This presentation gives general overview about different aspects of PILONIDAL DISEASE including pathophysiology, etiology, clinical Presentation, different treatment options available etc
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
a basic and concise info on one of the most common condition encountered in our daily practice. this info has been gathered from many sources. please feel free to point out any mistakes.
Pilonidal Sinus : Common Presentations with original picturesDr.Deepak Rathi
#ayurveda #ksharsutratherapy #pilonidalsinus
http://www.ksharsutratherapy.com/pilonidal-sinus
Kshar Sutra Therapy - The Best Treatment for Anal Fistula, Anal Fissures, Hemorrhoids and Pilonidal Sinus
What Is Pilonidal Sinus Disease (PNS)
A pilonidal sinus (PNS) is a small cyst or abscess that occurs in the cleft at the top of the buttocks. A PNS usually contains hair, dirt, and debris. It can cause severe pain and can often become infected. If it becomes infected, it may ooze pus and blood and have a foul odor. A PNS is a condition that mostly affects men and is also common in young adults. It’s also more common in people who sit a lot, like cab drivers.
What Are the Causes of Pilonidal Sinus Disease
The exact cause of this condition is not known, but its cause is believed to be a combination of changing hormones (because it occurs after puberty), hair growth, and friction from clothes or from spending a long time sitting. Activities that cause friction, like sitting, can force the hair growing in the area to burrow back under the skin. The body considers this hair foreign and launches an immune response against it, similar to how it would react when dealing with a splinter. This immune response forms the cyst around your hair.
Identifying a Pilonidal Sinus
You may not have any noticeable symptoms at first other than a small, dimple-like depression on the surface of your skin. However, once the depression becomes infected, it will quickly develop into a cyst (a closed sac filled with fluid) or an abscess (a swollen and inflamed tissue where pus collects).
The signs of an infection include:
1. Pain when sitting or standing
2. Swelling of the cyst
3. Reddened, sore skin around the area
4. Pus or blood draining from the abscess, causing a foul odor
5. Hair protruding from the lesion
6. Formation of more than one sinus tract, or holes in the skin
You may also experience a low-grade fever, but this is much less common.
How Can I Prevent Pilonidal Sinus Disease
You can prevent recurrence of PNS by washing the area on a daily basis with a mild soap, making sure all soap is removed, keeping the area completely dry, and avoiding sitting for long periods.
Treatment Centre :
Piles & Fistula Care Centre
Piles & Fistula Care Centre is a centre dedicated for the cure of Anal Diseases like Fistula, Pilonidal Sinus, Piles (Hemorrhoids) & Fissures and other anal conditions as well.
It is run by the well known Kshar Sutra Therapy Specialist Dr Deepak Rathi.
For More information on anal diseases and their treatment kindly visit: www.ksharsutratherapy.com
You can contact Dr.Deepak Rathi on 9818050963, 9716744975
For more information on Kshar Sutra Therapy kindly visit :
http://www.ksharsutratherapy.com/pilonidal-sinus
A breif discussion on some of the available options in the reconstruction of pilonidal sinus defect. Post excision of pilonidal sinus. A plastic surgery view of the problem.
This is the second presentation on Scrotal Swellings. I have included unique classical clinical vignette, mind map and a tabular column to clinch the correct diagnosis.
this is power point presentation for ophthalmic assistant student regarding basic knowledge for ocular parasites like, LOA LOA, RIVER BLINDNESS , ONCHOCERCIASIS , TOXOPLASMOSIS & TOXOCARIASIS etc. which consist basic test , epidemiology, lab investigation, culture & management .
what is loa loa.
loa loa is eradicated mostly from from Asian country like India, Nepal, China etc. , the presentation is for 2nd year O.A students & EHW. which shows basic....knowledge
and invade the genital ridges in the sixth week of
development. here they form primitive sex cords. in
the absence of tdf, medullary cords disappear and
get replaced by a vascular stroma (ovarian medulla).
