Obstructive sleep apnea/hypopnea (OSAH) is defined as 5 or more respiratory events per hour of sleep lasting at least 10 seconds, accompanied by oxygen desaturation and arousal from sleep. It is caused by collapse of the upper airway during sleep due to reduced muscle tone. Diagnosis involves polysomnography and is treated primarily with continuous positive airway pressure (CPAP) or oral appliances. Surgical treatments aim to enlarge the upper airway through procedures such as uvulopalatopharyngoplasty (UPPP) or maxillomandibular advancement.
OSA is an entity that is increasingly being managed by otolaryngologists...Hope this presentation helps to clear any doubts regarding its diagnosis and management!
This presentation gives some basic information regarding the definition , etiology and pathophysiology of " obstructive sleep apnea" which is a serious sleep disorder .Treatment methods are briefly reviewed with special emphasis on the role of the oral surgeon and orthodontist in the management of this medical condition .
Obstructive sleep apnea (OSA) is a prevalent chronic disease characterized by pharyngeal collapse during sleep.
Sleep disorder that involves cessation or significant decrease in airflow through the upper airway in the presence of breathing effort.
Obstructive sleep apnea is the second most common sleep disorder, insomnia being the most common.
Associated with recurrent oxyhemoglobin desaturations and arousals from sleep
Apnea index- no. of apneas /hr of total sleep time.
AHI (APNEA-HYPOPNEA INDEX)- No of apneas and hypoapneas/hr of total sleep time.
RDI (Respiratory Disturbance Index) – no. of apneas, hypoapneas and respiratory effort related arousals(RERA)/hr of total sleep time.
Snoring and Obstructive Sleep Apnea:ManagementDr. Paulose
By Dr.K.O.Paulose FRCS DLO
Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, South India.www.drpaulose.com
www.snorefreesleep.com
Presentation in Indian Medical Association meeting on 07102011, Trivandrum Chapter.
Videonystagmography is also known as VNG, is a most advanced diagnostic test for a balance disorder. Individuals who feel dizzy and face difficulty in maintaining their balance and equilibrium should undergo the videonystagmography diagnostic test.
Surgical options for Obstructive sleep apnoea syndromeGirish S
OBSTRUCTIVE SLEEP APNEA SYNDROME- REVIEW AND VARIOUS SURGICAL OPTIONS IN DETAIL.. based on Cummings & Scott new edition.. MS OTORHINOLARYNGOLOGY...
complete and detailed review of each operations like uvulopalatoplasty,epiglottoplasty, pillar implantation, tongue base reduction, laser and coblation techniques.. .
OSA is an entity that is increasingly being managed by otolaryngologists...Hope this presentation helps to clear any doubts regarding its diagnosis and management!
This presentation gives some basic information regarding the definition , etiology and pathophysiology of " obstructive sleep apnea" which is a serious sleep disorder .Treatment methods are briefly reviewed with special emphasis on the role of the oral surgeon and orthodontist in the management of this medical condition .
Obstructive sleep apnea (OSA) is a prevalent chronic disease characterized by pharyngeal collapse during sleep.
Sleep disorder that involves cessation or significant decrease in airflow through the upper airway in the presence of breathing effort.
Obstructive sleep apnea is the second most common sleep disorder, insomnia being the most common.
Associated with recurrent oxyhemoglobin desaturations and arousals from sleep
Apnea index- no. of apneas /hr of total sleep time.
AHI (APNEA-HYPOPNEA INDEX)- No of apneas and hypoapneas/hr of total sleep time.
RDI (Respiratory Disturbance Index) – no. of apneas, hypoapneas and respiratory effort related arousals(RERA)/hr of total sleep time.
Snoring and Obstructive Sleep Apnea:ManagementDr. Paulose
By Dr.K.O.Paulose FRCS DLO
Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, South India.www.drpaulose.com
www.snorefreesleep.com
Presentation in Indian Medical Association meeting on 07102011, Trivandrum Chapter.
Videonystagmography is also known as VNG, is a most advanced diagnostic test for a balance disorder. Individuals who feel dizzy and face difficulty in maintaining their balance and equilibrium should undergo the videonystagmography diagnostic test.
Surgical options for Obstructive sleep apnoea syndromeGirish S
OBSTRUCTIVE SLEEP APNEA SYNDROME- REVIEW AND VARIOUS SURGICAL OPTIONS IN DETAIL.. based on Cummings & Scott new edition.. MS OTORHINOLARYNGOLOGY...
complete and detailed review of each operations like uvulopalatoplasty,epiglottoplasty, pillar implantation, tongue base reduction, laser and coblation techniques.. .
A supercool powerpoint about thyroid cancer that is very hard to understand unless I am speaking to you and filling in the blanks so check out my blog and look for a related post:
http://m4tt5-b10-bl0g-2o1o.blogspot.com/
Obstructive sleep apnea (OSA)—also referred to as obstructive sleep apnea-hypopnea—is a sleep disorder that involves cessation or significant decrease in airflow in the presence of breathing effort. It is the most common type of sleep-disordered breathing and is characterized by recurrent episodes of upper airway collapse during sleep. These episodes are associated with recurrent oxyhemoglobin desaturations and arousals from sleep.
"Breath Easy: The Role of Orthodontics in Managing Obstructive Sleep Apnea"safabasiouny1
obstructive sleep apnea and orthodontics including diagnosis and treatment
Sleep disruption caused by breathing disorders are potentially life-threatening and therefore an important global health issue.
