This document discusses nasal polyps and antrochoanal polyps. It defines nasal polyps as non-neoplastic masses of edematous nasal or sinus tissue. The main types are bilateral ethmoidal polyp and antrochoanal polyp. Nasal polyps are commonly caused by inflammatory conditions like rhinosinusitis or disorders of ciliary motility. Antrochoanal polyps originate in the maxillary sinus near its ostium. Symptoms include nasal obstruction, loss of smell, and discharge. Treatment involves polypectomy, intranasal ethmoidectomy, or endoscopic sinus surgery depending on the type and location of polyp.
Inflammation of the mucosa of sinuses associated with inflammation of the nasal mucosa is called rhinosinusitis (RS).
CLASSIFICATION:
• Acute RS: Symptoms lasting for less than 4 weeks with complete resolution.
• Subacute RS: Duration 4-12 weeks.
• Chronic RS: Duration ~ 12 weeks.
• Recurrent RS: Four or more episodes of RS per year; each lasting for 7-10 days or more with complete resolution in between the episodes.
• Nasal obstruction.
• Nasal discharge/congestion, anterior, or posterior in the form of postnasal drip.
• Facial pain or pressure.
• Alteration in the sense of smell, hyposmia or anosmia.
• Other symptoms include cough, fever, halitosis, fatigue, dental pain, pharyngitis, headache or ear fullness.
Nasal Polyps are defined as pale, polypoidal, pedunculated , prolapsed sinus mucosa into the nose.
They cause nasal obstruction. Nasal allergy and infecions are proposed to be the most common etiological factors for nasal polyps.
This presentation explains in detail about every aspect of nasal polyps.
Nasal polyps are soft, painless, noncancerous growths on the lining of your nasal passages or sinuses. They hang down like teardrops or grapes. They result from chronic inflammation and are associated with asthma, recurring infection, allergies, drug sensitivity or certain immune disorders.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Inflammation of the mucosa of sinuses associated with inflammation of the nasal mucosa is called rhinosinusitis (RS).
CLASSIFICATION:
• Acute RS: Symptoms lasting for less than 4 weeks with complete resolution.
• Subacute RS: Duration 4-12 weeks.
• Chronic RS: Duration ~ 12 weeks.
• Recurrent RS: Four or more episodes of RS per year; each lasting for 7-10 days or more with complete resolution in between the episodes.
• Nasal obstruction.
• Nasal discharge/congestion, anterior, or posterior in the form of postnasal drip.
• Facial pain or pressure.
• Alteration in the sense of smell, hyposmia or anosmia.
• Other symptoms include cough, fever, halitosis, fatigue, dental pain, pharyngitis, headache or ear fullness.
Nasal Polyps are defined as pale, polypoidal, pedunculated , prolapsed sinus mucosa into the nose.
They cause nasal obstruction. Nasal allergy and infecions are proposed to be the most common etiological factors for nasal polyps.
This presentation explains in detail about every aspect of nasal polyps.
Nasal polyps are soft, painless, noncancerous growths on the lining of your nasal passages or sinuses. They hang down like teardrops or grapes. They result from chronic inflammation and are associated with asthma, recurring infection, allergies, drug sensitivity or certain immune disorders.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
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.
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
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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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
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
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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
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.
