This document discusses pleural effusions, which occur when fluid accumulates in the pleural space between the lungs and chest wall. A small amount of fluid is normal but excess fluid can accumulate if the rate of fluid formation exceeds drainage by lymphatics. Effusions are classified as transudative or exudative based on their protein content and cell characteristics. Common causes of transudative effusions include heart failure and cirrhosis, while exudative effusions have infectious or inflammatory causes like pneumonia or cancer. Diagnosis involves physical exam, imaging like chest x-ray, and analyzing pleural fluid obtained via thoracentesis.
Pleural effusion may be defined figuratively as the juice, oozing from the leaky lingerie of the lung. However the text book definition is the abnormal accumulation of fluid in the pleural space due to disturbances in the forces that keep the pleural fluid economy in equilibrium...
Apparently a lengthy presentation actually very good for junior physicians as it covers all aspects of assessment, diagnosis and treatment of pleural effusion
Pleural effusion is an accumulation of fluid in the pleural cavity
between the lining of the lungs and the thoracic cavity (i.e., the visceral
and parietal pleurae
).
Abnormal fluid accumulation in potential space in between parietal and visceral pleurae – there is imbalance between formation and absorption in response to injury, inflammation or both locally and systematically
Pleural effusion may be defined figuratively as the juice, oozing from the leaky lingerie of the lung. However the text book definition is the abnormal accumulation of fluid in the pleural space due to disturbances in the forces that keep the pleural fluid economy in equilibrium...
Apparently a lengthy presentation actually very good for junior physicians as it covers all aspects of assessment, diagnosis and treatment of pleural effusion
Pleural effusion is an accumulation of fluid in the pleural cavity
between the lining of the lungs and the thoracic cavity (i.e., the visceral
and parietal pleurae
).
Abnormal fluid accumulation in potential space in between parietal and visceral pleurae – there is imbalance between formation and absorption in response to injury, inflammation or both locally and systematically
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 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.
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident TrainingOpen.Michigan
This is a lecture by Andrew Barnosky, DO from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Prevenzione del tromboembolismo venoso (TEV) in medicina internaPlinio Fabiani
The majority of hospitalized patients have risk factors for VTE.
DVT is common in many groups of hospitalized patients.
DVT and PE acquired in hospital are often clinically silent.
DVT and symptomatic PE → fatal PE.
Costs of exams in symptomatic patients.
Risks and costs of the treatment of VTE is not prevented, eg .: bleeding.
The future increase in risk of VTE recurrence.
Thromboprophylaxis is highly effective in the prevention of DVT and proximal DVT.
The Cost/Effectiveness of prophylaxis has been repeatedly demonstrated.
A simplified description of ascitic fluid analysis. Aim of the presentation is to give a very clear understanding about the analysis of ascities.
Presentation will help the medical residents diagnose the cause of fluid accumulation in abdomen and thus will guide to adopt the appropriate pathway to solve the issue.
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
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
- 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
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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!
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
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.
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. INTRODUCTION
There is normally a very thin layer of fluid (from 2 to
10 μm thick) between the two pleural surfaces, the
parietal pleura and visceral pleura.
The pleural space and the fluid within it are not
under static conditions.
During each respiratory cycle the pleural pressures
and the geometry of the pleural space fluctuate
widely. Fluid enters and leaves the pleural space
constantly.
3. The serous membrane
covering the lung
parenchyma is called the
visceral pleura.
The remainder of the lining of
the pleural cavity is the
parietal pleura.
The parietal pleura receives
its blood supply from the
systemic capillaries.
The visceral pleura is
supplied predominantly by
branches of the bronchial
artery in humans
4. The lymphatic vessels in the parietal
pleura are in direct
communication with the pleural space by
means of stomas.
These stomas are the only route through
which cells and large particles can leave
the pleural space.
Although there are abundant lymphatics
in the visceral pleura, these lymphatics
do not appear to participate in the
removal of particulate matter from the
pleural space.
5. MECHANISM OF PLEURAL FLUID TURNOVER
Dependent on the hydrostatic and oncotic pressures across membranes.
When the capillaries in the parietal pleura are considered, it can be seen that the
net hydrostatic pressure favoring the movement of fluid from these capillaries to
the pleural space
is the systemic capillary pressure (30cm H2O) minus the
negative pleural pressure (-5cm H2O) or 35cm H2O.
Opposing this is the oncotic pressure in the blood (34cm H2O) minus the oncotic
pressure in the pleural fluid (5 cm H2O), or 29cm H2O.
The resulting net pressure differences of 6 cm H2O (35-29) favors movement of
fluid from the parietal pleura into the pleural space.
8. PATHOPHYSIOLOGY
Pleural fluid will accumulate when the rate of
pleural fluid formation is greater than the rate of
pleural fluid removal by the lymphatics.
Pleural effusions have classically been divided into
Transudative
Exudative
9. A transudative pleural effusion occurs when
alterations in the systemic factors that influence
pleural fluid movement result in a pleural effusion.
Ex. Heart failure, nephrotic syndrome, hepatic
cirhosis.
