This document describes the perioperative management of a 6-month-old boy undergoing permanent pacemaker implantation for congenital complete heart block. Key aspects of management included premedication with atropine and promethazine to prevent vagal stimulation, induction with ketamine to avoid negative chronotropic effects, and maintenance with non-depressant anesthetics like isoflurane. Intraoperative monitoring and defibrillator equipment were readily available due to the risk of arrhythmias. The pacemaker implantation procedure and postoperative course were uncomplicated with this careful anesthetic approach.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
To interrupt blood supply to the acardiac twin in a case of TRAP sequence of monochorionic diamniotic multiple pregnancy to allow for continuation of the normal twin.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
To interrupt blood supply to the acardiac twin in a case of TRAP sequence of monochorionic diamniotic multiple pregnancy to allow for continuation of the normal twin.
Presentazione realizzata dalla dott.ssa Daniela Miani, Unità Scompenso e Trapianto Cardiaco, AOU S. Maria della Misericordia di Udine, nell'ambito del corso "Le malattie neuromuscolari", Udine, 16 dicembre 2013.
Per maggiori informazioni: http://malattierare.aou.udine.it/
One of the hardest specialties is neuro anesthesia. When I initially started, I were so dumb founded. The things in brain did not only change, they become instantly harder. The drugs which were supposed to work now did not because the brain had developed edema or there was no blood supply. I worked real hard on this presentation. Took help from the textbooks and my teachers and has helped me. I hope you will found it somewhat helpful. Some of the answers are beyond the scope of this presentation due to the diversity of the field.
Repolarization theory
The early phase of the action potential (AP) in epicardial
cells demonstrates spike and dome morphology (Phase 1
and Phase 2). This period of the AP is influenced by
the fast inward sodium current INa, transient outward
potassium current Ito, and L‑type calcium current ICal. As
the dome is depressed, the epicardial AP is shortened.[67]
The interplay of currents during Phase 1 of the AP can
lead to depression of the AP dome. Normally, there is
higher Ito in the epicardium. In certain situations (such
as SCN5A or KCNE3 mutations), the Ito may become
increased in a nonuniform manner in different regions
of the epicardium, leading to epicardial dispersion of
repolarization [Figure 4]. This creates a transmural
gradient between epicardium and endocardium, which
manifests as the typical ST‑segment elevation pattern on
surface ECG.
Global Hospitals’ Advanced Heart, Lung & Vascular Institute provides all kinds of endovascular procedures including coronary intervention and peripheral intervention, heart surgery, heart bypass surgery as well as heart transplantation surgery in Hyderabad, Chennai, and Bangalore
Presentazione realizzata dalla dott.ssa Daniela Miani, Unità Scompenso e Trapianto Cardiaco, AOU S. Maria della Misericordia di Udine, nell'ambito del corso "Le malattie neuromuscolari", Udine, 16 dicembre 2013.
Per maggiori informazioni: http://malattierare.aou.udine.it/
One of the hardest specialties is neuro anesthesia. When I initially started, I were so dumb founded. The things in brain did not only change, they become instantly harder. The drugs which were supposed to work now did not because the brain had developed edema or there was no blood supply. I worked real hard on this presentation. Took help from the textbooks and my teachers and has helped me. I hope you will found it somewhat helpful. Some of the answers are beyond the scope of this presentation due to the diversity of the field.
Repolarization theory
The early phase of the action potential (AP) in epicardial
cells demonstrates spike and dome morphology (Phase 1
and Phase 2). This period of the AP is influenced by
the fast inward sodium current INa, transient outward
potassium current Ito, and L‑type calcium current ICal. As
the dome is depressed, the epicardial AP is shortened.[67]
The interplay of currents during Phase 1 of the AP can
lead to depression of the AP dome. Normally, there is
higher Ito in the epicardium. In certain situations (such
as SCN5A or KCNE3 mutations), the Ito may become
increased in a nonuniform manner in different regions
of the epicardium, leading to epicardial dispersion of
repolarization [Figure 4]. This creates a transmural
gradient between epicardium and endocardium, which
manifests as the typical ST‑segment elevation pattern on
surface ECG.
