International Lung Symposium on Pleural Diseases, Manila 2019.
Practice changing clinical trials in pleural diseases from 2017 to 2019 by Dr. Gary Lee.
This presentation discusses steps in diagnosis of pleural effusion using a simulated patient scenario. Besides talking about different findings we can possibly see in a pt with pleural effusion on examination, CXR, USG, CT and labs, It also briefly discuss the proper steps in performing thoracocentesis.
International Lung Symposium on Pleural Diseases, Manila 2019.
Practice changing clinical trials in pleural diseases from 2017 to 2019 by Dr. Gary Lee.
This presentation discusses steps in diagnosis of pleural effusion using a simulated patient scenario. Besides talking about different findings we can possibly see in a pt with pleural effusion on examination, CXR, USG, CT and labs, It also briefly discuss the proper steps in performing thoracocentesis.
This presentation is about pulmonary manifestations of systemic vasculitis,in it m discussing about WEGNER,S GRANULOMATOSIS, churg-strauss syndrome and MPA
This presentation is about pulmonary manifestations of systemic vasculitis,in it m discussing about WEGNER,S GRANULOMATOSIS, churg-strauss syndrome and MPA
Pulmonary Thromboembolism is a blood clot that originates in a deep vein in the leg and travels to the lung, blocking blood flow to an artery in the lung. A clot in a different vein is an uncommon condition known as deep vein thrombosis (DVT). For more information, please contact us: 9779030507.
Catheter ablation of atrial fibrillation is typically performed with uninterrupted anticoagulation with warfarin or interrupted non–vitamin K antagonist oral anticoagulant therapy. Uninterrupted anticoagulation with a non–vitamin K antagonist oral anticoagulant, such as dabigatran, may be safer; however, controlled data are lacking. We investigated the safety of uninterrupted dabigatran versus warfarin in patients undergoing ablation of atrial fibrillation.
Dr. mahajna muhammad MD
sackler faculty of medicine
Tel-Aviv Uni.
The potential benefit of dual antiplatelet therapy beyond 1 year after a myocardial infarction has not been established. We investigated the efficacy and safety of ticagrelor, a P2Y12 receptor antagonist with established efficacy after an acute coronary syndrome, in this context.
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clinical approach and overview
clinical manifestation
diagnosis
treatment
complications.
Dr.mahajna muhammad
plastic surgery department
Tel_Aviv-Uni
Initial evaluation and management of small and moderate burns is a routine part of general plastic surgery practice. An ability to accurately evaluate and provide proper initial care for these injuries is essential.
Outcomes for patients with burns have improved dramatically over the past 20 years, but burns still cause substantial morbidity and mortality. [1] Proper evaluation and management, coupled with appropriate early specialty referral, greatly help in minimizing suffering and optimizing results
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
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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
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.
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
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.
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!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New 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.
5. • Definition and overview
• Pathophysiology
• Etiology
• Clinical manifestation
• Complications
• Lab tests and diagnosis
• Treatment and management
6. Definition and overview
• Up to 25 ml of pleural fluid is normally present ,not detectable on
conventional chest radiographs.
• Pleural fluid arise from systemic pleural vessels and exit through
lymphatic
• About 100-200ml of fluid circulates though the pleural space Within
a 24-hour period
• Has an alkaline pH of about 7.64
• A pleural effusion is present when there is an excess quantity of
fluid in the pleural space.
12. LEADING CAUSES OF PLEURAL EFFUSION IN USA
IN DECREASING ORDER OF INCIDENCE
1. CONGESTIVE HEART FAILURE
2. PNEUMONIA
3. CANCER
4. PULMONARY EMBOLISM
5. VIRAL DISEASE
6. CABG
7. CIRRHOSIS WITH ASCITES
17. 1. CHF : Distended neck veins, an S3 gallop, or
peripheral edema
2. PE : A right ventricular heave or thrombophlebitis
and sinus tachycardia .
3. neoplastic disease :The presence of
lymphadenopathy or hepatosplenomegaly suggests.
