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Approach to a trauma patient - Advanced Trauma Life SupportParthasarathi Ghosh
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References - ATLS Manual 10th Edition
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At the end of the session, the students shall be able to
Describe the HIV AIDS introduction, epidemiology of HIV AIDS, diagnosis of HIV AIDS, treatment of HIV AIDS and prevention control of HIV AIDS.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
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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!
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.
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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
- 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
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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
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1. HIV and the Surgeon
Dr Okpako Isaac Oghenero
Senior Registrar Plastic and Reconstructive surgery
Department of surgery
University of Abuja Teaching Hospital Gwagwalada
14/11/2023
2. Outline
• Introduction
• Historical perspective
• Epidemiology
• Structure
• Life cycle
• Pathophysiology
• HIV and the surgeon
• Management
• Factors affecting transmission
• Risk of transmission
• How to handle needle prick/ body fluid contact
• Use of Post exposure prophylaxis
• Current trend
• Conclusion
3. Introduction
• HIV – human immunodeficiency virus is a retro virus that is known to
be destructive to T cells
• By destroying T cells they alter the immune system and makes the
body prone to opportunistic infections
4. Historical perspective
• First known AIDS patient died.(1976)
• First human retrovirus isolated (HTLV-1) (1980).
• Named HIV-1 & later HIV-2.(1986)
5. Epidemiology
• Nigeria is the most populous country in Africa with an estimated
population of over 200 million.
• First reported AIDS case in the country was in 1986.
• Estimated number of affected person in 2006 was 2.9million (female
predominance).
• It is estimated that there are about 1.8 million people in Nigeria living
with HIV in 2019
6. Structure
• HIV is a retrovirus of the lentivirus family
• It is an RNA virus
• It has a cylindrical core containing the RNA genome, reverse
• transcriptase, and some core proteins
• The virus envelope is derived from the host cell membrane,
• The envelope has a protein called GP 120 which has affinity for CD4
bearing cell chief of which is the T helper cell
7.
8. Life cycle
• It has seven phases
• Binding
• Fusion
• Reverse transcription
• Integration
• Replication
• Assembly
• Budding
9.
10. Pathophysiology
• Mode of transmission
• Unprotected sexual contact with an infected person (oral, analor
vaginal) (75%)
• Vertical transmission
• Exposure to infected blood/blood products e.g. needle pricks sharing
of needles by intravenous drug abusers
• Transfusions and Blood Products: Hemophiliac population
11. Pathophysiology
• Mode of transmission
• About 378,000 - 756,000 needle sticks occur every year.
• 30% are due to recapping,
• 30% are due to improper disposal, and
• 30% are due to unexpected movement of patient or another worker
12. Pathophysiology
• Seroconversion / window period
• This is the period from inoculation to when an individual produces
sufficient antibodies to be able to test positive to the disease
• Usually within 6 to 12 weeks
• Most people by 3 months would have seroconverted hence 3 months
is generally used as the window period
13. Pathophysiology
• AIDS
• With HIV infection, there is continuous destruction of the helper T cells and
replication of more viruses within the dying Helper T cells
• Helper T cells are necessary for amplification of immune responses among other
functions
• The consequent production of more viruses and destruction of helper T cells would
eventually lead to a state of weakened immunity referred to as AIDS with resultant
opportunist infections
• Median progression rate (HIV to AIDS) is about 10 years
14. Pathophysiology
• Criteria for diagnosis of AIDS
• Less than 200 CD4+ T cells per cubic millimeter of blood, compared with about 1,000
CD4+ T cells for healthy people
• CD4+ T cells accounting for less than 14 percent of all lymphocytes
• One or more of the following
• Candidiasis of bronchi, esophagus, trachea or lungs
• cervical cancer that is invasive
• Coccidioidomycosis that has spread
• Cryptococcosis that is affecting the body outside the lungs
• Cryptosporidiosis affecting the intestines and lasting more than a month
• Cytomegalovirus disease outside of the liver, spleen or lymph nodes
• Cytomegalovirus retinitis that occurs with vision loss
• Encephalopathy that is HIV-related
• Herpes simplex including ulcers lasting more than a month or bronchitis, pneumonitis or
esophagitis
• Histoplasmosis that has spread
15. Pathophysiology
• CD4 counts determine staging of HIV disease and need for treatment.
• Viral Loads determine effectiveness of ARV treatment.
