Lung transplantation involves removing diseased lungs and replacing them with healthy donor lungs. It is used to treat end-stage lung diseases like COPD, pulmonary fibrosis, and cystic fibrosis. Candidates undergo evaluation including lung function tests and imaging. Donor lungs must be disease-free and match the recipient's size. The surgery connects the donor lungs to blood vessels and airways. Patients are monitored closely after for bleeding, infection, and organ rejection. Long term immunosuppression is required to prevent rejection and complications include infections and chronic lung allograft dysfunction.
Interstitial lung disease is a general category that includes many different lung conditions. All interstitial lung diseases affect the interstitium, a part of the lungs' anatomic structure.
Some of the types of interstitial lung disease include:
Interstitial pneumonia: Bacteria, viruses, or fungi may infect the interstitium of the lung. A bacterium called Mycoplasma pneumonia is the most common cause.
Idiopathic pulmonary fibrosis : A chronic, progressive form of fibrosis (scarring) of the interstitium. Its cause is unknown.
Nonspecific interstitial pneumonitis: Interstitial lung disease that's often present with autoimmune conditions (such as rheumatoid arthritis or scleroderma).
Interstitial lung disease is a general category that includes many different lung conditions. All interstitial lung diseases affect the interstitium, a part of the lungs' anatomic structure.
Some of the types of interstitial lung disease include:
Interstitial pneumonia: Bacteria, viruses, or fungi may infect the interstitium of the lung. A bacterium called Mycoplasma pneumonia is the most common cause.
Idiopathic pulmonary fibrosis : A chronic, progressive form of fibrosis (scarring) of the interstitium. Its cause is unknown.
Nonspecific interstitial pneumonitis: Interstitial lung disease that's often present with autoimmune conditions (such as rheumatoid arthritis or scleroderma).
Mechanical ventilation ppt including airway, ventilator, tubings and connections, nursing management, trouble shooting common problems and issues, suctioning etc.
Power point presentation about general principles of organ transplantation and pioneer surgons and investigators, Specific discussion about Heart, Heart lung and Lung transplantation is given
Mechanical ventilation ppt including airway, ventilator, tubings and connections, nursing management, trouble shooting common problems and issues, suctioning etc.
Power point presentation about general principles of organ transplantation and pioneer surgons and investigators, Specific discussion about Heart, Heart lung and Lung transplantation is given
Chronic Obstructive Pulmonary Disease (COPD) by Dr Kemi DeleKemi Dele-Ijagbulu
Presentation on definition and general overview of COPD, how to differentiate COPD from Asthma, how to make diagnosis of COPD, simple tools for assessment of COPD; available therapeutic options; as well as management of stable COPD, COPD exacerbations and comorbidities
A common, preventable and treatable disease, characterized by persistent respiratory symptoms and airflow limitation that are usually progressive and associated with an enhanced chronic inflammatory response in the airways and/or alveoli due to significant exposure to noxious particles or gases. (Vogelmeier et al., 2017).
The global spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of M. tuberculosis have resulted in a resurgence of almost incurable and even fatal cases for which only a few therapeutic options are available. Surgery has been applied to improve treatment success rates in MDR-TB patients and a combined medical and surgical approach is increasingly being used to treat patients with M/XDR-TB. This presentation discuss the history, indications,contraindication and the perioperative workup for TB patients that might need surgery
this presentation is based on the lastest WHO recommendation for surgery for pulmonary TB
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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
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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.
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.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
2. Overview :
• Introduction
• Purpose of lung transplantation
• History
• Indications
• Disease specific selection criteria
• Contraindications
2
3. Overview :
• Description
• Laboratory studies
• Donor-related issues
• Preoperative care
• Post operative care
• Complications
• Normal results
3
4. Introduction :
• Lung transplantation involves removal of one
or both diseased lungs from a patient and the
replacement of the lungs with healthy organs
from a donor
• Lung transplantation may refer to single,
double, or even heart-lung transplantation .
• Lung transplantation is an accepted modality
of treatment for end stage lung disease that is
unresponsive to medical therapy
4
5. Purpose :
• To replace a lung that no longer functions with
a healthy lung.
• To perform a lung transplantation, there
should be potential for rehabilitated breathing
function.
• Other medical treatments should be
attempted before transplantation.
• Many candidates for this procedure are
dependent on oxygen therapy
5
6. History of procedure :
• Animal experimentation by various pioneers,
including Demikhov and Metras, in 1940s and
1950s demonstrated that the procedure is
feasible technically.
• First human lung transplantation was done in
1963. The donation was essentially after
cardiac death, and the recipient of the left lung
transplant survived only 18 days.
