1. Most children infected with H. pylori are asymptomatic or have chronic gastritis. Symptoms may include epigastric pain if peptic ulcers develop. H. pylori infection is also linked to MALT lymphoma, ITP, and iron deficiency anemia.
2. Testing for H. pylori in children is recommended for conditions like peptic ulcer disease, MALT lymphoma, refractory ITP, or refractory iron deficiency anemia. Endoscopy with biopsy is preferred for diagnosis to allow testing and antibiotic sensitivity. Non-invasive tests can be used for follow up.
3. Treatment is recommended when H. pylori is likely related to complications. Definite indications
Toan chuyển hóa là một khái niệm rất thường gặp trong thức hành lâm sàng, đặc biệt các khoa ICU, cấp cứu, nội tiết...cách tiếp cận khoa học và hiểu rõ cơ chế gần như là xương sống của việc đánh giá một bệnh nhân trong tình trạng toan chuyển hóa. Toan hóa máu không khó để nhận diện nhưng nhận diện thế nào cho đúng lại là một vấn đề khác.
Toan chuyển hóa là một khái niệm rất thường gặp trong thức hành lâm sàng, đặc biệt các khoa ICU, cấp cứu, nội tiết...cách tiếp cận khoa học và hiểu rõ cơ chế gần như là xương sống của việc đánh giá một bệnh nhân trong tình trạng toan chuyển hóa. Toan hóa máu không khó để nhận diện nhưng nhận diện thế nào cho đúng lại là một vấn đề khác.
Acid peptic disease /dental courses /certified fixed orthodontic courses by I...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
The lecture was presented during the 13th annual conference of KLRC held in Alexandria 15 -17 August 2017
The lecture was directed to describe the current situation of H.Pylori infection in middle east ,particularly in Egypt , and to put some spotlights on the current regimens of treatment , and the situation of antibiotic resistance in Egypt and its impact on treatment choice
This was a joint lecture for the Chong Hua Hospital Postgraduate Course by OB-infectious disease specialist Dr Helen Madamba and IM-infectious disease specialist Dr Mitzi Chua.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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.
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
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
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
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
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.
Follow us on: Pinterest
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
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. -Xn nội soi dạ dày thường đk sử dụng chẩn đoán H.pylori ở trẻ em hơn những xn
không xâm lấn(noninvasive tests).(Khuyến cáo) : histology, rapid urease testing, and
H. pylori culture, molecular-based test (polymerase chain reaction [PCR] or
fluorescence in situ hybridization [FISH]).
+Nội soi làm xn H.hylori thì phù hợp vì chỉ định xn thường diễn ra trong quá trình
nội soi khi bệnh loét dd-tá tràng, hoặc viêm dd nốt được ghi nhận.
+XN khi nội soi cho phép xn tính nhạy kháng sinh và chẩn đoán chắc chắn nhất
- Xét nghiệm không xâm lấn : không khuyến cáo cho chẩn đoán H.pylori ban đầu.
Ngoại lệ chẩn đoán H.pylori ở bệnh nhân ITP hoặc tiền sử gia đình K dạ dày thuộc
trực hệ 1. XN không xâm lấn cũng phù hợp để confirm tiệt trừ sau điều trị.
+ H. pylori stool antigen assay
+ Urea breath test (trẻ >6 tuổi có thẻ hợp tác)
-Huyết thanh học (không khuyến cáo ): XN huyết thanh học H.pylori không khuyến
cáo cho cả chẩn đoán và theo dõi điều trị. Những xn này có độ nhạy và độ đặc hiệu
thấp, do vậy giá trị dự đoán dương thấp. Không phân biệt được nhiễm trùng đang hoạt
đông và nhiễm trùng đã mắc trước kia.
4.Chẩn đoán nhiễm H.pylori?
Bệnh nhân được nội soi Bệnh nhân không chỉ định nội soi or
CCĐ
+ Cấy H.pylori (+)
+Bằng chứng H.pylori/mô bệnh học +
(Rapid urease test/ Polymerase chain
reaction (PCR)/ Fluorescence in situ
hybridization (FISH))
Nếu chỉ có GPB (+) có thể sử dụng xn
không xâm lấn để hỗ trợ chẩn đoán
+ urea breath test
+ stool antigen assay
=> These tests can be used to diagnose
H. pylori infection in children under the
following limited circumstances:
•Patients with immune
thrombocytopenia (ITP) or family
history of gastric cancer .
•Follow-up testing to confirm
eradication after treatment for
documented H. pylori infection
5. Trẻ có chỉ định điều trị tiệt trừ H.pylori không ?
Điều trị khi có nghi ngờ cao H.pylori liên quan đến những biến chứng.Và chỉ định
điều trị giống vs chỉ định làm xn chẩn đoán.
