Right Paratracheal Stripe
Posterior wall of the bronchus intermedius
Left Paratracheal Stripe
Left subclavian artery border
Posterior-superior junction line
Right Paratracheal Stripe
Posterior wall of the bronchus intermedius
Left Paratracheal Stripe
Left subclavian artery border
Posterior-superior junction line
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
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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.
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
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.
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
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
- 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
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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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
2. Mediastinal Compartments
Posterior Mediastinum:
Also called paravertebral
compartment
Defined by :
Posterior Pericardium
Anterior Spinal Ligament
Superiorly: T4 vertebral body
Inferiorly: Diaphragm
Contains:
Oesophagus, Descending Aorta,
Sympathetic Chain, Vagus
Nerves, Thoracic Duct, Azygos
and Hemiazygos veins, and
Lymph Nodes
3. Epidemiology
Adults:
65% anterosuperior
10% middle
25% posterior compartments
Children:
25% anterosuperior
10% middle
65% in posterior compartments
Generally the incidence of posterior mediastinal lesions is higher in children.
50% are asymptomatic and are diagnosed incidentally
The absence of symptoms is generally is a clue to a benign lesion
Symptomatic lesions:
Children: 60%-80%
Adults: 50%-60%
4. Diagnosis
CT Scan is the diagnostic modality of choice and is superior to even MRI in
majority of the cases
MRI rarely indicated
Thoracic US is not helpful in posterior mediastinal lesions
Biopsy: is not necessary in majority of the cases and likelihood of a positive
result parallels the presence of symptoms
If needed:
CT-guided
Thoracoscopic
Limited posterolateral thoracotomy
5. Neurogenic Tumours
Young adults and children
They are the most common malignant neoplasm in children but they are less
common than anterior mediastinal malignancies in adults.
Lymphomas and Thymomas are more common in adults
Malignancy rate:
Children: 50%
Adults: 10%
They originate from embryonic neural crest cells around the spinal ganglia
and from either sympathetic or parasympathetic components
6. Neurogenic Tumours
Source:
Intercostal nerve:
Neurofibroma : benign
Of patients with nerve sheath tumours 25%-40% have multiple
neurofibromatosis (von Recklingausen’s disease) and the incidence of
malignancy is more common in these patient
Neurilemoma (Schwannoma) :
Mostly benign but malignant schwannomas are rare
The most common neurogenic tumor
Neurogenic Sarcoma (rare)
Sympathetic Ganglia: can also have pheochromocytoma
Ganglioneuroma
Ganglioneuroblastoma
Neuroblastoma
Other: phrenic nerves, Vagus nerves
7. Neurogenic Tumours
Those with benign lesions are generally asymptomatic
Malignant tumors might present with symptoms such as:
Spinal cord compression
Cough
Dyspnea
Chest wall pain
Hoarseness
Rarely Horner’s syndrome
Rarely pheochromocytoma:
Neuroblastoma or ganglioneuroma
In all symptomatic patients, esp. those with significant hypertension it is
necessary to check for 24 h urine HVA (homovanillic acid) and VMA
(vanillylmandelic acid)
If elevated then prior to operation to avoid adrenergic crisis:
α-adrenergic blockers
beta-blockers
8. Neurogenic Tumours
Intercostal nerves:
Neurofibroma
Poorly encapsulated
Random arrangement of spindle-shaped cells
Neurilemomas
The most common neurogenic tumor
Well-encapsulated
Firm, gray-tan
Two morphologic types:
Antoni’s type A:
Organized architecture with a cellular palisading pattern of growth
Antoni’s type B:
Loose reticular pattern
Both of the above can happen as parts of neurofibromatosis type 1 (von
Recklinghausen’s disease) and if left untreated can degenerate to neurosarcoma
14. Sympathetic Source
Neuroblastic Tumors:
Arising from primitive sympathetic
ganglia
Comprise:
Neuroblastoma
Ganglioneuroblastoma
Ganglioneuroma
These differ in their degree of cellular
and extracellular maturation
Immature tumors:
Tend to be aggressive
Occur in younger patients
(median age < 2)
Mature tumors:
Older children (median age 7)
More benign
Anywhere sympathetic nervous
tissue exists:
Neck
Posterior Mediastinum
Adrenal Gland
Retroperitoneum
Pelvis
15. Sympathetic Source
Ganglioneuroma:
The most common neurogenic tumor occurring in children
Benign
Composed of gangliocytes and mature stroma
Early age
Located in the paravertebral region
Ganglioneuroblastoma:
Composed of mature gangliocytes and immature neuroblasts
Intermediate malignant potential
18. Sympathetic Source
Neuroblastoma:
Children < 4 y
Small, round immature cells organized in rosette pattern
Highly invasive
Metastasized by the time the diagnosis is made:
Regional lymph nodes, bone, brain, liver, lung
Some may have benign course
Symptoms:
Cough, dysphagia, chest pain, and occasionally paraplegia
Paraneoplastic:
Profuse watery diarrhea due to VIP
Opsoclonus-Polymyoclonus syndrome
Pheochromocytoma-like syndrome
Prognosis:
Influenced by: DNA content, tumor proto-oncogenes, and catecholamine synthesis
The above aid in categorizing patients with neuroblastoma into low, intermediate,
and high-risk
Rx: Resection +/- Chemotherapy
21. Investigations
CT:
Can help to identify the tumor and extent of involvement
Those from peripheral nerves:
Well-defined, round or oval masses
Noncalcified
Neurilemoma:
