Oral medicine involves diagnosing and managing diseases of the oral cavity, salivary glands, and orofacial region in patients with systemic conditions. Specialists provide care to medically complex patients and those receiving cancer treatment. They diagnose non-surgical oral conditions and manage pharmacotherapy. Examinations include medical history, vital signs, head/neck exam, and lab tests to establish diagnoses and treatment plans considering medical factors.
describes the etiopathogenesis , clinical features, investigations, differential diagnosis and management and prophylaxis of all important viral lesions affecting the oral cavity
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostoticii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformansc. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitisb. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibromab. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular typeii. Psammomatoid type
d. Gigantiform cementomas
describes the etiopathogenesis , clinical features, investigations, differential diagnosis and management and prophylaxis of all important viral lesions affecting the oral cavity
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostoticii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformansc. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitisb. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibromab. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular typeii. Psammomatoid type
d. Gigantiform cementomas
CASE HISTORY AND PHYSICAL EVALUATION OF DENTAL PATIENTS /prosthodontic coursesIndian 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.for more details please visit
www.indiandentalacademy.com
Introduction to operative dentistry and Patient assessment.pptxridwana30
Introduction and the scope of operative dentistry with advancement of operative field. The examination procedure for assessing a patient for operative treatment and reaching a comprehensive treatment plan.
diagnostic aids part 1 diagnosis, examination, BMR, EMG.docxDr.Mohammed Alruby
Introduction:
Proper treatment plane depends on prompt diagnosis, good clinician should have a bird’s eyes to first identify the problem and find its etiology
Definitions:
= Grabber and Rackosi: defined diagnosis as:
Recognition and systemic designation of anomalies, the practical synthesis of the finding, permitting therapy to be planned and identification to be determined
=a continuous evaluation process in orthodontics starting right from the first interaction with the patient continuing through different stages till end of treatment and course follow up visits
Goal of orthodontic diagnosis:
Is to produce a comprehensive description of the patient’s problem and then to synthesis the various elements of description into a rational problem list
Diagnostic aids:
Data required for orthodontic diagnosis are derived from routine essential diagnostic aids and also from supplemental aids when needed, Graber categorized the diagnostic aids into essential and supplemental aids
Essential:
- Case history
- Study models
- Certain radiographs: periapical, bite wing, panoramic radiograph
- Facial photographs
- Intra-oral photographs
Supplemental:
- Specialized radiographs: occlusal of maxilla and mandible, lateral cephalogram
- Hand &wrist radiograph
- Electromyography
- Endocrine test
- Basal metabolic rate
Case history:
Complete case history includes all the relevant information derived from the patient and parents and essential for planning
Personal details:
Name:
The patient’s name should be recorded for the purpose of identification and communications
Calling the patient by his/her name not only establishes a good report but also imparts confidence in the patient mind about treatment providers
In case of children, it might help to know their pet problems
Age:
= certain malocclusion occurring during growth period are transient and self-correcting
= growth modification procedures such as functional appliances can be carried out during growth periods
= surgical respective procedures such as orthognathic surgery are best carried out after cessation of growth
= chronological age is important for the maintaining of shedding and eruption time tables as well
Gender:
= recording gender of the patient is important for treatment planning, females are observed to precede males in growth related events such as onset of growth spurt, eruption of the teeth and onset of puberty
= gender may also have a bearing on patient’s compliance toward certain types of orthodontic treatment
Occupation and address:
Occupation of patient / or parents gives an idea about socioeconomic condition which might affect the selection of orthodontic appliances and can give an idea about awareness
Address of patient determine the sociality of the patient and this effect on the treatment because some countries have normally bi-maxillary protrusion and also determine the awareness of patient about treatment and oral hygiene
Patient behavior:
Behavior of patient depend on: patient
Lecture 3 Facial cosmetic surgery
Maxillofacial Surgery
Dental Students Fifth Year second semester
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
Lecture 1 Facial cosmetic surgery
Maxillofacial Surgery
Dental Students Fifth Year second semester