Sleep disorders, particularly untreated obstructive sleep apnea (OSA) has been known as a risk and possible causative factor in
1.
development of systemic hypertension,
2.
depression,
3.
stroke, angina
4.
cardiac dysrhythmias.
5.
can be associated with motor vehicle accidents,
6.
poor work performance and therefore, also makes a person prone to occupational accidents and reduced quality of life.
7.
adversely affects patients on their personal, social and professional levels.
Obstructive sleep apnea (OSA)
Definition: cessation of airflow for more than 10 seconds and hypopnoea is 50% reduction in air flow
It is Classified as central, obstructive and mixed and can be graded as mild, moderate and severe
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
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
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
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.
4. DEFINATION
Defined as 5 or more respiratory events (apnoeas /
hypopnoeas / RERAs) per hour of sleep lasting
≥10seconds in association with excessive day time
somnolence, waking with gasping, choking, or breath
holding spells or witnessed spells of apnoeas, snoring
or both,
Usually accompanied by reduction in blood oxygen
saturations of at least 3% – 4% and is terminated by
brief, unconscious arousals from sleep.
6. Features of upper airway in patients of
OSAH
Upper airway muscle are more hyper trophic
Contract more powefully during wakefullness
Delay between Upper airway muscle activity and
diaphragm muscle activity
Posterior displacement of tongue and mandible
Oval shaped airway
9. APNOEA
AROUSAL
Loud snort and compensatory phase of
hyperventilation
sleep
Hypoxaemia
Hypercapnia
Neg pressure
Stimulus to resp and
reticular
Increased resp effort
Vasocostriction
Tachycardia
Inc BP
10.
11. SYMPTOMS
Night Time Symptoms
Loud, habitual snoring
Witnessed apnoeas
Nocturnal awakenings
Gasping and choking
episodes during sleep
Nocturia
Abnormal body
movements
o Day time symptoms
o Unrefreshing sleep
o Daytime headaches
o Excessive daytime sleepiness
o Lack of concentration, poor
memory, irritability
o May lead to automobile or work
related accidents
o Decreased libido
24. DRUG INDUCED SLEEP ENDOSCOPY
Commonly performed
Propofol
Target controlled propofol infusion
Anaesthetist
All monitors
Saturation to be maintained
27. MRI
Localization of site of obstruction
Quantify the amount of surgical tissue volume
reduction necessary to resolve snoring
High cost
Time factor
32. Specific Medical therapies
Positional therapy – (LATERAL POSITION)
Positive Airway pressure
CPAP – mainstay of treatment, acts as pneumatic
splint(prevents collapse of airway and avoids OSA)
Bi-level systems
Auto CPAP
Oral Appliances
Tongue retaining devices
Mandibular advancing devices
Snore guard
Palatal Lifting devices
NAPA (Nocturnal Airway Patency Device)
33. CPAP(CONTINOUS POSITIVE
AIRWAY PRESSURE )
Acts as pneumatic splint
whereby blowing air via a tube and mask through
the nasal and/or oral passageway
support the pharyngeal and palatal walls
preventing collapse of the airway.
34. METHOD OF TITRATION
Admit a patient for overnight diagnostic Polysomnography,
and halfway through the night, when the severity and the
diagnosis of OSA have been confirmed, to commence CPAP
for the second half of the night. This is referred to as a
SPLIT NIGHT.
CPAP titration technique – The starting pressure is usually
approximately 4 cm H20 and the pressure is increased
quickly until all apnoeas and hypopnoeas are eliminated.
Another technique increasingly used is to send the subject
home with an autoCPAP machine. Most autoCPAP machines
will collect data on compliance, leaks and pressure profile.
39. UVULOPALATOPHARYNGOPLASTY
Where obstruction is at upper pharyngeal or velopharyngeal
level
Remove tonsils, trimming faucial pillars, removal of
uvula and variable amount of soft palate mucosa
then suturing anterior and posterior faucial pillars
and anterior and posterior soft palate mucosa
Stiffen soft palate by scarring
Increase space behind soft palate
Reduction in obstruction
41. SUCCESS OF UPPP
Friedman staging for success of
UPPP
Palate position
BMI
Tonsil size
Friedman staging for success
of UPPP
Stage 1 80%
Stage 2 40%
Stage 3 8%
42. PALATAL IMPLANTS
Placement of three woven
implants which stiffen the
palate
Fibrotic bands within capsule
which stiffens palate further
43. RADIOFREQUENCY TISSUE
VOLUME REDUCTION
Submucosal application of the
radiofrequency energy to the midline soft
palate.
Initial treatment directed at a point
approximately midway between the hard
and soft palate junction and the base of the
muscular uvulae.
Carried out as a day care or OPD procedure
Less complications
44. LASER MIDLINE GLOSSECTOMY
Approximately 2.5 x 5cm
midline tongue tissue is
excised.
Might also require lingual
tonsillectomy, reduction of
aryepiglottic folds and
partial epiglottectomy.
Usually combined with
tracheostomy for airway
protection.
49. HYOID MYOTOMY AND
SUSPENSION
Hyoid mobilized by inferior
myotomy and fixed anteriorly
and inferiorly to thyroid
cartilage
Advances the hyoid and
epiglottis anteriorly
Increases retro lingual space