6
7. Cont……….d:
• From 1963-1978, multiple attempts at lung
transplantation failed because of rejection and
problems with anastomotic bronchial and
tracheal healing.
• The first successful single lung transplant was
reported by Dr. Joel Cooper at the University
of Toronto in 1986 .
7
8. Cont……….d:
• In 1988, Dr. Alexander Patterson described the
technique of double-lung transplantation.
• Dr. Denton Cooley and associates were the
first to attempt heart-lung transplantation in
1968.
• First heart-lung transplant in India- 3 May
1999 at Madras Medical Mission.
8
9. AGE DISTRIBUTION OF LUNG TRANSPLANT
RECIPIENTS
0
5
10
15
20
25
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 66+
Recipient Age
%oftransplants
J Heart Lung Transplant 2008;27: 937-983
9
10. Indication of lung transplantation :
• Obstructive lung disease:
A. Chronic obstructive pulmonary disease
• Restrictive lung diseases:
A. Idiopathic pulmonary fibrosis (IPF)
B. Interstitial lung disease
10
11. Indication of lung transplantation :
• Septic lung disease:
A. Cystic fibrosis (CF)
B. Bilateral bronchiectasis
• Pulmonary vascular disease:
A. Primary pulmonary hypertension (PPH)
B. Eisenmenger’s syndrome
11
12. Diagnosis of Lung Transplant Recipients in US
(1986-2007)
40%
13%13%
8%
14%
2%
4%
1% 4% 1% COPD
Alpha I Anti Def
IPF
Other
Cystic Fibrosis
IPAH
Talcosis
BO
Eisenmenger's
Bronchiectasis
J Heart Lung Transplant 2008;27: 937-983 12
13. Disease specific selection criteria
COPD-
Pt. with BODE index 7 to 10 of at least 1
of the following:
1. FEV1 < 25% predicted ( without
reversibility)
2. PaCO2 >55 mm of Hg
3. Elevated pulmonary artery pressure
(PAP)
4. Cor pulmonale
13
14. Cont……….d:
Other indices shown to correlate mortality-
1)subjective breathlessness
2)weight loss
3)exercise tolerance
4)hospitalization
5) lung morphology
all patients requiring hospitalization for
exacerberation should be considered for
surgery
1 year mortality after hospitalization -23%
14
15. The BODE Index For COPD
Can Fam Physician 2008;54:706-11
17. Cont……….d:
IPF-
• Highest attrition rate with waiting list
mortality 30%
• Initially, owing to unpredictable nature of
course, view was to refer all patients for
transplantation at diagnosis
• Patients with exercise induced desaturation
are ideal candidates
17
18. Cont……….d:
Current consensus-
1) Symptomatic progressive disease despite 3
months of medical therapy
2) Rest or exercise induced desaturation
3) Symptomatic with-
VC< 60-70%predicted
DLCO < 50-60% pred.
18
19. Cont……….d:
Cystic fibrosis
Prognostic criteria-
1)age per year
2)sex
3)FEV1
4)weight for age
5)Pancreatic insufficiency
6)D.M.
7)S.aureus
8)B.cepacia
9)No. of acute exacerberations
19
20. Cont……….d:
• Patients divided into 5 prognostic groups
• Only group 1&2 with 5 year survival rate <30%
benefited
• Resistant B. cepacia infection is absolute
contraindication
20
21. Cont……….d:
PPH
• Advancement in medical management-
reduced need for transplantation
• 1990- 10.5% of all cases
• 2001- 3.6% of all cases
21
22. Cont……….d:
• Criterias for PPH
Symptomatic progressive disease
despite optimal medical treatment for
3 months
Cardiac index < 2 lit/min/m2
Right atrial pessure>15 mm Hg
PAP mean > 55 mm Hg
22
23. Cont……….d:
Eisenmengers syndrome
• Better prognosis than patients with
PPH with similar PAP levels
• Epoprostenol therapy improved
survival & reduced need for
transplantation
• Heart -lung transplantation is preferred
23
24. Cont……….d:
Sarcoidosis
• Most patients benign course 10-20%
permanent sequel
• 2.5% of all transplants
• Only stage 4 disease is considered
• FVC < 50% & FEV1 < 40%
24
26. Contra-indication (Absolute ):
• Malignancy in the last 2 years
• Non-curable chronic extra pulmonary
infection including chronic active
hepatitis B , C , and HIV
• Untreatable advanced dysfunction of
another major organ system
• Current cigarette smoking
26
27. • Poor nutritional status
• Poor rehabilitation potential
• Significant psychosocial problems
• Substance abuse history of medical
noncompliance
27
28. Relative Contraindications :
• Age : advanced age is associated with
higher mortality rates .