cortical cords develop and surround one or more
primitive germ cells. the germ cells subsequently
develop into oogonia, while the surrounding epithelial
cells form the follicular cells. this differentiates
undifferentiated gonads into ovaries. stroma of ovary
develops from basal mesenchyme. granulosa and theca
cells develop from celomic epithelium.
development of genital ducts
development of genital duct system and the external
genitalia occurs under the influence of hormones
circulating in the fetus. sertoli cells in the fetal testes
produce a nonsteroidal substance known as müllerian
inhibiting substance (mis) that causes regression of
müllerian ducts. androgen from the fetal testes causes
masculinization of external genitalia. in the absence of
mis, müllerian ducts develop and mesonephric duct
system regresses. in the absence of androgen, external
genitalia differentiate into female phenotype. the
müllerian duct develops between the fifth and sixth
weeks lateral to intermediate cell mass and wolffian
duct. the müllerian duct has the following three parts:
•cranial vertical portion that opens into celomic
cavity. later it differentiates into fallopian tubes.
•horizontal part crosses the mesonephric duct.
•caudal vertical part that fuses with its partner
from opposite side. this fused part later differ
entiates into uterus, cervix, and upper one-third
of the vagina.
the dorsal celomic epithelium (which forms
müllerian duct) remains open at its site of origin and
ultimately forms the fimbriated ends of the fallopian
tubes. at their point of origin, each of the müllerian
ducts forms a solid bud. each bud penetrates the
mesenchyme lateral and parallel to the wolffian duct.
as the solid buds elongate, a lumen appears in the
cranial part, beginning at each celomic opening. the first time
Experiential Learning through the lens of Communities of Practice (CoP) theoryJibran Mohsin
Individual Presentation on "Experiential Learning through the lens of Communities of Practice (CoP) theory"
Advanced Level Course on Teaching and Learning 1
Master of Health Professions Education
Department for Educational Development
The Aga Khan University
Tuesday, February 07, 2023
Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomized, open-label, phase 3 trial
CURRICULUM ON RESIDENCY PROGRAM FOR FCPS MOLECULAR PATHOLOGYJibran Mohsin
CURRICULUM ON RESIDENCY PROGRAM FOR FCPS MOLECULAR PATHOLOGY (Advanced Level Course on Curriculum Development in Health Professions Education, Department for Educational Development, The Aga Khan University)
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
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.
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!
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
- 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
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
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.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
3. BACKGROUND-Journey from historical congenital
theories to new acquired theories
• Described back as far as 1833, when Herbert Mayo described a
hair-containing cyst located just below the coccyx
• R.M.Hodge coined the term "pilonidal" from its Latin origins in 1880
• In the 19th and early 20th centuries
– studied on an embryologic basis by many authors, considering it to be
of congenital origin.
– congenital remnant of an epithelial-lined tract from postcoccygeal
epidermal cell rests or vestigial scent cells
– Excision of the lesion was thought to be fundamental to removing all
embryologic remnants
4. BACKGROUND-Journey from historical congenital
theories to new acquired theories
• Gained prominence and practical importance amongst World War II soldiers
with a high incidence of the disease, so much so it came to be known as
Jeep seat/ Jeep(riders‘) disease (Jeep/driver’s bottom)*
– nearly 80,000 US soldiers were admitted and treated at US Army
Hospitals between the years 1941-1945 with average hospital stay time
of 55 days
– Prompt return of soldiers to the field was important, leading to a variety
of proposed surgical treatments aimed at this goal
____________________________________________________
*large portion of people who were being hospitalized for it rode in Jeeps, and prolonged rides in
the bumpy vehicles were believed to have caused the condition due to irritation and pressure
on the coccyx
5. BACKGROUND-Journey from historical congenital
theories to new acquired theories