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
Facial neuropathology Maxillofacial SurgeryLama K Banna
Lecture 4 facial neuropathology
Maxillofacial Surgery
Dental Students Fifth Year second semester
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
Lecture 2 Facial cosmetic surgery
Maxillofacial Surgery
Dental Students Fifth Year second semester
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
Lecture 12 general considerations in treatment of tmdLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name 12 general considerations in the treatment of TMJ
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name TMJ temporomandibular joint
Lecture 10
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
Lecture 11 temporomandibular joint Part 3Lama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name TMJ temporomandibular joint Part 3
Lecture 11
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name TMJ anatomy examination 2
Lecture 9
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Lecture 7 correction of dentofacial deformities Part 2Lama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name Correction of dentofacial deformities Part 2
Lecture 7
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Lecture 8 management of patients with orofacial cleftsLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name management of patients with orofacial clefts
Lecture 8
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Lecture 5 Diagnosis and management of salivary gland disorders Part 2Lama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name Salivary gland 2
Diagnosis and management of salivary gland disorders Part 2
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Lecture 6 correction of dentofacial deformitiesLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name Correction of dentofacial deformities
Lecture 6
Al Azhar University Gaza Palestine
Dr. Lama El Banna
lecture 4 Diagnosis and management of salivary gland disordersLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name Salivary gland
Diagnosis and management of salivary gland disorders
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Maxillofacial Surgery 1
Dental Students Fifth Year First semester
Lecture Name maxillofacial trauma Part 3
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name maxillofacial trauma part 2
Al Azhar University Gaza Palestine
Dr. Lama El Banna
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
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 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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
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
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
1. Oral Medicine
Dr. Rawand Samy Mohamed Abu Nahla
Oral Medicine, periodontology& oral Radiology Department.
Dr. Haydar. A. Shafy Faculty Of Dentistry.
El Azhar University.
3. The field of oral medicine consists chiefly of the diagnosis and medical
management of the patient with complex medical disorders involving the
oral mucosa and salivary glands as well as orofacial pain and
temporomandibular disorders.
Specialists trained in oral medicine also provide dental and oral health care
for patients with medical diseases that affect dental treatment, including
patients receiving treatment for cancer, diabetes, cardiovascular diseases,
and infectious diseases.
4. Oral medicine is the specialty of dentistry that is concerned with the oral health care of
medically compromised patients and with the diagnosis and nonsurgical management
of medically related disorders or conditions affecting the oral and maxillofacial region.
Oral medicine specialists are concerned with the nonsurgical medical aspects of
dentistry. These specialists are involved in the primary diagnosis and treatment of oral
diseases that do not respond to conventional dental or maxillofacial surgical
procedures.
The practice of oral medicine will provide optimal health to all people through the
diagnosis and management of oral diseases.
5. Fundamental to this vision are the following:
1. Recognition of the interaction of oral and systematic health.
2. Integration of medical and oral health care.
3. Management of pharmaco therapeutics necessary for treatment of
oral and systemic diseases
4. Investigation of the etiology and treatment of oral diseases through
basic science and clinical research.
5. Research, teaching, and patient care.
6. 6. Provision of care for medically complex patients and for those
undergoing cancer therapy.
7. Prevention, definition and management of the following
disorders:
Salivary gland disease.
Orofacial pain and other neurosensory disorders.
Disorders of the oral mucosa membranes.
7. To get relevant medical and dental information (including the examination of the
patient) and the use of this information for dental treatment. This process can be
divided into the following four parts:
1. Taking and recording the medical history.
2. Examining the patient and performing laboratory studies.
3. Establishing a diagnosis
4. Formulating a plan of action (including dental treatment modifications and
necessary medical referrals)
8. MEDICAL HISTORY
Obtaining a medical history is an information gathering process for assessing a
patient’s health status.
