Clinically, more term babies suffered from hypoxic ischemic encephalopathy (HIE) than premature babies. However, pathologically, more premature babies suffered from HIE than term babies. The main clinical manifestations of HIE are symptoms of consciousness, including excitation symptoms like hyperalertness, irritability, and seizures, or depressing symptoms like coma and hypotonia. Management of HIE focuses on monitoring, controlling seizures, general supportive care, and recent advances like therapeutic hypothermia. The prognosis depends on the severity of brain damage and treatment, with mild or moderate cases often recovering completely but severe cases having a high risk of mortality or long-term complications.
Management of hypoxic ischemic encephalopathy (HIE) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Management of hypoxic ischemic encephalopathy (HIE) . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
Management of hypoxic ischemic encephalopathy (HIE) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Management of hypoxic ischemic encephalopathy (HIE) . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
Birth asphyxia, with Tanzania perspectiveJoseph Kimaro
Birth asphyxia is one of contributors to neonatal death, Some of the causes are easily preventable. Health care workers should be equipped with knowledge, skills, equipment and supplies for management of asphyxiated newborns.
management of intraventricular hemorrhage with alteplaseSurendra Patel
Intraventricular hemorrhage (IVH) is mostly secondary to spontaneous intracerebral hemorrhage (ICH), traumatic brain injury (TBI) or aneurysmal and arteriovenous malformation rupture. IVH is a proven risk factor for poor prognosis, and mortality estimates for IVH range from 50% to 80%. For IVH secondary to spontaneous supratentorial hemorrhage, the mortality and poor prognosis rate are 72% and 86%, respectively. The outcome is often worsened by development of acute hydrocephalus, mass effect of ventricular blood, the toxicity of intraventricular blood clots, and chronic hydrocephalus.The current therapy for intraventricular hemorrhage (IVH) causing obstructive hydrocephalus is drainage of blood and CSF through an external ventricular drain (EVD). Thrombolytic drugs, particularly recombinant tissuetype plasminogen activator (rtPA), can be administered safely into the ventricles of patients with IVH once IVH volume has stabilized and these drugs significantly shorten the time of blood clot resolution in both experimental models and humans.
Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathyMCH-org-ua
International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)
Growth charts in Neonates- Preterm and termSujit Shrestha
Growth charts in Newborn, Preterm and term neonates. All historically used charts in NICU are discussed here.
Presented by Dr Sujit, in Sir Ganga Ram Hospital
Antibiotic use in neonates. Protocols , Rationale, Antibiotic stewardship and newer agents, NICU microbiological profile. A grand presentation by Dr. Maskey in TUTH.
The newer antibiotics added to Our Arsenal against resistant bacteria. Know about the upcoming antibiotics and newer antibiotics in use.
Free text at
http://medchrome.com/basic-science/pharmacology/newer-antibiotics-review/
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
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
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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 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.
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
1. DR SUJIT SHRESTHA
NEONATOLOGY ( SGRH)
MD PEDIATRICS ( IOM, TUTH)
LECTURER, DEPARTMENT OF PEDIATRICS
NMCTH
Hypoxic Ischemic Encephalopathy
(Neonatal Asphyxia): MBBS
2. Definition: Birth asphyxia
Birth asphyxia is defined as a reduction of
oxygen delivery and an accumulation of carbon
dioxide owing to cessation of blood supply to the
fetus around the time of birth.
4. APGAR score
Score 0 1 2
Heart rate none <100 > 100
Respiration none irregular regular
Muscle tone limp reduced normal
Response to none grimaced cough
stimulation
Color of trunk white blue pink
7. Diagnosis
1/ Evidence of fetal distress
2/ Fetal metabolic acidosis
3/ Abnormal neurological state
4/ Multiorgan involvement
8. HIE Definition
Refers to CNS dysfunction or encephalopathy
associated with Perinatal asphyxia.
Potential to cause mortality and long term sequele
like disabilities and cerebral palsy.
9. Etiology
Pathologically, any factors which interfere with
the circulation between maternal and fetal blood
exchange
maternal factor, delivery factor and fetal factor.
10. Etiology—High Risk Factors
Maternal factor:
hypoxia, anemia, diabetes, hypertension, smoking,
nephritis, heart disease, too old or too young,etc
Delivery condition:
Abruption of placenta, placenta previa, prolapsed
cord, premature rupture of membranes,etc
Fetal factor:
Multiple birth, congenital or malformed fetus,etc
11. Pathophysiology
Asphyxia self-defensive mechanism
redistribution of blood flow to vital organs
( brain, heart and adrenal) to prevent from
hypoxic damage. ‘ Diving Reflex’
12. Pathophysiology
Hypoxic cellular damages:
a. Reversible damage(early stage):
Hypoxia may decrease the production of ATP,
and result in the cellular dysfunctions . But these
change can be reversible if hypoxia is reversed in
short time.
14. Pathophysiology
Cerebral blood flow
Early stage: normal (intraorgans shunt)
then slow down (selective vulnerability)
finally ischemia – Watershed regions
Cerebral metabolism – altered
Cellular electrolyte alteration- Na, Ca
17. Status Marmoratus: basal ganglia lesion resulting from
asphyxia. The lesions have a marbled appearance caused by
neuronal loss and an overgrowth of myelin in the putamen,
caudate, and thalamus.
Selective vulnerability - The hippocampal pyramidal
cells of CA1, pyramidal neocortical neurons (layers 3, 5, and
6), Purkinje cells, and striatal neurons have the highest
vulnerability.
18. Clinically, more term babies suffered
from this disease than premature
babies.
Pathologically, more premature
babies suffered from this disease
than term babies.
27. Electrolytes- Na and Calcium should be monitored.
Avoid Polycythemia: If Hct>65-70 , partial exchange
transfusion is done to bring Hct level to 55.
28. Control of seizures: HIE seizures are difficult to
control
Phenobarbital
loading dose 15-20mg/kg, iv
maintenance dose 3-5mg/kg, iv
Phenytoin
loading dose 15-20mg/kg, iv
maintenance dose 5mg/kg, iv
Midazolam: 0.1-0.3mg/kg, iv
Leveracetam, Topiramate
29. Special Investigations
EEG
Routine EEG does not help
Continous aEEG- Amplified EEG used for cerebral function
monitoring
Detects voltage pattern- burst, low voltage, isoelectric
Detects electrical seizure activity
Cranial Ultrasound:
Not good modality
Preterm – IVH, Periventricular leukomalacia
Severe cases- hypoechoic areas.
31. CT scan: only indicated in emergency
Generalized low attenuation of brain parenchyma in acute
stage.
local or patchy hypodensity, extensive & generalized hypodensity,
usually combined with brain hemorrhage
MRI
Time consuming
DWI ( Diffusion weighted imaging) is helpful in early stage.
Within hours shows restricted diffusion to hypoxic areas.
32. Recent advances in Management
Cerebral Hypothermia
Selective head cooling ( CoolCap trial ) vs Whole body cooling
Decreases brain metabolism and injury.
>=36 weeks and >=2000gm
Cooling upto 33-34 C.
Provided for 72 hours
Seen to have better outcomes specially for moderate HIE cases.
34. Prognosis
Depend on the severity of brain damage & medical
treatment, usually:
Mild or moderate cases could be cured completely, but
severe cases represent poor prognosis with high mortality
or cerebral complications such as mental retardation &
cerebral palsy.
35. Overall mortality – 20%
Overall incidence of sequele - 30%
Mild : 100% good prognosis
Mod : 80% normal
Severe : 50% death, 50% sequele
Presence of seizure increases chance of Cerebral
palsy by 50-70 times.