4. Ascites may suggest a hepatic cause.
5. Para pneumonic effusion :Signs of consolidation
above the level of the fluid in a febrile patient
suggests.
18. • Mainly Asymptomatic as isolated condition .
• Symptoms are more likely when a pleural effusion is moderate
or large-sized >400-500ml
• if inflammation is present.
• Symptoms of pleural effusions may include:
A. Shortness of breath
B. Chest pain, especially on breathing in deeply (pleurisy, or
pleuritic pain)
C. Fever
D. Cough
E. Because pleural effusions are usually caused by underlying
medical conditions, symptoms of these conditions are also
often present
Symptoms of Pleural Effusions
22. Exceptions
These are processes that typically cause exudative effusions,
but may cause transudative effusions.
•Amyloidosis
•Chylothorax
•Constrictive pericarditis
•Hypothyroid pleural effusion
•Malignancy
•Pulmonary embolism
•Sarcoidosis
•Superior vena cava obstruction
•Trapped lung
23. SERUM
• Serology for autoimmune disorders : RF factor , Anti
CCP , ANA , ANTI dDNA ….
• Routine : RBC , hemoglobin , WBC , PMN …..
• Infectious : CRP , ESR , WBC , PMN , leukocytosis ,
acute phase proteins , LDH
• Albumin , total protein
• Renal function
• Liver enzymes , ALT , AST , GGT , ALP
• PT , PTT , INR* , PLT
24. RADIOLOGY
Effusions of more than 175 mL are usually apparent as
blunting of the costophrenic angle.
• Location : TB Vs CHF Vs cirrhosis
• Mediastinal shift
• Heart enlargement [ CHF]
• Amount
• Recent Vs previous
• Reccurent [ malignancy e.g. mesothelioma]
A. CXR [ PA , AP , lateral decubitus ]
B. Ultrasound
C. CT
25. LOCATION AMOUNT CORRELATION
75 mL barley detectable
175 mL obscure the lateral cost phrenic sulcus on an PA
500 mL obscure the diaphragmatic contour on an PA
1000 ml reaches the level of the 4th anterior rib,
On decubitus radiographs and CT scans, less than 10 mL can be
identified
PORCEL et al. AFP 2006; 73: 1212
26. QUANTITATION OF EFFUSION
Based on the decubitus films
1. small effusions <1.5 cm
2. moderate =1.5 to 4.5 cm
3. large effusions >4.5 cm.
Effusions thicker than one 1cm are usually large enough
for sampling by thoracentesis, since at least 200 mL of
liquid are already present
30. INDICATIONS FOR THORACENTESIS
LIKELY INDICATED IN MOST PATIENTS!
> 1 CM LAYERING ON LATERAL DECUBITUS
CHF IS HIGHLY UNLIKELY [ E.GLARGE EFFUSION
RECURRENT PLEURAL EFFUSION , MALIGNANCY
PLEURAL EFFUSION AND FEVER: EMPYEMA
THERAPEUTIC THORACENTESIS: DYSPNEA, CHEST PAIN …
UNCLEAR ETIOLOGY OR OBVIOUS CAUSE WITH ATYPICAL PRESENTATION
CHF WITH ATYPICAL PRESENTATION [E.G. UNEQUAL BILATERAL EFFUSION]
31. CONTRAINDICATIONS
There are no absolute contraindications to thoracentesis
Benefit Vs risks
Caution if :
A. PTT , PT
B. Cr >6 mg/dL
C. decisions to reverse the coagulopathy or correct the
thrombocytopenia should be individualized
D. Anticoagulation or a bleeding diathesis
33. • PAIN AT THE PUNCTURE SITE
• BLEEDING (HEMATOMA, HEMOTHORAX (1%) , OR
HEMOPERITONEUM)
• PNEUMOTHORAX ( 2-6%)
• SOFT TISSUE INFECTION
• SPLEEN OR LIVER PUNCTURE
• VASOVAGAL EVENTS
• SEEDING THE NEEDLE TRACT WITH TUMOR
• ADVERSE REACTIONS TO THE ANESTHETIC
34. Pleural fluid glucose, lactate, amylase, triglyceride, and/or tumor
markers
Microscopic examination –(WBCs) or (RBCs) or microorganisms.