The medical history comprises a systematic review of the patient’s chief or
primary complaint, a detailed history related to this complaint, information
about past and present medical conditions, pertinent social and family histories.
9. 1-Chief Complaint and History Of The Present
Illness
The chief complaint is established by asking the patient to describe the problem for which he or
she is seeking help or treatment. The chief complaint is recorded in the patient’s own words as
much as possible and should not be documented in technical (ie, formal diagnostic) language
unless reported in that fashion by the patient.
Patients may or may not volunteer a detailed history of the problem for which they are seeking
treatment, and additional information usually needs to be elicited by the examiner.
The patient’s responses to these questions constitute the history of the present illness (HPI).
10. The HPI is the course of the patient’s chief complaint:
When and how it began; what exacerbates and what ameliorates
the complaint (when applicable); if and how the complaint has been
treated, and what was the result of any such treatment; and what
diagnostic tests have been performed.
Direct and specific questions are used to elicit this information and
should be recorded in the patient record in narrative form, as follows:
11. 1. When did this problem start?
2. What did you notice first?
3. Did you have any problems or symptoms related to this?
4. What makes the problem worse or better?
5. Have the symptoms gotten better or worse at any time?
6. Have any tests been performed to diagnose this complaint?
7. Have you consulted other dentists, physicians, or anyone else related to
this problem?
8. What have you done to treat these symptoms?
12. 3-PAST MEDICAL HISTORY(PMH):
The past medical history (PMH) includes information about any significant or serious illnesses a patient may
have had as a child or as an adult. The patient’s present medical problems are also enumerated under this
category. The PMH is usually organized into the following subdivisions:
(1) Serious or significant illnesses.
(2) Hospitalizations.
(3) Transfusions.
(4) Allergies.
(5) Medications.
(6) Pregnancy.
13. 2-PAST DENTAL HISTORY (PDH)
Despite its frequent omission from the dental record, the past dental
history (PDH) is one of the most important components of the patient
history.
This is especially evident when the patient presents with complicating
dental and medical factors such as restorative and periodontal needs
coupled with a systemic disorder such as diabetes.
14. Significant items that should be recorded routinely are the frequency of past
dental visits:
previous restorative, periodontic, endodontic, or oral surgical treatment.
Reasons for loss of teeth; untoward complications of dental treatment.
Fluoride history, including supplements and the use of well water.
Attitudes towards previous dental treatment; experience with orthodontic
appliances and dental prostheses; and radiation or other therapy for oral or facial
lesions.
15. 4-FAMILY HISTORY
Serious medical problems in immediate family members (including parents, siblings,
and children) should be listed.
Disorders known to have a genetic or environmental basis (such as certain forms of
cancer, cardiovascular disease including hypertension, allergies, asthma, renal
disease, stomach ulcers, diabetes mellitus, bleeding disorders, and sickle cell anemia)
should be addressed.
16. 5-SOCIAL HISTORY
Different social parameters should be recorded. These include marital status
(married, separated, divorced, single, or with a “significant other”); place of
residence (with family, alone, or in an institution); educational level; occupation;
religion; travels abroad; tobacco use (past and present use and amount); alcohol use
(past and present use and amount).
When obtaining the social history, the clinician should take into account the
patient’s chief complaint and PMH in order to gather specific information
pertinent to the patient’s dental management.
17. 5-EXAMINATION OF THE PATIENT
The routine oral examination (ie, thorough inspection, palpation, auscultation, and
percussion of the exposed surface structures of the head, neck, and face; detailed
examination of the oral cavity, dentition, oropharynx, and adnexal structures, as
customarily carried out by the dentist) should be carried out at least once annually or at
each recall visit
18. The examination procedure in dental office settings includes the following:
1.Registration of vital signs (respiratory rate, temperature, pulse, and blood
pressure).
2. Examination of the head, neck, and oral cavity, including salivary glands,
temporomandibular joints, and lymph nodes.
