The document discusses a study examining the effects of hypercapnia (high carbon dioxide levels) on cerebral autoregulation and brain injury in very low birth weight infants. The study found that the slope of the relationship between cerebral blood flow and blood pressure, indicating impaired autoregulation, increased with higher levels of carbon dioxide. It suggests that the practice of permissive hypercapnia during early development may impair autoregulation and increase the risk of brain injuries like intraventricular hemorrhage in preterm infants.
Newborn Care: Neonatal asphyxia and resuscitationSaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: resuscitation at birth, assessing infant size and gestational age, routine care and feeding of both normal and high-risk infants, the prevention, diagnosis and management of hypothermia, hypoglycaemia, jaundice, respiratory distress, infection, trauma, bleeding and congenital abnormalities, communication with parents
Newborn Care: Neonatal asphyxia and resuscitationSaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: resuscitation at birth, assessing infant size and gestational age, routine care and feeding of both normal and high-risk infants, the prevention, diagnosis and management of hypothermia, hypoglycaemia, jaundice, respiratory distress, infection, trauma, bleeding and congenital abnormalities, communication with parents
Intra Partum Cardiotocography - dr vivek patkardrvivekpatkar
Cardiotocography ( CTG )
is a procedure of graphically ( graph) recording fetal heart activity and uterine contractions ( Toco ) – both recorded in the same time scale simultaneously and continuously through uterine quiscience and contractions
Intra uterine growth restriction (iugr) Doppler sudy Ryan Mulyana
Intra Uterine Growth Restriction (IUGR) and SGA:
Doppler Management and Prediction of Outcome
Ryan Saktika Mulyana, dr, M.Biomed, SpOG(K)
Maternal and Fetal Medicine, Obstetrics and Gynecology Department,
Udayana University Hospital, Udayana University
Intra Partum Cardiotocography - dr vivek patkardrvivekpatkar
Cardiotocography ( CTG )
is a procedure of graphically ( graph) recording fetal heart activity and uterine contractions ( Toco ) – both recorded in the same time scale simultaneously and continuously through uterine quiscience and contractions
Intra uterine growth restriction (iugr) Doppler sudy Ryan Mulyana
Intra Uterine Growth Restriction (IUGR) and SGA:
Doppler Management and Prediction of Outcome
Ryan Saktika Mulyana, dr, M.Biomed, SpOG(K)
Maternal and Fetal Medicine, Obstetrics and Gynecology Department,
Udayana University Hospital, Udayana University
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
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.
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
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!
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.
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.
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
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Hypercapnia On Cerebral Autoregulation
1. The Effects of Hypercapnia on Cerebral Autoregulation and Neonatal Brain Injury Jeffrey R. Kaiser, MD, MA Department of Pediatrics, Section of Neonatology UAMS College of Medicine Maternal Fetal Network Meeting October 7, 2005 Supported by NINDS 1 K23 NS43185
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7. PaCO 2 is a Potent Regulator of Cerebral Arterioles and CBF CBF CBF
8. Changes in CBF are Highly Associated with Changes in PaCO 2 in VLBW Infants CBF PaCO 2 Kaiser et al, J Pediatr 2004 r 2 = 0.96
9. Maximum PaCO 2 is associated with Worst Grade IVH in VLBW Infants P < 0.001, n = 574 Kaiser et al, In Submission 72-91 81 4 71-84 78 3 69-84 76 2 63-73 68 1 64-68 66 0 95% CI Max PaCO 2 (mm Hg) Worst Grade
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11. Experimental Setup: Continuous Measurement of CBF velocity, Blood Gases, and BP Setup
12. Experimental Setup: Continuous Measurement of CBF velocity, Blood Gases, and BP Transcranial Doppler Setup
13. Experimental Setup: Continuous Measurement of CBF velocity, Blood Gases, and BP Transcranial Doppler Fiber Optic Sensor Setup
14. Experimental Setup: Continuous Measurement of CBF velocity, Blood Gases, and BP Transcranial Doppler Fiber Optic Sensor Setup Umbilical Arterial Catheter Cardio-respiratory Monitor
