An 18-year-old male presented with 3 months of left knee pain and 2 months of swelling above the knee. Examination revealed a hard, ill-defined swelling on the distal left thigh. Radiological investigation and biopsy were needed to confirm a diagnosis of osteosarcoma, which commonly affects long bones in teenagers and young adults. Treatment may involve limb salvage surgery combined with chemotherapy or amputation, with the goal of confirming the diagnosis, evaluating spread, and adequately treating the cancer.
Ewing's sarcoma is the 3rd most common primary malignant bone tumor in the world. It affects people at first 2 decades. In this presentation, every important aspect of this bone tumor has been described extensively but in brief.
Highly malignant tumor of mesenchymal origin.Spindle shaped cells that produce osteoid.2nd most common primary malignant bone tumor after MM.Incidence – 1 to 3 per million per year
Treated by chemo,amputation or rotationplasty
emergencies in patient with abdominal pain to be ruled out first that might save the patients life , with ther clinical minute diagnosis and management in the ER then and there.
Ewing's sarcoma is the 3rd most common primary malignant bone tumor in the world. It affects people at first 2 decades. In this presentation, every important aspect of this bone tumor has been described extensively but in brief.
Highly malignant tumor of mesenchymal origin.Spindle shaped cells that produce osteoid.2nd most common primary malignant bone tumor after MM.Incidence – 1 to 3 per million per year
Treated by chemo,amputation or rotationplasty
emergencies in patient with abdominal pain to be ruled out first that might save the patients life , with ther clinical minute diagnosis and management in the ER then and there.
Long case examination done during MBBS and MD examination. Neurology case is mostly the long case. History, general examination , systemic examination, provisional diagnosis, investigation and final diagnosis are the sequential steps. Neurology examinations includes higher mental function, cranial nerve examination, motor and sensory system examination, cerebellar signs, gait, peripheral nerves, spine and skull and peripheral nerve examination.
Case of chronic mesenteric ischemia, with pre-operative history and evaluation using ultasound doppler, CT angiogram and laboratory values. This followed by a detailed description of the surgical steps. A discussion then ensues over the management modalities and discussion on the outcomes using references and meta-analysis data
Salivary glands Disorders and management.Manish Shetty
Short, brief description of the salivary gland disorders.
it explain the basic anatomy, physiology of the salivary glands.
all the 3 salivary gland are individually explained with appropriate management of it disorders.
Adrenal Gland and its Disorders with surgical management.Manish Shetty
Short and brief description of adrenal gland and its disorder.
it involves the basic anatomy, physiology and metabolism of adrenal hormones.
.Adrenal gland tumor like adrenal cortical tumor phaechromocytoma, incidentalaoma are mentioned in this PPT.
it explains the clinical symptoms, investigation and desired management of adrenal gland disorders.
Short and brief presentation of anatomy, physiology , disorder and management of parathyroid glands.
management of MEN syndrome, hyper and hypoparathyroidism.
disorder of calcium metabolism like tetany,.
surgical steps of parathyroidectomy with indication and complications
Brief quick information of TB HIP.
introduction , pathophysiology, stages, signs and symptoms, clinical assessment, investigation, XRAY, and management of TB hip joint.
Describe about the chief complaints , gait assessment, special test and local examination of hip joint.
includes the special tests like thomas test, tredenlenberg test, DDH test etc..
Includes brief info about epidemiology, etiology, TNM staging, types,symptoms and management of CA larynx/ larynx carcinoma.
glottic ,subglottic and supraglottic carcinoma of larynx is also discussed with the individual management.
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.
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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
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
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
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. CASE SCENARIO
18 year Old Male patient with chief complaints of
• Pain in the left knee– 3 Month
• Swelling above the knee joint – 2 Months
3. HISTORY OF PRESENT ILLNESS
• The patient was in usual state of health then he developed pain which
was acute in onset, it was severe, continuous, non-radiating type of pain
since 3months.
• Swelling over the left leg which was insidious in onset, initially small in
size and rapidly progressed to current size.
• No history of fever, trauma/injury.
