This document discusses the management of chronic sinusitis. It outlines investigations like diagnostic nasal endoscopy and various types of x-rays that can evaluate the sinuses. Treatment begins conservatively with antibiotics, decongestants, and sinus irrigations. Surgery is considered if conservative treatment fails and may involve draining individual sinus cavities through the nose or making openings between sinuses and the nasal cavity. Newer functional endoscopic sinus surgery utilizes an endoscope through the nose to access and drain the sinuses minimally invasively.
Tooth extraction is a common practice for the oral surgeons. As a post extraction complication, formation of a communication between oral cavity & maxillary sinus through the socket of alveolar bone during extraction of maxillary premolars & molars, which is known as oroantral fistula is also a common phenomenon. If it can’t be early diagnosed & treated, chronic sinusitis of maxillary sinus may occur which is a very painful condition of cranium.
An oroantral communication is an unnatural perforation between oral cavity and maxillary sinus.
Oroantral fistula is an epithelized, pathological, communication between these two cavities. A fistulous tract present more than 14 days should be considered as chronic fistula.
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.
Tooth extraction is a common practice for the oral surgeons. As a post extraction complication, formation of a communication between oral cavity & maxillary sinus through the socket of alveolar bone during extraction of maxillary premolars & molars, which is known as oroantral fistula is also a common phenomenon. If it can’t be early diagnosed & treated, chronic sinusitis of maxillary sinus may occur which is a very painful condition of cranium.
An oroantral communication is an unnatural perforation between oral cavity and maxillary sinus.
Oroantral fistula is an epithelized, pathological, communication between these two cavities. A fistulous tract present more than 14 days should be considered as chronic fistula.
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
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2 Case Reports of Gastric Ultrasound
- 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
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.
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
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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
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
2. INVESTIGATIONS
• Diagnostic nasal endoscopy :
1. Deviated nasal septum , presence of spurs
2. Mucopurulent secretions in the middle meatus
3. Presence of polyps , edematous mucosa.
3. • X ray PNS :
1. Water’s view ( occipitomental view ) : better view of
maxillary sinus , also frontal sinus
2. Caldwell’s view ( occpitofrontal view ) : better view of
frontal sinus.
3. Submentovertical view : ethmoid and sphenoid sinus
4. Lateral view : extent of pneumatization of frontal and
sphenoid sinus
5. Oblique view : posterior and middle ethmoid sinus
4.
5. • X-RAY PNS findings :
1. Thickened polypoidal mucosa
2. Thickening of the bony sinus wall
3. Opacity of the sinus
• Aspiration and irrigation :
Presence of pus in the sinus is confirmatory.
6. • CT PNS :
1. Information regarding the position and status of
various structures related to the sinus like orbit ,
anterior cranial fossa , optic nerve , internal
carotid artery, cribriform plate, attachment of
uncinate process.
2. Gives information regarding the osteomeatal
complex.
7. TREATMENT
• it is essential to search for the underlying aetiological
factors which obstruct sinus drainage and ventilation.
• A work up for nasal allergy maybe required.
• Culture and sensitivity of sinus discharge helps in the
proper selection of the antibiotic.
• Initial treatment of chronic sinusitis is conservative ,
including antibiotics , decongestants, antihistaminics and
sinus irrigations.
8. SURGERY FOR CHRONIC SINUSITIS
• Chronic maxillary sinusitis :
1. Antral puncture and irrigation: sinus cavity is irrigated with a cannula
passed through inferior meatus. Removal of pus and exudates helps the
sinus mucosa to revert to normal.
2. Intranasal antrostomy : it is indicated if sinus irrigations fail to resolve
infection. A window is created in the inferior meatus to provide aeration to
the sinus and its free drainage.
3. Caldwell luc operation : in this procedure, antrum is entered through its
anterior wall by sublabial incision. All irreversible diseases are removed
and a window is created between antrum and inferior meatus.
9. • Chronic frontal sinusitis :
1. Intranasal drainage : Correction of deviated septum, removal of a polyp or
anterior portion of middle turbinate, or intranasal ethmoidectomy provide
drainage through the frontonasal duct. Treatment of associated maxillary
sinusitis also helps to resolve chronic frontal sinusitis.
2. Trephination of frontal sinus
3. External frontoethmoidectomy (Howarth’s or Lynch operation) : The
frontal sinus is entered through its floor by a curvilinear incision round the
inner margin of the orbit. Diseased mucosa is removed, ethmoid cells
exenterated and a new frontonasal duct created.
4. Osteoplastic flap operation. It may be unilateral or bilateral. A coronal or a
brow incision is used. The anterior wall of frontal sinus is reflected as an
osteoplastic flap, based inferiorly. The diseased tissues are removed and
the sinus drained through a new frontonasal duct. If it is desired to
obliterate the sinus, all diseased as well as healthy mucosa are stripped
off and the sinus obliterated with fat.
10. • Chronic ethmoid sinusitis :
1. Intranasal ethmoidectomy : This operation is done for chronic
ethmoiditis with polyp formation. The ethmoid air cells and the
diseased tissue are removed between the middle turbinate and
the medial wall of orbit by the intranasal route. The frontal and
sphenoid sinuses can also be drained by this operation.
2. External ethmoidectomy. In this operation, ethmoid sinuses are
approached through medial orbital incision. Access can also be
obtained to sphenoid and frontal sinuses and the operation is
called fronto-spheno-ethmoidectomy.
11. • Chronic sphenoiditis :
1. Sphenoidotomy. Access to the sphenoid sinus
can be obtained by removal of its anterior wall.
This is accomplished by external
ethmoidectomy or trans-septal approach,
usually the former, because of the coexistence
of ethmoid disease with chronic sphenoiditis.
12. FUNCTIONAL ENDOSCOPIC SURGERY OF SINUSES
• Endoscopic surgery has made a great contribution towards
management of sinus disease.
• Indications for conventional operations like those of Caldwell–Luc,
frontal sinus operations and external ethmoidectomy have greatly
reduced.
• Endoscopic surgery is minimally invasive surgery and does not require
skin incisions or removal of intervening bone to access the disease.
• In the sinuses, ventilation and drainage of the sinuses is established
preserving the nasal and sinus mucosa and its function of mucociliary
clearance.