Global Hospitals’ Advanced Heart, Lung & Vascular Institute provides all kinds of endovascular procedures including coronary intervention and peripheral intervention, heart surgery, heart bypass surgery as well as heart transplantation surgery in Hyderabad, Chennai, and Bangalore
Although large efforts are spent for creating fistula as the primary access, use of Hemodialysis Vascular catheters are still the major access on the first Hemodialysis session and after 4 month whether we would like it or not.
"USRDS 2013"
Pituitary Adenomas Complicating Cardiac Surgery Summary and Review of 11 Case...ssuser97871f
ABSTRACT From the literature and our own experience, 11 cases of hemorrhage or infarction
of a pituitary adenoma associated with cardiac surgery have been identified over a 13-year
period. Males outnumbered females by 10 to 1. Symptoms observed were headache, lethargy,
confusion, obtundation, unilateral ptosis, meiosis, and opthalmoplegia involving cranial
nerves 111, IV, and VI, visual field deficits, and hemiparesis. Diagnosis in most recent cases has
been confirmed with computerized tomography or magnetic resonance imaging. All patients
received adrenocortical steroid therapy initially. Eight patients underwent transsphenoidal hy-
pophysectomy and all survived. One patient underwent decompression craniotomy and died.
lntracranial surgery was deferred in 1 patient who survived and in another who died of a mas-
sive stroke. Residual neurological deficits were noted to be either absent, minimal, or resolv-
ing in 7 of the 9 patients who survived their initial hospitalization. While numerous mecha-
nisms have been proposed to explain the hemorrhage and necrosis of a pituitary adenoma
during heart surgery, no direct cause has been clearly identified. Surgical treatment is com-
monly necessary since untreated pituitary apoplexy is often fatal. Transsphenoidal hypo-
physectomy with decompression is the preferred method of treatment with a low perioperative
mortality and fairly good long-term prognosis. Symptoms of severe headache, lethargy,
confusion, obtundation, unilateral ptosis, meio-
sis, opthalmoplegia involving cranial nerves Ill,
IV, and VI, visual field deficits, and hemiparesis
observed in patients following cardiac surgery
may indicate hemorrhage or infarction of a pi-
tuitary adenoma. The diagnosis can generally
be confirmed through CT or MRI scan. Treat-
ment of those with severe symptoms, particu-
larly if there has been an acute visual loss, can
be best accomplished by timely TSSHX decom-
pression.
Operative
mortality
with
the
transsphenoidal approach should be minimal.
The long-term outlook is generally good with
early resolution of neurological residuae, pro-
vided intervention is promptly undertaken. The
precise mechanism that triggers hemorrhage
and infarction of pituitary adenomas during car-
diac surgery remains unclear and suggests an
area for further investigation.A number of reports of hemorrhagic necrosis
of a pituitary adenoma complicating cardiac
surgery have appeared since 1980.1-6 While
this so-called “pituitary apoplexy syndrome”
has been widely described, the incidence of as-
sociation with cardiac surgery and the precise
mechanism of pituitary tumor injury remains un-
The purpose of the present article is to
provide further insight into the diagnosis and treatment of this condition in the cardiac surgi-
cal patient, to provide guidelines for optimal
cardiac surgical management of patients with
known pituitary tumors, and to add our own ex-
perience to the literature. Each case was tabulated by author, year,
age, sex
Fabry Disease (FD), also known as Anderson-Fabry disease, is an inherited X-linked disorder characterized by the absence (in men) or defi ciency (in women) in α-galactosidase A, activity that causes a progressive accumulation of glycosphingolipids within lysosomes of cells in all the major organ systems and progressive organ damage that fi rst manifests in childhood or early adulthood. End Stage Renal Disease (ESRD) is a major cause of morbidity and premature mortality in FD. We present a male patient with FD who was transplanted with kidney from a living donor and had a sudden cardiac arrest on the 4th day after operation. We suggest detailed preoperative examination including coronary angiography, echocardiography for these patients and also a multidisciplinary care is required for perioperative management of FD patients.