WBC differential—determination of percentages of different types of
WBCs
High PMN bacterial infection
High lymphocytes TB
Gram stain –Bacterial culture and susceptibility testing
Less commonly ordered tests for infectious diseases, such as tests
for viruses, mycobacteria (AFB smear and culture), and parasites.
Ph
RF factor
Cytology
Appearance : cloudy , milky , bloody . . . .
Pleural Fluid Analysis
43. Clinical features suggestive of malignancy:
1. Symptoms > one month
2. Absence of fever
3. Bloody tinged fluid
4. CT very suggestive for malignancy
5. Persistent pneumonia
6. Pts history : smoking , asbestosis , malignancy history
Pleural fluid:
A. Appearance : Mostly bloody
B. WBC differential : mainly lymphocytic
C. Glucose : mostly decreased <60 mgdL , or normal
D. Elevated lactate >2/3 X serum lactate
E. PH < 7.2 typically
F. Cytology and tumor markers are positive**
46. Typical symptoms include : cough, chest pain, shortness of
breath and fever , persistent pneumonia**
an accumulation of pus in the plural cavity along with :
a. Pleural PH < 7.2 with normal blood PH.
b. Pleural gluc< 60 mgdl
c. Pleural lactate >2/3 serum lactate
d. Purulent , cloudy , yellow-brownish fluid
Treatment and management :
1. Thoracentesis
2. Chest tube
3. Antibiotics for 1-4 weeks or until improvement
4. Cipro , Flagyl , Penicillin's , clindamycin , vancomycin ,
gentamycin
Consider streptokinase ,
urokinase for fibrinolysis
47.
48. CLINICAL SYMPTOMS
Shortness of breath, cough , chest pain-- common to
pneumonia.
Febrile respiratory illness, accentuation, prolongation the
symptoms in pneumonia-- alert the possibility of empyema.
Aerobic empyema-- acute febrile illness.
Anaerobic empyema-- more indolent, usually 10 days.
51. • 15-20% of effusions
• Careful review of history, PE, meds, risk
factors
• Consider occult abdominal process
• Consider PE
Meigs' syndrome : triad of
ascites
pleural effusion
benign ovarian tumor .
It resolves after the resection of the tumor.
52. JOSÉ M. PORCEL, M.D., Arnau de Vilanova University Hospital, Lleida, Spain
RICHARD W. LIGHT, M.D., Saint Thomas Hospital, Nashville, Tennessee
Am Fam Physician. 2006 Apr 1;73(7):1211-1220.
53.
54.
55.
56. RESOURCES
1. REDUCING IATROGENIC RISK IN THORACENTESIS: ESTABLISHING BEST PRACTICE VIA EXPERIENTIAL
TRAINING IN A ZERO-RISK ENVIRONMENT.
DUNCAN DR, MORGENTHALER TI, RYU JH, DANIELS
CHEST. 2009;135(5): 1315
2. PNEUMOTHORAX FOLLOWING THORACENTESIS: A SYSTEMATIC REVIEW AND META-ANALYSIS.
GORDON CE, FELLER-KOPMAN D, BALK EM, SMETANA GW
ARCH INTERN MED. 2010;170(4):332
3. COMPLICATIONS ASSOCIATED WITH THORACENTESIS.
SENEFF MG, CORWIN RW, GOLD LH
CHEST 1986; 90:97-100
4. THORACENTESIS: COMPLICATONS, PATIENT EXPERIENCE AND DIAGNOSTIC VALUE.
COLLINS TR, SAHN SA. AM REVIEW RESPIRATORY DISEASE 1983; 127:A114
5. HARRISON’S PRINCIPLES OF INTERNAL MEDICINE, 18TH EDITION.
FAUCI, BRAUNWALD, KASPER, HAUSER, LONGO, JAMESON, LOSCALZO.
6. UPTODATE ONLINE. WWW.UPTODATE.COM.
7. PORCEL ET AL. AFP 2006; 73: 1212
8.