Exudative pleural effusions occur when the pleural
surfaces are altered. Ex. Pleurisy.
11. CLINICAL FEATURES
Many patients have no symptoms due to the
effusion when effusion is small.
Pleuritic chest pain is the usual symptom of
pleural inflammation.
Irritation of the pleural surfaces may also result in a
dry, nonproductive cough.
With larger effusions, dyspnea results from lung
compression.
12. PHYSICAL EXAMINATION
Signs are proportional to amount of effusion.
Fullness of intercostal spaces.
Decreased or absent tactile fremitus.
Dullness to percussion.
Diminished breath sounds over the site of the effusion.
Change in findings with change in position.
Signs of pneumonia like bronchial breathing,crackles
etc.
13. CHEST XRAY
The first fluid accumulates in the lowest portion of the thoracic
cavity, which is the posterior costophrenic angle.
The earliest radiologic sign of a pleural effusion is blunting of
the posterior costophrenic angle on the lateral chest
radiograph.
If a posteroanterior radiograph is obtained with the patient
lying on the affected side, free pleural fluid will gravitate
inferiorly and a pleural fluid line will be visible.
14.
15. Pleural fluid is loculated when it does not shift freely
in the pleural space as the patient’s position is
changed.
Loculated pleural effusions occur when there are
adhesions between the visceral and parietal
pleurae.
Both ultrasound and computed tomography (CT)
have useful in making this differentiation.
18. Should thoracentesis be performed?
If thoracentesis is done
Is the fluid a transudate or exudate?
If the fluid is an exudate
What is the etiology?
19. SHOULD THORACENTESIS BE PERFORMED?
Most patients should be tapped
Newly recognized effusion.
Two exceptions
Small Effusions ( < 1 cm on decubitus)
Congestive Heart Failure
Thoracentesis only if bilateral effusions not equal.
Fever.
Pleuritic chest pain.
Impending respiratory faillure.
20. Is The Fluid A Transudate Or Exudate?
Transudative Effusions
Mechanical
No capillary leak or cytokine activation
Excessive formation or impaired absorption
Limits the differential with no additional workup
CHF, Cirrhosis, or Nephrotic Syndrome
If Exudative, more investigation required
Method: LIGHT’s Criteria
21. LIGHT’S CRITERIA (EXUDATE)
Pleural fluid total protein/ serum protein >0.5
Pleural total protein > 3g/dl.
Pleural fluid LDH/serum LDH > 0.6
Pleural fluid LDH > 200 IU/l.
Pleural fluid LDH level > 2/3 of upper normal
level of serum LDH.
26. Parapneumonic effusion
Any pleural effusion associated with bacterial or
viral pneumonia
Loculated parapneumonic effusion
Not free flowing
Multiloculated parapneumonic effusion
Noncommunicating compartments
Empyema (fibrosuppurative exudate)
Pus in the pleural space.
pH < 7.2, Glucose < 60 mg/dL, High LDH.
27. EMPYEMA
Empyema is an accumulation of pus in the pleural
space.
It is most often associated with pneumonia.
It can also be produced by :
Rupture of a lung abscess into the pleural space.
Contamination introduced from trauma or thoracic
surgery.
Mediastinitis or the extension of intra-abdominal
abscesses.
29. NATURAL HISTORY EMPYEMA
Exudative stage
Rapid accumulation of inflammatory fluid
Normal pH, Glucose, and LDH level
Antibiotics effective
Fibropurulent stage
PMN’s, Fibrin deposition, loculations occur
Low pH and glucose, high LDH
Organization stage (fibrothorax)
Fibroblast proliferation between pleural layers
Pleural peel develops, decortication required
30. CLINICAL FEATURES
Primary signs & symptoms of pneumonia.
Most patients are febrile, develop increased work of
breathing or respiratory distress, and often appear
more ill.
Physical findings are similar to effusion.
31. DIAGNOSIS
Similar to other effusion radiologically.
Pleural fluid analysis is must to differentiate.
Characteristic of pus :
Bacteria are present on Gram staining.
pH is <7.20.
>100,000 neutrophils/μL.
Pleural fluid culture & PCR analysis to identify
organism.
32. TREATMENT
Systemic antibiotics.
Depends on culture & sensitivity report.
2 weeks of IV antibiotics.(in staphylococci infection
response is very slow so required for 3-4wks.)
Closed tube drainage.
VATS
Open decortication.
33. TREATMENT
In the child who remains febrile and dyspneic >72
hr after initiation of therapy with intravenous
antibiotics and thoracostomy tube drainage,
surgical decortication via VATS or open
thoracotomy may speed recovery.
If pneumatoceles form, no attempt should be made
to treat them surgically or by aspiration, unless they
reach cause respiratory embarrassment or become
secondarily infected.
34. COMPLICATIONS
Local
Bronchopleural fistula.
Pyopneumothorax.
Purulent pericarditis.
Pulmonary abscesses.
Peritonitis from extension
through the diaphragm.
Osteomyelitis of the ribs.
Systemic
Septicemia.
Meningitis
Arthritis.
Osteomyelitis.