15. How can we securely fix the Doppler transducer to the newborn head for continuous monitoring?
31. Multivariate Predictors of Severe IVH * Compared to Max PaCO 2 <56 mm Hg .003 1.7-12.8 4.7 Max PaCO 2 >75* .009 1.4-11.1 3.9 Max PaCO 2 63-75* .037 1.1-8.9 3.1 Max PaCO 2 56-63* .019 1.1-3.4 2.0 Vasopressors .035 1.0-3.2 1.8 Multiples NS .39-1.1 .64 Apgar 1 min >3 .003 .71-.93 .81 Gestational age (w) P value 95% CI OR Factor
Editor's Notes
While the etiology of neonatal brain injury is multifactorial, including vascular, extravascular, and intravascular factors, disturbances of CBF and cerebral autoregulation play an important role, and will be discussed here.
Cerebral autoregulation is an essential physiologic mechanism that… This process is achieved in the normal brain by constriction or relaxation of cerebral arterioles induced, respectively, by increases or decreases of BP. The BP range over which CBF remains constant is known as the autoregulatory plateau. In this portion of the curve,the slope is 0. Below and above this range, CBF changes in a pressure-passive manner.
Although cerebral autoregulation is generally considered to be impaired in sick newborn ventilated premature infants. Recent evidence, however, suggests that many premature newborns have intact autoregulation.
PCO2 changes were highly associated with changes in CBF. This is consistent with PCO 2 ‘s known effects on the cerebral vasculature, where hypercapnia produces vasodilation thus increasing CBF.
We observed… ~75% increase in CBF ( Increased in every VLBW infant, Average % increase 75 %) Significant hypercapnia (~50% increase) , Average ∆ from baseline 21 mm Hg From logistic regression analysis, CBF changes were predominantly associated with changes in PaCO2 and not BP
In the determination of cerebral autoregulatory capacity in VLBW infants, we compare changes in CBF to changes in BP after routine neonatal care procedures. Autoregulation testing employed in adults is too invasive for use in premature infants and in fact may induce brain injury in infants lacking autoregulation Surfactant administration and endotracheal suctioning were chosen since they are commonly used procedures in ventilated VLBW infants and are known to affect BP, gas exchange, and CBF.
Continuous Doppler measurements of the middle cerebral artery CBF velocity were made using a transcranial Doppler ultrasound system. The system performs fast Fourier transformation analysis enabling real-time display and calculation of of the blood flow spectra and values for mean CBF velocity, as well as peak systolic and end-diastolic velocities.
Baseline monitoring of physiological variables begins 15 minutes before surfactant administration or endotracheal suctioning and continued for about 45 minutes post-procedure.
Based upon the previous studies in adults and animals, we hypothesized
Permissive hypercapnia, a strategy allowing high PaCO 2 (45−55 mm Hg), is widely used by neonatologists to minimize lung damage in very low birth weight infants. Randomized controlled trials of permissive hypercapnia, however, failed to demonstrate significant improvements in survival without chronic lung disease over routine ventilation strategies.
For each suctioning session, the slope of the relationship between mCBFv and MABP was estimated over the presumed autoregulatory plateau between 30 and 40 mm Hg, when PaCO 2 was statistically fixed at 30, 35, 40, 45, 50, 55, and 60 mm Hg using a multiple regression model. A slope near or equal to 0 suggests intact cerebral autoregulation. Progressive values >0 represent increasing impaired autoregulation.
Here you can see the slopes of the autoregulatory plateau with increasing PaCO2 levels. Again, the slopes for CO2 30-40 are not statistically different from 0, while the slopes for PaCO2 levels >40 progressively increase.
The results are displayed here in a different way. Here you can see the slopes of the autoregulatory plateau with increasing PaCO2 levels. Again, the slopes for CO2 30-40 are not statistically different from 0, while the slopes for PaCO2 levels >40 progressively increase.
The slope of the relationship between mCBFv and MABP increases with increasing PaCO 2 levels, suggesting that the cerebral circulation becomes more pressure passive with increasing PaCO 2 .
With increasing hypercapnia, there is maximal vasodilation of resistance arterioles, such that: further vasodilation becomes inadequate during hypotension. Sufficient vasoconstriction is not possible when BP increases. The cerebral circulation becomes pressure-passive.