Ureteropelvic junction obstruction by\ Eman Salman
It was used for student presentation in Urology course rotation
I Hope you find what is helpful for your knowledge ♥
Ureteropelvic junction obstruction by\ Eman Salman
It was used for student presentation in Urology course rotation
I Hope you find what is helpful for your knowledge ♥
Vesicoureteric reflux , a common condition in children which could be misdiagnosed . Early diagnosis can help prevent renal scarring and other complications
Intussusception - A Comprehensive PresentationJemie Nnanna
A comprehensive presentation on Intussusception, a major cause of intestinal obstruction which could be fatal if not attended to promptly.
Contains - introduction, Epidemiology, Classification, Pathophysiology, Clinical features, Investigation, Management
Hello Guys,
This presentation talks about diagnosis and management of Antenatally detected hydronephrosis. We have discussed evidence based fetal hydronephrosis management including - antenatal followup schedule, fetal interventions, postnatal screening and follow up proforma, MCU, Functional renal scans, prophylactic antibiotics and available surgical management options.
POSTERIOR URETHRAL VALVES- Pediatric Surgery
• Dear viewers,
• Greetings from “ Surgical Educator”
• Today I have uploaded one more video in Pediatric Surgery/Pediatric Urology- “ Posterior Urethral Valves”
• Posterior Urethral Valves is the congenital cause for Bladder Outlet Obstruction, resulting in abnormal development of the kidneys as well as the bladder.
• In this video, I talked about the learning outcomes, introduction, etiopathogenesis, clinical features, investigations, differential diagnosis, treatment, follow-up and prognosis of “ Posterior Urethral Valves”
• I hope you will enjoy the video for its educational value.
• You can watch all my teaching videos in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
Vesicoureteric reflux , a common condition in children which could be misdiagnosed . Early diagnosis can help prevent renal scarring and other complications
Intussusception - A Comprehensive PresentationJemie Nnanna
A comprehensive presentation on Intussusception, a major cause of intestinal obstruction which could be fatal if not attended to promptly.
Contains - introduction, Epidemiology, Classification, Pathophysiology, Clinical features, Investigation, Management
Hello Guys,
This presentation talks about diagnosis and management of Antenatally detected hydronephrosis. We have discussed evidence based fetal hydronephrosis management including - antenatal followup schedule, fetal interventions, postnatal screening and follow up proforma, MCU, Functional renal scans, prophylactic antibiotics and available surgical management options.
POSTERIOR URETHRAL VALVES- Pediatric Surgery
• Dear viewers,
• Greetings from “ Surgical Educator”
• Today I have uploaded one more video in Pediatric Surgery/Pediatric Urology- “ Posterior Urethral Valves”
• Posterior Urethral Valves is the congenital cause for Bladder Outlet Obstruction, resulting in abnormal development of the kidneys as well as the bladder.
• In this video, I talked about the learning outcomes, introduction, etiopathogenesis, clinical features, investigations, differential diagnosis, treatment, follow-up and prognosis of “ Posterior Urethral Valves”
• I hope you will enjoy the video for its educational value.
• You can watch all my teaching videos in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
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.
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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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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6. PHYSICAL EXAMINATION:
The physical examination of the newborn can
detect abnormalities that suggest genitourinary
abnormalities. These include the following:
7. 1. The presence of an abdominal mass that
could represent an enlarged kidney due to
obstructive uropathy or multicystic
dysplastic kidney (MCDK).
8. 2.Potter appearance
Note the flattening of the nose and
the low-set ears. Pressure deformity from
the oligohydramnios
The facies results from oligohydramnios
causing prolonged intrauterine
compression on the entire face. The nose
is flattened, there are large vertical
creases below the eyes, the ears are low
set and dysplastic, and there is mild
micrognathia.
9. 3. A palpable bladder in a male infant, especially
after voiding, may suggest posterior urethral
valves.
11. Autopsy specimen of the infant with
congenital posterior urethral valves.
Note the urethral valves, enlarged
bladder,bilateral hydroureter, and
bilateral hydronephrosis.
Huge distended ureters and
hydronephrotic kidney
12. 4. supernumerary nipples is associated with an increased
risk of CAKUT, particularly vesicoureteral reflux.
13. 5. The presence of outer ear abnormalities are associated with an
increased risk of congenital anomalies of the kidney and urinary
tract (CAKUT).
14. 6. A male infant with prune belly syndrome will have deficient
abdominal wall musculature and undescended testes. The presence of
associated anomalies should be noted.
Currently it is thought that
the marked distention of
the bladder and ureters
and renal involvement
result in the ablation of
the abdominal muscles,
especially the recti. The
kidneys may be
hypoplastic or severely
hydronephrotic as a result
of the obstruction.