• No history of similar swelling in the past.
• No history of cough, hemoptysis.
4. PAST HISTORY
• No history of Diabetes, Hypertension, TB, asthma, cardiac disease
• No history of surgery in the past.
FAMILY HISTORY
• Insignificant family history.
PERSONAL HISTORY
• Patient consumes mixed diet, normal bowel and bladder habits.
• Sleep and appetite are normal.
• No addictions
6. GENERAL PHYSICAL EXAMINATION
• Patient was conscious, co-operative and well oriented to time, place
and person.
VITAL SIGNS: -
Pulse – 70 beats per minute, regular rhythm, normal volume &
character.
Blood pressure – 130/70 mm of Hg
Respiratory Rate – 18 cycles per minute.
Afebrile at the time of examination
NO pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema.
7. SYSTEMIC EXAMINATION
CVS – S1 and S2 heard, no added murmurs.
RS – NVBS heard, no added sounds.
CNS – Higher mental functions are normal
Per Abdomen – soft, non-tender, no organomegaly.
8. LOCAL EXAMINATION (LEFT LEG):-
INSPECTION:
• Ill defined Swelling present over the distal aspect of left thigh
• Skin over the swelling is shiny with prominent veins
• No open wound, No discharging sinus
PALPATION:
• local rise in temperature was present.
• Tenderness is present.
• Swelling is hard in consistency, margins are ill defined, not mobile
• No bony crepitus.
• Movements at the knee joint are painful and restricted
• No distal neuro vascular deficit.
10. EPIDEMIOLOGICAL FEATURES :-
• Second most common
• Highly malignant tumor
• Age group :-
Primary osteosarcoma :- 15 - 25 years
Secondary Osteosarcoma :- 45 year onwards
• Commonly involves the Metaphysis of long bone
• Tumor most commonly metastasis to lungs.
11. SITE OF INVOLVEMENT :-
Typical sites:-
• Distal end of femur
• Proximal tibia
• Upper end of Humerus
13. HISTOLOGIC APPEARNCE
• Tumours vary in the richness of the osteoid, cartilaginous, or vascular components
but common to all is a basically anaplastic mesenchymal parenchyma with tumour
cells surrounded by osteoid.
16. BLOOD INVESTIGATION
•Serum alkaline phosphatase (SAP):
It is generally elevated, but is of no diagnostic
significance. A rise of SAP after an initial fall
after tumour removal is taken as an indicator of
recurrence or metastasis.
17. AIMS OF TREATMENT
• Confirm the diagnosis
• Evaluate spread of the tumour
• Execute adequate treatment.
• Follow up
1. Clinical
2.Radiological
3.Histopathological1. CHEST XRAY
2.CT SCAN
3.MRI
18. LIMB ABLATION
SURGERY
LOCAL TREATMENT OF TUMOR
LIMB SAVING
SURGERY
AMPUTATION
AND PATIENT USES
ARTIFICAL LIMB
AMPUTATION
SITE Level
• Lower end of femur Mid thigh* amputation
Hip disarticulation
• Upper end of femur Hip disarticulation*
Hindquarter amputation
• Upper end of tibia Mid thigh amputation
• Upper end of Humerus Forequarter amputation
1. Radical resection with
reconstruction
2. Arthodesis
3. Joint replacement
19. RADIOTHERAPY CHEMOTHERAPY IMMUNOTHERAPY
Local control of diease in
surgical inaccessible site
1. Methotrexate
2. Citrovorom Factor
3. Endoxan
4. Cisplatinum
Portion of the tumour is
implanted into a sarcoma
survivor and is removed after
14 days. The
sensitised lymphocytes from
the survivor are infused into
the patient.
20. PROGNOSIS
• Without treatment, death occurs within 2 years, usually within 6 months of
detection of metastasis.
• 5-year survival with surgery alone is 20%.
• With surgery and adjuvant chemotherapy, a 5-year disease free period is reported
to be as high as 70 per cent.
• A primarily lytic type (telangiectatic) osteosarcoma has the worst prognosis.