A study to assess the effectiveness of structured teaching program on knowledge regarding care of patients after cardiac surgery among staff nurses at Shree Narayana, Hospital, Raipur, chhattisgarh.
A 82 years old man with hemispheric stroke: decisions in a complex casePelouze Guy-André
Stroke is a major challenge to our healthcare systems because it demands fast decisions involving several specialists. Emergency imaging and interventional neurology transformed the prognosis of stroke.
Heart Transplantation in India, Delhi by expert surgeon Dr. Kewal Krishan. If you have know more information visit us www.kewalkrishan.com or call 91-9650300500 . Patients should receive maximal medical therapy before being considered for transplantation. They should also be considered for alternative surgical therapies including CABG, valve repair / replacement, cardiac septalplasty, etc
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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!
- 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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
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
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.
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
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.
2. PACEMAKER IMPLANTATION 629
Fig 1. ECG of congenital
complete heart block (atrioven-
tricular interruption). Ventricu-
lar rate 37 beats/min, atrial rate
100 beats/min.
Atropine and promethazine were used for premedication to managing the patient with CCHB with a very slow heart rate
counter vagal stimulation and drug-induced bradycardia. With requiring an epicardial pacemaker implantation.
adequate intravascular volume and use of ketamine, pancuro- In summary, congenital complete heart block rarely presents to
nium, isoflurane, morphine, and midazolam anesthesia, the anesthesiologists either for PPI or surgery. Early diagnosis and
authors did not face any problem. Diaz and Friesen4 used understanding of the pathophysiology of CCHB may help in
succinylcholine, halothane, fentanyl, and neostigmine with preventing sudden deaths or death during incidental surgery for
prior atropine administration in a case of CCHB for large bowel congenital anomalies. The perioperative management of PPI in-
obstruction caused by megacolon. Anesthesiologists are in- cludes the prior use of isoproterenol, epinephrine, and TP before
creasingly involved in the care of patients undergoing proce- the PPI. Atropine premedication and avoidance of anesthetics that
dures in catheterization and electrophysiologic laboratories in- slow heart rate are of prime importance, along with a defibrillator
cluding pacemaker implantation. This is good experience for and external and transvenous pacemakers in the operating room.
REFERENCES
1. Lee C, Mason LJ: Pediatric cardiac emergencies. Anesthesiol 7. McCue CM, Mantakas ME, Tingelstad JB, et al: Congenital heart
Clin North Am 19:287-308, 2001 block in newborns of mothers with connective disease. Circulation
2. Machado MV, Tynan MJ, Curry PVL, et al: Fetal complete heart 56:82-90, 1977
block. Br Heart J 60:512-515, 1988 8. Paredes RA, Morgan H, Lachelin GCL: Congenital heart block
3. Pinsky WW, Gillethe PC, Garson A, et al: Diagnosis, manage- associated with maternal primary Sjogren’s syndrome. Br J Obstet
ment, and long-term results of patients with congenital complete atrio- Gynaecol 90:870-871, 1983
ventricular block. Pediatrics 69:728-733, 1982 9. Frankville D: Anesthesia for noncardiac surgery in children and
4. Diaz JH, Friesen RH: Anesthetic management of congenital com- adults with congenital heart disease, In: Lake C (ed): Pediatric Cardiac
plete heart block in childhood. Anesth Analg 58:334-336, 1979 Anesthesia (ed 3). Stamford, CT, Appleton & Lange, 1998, pp 616-621
5. Morquio L: Sur une maladie infantil et familiale caracterisee par 10. Gewitz M, Vetter V: Cardiac emergencies, in Fleisher GR,
des modifications permanetes du pouls, des attaques syncopales et Luduig S (eds): Textbook of Pediatric Emergency Medicine (ed 4).
epileptiformes et la morte subite. Archives Medicine des Enfants Philadelphia, Lippincott Williams and Wilkins, 2000, pp 659-700
4:467-475, 1901 11. Lev M, Cuadros H, Paul MH: Interruption of atrioventricular
6. Plant RK, Steven RA: Complete atrioventricular block in a fetus. bundle with congenital atrioventricular block. Circulation 43:703-710,
Am Heart J 30:615-618, 1945 1971