.
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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!
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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.
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.
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
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
2. Omphalocele (Exomphalos)
Incidence: 1 in 5000 live births
• Gut contents are normally extruded out in
the 5th week of fetal life
•During this time the pleuro peritoneal
cavities which are in unison get divided into
thoracic
and abdominal cavities by the newly formed
diaphragm (around 7th week)
•around 9th week, the extruded gut contents
come back into the abdominal cavity.
•If there is failure on part of the gut contents to come back into the abdominal
cavity in entirety, then a part of the gut remains outside.
• This mass of tissue is ensheathed by a membrane called amnion
•this membrane affords protection against both infection and loss of extracellular
fluid.
• typically the umbilical cord is at the apex of the mass.
3. Gastroschisis
Incidence: 1 in 5000 live births
• Gut contents are normally extruded out in the 5th
week of fetal life
•During this time the pleuro peritoneal cavities which
are in unison get divided into thoracic and
abdominal cavities by the newly formed diaphragm
(7th week)
• around 9th week, the extruded gut contents come
back into the abdominal cavity.
• unlike an omphalocele, gut contents enter back in
entirety at 9th week.
•owing to a disruption in blood supply from the omphalomesenteric artery, there is
ischemia and atrophy of several layers of abdominal wall at base of the umbilical
cord.
• This leads to an area of weakness in the abdominal wall.
4. Gastroschisis
•It is through this weakness that gut
contents pouch out later in foetal life. There
is no membrane covering the mass and
therefore no protection is afforded against
infection or loss of extra cellular fluid.
•As the gut lies exposed (without a
membrane) it tends to irritate the uterine
lining increasing the chances of premature
delivery.
•typically the umbilical cord is at one side of
the mass
5. Associated congenital anomalies
•Are more with omphalocele than Gastroschisis
1. Bowel atresia
2. Imperforate anus
3. Congenital heart disease (20%)
4. Bladder exostrophy
5. Beckwith Weidman syndrome: Mental retardation, hypoglycemia, congenital
heart disease, large tongue and omphalocele
6. Other defects predominantly involving the gut such as malrotation.
6. Antenatal diagnosis
•Involves assessment of α fetoprotein levels which are high in
abdominal wall defects.
•Maternal Serum α fetoprotein level is also assessed but is less sensitive than α
fetoprotein from amniotic fluid.
• Levels of these markers are high in omphalocele.
• USG helps in definitive diagnosis
• USG additionally helps in picking up coexistent congenital anomalies.
7. Preoperative care
•Obtain I.V. access
• Assess for associated congenital anomalies
• Manage respiratory insufficiency.
• Aspirate from the nasogastric tube.
8. Perioperative care
1. Anticipate difficulty airway in a neonate with large tongue as in Beckwith
Wiedemann syndrome
2. IV or inhalational induction may be preferred. Rapid sequence induction is also
found to be useful.
3. Endotracheal intubation (nasal tube) and IPPV are required.
4. Maintenance with volatile anesthetic with oxygen and air.
5. If extubation is not planned for at the end of surgery then judicious use of opoids
is accepted.
6. A caudal epidural confers good post operative analgesia.
7. An arterial line is helpful in monitoring blood pressure and arterial blood gases.
8. Since a large volume of tissue is exposed to room air, the amount of loss in
terms of fluids can be substantial and need to be replenished.
9. To this end, organ perfusion needs to be maintained at optimal levels, especially
so when the abdominal contents are compressing the inferior vena cava and
compromising cardiac output.
9. Perioperative care
11.During surgery intra-abdominal pressure increases, lung compliance falls, and
ventilation usually becomes more difficult. Ventilatory rate and pressure along
with the FIO2 usually need to be increased. A slight degree of head up may be
helpful.
12. To summarise, the chief concerns in these surgeries are fluid loss replacement
and maintaining ventilation.
13.Fluid loss must be minimised by covering the gut contents outside the
abdominal cavity with a sterile bag containing saline.
10. Perioperative care
14.Fluid loss replacement is best done with balanced salt solution with 5% albumin.
15.It is best to avoid N2O to prevent further abdominal distension.
16.Adequate muscle relaxation is important to facilitate better closure of abdominal
wall, but if the defect is large then a forceful closure may hamper circulation to
bowel, Kidneys and lower limb. In fact use of pulse oximetry to assess perfusion
in the lower limb is avidly advocated.
11. When to attempt a primary closure in a single
sitting as opposed to multiple sittings…?
• Intragastric pressure is measured.
• If it is below 20 mm of Hg then a primary closure is done in a single sitting.
• If it is above 20 mm of Hg then a delayed closure technique is adopted.
If closure is difficult through conventional approaches…?
• A wide silo is incorporated into the abdominal wall covering the viscera.
• Every 2-3 days the silo is reduced either bedside or on the OT table with or
without Ketamine.
• A hurried reduction impedes circulation and compromises oxygenation
• After several stages of such reduction final solution is to achieve complete
closure under general anesthesia with muscle relaxation.
• Surgery may not be an immediate solution, but probably remains the only
effective one.
12. Post operative care
• Coexistent pulmonary hypoplasia (especially in Omphalocele) requires careful
consideration during ventilation
Too little risks inadequate
oxygenation
Too much results in barotrauma
• Better not to extubate
• Postoperative complications include
Post operative hypertension
Edema of extremities
13. Post operative care
• Post operative hypertension
Increased intra abdominal pressure
Decreased renal perfusion
Increased renin secretion
Activation of renin-angiotensin-aldosterone
system
Hypertension