Lecture on DKA in pregnancy - presented at JGH Obstetrics & Gynaecology Teaching Jan 2020. Fictional details have been used to anonymise any resemblance to persons living or passed.
An introduction to total parenteral nutrition. This was from a lecture given to medical students, internal medicine residents, and gastroenterology fellows
I presented a hyperemesis case for a Case Study Seminar where university faculty were invited to attend and RD\'s from the community could receive CPE\'s for attending.
Lecture on DKA in pregnancy - presented at JGH Obstetrics & Gynaecology Teaching Jan 2020. Fictional details have been used to anonymise any resemblance to persons living or passed.
An introduction to total parenteral nutrition. This was from a lecture given to medical students, internal medicine residents, and gastroenterology fellows
I presented a hyperemesis case for a Case Study Seminar where university faculty were invited to attend and RD\'s from the community could receive CPE\'s for attending.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
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
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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ibdpresentation-140206191203-phpapp01.pdf
1. +
Inflammatory Bowel Disease
Christina Kalafsky, Dietetic Intern
University of Maryland College Park
Children’s National Medical Center Case Study
January 31, 2014
3. +
Inflammatory Bowel Disease
Inflammatory bowel disease
(IBD) involves chronic
inflammation throughout the
GI tract.
Crohn’s Disease
Ulcerative Colitis (UC)
Indeterminate Colitis
Diagnosis:
EGD/Colonoscopy
Biopsies
Blood Work
4. +
Inflammatory Bowel Disease
Who:
IBD can affect children of any age
Peak incidence of IBD onset is between 15 – 25 years old
Affects males and females equally
Causes:
Abnormal reaction of the body’s immune system- once it’s “turned
on,” it does not know how to “turn off” properly.
**Genetics
Stress
Toxins/Antigens
Bacterial Overgrowth
5. +
Inflammatory Bowel Disease
Signs/Symptoms:
Abdominal pain, diarrhea, weight loss, GI bleeding.
Location of the inflammation
Nutritional Implications: Malnutrition
Inadequate Oral Intake
Malabsorption
Increased Energy Needs
Malnutrition Impaired growth
Treatment:
Corticosteroids
Ulcerative colitis can be cured by a total colectomy
No cure for Crohn’s disease- May achieve prolonged remissions with
diet, surgical intervention, and medical treatment.
100% exclusive EN feeds can be used to induce remission
6. +
Nutrition and IBD
There is no specific meal plan for IBD
During a Flare:
Low residue diet
Avoid “trigger foods” (sugar, artificial sweeteners, spicy foods,
caffeine, lactose)
BRAT diet
Small, frequent meals
CAM
During Remission:
Regular, balanced diet following
MyPlate guidelines
Continue to avoid “trigger foods”
8. +
Case Study Background
KK is a 15 year old female
PMH: No previous illnesses or hospitalizations
Admitted 1/18/14- Presented with worsening abdominal pain,
emesis x 12 days, diarrhea and fever
Hx of constipation. Experienced lower abdominal pain, loose
stools, hematochezia, and a reported 24-pound unintentional
weight loss over the past two months.
Patient with suspected IBD and development of sepsis.
No family hx of IBD
10. +
Medications
Medication Function
Possible Nutrition-Related Side
Effects
Vancomycin Antibiotic Diarrhea
Magnesium Sulfate
(PRN)
Repletion Hypermagnesemia
Morphine (PRN) Opiate (narcotic) analgesic Nausea, Vomiting, constipation,
diarrhea, loss of appetite, weight loss
Piperacillin Antibiotic Diarrhea, upset stomach, vomiting,
unpleasant or abnormal taste, gas,
constipation
Protonix Proton pump inhibitor, anti-
GERD
Nausea, vomiting, gas; may decrease
absorption of iron and vitamin B12
Nalbuphine Analgesic Upset stomach, vomiting, dry mouth,
stomach cramps, bitter taste
Zofran Anti-nausea Dry mouth, abdominal pain,
constipation, diarrhea
11. +
Weight-for-Age
Reported Weight Two Months
Ago:
56.8 kg
50th – 75th percentile
Weight Age: 18.5 years old
Current Weight:
45.8 kg
10th – 25th percentile
Weight Age: 13 years old
14. +
Diet History
Patient experienced emesis associated with food intake for 12
days prior to admission.
