A female newborn with cyanosis and heart murmur was found to have a large ventricular septal defect, severe right ventricular outflow tract obstruction, and pulmonary hypoplasia. She was started on prostaglandin infusion and oxygen to stabilize her saturation. The document discusses various options for palliation in her condition including surgical shunts, PDA stenting, RVOT balloon dilation, and RVOT stenting. RVOT stenting is described as a feasible and generally safe palliative procedure that can augment pulmonary blood flow in critically ill patients who are unfit for surgical palliation. Primary repair is the treatment of choice when feasible, but non-surgical interventions are emerging as effective alternatives to surgical shunts
Successful Valve in Ring Abolishing the Stenosis and Regurgitation with Robus...Premier Publishers
Transcatheter mitral valve-in ring implantation (TMViRI), is a novel alternative treatment strategy and promising technique for patients at high risk of repeat open-heart surgery. In this report we demonstrate a case of 61 years old male with multiple co morbidities who underwent mitral valve repair long time ago who successfully treated and dramatically improved through trans-septal approach, under trans oesophageal echocardiography and fluoroscopic guidance in Hybrid catheterization laboratory.
Successful Valve in Ring Abolishing the Stenosis and Regurgitation with Robus...Premier Publishers
Transcatheter mitral valve-in ring implantation (TMViRI), is a novel alternative treatment strategy and promising technique for patients at high risk of repeat open-heart surgery. In this report we demonstrate a case of 61 years old male with multiple co morbidities who underwent mitral valve repair long time ago who successfully treated and dramatically improved through trans-septal approach, under trans oesophageal echocardiography and fluoroscopic guidance in Hybrid catheterization laboratory.
Pulmonary atresia with intact interventricular septum management Ramachandra Barik
The goals of early palliation of pulmonary atresia with intact ventricular septum (PA-IVS) include the relief of cyanosis and ductal dependence by providing a reliable source of pulmonary blood flow, and the relief of right ventricular outflow tract (RVOT) obstruction to encourage forward flow and growth of right-sided
Pulmonary atresia with intact interventricular septum management Ramachandra Barik
The goals of early palliation of pulmonary atresia with intact ventricular septum (PA-IVS) include the relief of cyanosis and ductal dependence by providing a reliable source of pulmonary blood flow, and the relief of right ventricular outflow tract (RVOT) obstruction to encourage forward flow and growth of right-sided
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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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.
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.
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.
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
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
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
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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non surgical intervention in tof.pptx
1.
2. A female baby was born at 40 weeks of gestation and with
3200 g of birth weight had cyanosis and a heart murmur.
Echocardiogram revealed enlargement of the right ventricle,
large ventricular septal defect (8.4 mm), dextroposition of the
aorta (50%), and severe RVOT stenosis (PG 70 mm Hg) with
pulmonary hypoplasia. Pulmonary blood flow was secured
mainly by small ductus arteriosus. The patient started on
continuous prostaglandin infusion and was stabilised with
oxygen saturation approaching 80%.
4. Degree of cyanosis depends on
degree of right ventricular outflow tract obstruction
degree of pulmonary artery development
Favorable anatomy – good size confluent PA’s – Total
correction
In infancy and even in neonatal life, age is no BAR
5. Advantages of primary repair include
early abolishment of cyanosis,
minimisation of right ventricular hypertrophy and
fibrosis,
avoidance of left ventricular volume-loading from
palliative shunts and
potential reduction in dysrhythmias.