• Increased risk of opportunist infection if CD4 <200cell/mm³
• If Viral load > 10000 copies/ml suggest that ARV is no longer
effective.
17. Relationship
• Patients who require surgery for complications of HIV/AIDS
• HIV patient who require surgery for other surgical condition not
related to HIV/AIDS
• Asymptomatic HIV patient who require surgery for other non
HIV/AIDs related conditions
18. Patients who require surgery for complications of
HIV
• Some examples of surgery in this categories are
• Biopsies e.g lymph nodes ulcers
• Kaposi sarcoma
• Venous cut down
• Cryptosporidial acute cholangitis
• Cytomegalovirus induced gastrointestinal bleeding & perforation
• Gastrointestinal obstruction from Gastrointestinal stroma tumor
19. HIV patient who require surgery for other surgical
condition not related to HIV/AIDS
• Wound debridement for Road traffic accident
• Organ transplantation
• Acute appendicitis
• External/internal fixation of a fracture
20. Asymptomatic HIV patient who require surgery for
other non HIV/AIDs related conditions
• They may look more healthy than many people and this makes
suspicion less likely among hospital personnel and thus increases the
chances of transmission.
22. Management
• Preoperative
• History taking
• Ensure the following are evaluated in the history
• Knowledge of HIV status
• Medication being taken and adherence to medication and hospital care
• progression to AIDS and complication arising from use of HAART
• comorbidities (e.g. diabetes, asthma, hypertension, sickle cell anemia among
others) and if present their management
23. Management
• Preoperative
• Examination
• General physical examination
• Anemia, jaundice, BMI, level of hydration and lymphadenopathy
• Systemic examination
• Presence of and character of ulcers
• Presence of and character of tumors in all systems
• Presence of and character of deformity, malformation
24. Management
• Preoperative
• Investigation
• Confirmation of diagnosis
• Retroviral screening
• To know extent of disease progression
• CD count
• Viral load
• To prepare patient for surgery
• Fbc
• Eucr
• gxm
26. Management
• Intraoperative
• Adopt universal precautions
• The scrub-up ritual
• Double gloves
• Use of face mask
• Use of Eye protection
• Waterproof gown, shoes, and aprons
• No hand-to-hand passage of sharps
• No re-sheathing of Needles
• Finger not to be used as needle guide
• Correct disposal of sharps
27. management
• Post operative
• Adopt universal precaution
• Use of gloves face mask
• Avoid contact with patient body fluid
• recommencement of HAART
28. Factors affecting transmission
• Amount of blood involved in exposure
• Amount of virus in patient’s blood at time of exposure
• Post-exposure prophylaxis usage
29. • Risk of transmission
• Percutaneous- 0.3%
• Mucous membrane-0.1%
• Non-intact skin-< 0.1%
• The risk of HIV transmission (without prophylaxis) is 0.3%
• (3/1,000) from percutaneous injury and 0.09% (9/10,000)
• from mucocutaneous exposure
30. Risk of transmission
• Highest Risk
• deep parenteral inoculation via hollow needle
• parenteral inoculation with high viral titters
• Less Risky
• small volume via non-hollow needle
• mucosal exposure/non-intact skin exposure
• Risk not identified
• intact skin exposure
• exposure to urine, saliva, tears, sweat
31. How to handle needle prick/ body fluid
contact
• Percutaneous:
• Remove gloves
• Remove foreign materials
• Do not squeeze, allow blood or secretions flow freely
• wash needle pricks and cuts with soap and water
• on-intact skin exposure:
• wash with soap and plenty of water or antiseptic
• Mucous membrane
• flush, mouth or skin with plenty of water
• irrigate eyes with clean water, sterile saline
32. Use of Post exposure prophylaxis
• Evaluation
• If patient is negative no need for PEP but do repeat in 3 months
• Health personal positive – commence HAART
• Patient is positive and health personnel is negative commence Post
exposure prophylaxis
• If no possibility for testing assume positive and commence PEP and monitor
• PEP should be given less than 72 hrs at best within 1 hr of exposure and for
4 weeks with 3 drug combination
• AZT, lamivudine & indinavir
34. Conclusion
• HIV affects the surgeon in various ways as he/she would have to
operate on them either for conditions relating to the HIV or non
related HIV condition or even for patients who do not manifest
symptoms of the disease but need surgery