• After the war, Patey and Scarf hypothesized the acquired
origin of pilonidal disease
– penetration of hair into the subcutaneous tissue with consequent
granulomatous reaction
– basing this theory on
• the high incidence of recurrence, as well as
• occurrence of disease in other areas of the body, such as the hands of a
barber or sheep shearer
___________________________________________________
an acquired etiology of the disease is now the prevailing theory in the medical world
6. BACKGROUND-Journey from historical congenital
theories to new acquired theories
EVIDENCE IN FAVOR OF ACQUIRED THEORY OF ORIGIN
• Interdigital pilonidal sinus is an occupational disease of
hairdresser
– Hair within interidigital cleft(s) being from costumers
– Pilonidal sinus of axilla and umbilicus also reported
• Age incidence of appearance of pilonidal sinus(82 % occur
between 20-29 year) is at variance with age of onset of
congenital lesions
• Hair follicles have almost never been demonstrated in walls of
sinus and are lined with cuboidal epithelium
7. BACKGROUND-Journey from historical congenital
theories to new acquired theories
EVIDENCE IN FAVOR OF ACQUIRED THEORY OF ORIGIN
• Hairs projecting from sinus are dead hairs, with their pointed
ends directed towards the blind end of the sinus
• Disease mostly affects men, in particularly hairy men
• Recurrence is common, even though adequate excision of
track is carried out
8. Definition
PILONIDAL DISEASE
Spectrum of clinical presentations, ranging from
asymptomatic hair-containing cysts and sinuses to
large symptomatic abscesses of the sacrococcygeal
region that have some tendency to recur
(includes pilonidal abscess, sinus, cyst and fistula)
9. Definition
PILONIDAL SINUS
Condition found in the natal cleft overlying the
coccyx, consisting of 1 or more, usually non-infected,
midline openings, which communicate with a fibrous
track lined by granulation tissue and containing hair
lying loosely within the lumen
11. Classification
• 3 categories that represent different stages of
the clinical course
– (1) acute pilonidal abscess,
– (2) chronic pilonidal disease, and
– (3) complex or recurrent pilonidal disease.
• Ideal treatment varies according to the clinical
presentation/category of the disease
12. Epidemiology
WORLDWIDE INCIDENCE
7 per 10000 population
Gender Predisposition
Adult M:F ( 3-4 : 1)
Children M:F (1 : 4)
RACE
predominantly in white/Caucasians
13. Epidemiology
AGE*
typically in the late teens to early twenties,
decreasing after age 25 and
rarely occurs after age 40
average age of presentation 21 years(male) and 19 years(female) **
__________________________________________________
*it occurs after puberty, when sex hormones are known to affect the
pilosebaceous gland and change healthy body hair growth
**due to the fact that puberty occurs earlier in females
14. Pathophysiology
SAME AS FOR ACNE VULGARIS/HIDRADENITIS SUPPURATIVA
• Sex hormones affect the pilosebaceous glands after onset of puberty
– Hair follicle becomes distended with keratin.
– Resulting in folliculitis, leading to edema and follicle occlusion.
– Infected follicle extends and ruptures into the subcutaneous tissue, forming a
pilonidal abscess.
• resulting in a sinus tract leading to a deep, subcutaneous cavity.
• Direction of the sinus tract is cephalad(90%),
– coincides with the directional growth of the hair follicle.
– Places the tracking follicle approximately 5-8 cm from the anus.
_________________________________________
ACNE/FOLLICULAR OCCLUSION TETRAD = hidradenitis suppurativa, acne conglobata, dissecting
cellulitis of the scalp, and pilonidal sinus
15. Pathophysiology
– In the rarer instance that the sinus is located caudally, it is
usually found 4-5 cm from the anus.
– The laterally communicating sinus overlying the sacrum is
created as the pilonidal abscess spontaneously drains to the skin
surface.
– The original sinus tract from the natal (intergluteal) cleft becomes an
epithelialized tube.
– The laterally draining tract becomes a granulating sinus tract opening
18. Pathophysiology
Both mentioned mechanism
Create a subcutaneous, chronically
infected, midline track (PRIMARY SINUS)
SECONDARY TRACKS may spread laterally
from primary sinus
Emerge at skin as granulation tissue lined
discharging openings
19. Pathophysiology
• Microscopically, the sinus tract where the hair enters is lined with
stratified squamous epithelium with slight cornification (itself soft)
– Additional sinuses are frequent.