3. Examination of cranial nerve function.
4. Special examination of other organ systems.
5. Requisition of laboratory studies.
19. Normal values:
Normal respiratory rate during rest is 14 to 20 breaths per minute.
The normal oral (sublingual) temperature is 37°C (98.6°F), but oral temperatures < 37.8°C (100°F) are not
usually considered to be significant.
The normal resting pulse rate is between 60 and 100 beats per minute (bpm). A patient with a pulse rate >100
bpm (tachycardia),
Normal blood pressure Optimal Systolic Blood Pressure < 120 (mm Hg) and Diastolic Blood Pressure < 80
(mm Hg)
20. 1-Facial Structures:
Observe the patient’s skin for color, blemishes, moles, and other
pigmentation abnormalities; vascular abnormalities such as angiomas,
telangiectasias, nevi, and tortuous superficial vessels; and asymmetry,
ulcers, pustules, nodules, and swellings.
Note the color of the conjunctivae.
21. 2-Lips
Note lip color, texture, and any surface abnormalities as well as angular or vertical
fissures, lip pits, cold sores, ulcers, scabs, nodules, keratotic plaques, and scars. Palpate
upper lip and lower lip for any thickening (induration) or swelling.
Note orifices of minor salivary glands and the presence of Fordyce’s granules.
3-Cheeks
Note any changes in pigmentation and movability of the mucosa, a pronounced linea
alba, leukoedema, hyperkeratotic patches, intraoral swellings, ulcers, nodules, scars,
other red or white patches, and Fordyce’s granules.
22. 4-Maxillary and Mandibular Mucobuccal Folds
Observe color, texture, any swellings, and any fistulae. Palpate for swellings and
tenderness over the roots of the teeth and for tenderness of the buccinator insertion by
pressing laterally with a finger inserted over the roots of the upper molar teeth.
5-Hard Palate and Soft Palate
Illuminate the palate and inspect for discoloration, swellings, fistulae, papillary
hyperplasia, tori, ulcers, recent burns, leukoplakia, and asymmetry of structure or
function.
Examine the orifices of minor salivary glands. Palpate the palate for swellings and
tenderness.
23. 6-The Tongue
Inspect the dorsum of the tongue (while it is at rest) for any swelling, ulcers, coating, or
variation in size, color, and texture.
Observe the margins of the tongue and note the distribution of filiform and fungiform
papillae, depapillated areas, fissures, ulcers, and keratotic areas. Note the frenal
attachment and any deviations as the patient pushes out the tongue and attempts to move
it to the right and left.
Wrap a piece of gauze (4 cm × 4 cm) around the tip of the protruding tongue to steady
it, and lightly press a warm mirror against the uvula to observe the base of the tongue
and vallate papillae; note any ulcers or significant swellings.
24. 7-Floor of The Mouth
With the tongue still elevated, observe the openings of Wharton’s ducts, the salivary
pool, the character and extent of right and left secretions, and any swellings, ulcers, or
red or white patches.
Gently explore and display the extent of the lateral sublingual space, again noting ulcers
and red or white patches.
8-Gingivae
Observe color, texture, contour, and frenal attachments.
Note any ulcers, marginal inflammation, resorption, festooning, Stillman’s clefts,
hyperplasia, nodules, swellings, and fistulae.
25. 8-Teeth and Periodontium
Note missing or supernumerary teeth, mobile or painful teeth, caries, defective restorations, dental arch
irregularities, orthodontic anomalies, abnormal jaw relationships, occlusal interferences, the extent of
plaque and calculus deposits, dental hypoplasia, and discolored teeth.
9-Tonsils and Oropharynx
Note the color, size, and any surface abnormalities of tonsils and ulcers, tonsilloliths, and inspissated
secretion in tonsillar crypts. Palpate the tonsils for discharge or tenderness, and note restriction of the
oropharyngeal airway. Examine the faucial pillars for bilateral symmetry, nodules, red and white
patches, lymphoid aggregates, and deformities. Examine the postpharyngeal wall for swellings, nodular
lymphoid hyperplasia, hyperplastic adenoids, postnasal discharge, and heavy mucous secretions.