Major disadvantage : the neonatal brain may be more
prone to surgery-related neurological injury
6. Early primary repair : Preferred but not possible
when
Unsuitable anatomy – small PAs
Critically ill child
Very small infant, LBW, Preterm
7. McGoon ratio: (Diameter of RPA + Diameter of LPA/DAo)
Normal ≥ 2
Adequate for primary repair 1.2
Inadequate <0.8
Nakata Index: (CSA of RPA + CSA of LPA)/BSA
Normal value > 200 mm2/m2
> 150 mm2/m2 is adequate
Not usable preoperatively when MAPCAs are the major source of PBF &
one-stage unifocalization + full repair is planned
9. Neonatal shunt – high mortality and morbidity
25- 30% neonatal mortality
Ann Card Anaesth 2014;17:191-7
Overburdened surgical lists, Long stay (5-6 days post
surgery) and so bed occupancy in ICU!!
Complication of CPB, Second surgery difficult, blockage in
not rare…
PA growth and distortion of Pas.
12. Performed under general anaesthesia or deep
conscious sedation
Preferable to have a mildly constricted duct (enough
to allow the stent to be secured)
Recommended to stop prostaglandin infusion 6 - 12
hours before the procedure.
13. To confirm ductal size - echocardiography before catheterisation
laboratory
Delay the procedure if duct does not show a degree of constriction.
If ductal diameter is large as a result of prostaglandin therapy it may
be of benefit to administer a prostaglandin inhibitor (ibuprofen 5 -
10mg/kg intravenously)
Prefer to ensure good guide wire position before administering a
prostaglandin inhibitor as a protective measure
14. Retrograde femoral arterial access is most commonly used
Carotid and axillary routes have been described. The latter
requires cut down by a vascular surgeon
Smaller sheath sizes preferred to avoid vascular
complications
Patients heparinised (50 - 100U/kg iv) and routine
prophylactic antibiotics are given according to local
protocols
15. Various catheters may be utilized for angiography and
stent.
Routine angiography is usually performed with a pigtail
catheter
In the majority of cases, the configuration of a right
coronary artery catheter should enable one to cross the
duct safely
Sometimes a cut-off pigtail may be useful to cross the PDA.
In difficult cases a coaxial system may be extremely helpful
16. The following should be clearly demonstrated before stenting:
Origin from the aortic arch,
Diameter at pulmonary artery (most often the narrowest),
Ampulla diameter and
Ductal length
Ductal length can be misleading as ducts are often convoluted
or angled, thus difficult to measure accurately.
Measure the length of the PDA with the guide wire in position;
this tends to straighten the ductus and allows an improved
estimation of ductal length
17. Standard bare metal coronary stents used
Stents with the lowest profile are preferred
It is of the utmost importance to stent the entire
length of the duct as any unstented segment
will soon become constricted and may be
extremely difficult to recannulate
18. Stent sizes as recommended:
3.5 mm diameter in those patients weighing <3kg
4mm in those weighing 3 - 5kg, and
4.5mm stents in those patients weighing 5kg and above.
Heparin infusion is continued at a dose of 25U/kg/hr
for 24 - 48 hours.
Aspirin is simultaneously initiated at 2 - 3mg/kg/day
and patients are discharged on this dose.
23. Peri-procedural complications include
Acute stent thrombosis (2 - 3%),
Pre-stent ductal spasm (<1%),
Stent dislodgement and migration,
Vessel or chamber perforation
Long term complications resemble those of surgical shunts
and consist of
Progressive stent stenosis,
Pulmonary overflow with pulmonary hypertension and
Branch pulmonary artery distortion
24. Reduced waiting period before intervention
Avoids the side-effects of continuous prostaglandin
infusion
Rapid post-procedure Recovery and short hospital stay
Can be performed on relatively small and premature
newborns that are often critically ill.
25.
26.
27.
28.
29.
30.
31. Adequate for valvular PS
Inadequate for Infundibular or Supravalvular PS
Most TOF pts combined PS
Unreliable results
32.
33. Small babies,
With co morbidities,
Small PAs ,
Ostial stenosis of PAs,
Need palliation, significant blue
RVOT stent
34. First described by Gibbs & Colleagues in 1997
Advantages of RVOT stenting –
Physiological direction of pulsating flow
Symmetric growth of MPA & both PAs
Decreased morbidity as compared to surgical
shunt
35. FV – 5F - Small babies
6F – Can use guide catheter
RCA – BMW – Branch PA
Long sheath – useful – Injection – stent
36.