– sinus tract openings are actually an extension of the deep cavity
• Cyst/sinus cavities are lined with chronic granulation tissue and may
contain hair, epithelial debris, and young granulation tissue.
– Cutaneous appendages are not seen in the wall of cysts.
– Cellular infiltration consists of PMNs, lymphocytes, and plasma cells in varying
proportions.
– Foreign body giant cells in association with dead hairs are a frequent finding.
• Hair enters tip first, and the barbs on the hair prevent it from being
expelled, causing the hair to become entrapped.
– Physical examination occasionally may reveal a tuft of hair emerging from the
midline opening in the natal cleft.
20. Pathophysiology
3 pieces are instrumental in this process:
(1) the invader, hair;
(2) the force, causing hair penetration; and
(3) the vulnerability of the skin.
__________________________________________________________________
This process has been well characterized by Patey and Scarff as
well as a number of other authors from the second half of the
20th century through today
21. Pathophysiology
MICROBIOLOGY
most commonly reported bacteria cultured from pilonidal
abscesses differ by author
• In one study, anaerobic cocci were present 77% of the time;
aerobic, 4%; and mixed aerobic and anaerobic, 17%.
• Other studies quote Staphylococcus aureus, an aerobe, as
being the most common bacterial pathogen.
22. Pathophysiology
• Rarely, foreign bodies other than human hair
can cause this disease process.
– Rare case reports exist in which the hair did not
come from the patient but instead came from a
bird's feather, the type used to stuff feather
bedding.
23. Etiology- risk factors
• Male gender
• Hirsute individuals
• Dark (stiff) haired individuals rather
than softer blond hair
– Rare in Negroes
• Increased sweating/moisture
• Sitting occupations (or sedentary
lifestyle)-friction movements
– Driver of vehicle(own hair)
– Barber(customer hair)
– bird keeper/sheep keeper(Animal hair)
• folliculitis or a furuncle at another
site on the body
• Deep/narrow natal cleft
• Hair within the natal cleft (local irritation)
• Family history (38 % areas)
• Obesity
– risk factor for recurrent disease
– Buttock friction
• Other hair features
– Kinking(shape), medullation(nature)
sharp/coarseness, and growth rate
• Poor personal hygiene
• Local trauma(army recruits)
24. Clinical Manifestation
• Most common presentation in the ER is a intermittent painful
(persistent, throbbing), swollen discharging (serosanguinous/
purulent) lesion in the sacrococcygeal region about 4-5 cm
posterior to the anal orifice
– May be asymptomatic
• At times, spontaneous drainage may have occurred prior to
presentation to the clinician
• Occasionally, a history of trauma is recalled
• Patient may state that a similar lesion occurred in that area before,
for which the patient may have had a primary incision and
drainage or other definitive care prior to this presentation.
25. Clinical Presentation
• Given most patients are young and healthy, other
comorbidities are not common, and review of systems
is often negative, including fever and chills.
• There is no known preponderance of this disease in
smokers or alcohol or drug abusers.
• Although usually found near the coccyx/natal
(intergluteal) cleft /sacrococcygeal region
– Condition can also affect the umbilicus, web spaces of hand,
armpit or genital region (though rarer)
29. Clinical Presentation
• Usually, the patient is afebrile and nontoxic(minimum
constitutional symptoms)
• Local examination may show a relatively unremarkable sinus
tract in the sacrococcygeal region
– Primary sinus having 1 or more openings
• All strictly in the midline, with tuft of hairs seen in opening of sinus
• Between level of sacrococcygeal joint and tip of coccyx
• or may have secondary lateral openings superior to the midline pit.
• Usually at ER presentation, the patient has typical findings of an
abscess, including redness, warmth, local tenderness, and fluctuance
with or without induration.
