ITP is the most common cause of acute thrombocytopenia in otherwise healthy children, usually occurring 1-4 weeks after a common viral infection. The exact cause is unknown but is believed to involve autoantibodies against platelets. Clinical presentation involves bruising and petechiae. Diagnosis is made based on thrombocytopenia on CBC and normal bone marrow biopsy. First line treatment includes IVIG or corticosteroids to rapidly increase platelet counts. For chronic cases or those with life-threatening bleeding, splenectomy may be considered, though it carries risks of infection and thrombosis.
simlpe approach to anemia in children , how to diagnose anemia in kids ,types of anemias ,causes of anemia , iron deficeincy anemia, hemolytic anemias , laboratory tests in anemia ,
simlpe approach to anemia in children , how to diagnose anemia in kids ,types of anemias ,causes of anemia , iron deficeincy anemia, hemolytic anemias , laboratory tests in anemia ,
- 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
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
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
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
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.
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.
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).
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
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.
3. ITP is the most common cause of acute onset of
thrombocytopenia in an otherwise well child.
EPIDEMIOLOGY
• Occurs 01 in 20,000 births.
• Usually 1-4wk after exposure to a common viral infection
(50% - 65% of cases).
• Male : Female equal in childhood.
• More often in late winter & spring (peak season of viral
respiratory illness).
4. PATHOGENESIS
• Idiopathic.
• Exact antigenic target for most such antibodies in most
cases of childhood acute ITP remains undetermined.
• In chronic ITP May demonstrate antibodies
against platelet glycoprotein.
complexes, αIIb-β, GPIb.
5. • Most common viruses which are associated with ITP are
EBV (short duration) & HIV (chronic)
Rarely in children infected with H. pylori and following
vaccines.
6. CLINICAL MANIFESTATIONS
• Classic presentation of ITP in previously healthy child is
sudden onset of petechiae and purpura.
• Parents often state that child was fine yesterday and
now covered with bruises and dots.
• There may be bleeding from the gums and mucous
membrane.
• Finding on physical examination are normal other than
petechiae and purpura.
• Splenomegaly, lymphadenopathy, bone pain, pallor are
rare.
7. CLASSIFICATION SYSTEM BY UNITED KINGDOM
To characterize the severity of bleeding in ITP.
NO
SYMPTOMS MILD MODERATE SEVERE
Bruising and
petechiae,
occasional minor
epistaxis, very
little interference
with daily living.
More severe skin
and mucosal
lesions, more
troublesome
epistaxis and
menorrhagia.
Bleeding
episodes –
Menorrhagia,
epistaxis, melena
– requiring
transfusion or
hospitalization,
symptoms
interfering
seriously with the
quality of life.
8. INVESTIGATIONS
CBC:
• Severe thrombocytopenia (platelet count < 20 ˣ109 /L).
• Platelet size normal or increase (reflective of increase
platelet turnover).
• Hemoglobin, WBC Count, Differential Count should be
normal. (Mild anemia may be due to bleeding).
PT & APTT:
• Normal.
BLEEDING TIME:
• Increased.
9. PERIPHERAL SMEAR:
• Thrombocytopenia, normal erythrocyte and leukocyte
count.
BONE MARROW ASPIRATION / BIOPSY:
• Normal granulocyte and erythrocte series, with normal or
increased numbers of megkaryocytes.
• Immature megakararyocyte may b present reflective of
increase platelet turnover.
HIV STUDIES:
• At risk population.
10. COOMBS TEST (Direct antiglobulin testing):
• If unexplained anemia to rule out Evans Syndrome
(autoimmune hemolytic anemia with thrombocytopenia).
OR
• Before giving therapy with IV anti-D.
PLATELET ANTIBODY TESTING:
• Seldom useful in acute ITP.
Other lab tests should be performed as indicated by history and
examination.
11. DIFFERENTIAL DIAGNOSIS
• Acquired Aplastic Anemia
• Myelodisplastic Syndrome
• Leukemia
• Lymphoma
• DIC
• Hemolytic Uremic Syndrome
• SLE, HIV infection
• Wiskott-Aldrich Syndrome (WAS)
CONGNITAL:
a. TAR (Thrombocytopenia-Absent Radius) Syndrome
b. MYH0-Related thrombocytopenia
• Exposure to radiations, medications and drugs
(Heparin induce thrombocytopenia)
• Insect bite
12. TREATMENT
• There are NO DATA showing that treatment affects either
short term or long term clinical outcome of ITP.
• Anti-platelet antibodies bind to transfused platelets as well
as autologus platelets.
SUPPORTIVE MEASURES:
• Reassurance.
• Restricting physical activity
and avioding trauma.
• Avoid medications that supress
platelet production or alter their
function e.g, aspirin, heparin,
valproic acid, digoxin etc.
13. PLATELET TRANSFUSION:
May be given in sever cases but destroy rapidly.
PHARMACOLOGICAL TREATMENT:
As per American Society of Hematology Guidelines:
“A single dose of IVIG (0.8-1g/kg) or short course of
corticosteroids should be use as first line treatment.”
IVIG at a dose of 0.8 – 1g/kg/day for 1-2 days induces a
rapid rise in platelets usually > 20 ˣ109 /L in 95% patient
within 48hours.
LIMITATION OF IVIG: Expensive, high frequency of
headaches and vomiting suggestive of IVIG-induced
aseptic meningitis.
14. PREDNISONE:
• Corticosteroids 1-4mg/kg/24hour
IV ANTI-D THERAPY:
• For Rh +ve patients.
• 50-75µg/kg causes rise in platelet count to > 20 ˣ109 /L
in 80-90% of patients within 48-72hours.
• Ineffective in Rh –ve patients.
Each of these medications may be used to treat ITP exacerbations,
which commonly occur several week after an initial course of therapy.
15. SPLENECTOMY:
Should be reserved for 1 0f 2 circumstances.
1) The older child (≥4yr) with severe ITP that
has lasted >1yr (chronic ITP).
2) Whose symptoms are not easily
controlled with therapy is a candidate
for spleenectomy.
Splenectomy must also be considered when
life-threatening hemorrhage (intracranial hemorrhage)
complicates acute ITP, if platelet count cannot be corrected
rapidly with transfusion of platelets and administration of
IVIG and corticosteroids
16. RISK AFTER SPLENECTOMY
Life long risk caused by encapsulated organisms,
increased risk of thrombosis, and potential development of
pulmonary hypertension in adulthood.
VACCINATION:
Administration of pneumococcal, meningococcal
and Hemophilus influenzae type b vaccines
prior to splenectomy recommended.
PROPHYYLAXIS:
Prophylactic penicillin following splenectomy should be
considered.
17. ALTERNATIVE TO SPLENECTOMY:
Rituximab used (off-label) in children to treat chronic ITP.
In 30-40% it has induced a partial or complete remission.
THROMBOPOIETIC AGENTS
Stimulate thrombopoiesis (in chronic ITP):
1) Romiplastin
2) Eltrombopag