26. 9-Salivary Glands
Note any external swelling that may represent enlargement of a major salivary gland. A
significantly enlarged parotid gland will alter the facial contour and may lift the ear lobe;
an enlarged submandibular salivary gland (or lymph node) may distend the skin over the
submandibular triangle.
With minimal manipulation of the patient’s lips, tongue, and cheeks, note the presence of
any salivary pool, and note whether the mucosa is moist, covered with scanty frothy
saliva, or dry.
27. 10-Neck and Lymph Nodes
Examination of the neck is a natural extension of a routine dental examination and includes
examination of the submandibular and cervical lymph nodes (draining the oropharynx and
other tissues of the head and neck and anastomosing with lymphatics from the abdomen,
thorax, breast, and arm), the midline structures (hyoid bone, cricoid and thyroid cartilages,
trachea, and thyroid gland), and carotid arteries and neck veins.
With the patient’s neck extended, note the clavicle and the sternomastoid and trapezius
muscles, which define the anterior and posterior triangles of the neck. Palpate the hyoid
bone, the thyroid and cricoid cartilages, and the trachea, noting any displacement or
tenderness.
28. 11-Cranial Nerve Function
In examining patients with oral sensory or motor complaints, it is important to know if
there is any objective evidence of abnormality of cranial nerve function that might relate
to the patient’s oral symptoms.
A definitive answer to this question usually comes from specific testing of cranial nerve
function as part of a general physical examination carried out by either the patient’s
physician, an internist, or a neurologist. When the results of a neurologist’s examination
are not readily available, a cranial nerve examination carried out by the dentist.
29. Establishing The Diagnosis
In some circumstances, the diagnosis (ie, an explanation for the patient’s symptoms and identification of
other significant disease process) may be self-evident. When clinical data are more complex, the diagnosis
may be established by:
1. Reviewing the patient’s history and physical, radiographic, and laboratory examination data;
2. Listing those items that either clearly indicate an abnormality or that suggest the possibility of a significant
health problem requiring further evaluation.
3. Grouping these items into primary versus secondary symptoms, acute versus chronic problems, and high
versus low priority for treatment.
4. Categorizing and labeling these grouped items according to a standardized system for the classification
of disease.
30. Formulating A Plan Of Treatment And Assessing Medical Risk
Plan of Treatment
The diagnostic procedures (history, physical examination, and imaging and laboratory studies) outlined
previously are designed to assist the dentist in establishing a plan of treatment directed at those disease
processes that have been identified as responsible for the patient’s symptoms.
A plan of treatment of this type, which is directed at the causes of the patient’s symptoms rather than at the
symptoms themselves, is often referred to as rational, scientific, or definitive (in contrast to symptomatic,
which denotes a treatment plan directed at the relief of symptoms, irrespective of their causes).
Like the diagnostic summary, the plan of treatment should be entered in the patient’s record and explained to
the patient in detail (procedure, chances for cure [prognosis], complications and side effects, and required
time and expense).
31. 45-year-old Caucasian female presents for evaluation of a swelling in her lower lip. The
swelling has been present for 1 month. Her past medical history is remarkable for several angina
attacks during the past 4 years. The angina is being treated with nitroglycerins only when
necessary. Patient is not taking any daily medications. No history of any other cardiovascular
disease. No chest pains for the past 6 months.. Examination reveals a 2 mm × 2 mm hard
nonmovable pea-shaped lesion 10 mm medial to the right lip commissure and 5 mm inferior to
the vermilion border.
The lesion is consistent with a traumatic injury of a minor salivary gland. Patient has been advised that the
lesion may resolve by itself or the she can have it surgically removed with local anesthesia. Any dental treatment
of this patient needs to address her cardiovascular condition.