Patient with increased fluid needs due to losses through high
volume diarrhea and frequent emesis daily. KK was able to
keep down some Gatorade, however, this is likely not meeting
her estimated needs.
Based on patient’s report of poor intake prior to admission,
unintentional weight loss, and admitting lab values, the
patient’s diet was inadequate for estimated macronutrient,
micronutrient, and fluid requirements.
15. +
PES Statements
Altered GI function related to suspected IBD as evidenced by
lower abd pain x 2 months, loose stools, hematochezia, and
reported 24 lb unintentional wt loss.
Inadequate oral intake related to nausea and vomiting
(secondary to suspected IBD), as evidenced by reported poor
intake x 12 days PTA.
16. +
Estimated Nutrient Needs
Kcals: 42 kcal/kg
EER/age using IBW x 10% to account for inflammation associated
with IBD
34 kcal/kg while on TPN
Protein: 1.5 g/kg
ASPEN recommendations/age for critically ill
Fluids: 2016 ml/day (44.02 ml/kg)
Holliday-Segar Method
17. +
TPN
Date TPN Order
1/22/14 Total Volume: 2020 mL/day
Dextrose: 10%
Protein: 2 gm/kg/day
Lipid: 1 gm/kg/day (over 12 hours)
18. +
Recommendations
As soon as medically appropriate, advance to low-residue diet
as tolerated. RD available to provide education when needed.
Continue TPN. Recommend 2,020 ml total fluid, D10%, 2 g/kg
protein, 1 g/kg lipid to provide 33 kcal/kg.
Will continue to adjust TPN per electrolytes. Continue to bolus
as needed.
Monitor BMP, Mg and Phos q daily until stable. Monitor CMP,
TG, and Prealbumin q weekly while patient is on TPN.
Monitor weight twice weekly. Goal weight gain is catch-up
growth to the 50th-75th BMI/age percentile.
20. +
Output
Date Output
1/23/14 3550 ml total
1/24/14 4150 ml total
1650 ml stool
1/25/14 4150 ml total
1925 ml stool
1/26/14 6475 ml total
1975 ml stool
1/27/14 5865 ml total
3850 ml stool
1/28/14 3900 ml total
850 ml stool
1/29/14 2625 ml total
500 ml stool
1/30/14 1400 ml total
350 ml stool
21. +
Follow-Ups
1/28/14: (6 days after initial assessment)-
Transferred from the PICU to the 7th floor
TPN x 8 days; NPO except ice chips since admission (10 days)
5.5 kg weight gain since admission (likely related to hydration)
Currently replacing stool output >250 mL q 6 hours 1:1 with normal
saline.
Fevers, abdominal pain, bloody stools
Planned EGD/colonoscopy today
1/30/14: (2 days after follow-up)-
TPN x 10 days. Current TPN not meeting goal kcal needs as lipids were
discontinued today due to elevated LFT labs; Cont. NPO since
admission with only small sips of water and ice chips per GI
recommendations.
Weight fluctuations likely due to fluid shifts.
Stool output improving with only 350 mL documented.
22. +
References
1. Academy of Nutrition and Dietetics. Pediatric Nutrition Care Manual.
http://www.nutritioncaremanual.org. Accessed January 23, 2014.
2. Crohn’s & Colitis Foundation of America. What Are Crohn’s and Colitis? CCFA
Web site. Available at: http://www.ccfa.org/what-are-crohns-and-colitis/. Accessed
January 29, 2014.
3. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.
Pediatric Inflammatory Bowel Disease: Evaluation and Management. 2nd ed.
NASPGHAN Web site. Available at: http://www.naspghan.org/user-
assets/Documents/pdf/CDHNF%20Old%20Site/IBD%20Medical%20Professional
%20Resources/NEW_PediatricIBDSlideSet_2ndEdition.pdf. Accessed January
28, 2014.
4. ASPEN. Inflammatory Bowel Disease. The A.S.P.E.N. Pediatric Nutrition Support
Core Curriculum. 2010.
5. Children’s National. Nutrition and Gastrointestinal Diseases Slides. January 20,
2014.
6. Children’s National. Nutrition and Inflammatory Bowel Disease.
7. Children’s National. Critical Care Nutrition Support Slides. January 20, 2014.