32. Workup
• No specific laboratory studies or tests are needed to
diagnose pilonidal disease and its sequelae or
differentiate it from other disease entities
– It is a clinical diagnosis best elicited by history and physical
examination findings.
33. Treatment
• Conservative treatment
– INDICATION: patients whose symptoms are
relatively minor( and without abscess)
• natural history of condition is usually one of regression
– Cleaning out the tracks and removal of all hair,
with regular shaving of area and strict hygiene
34. Treatment
• Pilonidal Abscess(acute exacerbation)
– Conservative
• Rest, baths, local antiseptic dressings and broad-
spectrum antibiotics
– Surgery
• Incision and drainage
– Small longitudinal incision made over the abscess and off the
midline
– Through curettage of granulation tissue and hair
– May or may not be associated with complete resolution
35. Treatment
• Chronic Pilonidal Disease
– Lack of overall superiority of 1 method over others
– Factors affecting choice of method
• Time spent off work
• Perceived recurrence rates
• Surgeon preference
– Goals of the ideal procedure should be
• Reliable wound healing
• Low risk of recurrence
• Short period of hospitalization
• minimal inconvenience to the patient(low morbidity)
• few wound-management problems.
• Resumption to normal daily activities as quickly as possible.
36. Treatment
• POSITION: Jack Knife*(Kraske position) (prone with buttocks elevated)
• Anesthesia: General or Local
• OPTIONS
– Laying open & curetting of all tracks(demonstrated by methylene blue) +/-
marsupialisation
– Excision of all tracks with
• OPEN METHOD: wound left open-secondary intention healing over 3-4 weeks (Least recurrence)
• CLOSED METHOD:
– primary closure(+/- retention suturing)
– closure by some other means designed to avoid a midline wound
» Z-plasty,
» Karydakis procedure
• semilateral incision and lateralised suturing of wound away from midline
_________________________________________________________________________
*Jackknifing means the folding of an articulated vehicle (such as one towing a trailer) such
that it resembles the acute angle of a folding pocket knife
37.
38. – Bascom’s procedure
• Incision(s) 2-4 mm sized lateral to midline to gain access
to sinus cavity
• Pus drained, hairs removed with only minima/NO
excision of sinus/cavity wall
• Most effective for primary pilonidal sinuses
39. Treatment
POSTOPERATIVE CARE
• Daily pack/dressing change after warm shower/sitz bath
• elimination of hair (ingrown, local or other) from the wound every
1-3 weeks
– as effective in preventing recurrence as a secondary surgical
procedure
FOLLOW UP
• After 1-2 weeks
– examine the wound for healing,
– assess for potential recurrence,
– arrange for definitive care of the sacrococcygeal region if
necessary
40. Treatment
RECURRENT PILONIDAL SINUS
ETIOLOGY
• Part of sinus complex overlooked at primary operation
• New hairs enter the skin or the scar
• Persistence of a midline wound caused by shearing forces and scarring
TREATMENT
– Revisional surgery including extensive resection/re-excision followed by
wound closure and obliteration of natal cleft either by
• (Limberg-single/double Rhomboid) myocutaneous rotational buttock flap
• V-Y gluteal advancement flap
41.
42. Treatment
CONTRAINDICATION
• Although no specific contraindications exist for
the treatment of pilonidal disease, consider the
patient's overall situation and well-being
– weigh the complexity of the proposed surgical
procedure against the patient's individual
comorbidities and long-term prognosis.
43. Complications
• Recurrence of the abscess
– most common complication(40-50 %)
• Wound infection
– Leading to sacral osteomyelitis, necrotising fascitis and
rarely meningitis
• SCC in chronic pilonidal disease
– Exceedingly rare
– requires en bloc surgical resection and appropriate
oncologic care with local radiation and possibly
chemotherapy
44. Prognosis
• Excellent long-term prognosis
• Mortality is practically NIL
– unless SCC develops,
– though abscess recurrence is common