Variable enhancement: homogenous or heterogenous
On enhanced CT: variable attenuation
Neurofibroma:
Usually homogenous
Low-attenuation
On enhanced CT: homogenous enhancement or with early central blush
Malignant nerve sheath tumors show variable attenuation
22. Investigations
CT:
Sympathetic Chain Tumors:
Expand along the spinal axis
No calcification or bone changes
Ganglioneuroma:
Oblong homogenous low-attenuation lesions on both enhanced and
unenhanced CT
Neuroblastoma:
Aggressive soft tissue lesions with calcification
Ganglioneuroblastoma:
Mixed features of above
Paragangliomas:
Appear in aortopulmonary window
High contrast enhancement
24. Dumbbell Tumors
Tumors of the posterior mediastinum
that extend into the spinal canal via
the intervertebral foramen
It is necessary to identify these
tumors to have a better planning, as
inaccurate diagnosis would lead to
intra-spinal hemorrhage and cord
compression
MRI can identify these
Smoothly rounded, homogenous
density abutting the vertebral column
Rarely present with cord
compression symptoms
They comprise 10% of patients with
neurogenic tumors
Only 1-2% are malignant
25. Management
Standard of Care:
Surgical resection via thoracotomy or thoracoscopy
Most of the neurogenic tumors can be resected via thoracoscopy; however, malignant
transformation, local invasion, and tumors larger than 5 cm increase the likelihood of
conversion to thoracotomy
In most cases the tumor can easily be mobilized via thoracoscopy but any difficulty
necessitates the conversion to thoracotomy
Resection of the nerve root is necessary in most of the cases
A widened intervertebral foramen might be indicative of invasion of vertebral canal
(dumbbell tumor) and in these cases it is necessary to involve a neurosurgeon to
assist in full resection of the tumor via a laminectomy in one stage procedure
Neuroblastoma:
Spontaneous regression has been reported
Stage:
I (noninvasive): Surgical resection alone
II (locally invasive on same side of midline): Surgery + RTx
III (invasive across the midline): Debulking + RTx + ChemoTx + Second-look
operation
Children < 1 : good prognosis, prognosis has inverse correlation with age
27. Cysts
Rare, benign, congenital
20% of all mediastinal lesions
Include:
Bronchogenic
Hydatid
Enteric
Intramural Oesophageal
Neuroenteric Cysts
CT is the most effective modality of diagnosis
28. Bronchogenic
60% of all mediastinal cysts
Location:
Lung parenchyma
Mediastinum
Histology:
Ciliated columnar epithelium
Cyst wall: cartilage, mucus glands,
smooth muscle
Rarely communicate with the
tracheobronchial tree
Symptoms:
Occasional compression on the
adjacent structures
Recurrent infection
Pain, Cough, Hemoptysis
Rx:
If incidental finding in an otherwise
asymptomatic patient: observation is
accepted
If symptomatic esp. if pain, cough, or
hemoptysis the resection is strongly
advised.
31. Bronchogenic
Dysphagia: as a result of
compression effect on the
oesophagus
Presence of air-fluid level: suggests
the possibility of communication with
the tracheo-bronchial tree and
increased chance of recurrent
infections; hence, the possible need
for resection
If it becomes infected, it is very likely
that eradication is unsuccessful and
it needs to be resected
Symptoms tend to develop with time
and hence the resection is advised
in a healthy state before becoming
symptomatic.
They can be resected via
thoracoscopy or if in superior
mediastinum via mediastinoscope.
34. Gastroenteric Cysts
Gastroenteric or duplication cysts:
peri-oesophageal lesions that arise
from posterior division of the primitive
foregut.
Features:
Posterior or middle mediastinal mass
Within or adjacent to the oesophageal
wall
Communication with UGIT is
uncommon
Histology:
Nonkeratinizing squamous, ciliated
columnar, gastric, or small intestinal
epithelium
Epithelium is not a good differentiating
feature from bronchogenic cysts:
Presence of two muscular layers in
oesophageal cysts
Cartilage and bronchial glands in
bronchogenic cysts
Usually asymptomatic, but symptoms:
Resp: Cough, SOB, Recurrent
Pulmonary Infections, Chest Pain
If gastric mucosa: perforation into the
oesophagus can cause haematemesis,
or erosion into the adjacent lung can
cause an abscess
Dx: EUS, Chest CT, Technetium Tc
99m (to identify gastric mucosa)
Rx:
Resection: symptomatic, unclear cysts
– whether cystic or solid
Observation: clearly cystic lesions,
otherwise asymptomatic
37. Neuroenteric Cysts
5-10% of foregut lesions
Infants younger than 1
Connection to the meninges usually through a stalk
Associated with the congenital defects of the spine
Endodermal and ectodermal or neurogenic elements
Failure of separation of the notochord from the primitive gut
CT evidence of mediastinal lesion with either of : Scoliosis, Hemivertebrae,
Spina Bifida should prompt the possible Dx of neuroenteric cysts.
39. Castleman’s Disease
Giant lymph node hyperplasia
Vascular tumors surrounded by
large LAP
Types :
Localized: Hyaline Vascular, Plasma
Cell
Generalized or Multicenteric
Hyaline Vascular: 90% of lesions
Incidental finding in otherwise
asymptomatic
Spinal cord compression has also
been reported
Rx: Surgical excision, RTx is
ineffective
Plasma Cell:
More symptomatic: fever, fatigue,
weight loss, hemolytic anemia, high
ESR and hyper-γ- globulinemia as
the result of the over production of
IL-6
Resection is Rx of choice
Generalized:
Histologic features of both of the
localized forms
Older patients
Symptoms:
Severe systemic symptoms
Generalized LAP
Hepatosplenomegaly
Mortality : 50% with median survival
of 27 months and Progression to
lymphoma