Những chỉ định rõ ràng :loét dạ dày tá tràng +nhiễm H.pylori trên sinh thiết, u
lympho MALT phối hợp vs nhiễm H.pylori.
Chỉ định tương đối : Nhiễm H.pylori đk xác định ngẫu nhiên trên nội soi, ITP
mạn, thiếu máu thiếu sắt kháng trị. Những bn này cần thảo luận điều trị với bệnh
nhân và gia đình về những lợi ích và nguy cơ của điều trị.
Gia đình cần hiểu rằng điều trị không cải thiện triệu chứng (đặc biệt đau bụng
không đặc hiệu), thất bại điều trị, tái nhiễm và cần tuân thủ nghiêm ngặt phác đồ
trong 2 tuần.
3. Treatment regimens for Helicobacter pylori infection in children
CLA MET Suggested regimen
Patients without penicillin allergy: không dị ứng vs penicillin
Susceptible Susceptible ▪ PPI-AMO-CLA
Resistant Susceptible ▪ PPI-AMO-MET
Susceptible Resistant ▪ PPI-AMO-CLA
Resistant or unknown Resistant or
unknown
▪ Bismuth-PPI-MET-
tetracycline (if ≥8 years), or
▪ Bismuth-PPI-AMO-MET (if
<8 years), or
▪ PPI-AMO-MET with high-
dose AMO*
Patients with penicillin allergy( dị ứng vs penicillin)
Susceptible Susceptible ▪ PPI-MET-CLA
Resistant Susceptible ▪ Bismuth-PPI-MET-
tetracycline (if ≥8 years)¶
Susceptible Resistant ▪ Bismuth-PPI-CLA-tetracycline
(if ≥8 years)
Resistant or unknown Resistant or
unknown
▪ Bismuth-PPI-MET-
tetracycline (if ≥8 years)¶
The above regimens should be given for 14 days. If sensitivity testing is not
available, then the recommended regimen is the same as for CLA and MET
resistance. Resistance to CLA should also be assumed ( accept ) if the patient has any
prior exposure to this or other macrolide antibiotic. The strain should be assumed to
be resistant to MET if the patient has been exposed to this antibiotic within the past
6. If the follow-up test is negative, then no further testing is needed. If the patient
remains symptomatic, further evaluation should be tailored to the symptoms and this
may include upper endoscopy. Additional courses of treatment should be given only if
there is laboratory evidence of current H. pylori infection; treatment should not be
given empirically based on symptoms.
Treatment failure — Children who have persistent H. pylori infection after
completing initial therapy should be treated again with an alternate regimen.
Treatment options are limited compared with those for adults since some antibiotic
options are not approved or not appropriate for use in children [67]. In general, the
rescue therapy should be tailored to the initial antibiotic susceptibility patterns. If
either clarithromycin or metronidazole was included in the initial regimen, that
antibiotic should be avoided in the rescue regimen because use of these antibiotics
often induces secondary resistance. Examples of appropriate rescue regimens are
shown in the table (table 2).
Rescue therapies for Helicobacter pylori in pediatric patients who failed initial
treatment
Initial antibiotic susceptibility
Past treatment
regimen
Rescue treatment
CLA and MET susceptible PPI-AMO-CLA PPI-AMO-MET
CLA and MET susceptible PPI-AMO-MET PPI-AMO-CLA
CLA resistant, MET susceptible PPI-AMO-MET Treat like double resistance*
CLA susceptible, MET resistant PPI-AMO-CLA Treat like double resistance* or consider
performing a second endoscopy and use a
tailored treatment for 14 days
Primary antimicrobial sensitivity
unknown or double resistance
Triple therapy Consider performing a second endoscopy to
assess secondary antimicrobial susceptibility
or treat like double resistance*
CLA: clarithromycin; MET: metronidazole; PPI: proton pump inhibitor; AMO:
amoxicillin.
* Treatment regimens for double resistance are:
▪ Bismuth-PPI-MET-tetracycline (if ≥8 years), or
▪ Bismuth-PPI-AMO-MET (if <8 years), or
▪ PPI-AMO-MET with high-dose AMO
Where bismuth is available, bismuth-based quadruple therapy is preferred due to
better eradication rates compared with high-dose AMO. For dosing, refer to
UpToDate table on antibiotic dosing for H. pylori in children.
From: Jones NL, Koletzko S, Goodman K, et al. Joint ESPGHAN/NASPGHAN
Guidelines for the Management of Helicobacter pylori in Children and Adolescents
(Update 2016). J Pediatr Gastroenterol Nutr 2017; 64:991.