37. Diameter - on the pulmonary valve annulus – 1 – 2 mm
higher.
Length - RVOT infundibular length
Positioning equally important
Consider preserving Pulmonary valve
39. To preserved pulmonary valve
If pulmonary valve not preserved, will needed TAP;
Most patient undergoing RVOT stenting, needed TAP
– usually small annulus
Not to entrap the tricuspid valve with placement of the
stent
40. Take care to prevent stent embolization : too small
a stent Inc risk of stent instability and
embolization
Avoid entrapping Tricuspid valve
Diuretics may be needed post stenting to prevent
reperfusion lung injury
41.
42.
43.
44. Case series and case reports from worldwide
Not more than 200 cases reported
RCT not possible,
TC, PDA stenting and RVOT stenting had different
subjects.
45. 52 pts. Mean age – 63 days. Mean weight – 3.8 kg.
Surgical intervention deemed high risk in all
Only 1 procedural death and 1 emergency surgery
Saturations increased from 71% (52-83%) 92% (81-100%)
Heart Online First, published on July 11, 2013 as 10.1136/heartjnl-2013-304155
53. D.J. Barron et al. / European Journal of Cardio-Thoracic Surgery 2013
54. Most patient needed TAP – (Trans annular patch)
RVOT stenting – very severe cyanosis – very tight PS –
small annulus – will also need patch in ICR.
More bypass time and cross clamp time
The average bypass time was 109 ± 42 min and cross-
clamp time 68 ± 29 min V/S 88 ± 36 min and 63 ± 22
min
Karl TR. Tetralogy of Fallot: current surgical perspective. Ann Pediatr Cardiol
2008;1:93–100
55. Complete removal of the stent is not always possible.
Often, remnants of the stent are embedded into the
myocardium and close to the VSD margins.
Retained stent - focus for future ventricular
arrhythmias or infections ???
The small retained portions of the stent- not prevent
satisfactory anatomical repair, need close
surveillance in the future.
56. RVOT stenting is a logical palliative procedure to augment
pulmonary blood flow
It is feasible and generally safe
Life saving in a critically ill patient who is unfit for surgical
palliation
57. Small babies,
With co morbidities,
Small PAs ,
Ostial stenosis of PAs,
Need palliation, significant blue
RVOT stent
58. Primary repair is treatment of choice whenever feasible
Non surgical interventions such as PDA stenting, RVOT
stenting, and RVOT ballooning emerging as equally
effective and safe method of palliation as compared with
surgical shunts
Right ventricular (RV) angiography in the right anterior oblique view shows the aorta (Ao) and the RV outflow tract, which is severely stenotic due to anterosuperior deviation of the infundibular septum and pulmonary valve dysplasia (arrow). Note that the left pulmonary artery (LPA) is not visible. B) Ascending aortography in the posteroanterior view before stent deployment shows the origin of the LPA from a left-sided patent ductus arteriosus, with moderate stenosis at the PDA–LPA junction (arrow).
The asterisk (*) indicates the crista supraventricularis; RPA = right pulmonary artery
The stent positioning inside the patent ductus arteriosus is angiographically guided through the 4F introducer sheath, without the need for a guiding catheter.
The asterisk (*) indicates the pre-mounted coronary artery stent; Ao = aorta
The final angiographic result is shown after the patent ductus arteriosus stenting. Note that the stent is slightly oversized. B) Angiogram shows the appearance of the stented patient ductus arteriosus 6 months after implantation. There was a moderate aortic–LPA pressure gradient (aortic pressure, 60/22 mmHg; LPA pressure, 25/10 mmHg).
The asterisk (*) and the arrow both indicate the stented patent ductus arteriosus; Ao = aorta; LPA = left pulmonary artery