Descriptive and informative facts about Patent Ductus Arteriosus focusing on its clinical features, physical findings, natural course and diagnostic work up. The diagnostic work up does not include Echocardiography in this presentation.
Ventricular septal defects a brief and easy understanding of embryogenesis, pathophysiology, clinical features, types, diagnosis and management of various types of Ventricular septal defects
Ventricular septal defects a brief and easy understanding of embryogenesis, pathophysiology, clinical features, types, diagnosis and management of various types of Ventricular septal defects
A 30-minute talk, presented as part of the weekly teaching activities in Alder Hey Children's Hospital (Liverpool, UK). It addresses PDA evaluation in children - starting with embryology & anatomy with the basis behind physiological closure versus patency after birth. What is the role of echo study in diagnosing/evaluating PDA? Modes used with some clear movies? Its limitations?
Definition:
Also known as Hypoplastic Right Heart Syndrome (HRHS)
It is a rare congenital cardiac lesion characterized by heterogeneous right ventricular development, an imperforate pulmonary valve, and possible extensive ventriculocoronary connections.
It is a type of congenital cyanotic heart disease, a severe form of Tetralogy of Fallot (TOF)
Newborn patients present cyanotic with high desaturation and pulmonary blood flow that depend on patent ductus arteriosus
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
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.
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
- 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
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.
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.
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
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.
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
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!
3. NHF Cardiac Course
Flow through PDA depends on…
Size and
resistance
of Ductus
PVR:SVR
PVR
SVR
PVR: Pulmonary Vascular Resistance
SVR: Systemic Vascular Resistance
4. NHF Cardiac Course
Hemodynamic changes
At birth • High PVR, minimal L-R shunt, less symptoms
At 6-8
weeks
• PVR falls, increase in L-R shunts(Qp), symptoms
starts, PAH starts to develop
With time
• PVR gradually rises
• PVOD develops
• Right Ventricular failure
5. NHF Cardiac Course
• Blood flows from Aorta to PA both
in systole and diastole
• Increase in Qp
• Increased Pulmonary venous
return to LA
6. NHF Cardiac Course
• Increase in preload
• LV increases its stroke volume
• Dilatation and hypertrophy of LV
• Dilatation of Aorta
7. NHF Cardiac Course
History
Key points
Prematurity
Maternal rash in the first trimester
High altitude
Down syndrome/ Edward Syndrome/
Char syndrome
9. NHF Cardiac Course
Hemodynamic classification of PDA
PDA
Small
PDA
Moderate
PDA
Large
• Qp/Qs: <1.5
• LA/LV not dilated
• Normal PA pressure
• Shunt depends on the
size of the PDA
• Qp/Qs: >1.5-2
• LA/LV dilated
• PA pressure mildly
elevated /normal
• Shunts depend on
PVR:SVR ratio
• Qp/Qs: >2
• LA/LV dilated
• PA pressure elevated
10. NHF Cardiac Course
Neonatal presentation
Common Presentation
Respiratory Distress
Feeding Difficulty
Diaphoresis
Shock
IVH
Necrotizing Enterocolitis
Signs
Syndromic facies
Microcephaly
Cataract
Tachypnoea
Tachycardia
Signs
Bounding pulses
Hypotension with widened
pulse pressure
Not “typical” Continuous
Murmur
Crackles at lung bases
11. NHF Cardiac Course
• Asymptomatic
• Incidental detection
of systolic/
continuous murmur
• Unremarkable ECG
and Chest Xray
Small PDA Silent PDA
• Too tiny to
produce murmur
• Diagnosed by
echocardiography
13. NHF Cardiac Course
Large PDA
• Will be similar
to that of
moderate PDA,
but the
severity is
more.
Symptoms
• Severe failure to
thrive
• Bounding pulses
• Wide pulse pressure
• CHF
Signs
• Hyperdynamic precordium, chest deformity
• Forceful ill-sustained shifted apex
• Thrill at left upper chest
• P2 palpable, Loud S2
• Short systolic murmur, MDM, S3
Precordial
Findings
15. NHF Cardiac Course
Eisenmenger Physiology
Symptoms
• Less frequent
episodes of RTI
• Leg “fatigue”
• Duskiness of the
toes, with pink
fingers
Signs
• Sat UL- Normal
LL- <90%
• Toes- clubbed
• Features of right
heart failure
Precordium
• Apex not shifted
• Single S2,Loud P2
• Continuous PDA
murmur not
found
• Mid-diastolic
murmur of PR
16. NHF Cardiac Course
Physical findings…explained
Wide Pulse Pressure:
• Increase in the preload of LV
Increase stroke volume into the aorta
Aortic systolic pressure is elevated
• The diastolic pressure is lowered because of a good amount of blood
flow into the PA and not the descending Aorta (Diastolic run-off)
Ref: Pocket book of Pediatric Cardiology, 2nd Ed
17. NHF Cardiac Course
The Continuous machinery murmur
described by Gibson:
• Begins after S1
• Rises to a peak in late systole, near S2
• Continuous through second heart sound,
uninterrupted into diastole
• Declines in intensity during the course of
diastole
• Multiple clicks
Ref: Pocket book of Pediatric Cardiology, 2nd Ed
18. NHF Cardiac Course
• The duration of diastolic murmur of the PDA reflects the PA pressure
As the PVR rises the PA and Ao diastolic pressure equalizes.