• Most centers have an age cut-off
50 years for -Heart-lung transplantation,
60 years for- Bilateral lung transplantation,
65 years for -Single-lung transplantation.
28
29. • Ventilator dependence : patients who
are dependent on a ventilator prior to
the transplant have higher mortality
rates .
• A prolonged wait while the patient is on
a mechanical ventilator may lead to
various complications such as infections,
cardiovascular de-conditioning.
29
30. • Psychosocial issues : Individuals who
currently smoke, abuse drugs, or drink
alcohol heavily are not candidates for
transplantation.
• Patients with other psychosocial issues,
such as poor compliance and psychiatric
disorders that may complicate post
transplant therapy, are not considered
good candidates.
30
31. • Infection : patients who have active
tuberculosis infection are not candidates
for transplantation.
• Body weight : Patients who have poor
nutritional status and would have a poor
outcome following transplantation.
31
32. • Obesity (BMI >30) : also may be a
concern because of postoperative
atelectasis and pneumonia
• Extra pulmonary organ dysfunction :
Patients with a significant
heart, liver, or kidney disease are not
transplant candidates.
32
33. Description :
• Single lung transplantation is performed
via a standard thoracotomy (incision in
the chest wall) with the patient under
general anesthesia.
• Cardiopulmonary bypass (diversion of
blood flow from the heart) is not always
necessary for a single lung transplant.
33
34. Cont………..d:
• If bypass is necessary, it involves re-routing of
the blood through tubes to a heart-lung bypass
machine. Double lung transplantation involves
implanting the lungs as two separate lungs, and
cardiopulmonary bypass is usually required
• The patient's lung or lungs are removed and the
donor lungs are stitched into place. Drainage
tubes are inserted into the chest area to help
drain fluid, blood, and air out of the chest.
34
35. Figure
Patient positioned for bilateral lung transplant, through a clamshell incision
with the arms abducted. The skin incision is depicted in the mammary fold
heading laterally toward the mid-axillary line. The dotted line shows the
level of the 4th intercostal space. The position of the femoral artery, on both
sides, is also marked. The groin is prepped and draped, since during the
transplant procedure, an arterial femoral line may become necessary for
monitoring or even for cannulation for cardiopulmonary bypass.
35
38. Laboratory studies :
• The following diagnostic tests are usually
performed to evaluate a patient for lung
transplantation:
• Arterial blood gases (ABG ) test: which
measures the amount of oxygen that the
blood is able to carry to body tissues.
38
39. • Pulmonary function tests (PFTs): which
measure lung volume and the rate of air flow
through the lungs; the results measure the
progress of the lung disease.
• Computerized tomography (CT) scan. A chest
CT scan is taken of horizontal slices of the
chest to provide detailed images of the
structure of the chest.
39
40. • Ventilation perfusion scan (lung scan, V/Q
scan) is a test that compares right and left
lung function
• Electrocardiogram (ECG): is performed by
placing electrodes on the chest. A recording of
the electrical activity of the heart is obtained
to provide information about the rate and
rhythm of the heartbeat
40
41. • Echocardiogram (ECHO) is performed to
evaluate the impact of lung disease on the
heart. It examines the
chambers, valves, aorta, and the wall motion of
the heart.
ECHO also provides information concerning the
blood pressure in the pulmonary arteries. This
information is required to plan the
transplantation surgery.
41
42. • Blood test : Complete blood count ,
Coagulation profile.
• HIV, hepatitis B, hepatitis C
42
43. Donor-related issues:
• Younger than 65 years for lung transplantation
and younger than 45 years for heart-lung
transplantation
• Absence of severe chest trauma or infection
• Absence of prolonged cardiac arrest (heart-
lung only)
• Minimal pulmonary secretions Negative
screens for HIV, hepatitis C, and hepatitis B
43
44. • Blood type (ABO) compatibility
• Close match of lung size between donor and
recipient
• PaO2 > 300 mm Hg on 100% fraction of
inspired oxygen
• Clear chest radiograph
• No history of malignant neoplasms
44
45. Preoperative care:
• Preoperative assessment consist of both medical
& psychosocial evaluation.
• Assessment of patient‘s physical health is
assessed to determine candidacy for
transplantation.
• In preoperative phase the patient is assessed for
cardiac output & renal functions .
• Psychosocial evaluation focuses on assessing the
patient‘s history of compliance with medical
therapy & ability to cope with stress.
45
46. Post operative care :
• The patient is observed for excessive bleeding.