17. The most sensitive time for fetal urinary tract
evaluation is the 28th week. If dilatation is
detected, US should focus on:
• Laterality, severity of dilatation, and echogenicity of the
kidneys;
• Hydronephrosis or hydro-ureteronephrosis;
• Bladder volume and bladder emptying;
• Sex of the child;
• Amniotic fluid volume
Antenatal ultrasound
18. • Indications
– Follow-up of fetuses diagnosed in utero
with hydronephrosis
– Evaluation of newborns suspected of harboring
congenital anomalies
Postnatal ultrasound
19. Timing of the neonatal ultrasound
• Antenatal dilated pelvis may appear normal in
the first few days of life despite significant
obstruction
• Oliguria and dehydration during the first 24 to 48
hours of life may cause a distended renal pelvis to
shrink transiently
• Initial postnatal sonogram at 7 to 10 days is
recommended
20. • Ultrasonography should be performed within 24-48
hr of birth in neonates with suspected:
– posterior urethral valves,
– oligohydramnios
– severe bilateral hydronephrosis,
22. Society of Fetal Urology grading system for
hydronephrosis.(SFU)
Grade 1: renal pelvis is only visualized.
Grade 2: renal pelvis as well as a few, but not all,
calyces are visualized.
Grade 3: virtually all calyces are visualized.
Grade 4: similar to Grade 3 but, when compared to the
normal centralateral kidney, there is
parenchymal thinning.
23. Voiding Cystourethrography
• Any newborn with a prenatal diagnosis of
hydronephrosis should undergo a VCUG, even
if the postnatal ultrasonogram is normal
• The study is obtained before the baby leaves
the hospital
• If VUR is present, antimicrobial prophylaxis
should be started
24. • Indications for VCUG in the newborn include
the following conditions:
– prenatally diagnosed hydronephrosis,
– unilateral multicystic dysplastic kidney to rule out
contralateral reflux ,
– suspected bladder outlet obstruction (e.g., PUV,
urethral anomalies),
– suspected duplicated upper collecting system with
or without ureterocele
25. Antenatal HUN
Post natal USG; initial scan in 1st
week
Unilateral Bilateral
MCU
No reflux Reflux
Non-obstructive non
refluxing megaureter
VUJO
Ureterocele
Physiological
Primary VUR
PUV
Duplication anomalies
26. Nuclear Medicine Studies
• Radionuclide studies of the kidneys
(renograms) may be used to:
– assess renal perfusion,
– glomerular function of each kidney,
– structural anomalies,
– the presence or absence of obstruction
27. • Radiopharmaceuticals
are used for assessing
obstruction (diuretic
renogram:(
– technetium (Tc)-99m
MAG3
mercaptoacetyltriglycerine
– Tc-99m
diethylenetriaminepentaac
etic acid (DTPA)
• Reflux and functioning
of a duplicated
moiety
– Tc-99m dimercaptosuccinic
acid (DMSA) .
– Tc-99m glucoheptonate
(GHA(
28. Recommended Protocol for Diuretic
Renogram in the Neonate
• Infants should be older than 1 month at
renography to reduce the likelihood that renal
function is immature
• Oral hydration is offered as desired, beginning
2 hours before the study
• The bladder is catheterized to ensure that it is
empty
29. • Before the study, a dilute normal saline
solution is administered at a rate of 10 mL/kg
over 15 minutes, before injection of MAG-3 or
DTPA, and is continued for 15 minutes after
injection
• The renogram should be recorded in the
supine position
• Furosemide is administered at a dose of 1
mg/ kg after 20 to 30 minutes
30. Other Imaging Studies of the Upper
Urinary Tract
• Intravenous urography (IVU):
– The anatomic resolution of the IVU can be excellent
– renal function may be too immature at birth
– 2 to 3 weeks after birth, visualization of the
kidneys and collecting system can be obtained
following administration of 2 to 3 mL/kg of
contrast medium
• MRI:- requires GA
• Retrograde Pyelography :- rarely adds diagnostic
information
• Computed tomography (CT)
31. Ureteropelvic Junction Obstruction
• Incidence 1 in 1,000
• two-thirds are boys,
• 60 % the obstruction is on the left side
• 30 % to 50% of children with UPJ
obstruction are diagnosed prenatally
• 15 % of neonates with a UPJ
obstruction present with an abdominal
mass
32. • If initial ultrasound is normal repeat study
should be performed in 3 weeks
• Hydronephrosis should be graded according to
the SFU grading scale
• A prompt VCUG and diuretic renogram should
be done in:
– severe hydronephrosis with marked parenchymal
thinning
– bilateral hydronephrosis
33. • A VCUG is necessary to ascertain
– that the male urethra is normal
– to determine whether there is VUR, ( 15% of
children with a UPJ obstruction)
• Performing a pyeloplasty in a child with reflux
may subject the repair to high pressures and
result in an anastomotic leak.