5. AETIOLOGY
• Inflammatory conditions of nasal mucosa
– Rhinosinusitis
• Disorders of ciliary motility
– Kartagener’s syndrome
• Abnormal composition of nasal mucus
– Cystic fibrosis
6. AETIOLOGY
• Various disease associated with the formation of nasal
polyps are:
– Chronic rhinosinusitis
– Kartagener syndrome
– Cystic fibrosis
– Asthma
– Aspirin tolerance
– Allergic fungal sinusitis
– Young syndrome
– Churg-Strauss syndrome
– Nasal mastocytosis
7. PATHOGENESIS
Nasal mucosa becomes edematous due to
collection of ECF
polypoidal change
Sessile pedunculated
(due to gravity and excessive sneezing)
8. PATHOLOGY
Early stage Nasal polyp (surface covered by
ciliated columnar epithelium)
Transitional & squamous epithelium
Submucosa large ICS filled with serous fluid
+ infiltration with eosinophils and
round cells
Metaplastic change
in exposure to
atmospheric irritation
9. SITE OF ORIGIN
• Multiple nasal polyps always arise from the
lateral wall of nose, usually from the middle
meatus
• Common sites:
– Uncinate process
– Bulla ethmoidalis
– Ostia of sinuses
– Medial surface & edge of middle turbinate
10. SYMPTOMS
• Mostly seen in adults
• Nasal stuffiness leading to
total nasal obstruction
• Partial/total loss of smell
• Headache (associated sinusitis)
• Sneezing and watery nasal
discharge (associated allergy)
• Protruding mass
11. SIGNS
• On anterior rhinoscopy, polyps appear as
– Smooth, glistening
– Grape-like masses
– Often pale in color
– May be sessile or pedunculated
– Insensitive to probing
– Do not bleed on touch
– Often multiple and bilateral
• Broadening of nose
• Increase intercanthal distance
• May protrude from the nostril and appear pink and vascular, simulating
neoplasm
• Purulent discharge (associated sinusitis)
long standing case
12. DIAGNOSIS
• Clinical examination
• CT scan of paranasal sinuses
– exclude neoplasia
– plan surgery
• Histological examination
– especially in people >40 years
13. TREATMENT
CONSERVATIVE
• Antihistaminics & control of allergy
– may revert early polypoidal changes with
oedematous mucosa to normal
• Short course steroids
– in people who cannot tolerate antihistaminics or
with asthma
16. SITE OF ORIGIN
• Arise from the mucosa of
maxillary antrum near its
accessory ostium, comes out of
it, and grows in the choana
and nasal cavity
• Thus, it has 3 parts:
1. Antral: thin stalk
2. Choanal: round and globular
3. Nasal: flat from side to side
17. AETIOLOGY
• Exact cause is unknown
• Nasal allergy coupled with sinus infection is
incriminated
• Seen in children and young adults
• Usually single and unilateral
18. SYMPTOMS
• Unilateral nasal obstruction
• Bilateral nasal obstruction
– when polyp grows into the nasopharynx
– starts obstructing the opposite choana
• Thick and dull voice – hyponasality
• Nasal discharge – mostly mucoid
19. SIGNS
• Anterior rhinoscopy - may be
missed as it grows posteriorly
• Large, smooth, greyish mass
covered with nasal discharge
• Soft, can be moved up and
down with the probe
• May protrude from nostril
– shows pink, congested loop
20. SIGNS
• POSTERIOR RHINOSCOPY
– GLOBULAR MASS FILLING THE CHOANA OR THE NA
– A LARGE POLYP MAY HANG DOWN BEHINDSOFT P
• AND PRESENT IN OROPHARYNX
21. INVESTIGATIONS
• Nasal endoscopy
• May reveal choanal or antrochoanal polyp
hidden posteriorly in the nasal cavity
• Xrays of paranasal sinuses
• May show opacity of the involved antrum
• Lateral view xray:
• globular swelling in postnasal space
• column of air behind the polyp
22. DIFFERENTIAL DIAGNOSIS
–
1. A blob of mucus
disappear on blowing nose
–
–
2. Hypertrophied middle turbinate
pink appearance
hard feel of bone on probe testing
–
–
–
3. Angiofibroma
history of profuse recurrent epistaxis
firm in consistency
easily bleed on touch
–
–
–
4. Neoplasms
fleshy pink appearance
friable nature
tendency to bleed)
23. TREATMENT
• Avulsion (nasal/oral route)
• Recurrence is uncommon after complete removal
• In case of reccurence, Caldwell-Luc operation
– Complete removal of polyp from site of origin
• Endoscopic sinus surgery is now preferred
24.
25. Ethmoidal polyp Antrochoanal polyp
Age Common in adults Common in children
Etiology Allergy or multifocal Infection
Number Multiple Solitary
Laterality Bilateral Unilateral
Origin Ethmoidal sinuses Maxillary sinus near
ostium
Growth Mostly anteriorly & may
present at the nares
Backwards to choana, may
hang down behind soft
palate
Size & shape Usually small & grape-like
masses
Trilobed (antral, nasal,
choanal part)
Recurrence Common Uncommon if removed
completely
Treatment Polypectomy, endoscopic
surgery or ethmoidectomy
Polypectomy, endoscopic
removal
26. REFERENCE
• Diseases of Ear, Nose and Throat & Head and
Neck Surgery, 6th Edition, PL Dhingra, Elsevier