• Monitor vital signs ,ECG ,ABG values ,urine
output, O2 level analysis & chest tube
drainage.
• The patient may be started on mechanical
ventilation for 24 to 48 hours.
46
47. • Serum electrolytes ,complete blood count,
chest radiographs are obtained daily.
• Fluids are restricted.
• Lung sounds are auscultated.
• Severity of peripheral edema is monitored.
• Pain control is important to allow deep
breathing & coughing with chest
physiotherapy.
47
48. • The patient with lung transplantation is at high
risk to develop infection.
• So isolation is used to decrease exposure to
pathogens.
• Monitor the patient for clinical manifestation of
infection such as:
Change in vital signs especially fever
Local infection at i/v site & incision line
Changes in respiratory status like
excessive secretions, tachypnea,dyspnea
48
49. Immunosuppression
• Induction phase-
A) ATG
B) Selective IL2 receptor antagonists
• Maintenance phase-
A) Steroid + calceneurin inhibitor
B) Steroids ( low dose ) life long
C) Tacrolimus for 1-5 years
49
50. Newer drugs
1) Sirolimus (Rapamycine)- An analog of
Tacrolimus
2) Everolimus- used in combination with
cyclosporin & prednisolone shown to have
freedom from biopsy proven acute rejection
in 88% cases
50
52. Ischemia reperfusion injury
Most frequent cause of early mortality
presents as ALI / ARDS
Reduced incidence since 1990-
1) low K- dextran solution
2) nitric oxide added to flush solution
3) prevention of hyperinflation during harvesting
4)controlled reperfusion with leucocyte
depletion
52
53. Ischaemia reperfusion injury contd.
• Treatment-
A) diuretics
B) maximal ventilatory support
• Newer modalities
A) inhaled nitric oxide
B) inhaled prostacyclin
• Course-
resolves in 48-72 hrs
53
54. Infections
• Bacterial-
A) psuedomonas predominate in early post
op(75%)
B) nocardia-2.1%
C) legionella , mycobacteria rare
• routine antibiotic prophylaxis reduced the
incidence
• sputum cultures & antibiotic sensitivity done every
3 months
54
55. Viral infections
CMV predominates
• within 30-100 days after transplant
• occurs as reactivation or prim. infection
(donor)
• incidence varies between 13-75% in various
studies
• routine prophylaxis replaced by close
monitoring
• Treatment-gancyclovir 5mg/kg for 2-3 weeks55
56. • HSV&VZV can cause pnuemonia
• Acyclovir prophylaxis effective in patients not on
gancyclovir
• EBV related post-transplant lymphoproliferative
disease
• 4-10% cases
• usually fatal outcome
• recently Rituximab ( anti CD20 Ab) found effective
56
57. Fungal infections
• Aspergillus most common
1) ulcerative trachitis
2) bronchitis
3) pnuemonitis
4) disseminated diesase
5) ABPA- reported
• I.V. or aerolised ampho-B used for prophylaxis
57
60. Acute rejection
• TBLB - gold standard in diagnosis
• Noninvasive means-area of active research
1) Cytokine milieu in BAL fluid
2) gene upregulation as a biomarker
• Treatment- bolus I.V. steroids + increase in
maintenance immunosuppression
• role of surveillance bronchoscopy to detect
rejection early is controversial
60
61. Chronic rejection
Bronchiolitis Oblitrance Symdrome (BOA) :
• Predominantly a small airway disease
• occurs in 50% patients surviving for 5 years
• onset > 6months
• major cause of mortality
• CXR- can be normal late cases- bronchiectesis
• HRCT- mottled appearance with peripheral
lucency
61
62. TBLB- gold standard
• Role of induced sputum & BAL-
1) Induced sputum – RANTES levels and
eosinophils correlate with BOS
development
2) BAL- IL8 & neutrophil levels have
negative correlation
62
63. • Treatment- variable course even without
treatment
• various immunosuppressive regimens
tried
• macrolides under evaluation
63
65. Self care :
• Before discharge the patient should be teach
about the medication regimen.
• The patient should report for fever, dyspnea,
cough ,increased sputum production ,chest
pain, excessive weight gain, fatigue to
physician. During follow up the client is
monitored for manifestation of rejection &
progress in functional status.
65
66. • Exercise capacity has been the most
interesting functional outcome observes in
lung transplant recipient .
• Typically transplant recipient can walk 100
to 120m/min within 6 months of
transplantation.
66
67. Normal results:
• Demonstration of normal results for lung
transplantation patients include
a) adequate lung function,
b) improved quality of life,
c) lack of infection and rejection.
67