This document provides an overview of goiter (enlargement of the thyroid gland). It defines goiter and discusses the surgical anatomy and embryology of the thyroid gland. It covers the etiology, classification, pathophysiology, clinical presentation, workup, treatment, and complications of goiter. The document also discusses prevention of goiter through primary, secondary and tertiary prevention measures.
Benign prostatic hyperplasia is an enlargement of the prostate gland resulting from an increase in the number of epithelial cells and stromal tissue and developing upward into the bladder and obstructing the outflow of urine.
Benign prostatic hyperplasia is an enlargement of the prostate gland resulting from an increase in the number of epithelial cells and stromal tissue and developing upward into the bladder and obstructing the outflow of urine.
Intestinal obstruction is a significant or mechanical blockage of intestine that occurs when food or stool can not move through the intestine.
These obstruction may be complete or partial.
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A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a number of types. Most commonly they involve the abdomen, specifically the groin. Groin hernias are most commonly of the inguinal type but may also be femoral
Intestinal obstruction is a significant or mechanical blockage of intestine that occurs when food or stool can not move through the intestine.
These obstruction may be complete or partial.
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A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a number of types. Most commonly they involve the abdomen, specifically the groin. Groin hernias are most commonly of the inguinal type but may also be femoral
cause,pathogensis,clinical features,treatment,prevention are explained in short .. pls comment if u want anythin to be added .. or if u want to know something more abt typhoid ... i wud consider it as a positive stimulus for me ....
This is a clinical case presentation of Nodular Thyroid in a 40 year old woman. Detailed Anatomy, Physiology of Neck region including thyroid with their pahophysiology. Possible investigations and modalities of treatment have also been discussed in this presentation.
Gestational trophoblastic disease is a spectrum of interrelated disease processes originating from the placenta.
GTD is a spectrum of tumours with a wide range of biologic behaviour and potential for metastases
They are characterised by an abnormally high amount of HcG levels in the blood
Is a condition seen in some cases of AIDS or immunosuppression, in which the immune system begins to recover, but then responds to a previously acquired opportunistic infection with an overwhelming inflammatory response that paradoxically makes the symptoms of infection worse.
Myobacterium tuberculosis important cause of human TB.
Other closely related species in M. tuberculosis complex
M. bovis
M. africunum
M.microti
M. cannette
Vitamin A defficiency-Hamisi Mkindi.pptMkindi Mkindi
Vitamins
-Water soluble
-Fat soluble
Vitamin A
-fat-soluble vitamin ingested in the diet in
two forms.
-as retinol itself from animal sources or
-as provitamin carotene from plant sources
Previously termed acute renal failure
Reversible deterioration of renal function over hours to days manifested by:
Increase in BUN
Increase in creatinine
Reduced urine output
Oliguria : <400><100 ml urine output in 24 hours
Include infections of skin, subcutaneous tissue, fascia, and muscle, encompass a wide spectrum of clinical presentations, ranging from simple cellulitis to rapidly progressive necrotizing fasciitis.
Diagnosing the exact extent of the disease is critical for successful management of a patient of soft tissue infection
Genital warts are an epidermal manifestation attributed to the epidermotropic human papillomavirus (HPV).
> than 100 types of double-stranded HPV papovaviruses have been isolated thus far, and, of these, about 35 types have affinity to genital sites
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
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
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!
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
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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
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
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.
10. EMBRYOLOGY
Dv from TGD(median bud of pharynx)which
passes from foramen caecum at base of the
tongue to thyroid isthmus
First of the body's endocrine glands to
develop, on approximately the 24th day of
gestation.
2 main structures: the primitive pharynx and
the neural crest.
11. EMBRYOLOGY
The inferior parathyroid glands arise from
the dorsal wing of the third pharyngeal
pouch.
The initial descent of the thyroid gland
follows the primitive heart and occurs
anterior to the pharyngeal gut. At this point,
the thyroid is still connected to the tongue
via the thyroglossal duct.
24. Etiological classification
Physiological goitre
Goitres resulting from increased metabolic
demand of thyroid hormones e.g. during
pregnancy or puberty
Pathological goitre
Goitres resulting from diseases affecting the
thyroid gland e.g. Neoplastic or
inflammatory conditions
25. Epidemiological classification
Familial goitres
goitres that run in families as a result of
Inherited defect of thyroid hormone
synthesis
Endemic goitres
defined as thyroid enlargement affecting a
significant number of inhabitants of a
particular locality
Sporadic goitres
goitres that run sporadically
26. Anatomical classification
Cervical goitre
Goitre situated on the anterior aspect of the
neck
Retrosternal goitre
Goitre extends downward and get situated
behind the sternum
Intrathoracic goitre
The type of goitre which extends into thoracic
cavity
28. Functional classification
Toxic goitre
Type of goitre associated with thyroid
hyperfunction (hyperthyroidism)
Non-toxic
Type of goitre associated with thyroid
hypofunction (hypothyroidism) or normal
thyroid function (Euthyroid)
30. PATHOPHYSIOLOGY
The pathophysiological
consequences of goitres results from
one of the following:-
The effect of thyroid hormone
dysfunction
The effect of enlarged thyroid gland
The effect of primary disease causing
goitre
31. Effect of thyroid hormone
dysfunction
Thyroid hyperfunction (hyperthyroidism)
→Features of hyperthyroidism
Thyroid hypofunction (hypothyroidism)