34. •The most important diagnostic study is the “well-
tempered” MAG-3 diuretic renogram
•Obstruction
– Type 3 slope
– T ½ >20 mins
– Diffn function <35%
•Exceptions to this approach include
– an infant with a solitary kidney,
– bilateral hydronephrosis,
– reduced renal function,
– an abdominal mass,
– constant abdominal pain
35.
36. UTI?
• Boys with hydronephrosis, circumcision is
recommended to diminish the risk of UTI
• No consensus regarding the use of
prophylactic antibiotics
• 2-31% of infants with PUJO on observation
develop UTI
37. • The risk of UTI increased with SFU Grade
3 and 4 or APRPD ≥15 mm.
• Recommended in
–APD > 10mm
–SFU > 3,4
–VUR
• Amoxiclillin is usually given
10mg/kg/day) – first 3 mts).
• cotrimoxazole (1-2 mg/kg/d) or
nitrofurantoin (1 mg/kg/d) after 3 mts.
38. Indications for surgery
• T ½ greater than 20 minutes
• Differential renal function <35%
• Obstructive pattern of curve
• Exceptions to this approach include
– an infant with a solitary kidney,
– bilateral hydronephrosis,
– reduced renal function,
– an abdominal mass,
– infant with nearly constant abdominal pain
40. Posterior Urethral Valves
• Type I and type III valves are thought to be
clinically significant
• Type I valves are
– represented by leaflets or sails that extend distally
from either side of the verumontanum to the anterior
urethral wall at the level of the urogenital diaphragm
• A type III valve
– is a diaphragm just distal to the verumontanum that
has a small central perforation
41. • % 50 are diagnosed by prenatal USG
• When the diagnosis of urethral valves is
suspected, a VCUG should be performed
– A thick trabeculated bladder
– very distended posterior urethra
– Valve leaflets is seen
43. • 50 % of these patients have VUR,
• With 25% having bilateral and 25% having
unilateral reflux
44. • Important radiographic study is a renal and
bladder sonogram
– pelvic and calyceal dilation,
– cortical echogenicity,
– presence of dysplasia
45. Management
• The bladder should be drained with a 5 or 8
Fr pediatric feeding tube
• Initial treatment of the valves depends on the
age at presentation and the general condition
of the child
46. • cystoscope is used to examine the bladder,
– assessment of the degree of trabeculation,
– the presence of diverticula,
– the position of the ureteral orifices,
– examination of the valves
• WITH the 3-Fr Bugbee electrode The valve
leaflets should be ablated at the 5 and 7 o'clock
positions, and on occasion at the 12 o'clock
position
47. Vesicoureteral Reflux
• Neonates with medium- and high-grade
vesicoureteral reflux are detected by the
finding of hydronephrosis on prenatal
sonography
• Approximately 80% of such patients are boys
48. Evaluation
–USG
• Prenatal diagnosis
• Initial USG may be normal
–VCUG
• unilateral or unilateral hydronephrosis with
renal pelvic APD
more than 10 mm, SFU grade 3 - 4 or ureteric
dilatation
• Done prior to discharge from hospital
–DMSA scan
• To asses scarring
• After 4-6 wks of age
50. Spontaneous resolution
• At birth, likelihood of resolution is inversely
proportional to grade at presentation
• Some people adopt this, especially in girls around
puberty
• Due to remodeling of UVJ
• Up to 80% of grade 1 and 2 will resolve but only 50% of
grade 3 over a 2 year period, but this rises to 92% over
5 years
119
51. European Association of Urology
Guidelines on VUR
• All children diagnosed <1 year should be treated with
prophylactic antibiotics irrespective of
scars/symptoms and therapy for breakthrough fever.
Those with frequent breakthrough fevers require
correction
• Surgical correction should be considered in those
with high grade IV/V.
• No advantage of correcting grade I-III with no scars
or fever. Consider endoscopic treatment 120
52. SUMMARY
• Prenatal intervention for hydronephrosis is indicated
only in very select instances and in specialized centers .
Even when well selected, intervention is highly
controversial.
• Most diagnoses made based on a finding of prenatal
hydronephrosis can be handled conservatively.
• All ANH should be investigated with a post-natal US.
• Antenatal hydronephrosis does not necessary imply
obstruction, nor give any indication of the function of an
affected kidney.
53. SUMMARY
• The role of prophylactic antibiotics initiated at birth is
controversial.
• The need to further investigate mild postnatal hydronephrosis
SFU (0-2) with a VCUG is controversial, and depends on the
physician’s attitude toward diagnosing asymptomatic VUR
• Persistent moderate or severe hydronephrosis (SFU 3-4) should
be investigated with a VCUG, followed by diuretic renography if
the hydronephrosis cannot be explained by VUR.
• Indications for surgical intervention include reduced differential
function (<40%), progressive increase in hydronephrosis, febrile
infection or poor parental compliance.