The duration of the diastolic murmur shortens leaving a holosystolic murmur.
With Right to Left shunt, the
ductus is “Silent”.
With increasing PVR, the systolic portion of
murmur shortens
19. NHF Cardiac Course
Mid-diastolic murmur:
• An apical mid-diastolic murmur suggests a large left-to-right shunt
through the PDA, resulting in a large volume of blood flow crossing a
normal mitral valve.
• This murmur cannot be heard unless the diastolic portion of the
continuous murmur is decreased by an increase in PVR.
REF:POCKET GUIDE PEDIATRIC CARDIOLOGY
PERLOFF’S CLINICAL RECOGNITION OF CONGENITAL
HEART DISEASE, 6TH ED
20. NHF Cardiac Course
• The second heart sound is “paradoxical” in PDA,
• The A2 component closes later than the P2 component as it takes
more time to eject more blood from the LV
• The RV ejecting less blood than the LV, closes early
21. NHF Cardiac Course
Diagnostic Work up
• Chest X-ray
• ECG
• Echocardiography
• Multi slice cardiac CT with CT Angiogram
• Cardiac Catheterization
23. NHF Cardiac Course
ECG
• Normal sinus rhythm
• H/R 100/min
• Normal Axis
• LA enlargement:
Bifid or Biphasic P waves
• LV hypertrophy
• Deep Q waves
24. NHF Cardiac Course
• Echocardiography is an efficient tool for diagnosis and evaluation for
PDA.
• Cardiac catheterization done when….
25. NHF Cardiac Course
Cardiac Catheterization… when to do it?
Diagnosis
Shunt
Magnitiude
PVRI:SVRI
Additional
lesions, eg
Co-Arctaion
Therapeutic
(Device
closure)
26. NHF Cardiac Course
Catheter Trajectory
Venous Access:
IVC RA RV PA Ao
Catheter easily passes from PA to Ao
through PDA
Takes a specific “Hair Pin” appearance
27. NHF Cardiac Course
• Pressure Measurement:
RA RV Individual branch PA
MPA pressure tends to be higher if the catheter tip is near the orifice
The descending aortic pressure is recorded after the duct is crossed.
• Oxymtery: RV to PA step up usually confirms PDA. A step up of 6% is
taken to be significant
28. NHF Cardiac Course
• Arterial Access:
Aortography: for visualization and
assessment of PDA and any associated Co-
arctation
LV graphy : to see any associated VSD
29. NHF Cardiac Course
Choice of view
Left lateral ( 90 degree) Right Anterior oblique view(45◦)
degree)
30. NHF Cardiac Course
Haemodynamic
data
Site Without O2 With O2
SO2 Pressure SO2 Pressure
SVC 76 82
IVC 68 71
RA 74 80
RV 76 82
PA 82 100/53/67 90 100/48/66
AO 91.7 100/55/70 98.1 105/67/88
PV 99 100
Parameter Without
Oxygen
With
Oxygen
L/min/m2 BSA
QP 7.18 13.8
QS 5.49 5.44
Qp : Qs 1.3:1 2.54
PVRI 7.94 4.49
SVRI 11.29WU 15.07WU
PVR/SVR 0.703 0.313
FLOW AND RESISTENCE CALCULATION
33. NHF Cardiac Course
Differential Diagnosis
Points in favor Points against
Aorto Pulmonary Window • Bounding Pulse, Wide Pulse P
• Continuous machinery murmur
• Murmur found in left 3rd ICS
• Louder systolic component
• Clicks not found
• Does not peak at S2.
RSOV • Continuous murmur
• Bounding Pulse
• Murmur intensity maximum 4/6
in PDA
• Murmur at mid to lower sternal
border on left and right side
• Intensity 5 or 6/6
• Highly palpable thrill
VSD with AR Bounding pulses
Wide pulse pressure
Systolic murmur
• Murmur not continuous when
heard below the clavicle
34. NHF Cardiac Course
Natural history
• The PDA becomes anatomically closed by 15 hours of birth and functionally
closes off by 24-48 post natal hours
• It closes off by the first month in the term neonates, if at all.
• For the preterm babies, it takes a little longer, appropriately with the corrected
gestational age.
• The ductus is more likely to close off in a preterm baby because the ductual
smooth muscle is less responsive to oxygen.
• But in term babies the ductus is patent due to structural abnormality
35. NHF Cardiac Course
• Within early infancy a moderate/large PDA will cause CHF and
recurrent RTI if left untreated.
• If not timely closed large PDA can develop Eisenmenger syndrome,
even in the first decade.
• Although rare in this era, the narrow pulmonary end of the PDA can
develop infected endarteritis, which can dislodge and flow to lungs
• A rare complication after device/ surgical closure of PDA is ductal
aneurysm or rupture.