→ Features of hypothyroidism
32. Effect of enlarged thyroid
gland
Effect on the trachea→ dyspnea
Effect on the esophagus
→dysphagia
Effect on the superior venacava →
distended neck veins
Effect on the recurrent laryngeal
nerve → horsiness of voice
33. Effect of primary disease
causing goitre
The effect depends on the
underlying disease
36. History (Symptoms)…
Pressure-related symptoms
Dysphagia, dyspnoea, hoarseness of
voice, neck vein engorgement etc
Review of systems to assess toxicity
CNS- tremors, irritability, mental
disturbance
CVS- palpitation, dyspnoea, orthopnoea
GI- change of appetite, constipation,
diarrhoea
MSS- bone pain, weight change, heat or
cold preference, excessive sweating
37. History (Symptoms)……..
Past medical history
Previous medication, previous h/o
irradiation
Family and social history
H/o goitre in the family or in the
community
45. Imaging studies
Plain x-ray of the neck
Thyroid ultrasound
Thyroid radioisotope scan
CT scan/MRI
Barium swallow
46. Plain x-ray of the neck
Plain radiography of the neck may
reveal the following:-
Tracheal deviation or compression
Calcification within the goitre
47. Thyroid ultrasound
Help to determine the
physical characteristics of the
goitre and used to:-
distinguish solid from cystic
nodules
assess whether more than
one nodule exists
to assess the exact size
and shape of the thyroid
gland
Aid in ultrasound guided
FNAC
48. Thyroid radioisotope scan
Used to determine the functional activiity by
distinguishing a nodule as hot, warm, or cold,
based on the relative amount of uptake of
radioactive isotope
Hot nodules take up excessive amounts of
isotope and indicate autonomously functioning
nodules
Cold nodules does not radioactive isotope and
therefore indicate hypofunctional or
nonfunctional thyroid tissue
Warm nodules appear gray and suggest normal
thyroid function
The radioactive isotopes that are most commonly
include 123-Iodine, 99m-Technetium and 131-
Iodine
49. CT scan/MRI
Give excellent anatomical detail of
thyroid swelling but have no role in
the first line of investigation
Help to assess recurrence and
intrathoracic or retrosternal goitres
54. Medical treatment
Lugol’s iodine
↓ thyroid hormone synthesis
↓ vascularity
Antithyroid drugs eg Carbimazole
Used to restore the patient to a euthyroid
state
β-adrenergic blockers E.g. propranolol
↓ tachycardia & palpitation
Used to restore the patient to a euthyroid
It also ↓ vascularity
58. Preoperative care
Correct anemia, mobilize blood donor
Treatment of intercurent disease or
infections
The thyroid functional status should be
determined
The patient should be made euthyroid
59. Preoperative care……
Admit the patient a day before
operation
Anesthetic visit
An informed written consent for
operation and anaesthesia
60. Intraoperative care
Types of surgery (Thyroidectomy)
Subtotal thyroidectomy
Near-total thyroidectomy
Total thyroidectomy
Thyroid nodulectomy
The thyroid gland forms as a proliferation of endodermal epithelial cells on the median surface of the developing pharyngeal floor
The rudimentary lateral thyroid develops from neural crest cells, while the median thyroid, which forms the bulk of the gland, arises from the primitive pharynx.
The site of this development lies between 2 key structures, the tuberculum impar and the copula, and is known as the foramen cecum. The thyroid initially arises caudal to the tuberculum impar, which is also known as the median tongue bud. This embryonic swelling develops from the first pharyngeal arch and occurs midline on the floor of the developing pharynx, eventually helping form the tongue as the two lateral lingual swellings overgrow it.
The tubular duct later solidifies into a cord of cells that will form the follicular elements. The proximal segment retracts and subsequently obliterates entirely, leaving only the foramen cecum at the posterior aspect of the tongue. Nonetheless, in some individuals, remnants of this duct may still persist.
The foramen cecum represents the opening of the thyroglossal duct into the tongue; its remains may be observed as a small blind pit in the midline between the anterior two thirds and the posterior third of the tongue.
A pyramidal lobe of the thyroid may be observed in as many as 50% of patients. This lobe represents a persistence of the inferior end of the thyroglossal duct that has failed to obliterate.[1] As such, the pyramidal lobe itself may be attached to the hyoid bone, similar to a thyroglossal duct cyst, or may be incorporated into a thyroglossal duct cyst.
Follicular carcinoma:
Arise from multinodular goitre in cases of endemic goitre,suspect when MNG grows rapidly.
Classified into invasive(angioinvasion and capsular) and non invasive.
Tumor cells line BV and get dislodge into systemic circulation producing secondaries in the bones.
CP:
Solitary nodule,US microcalcification,Peak age 40 years,hard or restricted mobility.
Pts with a thyroid swelling presenting with metastasis in the bone in the form of bone swelling or pathological fractures,common flat bones:skull,ribs,sternum,vertebral column.
Investigations:
Routine investigations.
US scan.
FNAC of nodule.
CT scan
Alkaline phosphatase
Plain x ray reveals osteolytic lesions
Rx:
Surgery:thyroidectomy
Rx mets
Post op thyroxine
Anaplastic carcinoma:
Common older women 60-70.
Majority rapid growing thyroid swelling of shrt duration,surface is irregular and consistency is hard
Stridor
Infiltration of carotic sheath:Berry side positive
Early fixity
Dx:
FNAC and CT
MEDULLARY CARCINOMA OF THE THYROID
Arise from parafollicular C cells which are derived from ultimobranchial bodies and not from thyroid follicle
Hormones produced by MCT
-Calcitonin,prostaglandin and serotonin(5HT),ACTH
Rx:Surgery
T3 produced by deiodination of T4 in liver,muscle,kidney and anterior pituitary
T3 is 3x to 4x than T4
Half life of t3 is 24hrs and t4 is 7days
Free t3 is diadnostic of erly hyperthyroidism
T4:
In euthyroid state t4 is a predominant,total t4 reflect output from thyroid gland