Persistent pulmonary hypertension of the newborn (PPHN) complicates 10% of neonatal respiratory failures and can lead to mortality in 5-10% of cases. It is characterized by profound hypoxemia due to abnormally constricted pulmonary vasculature. Clinical evaluation involves assessing for pulmonary and cardiac causes through history, exams, oxygen responsiveness testing, and echocardiogram. Management follows a physiological approach including lung recruitment, selective pulmonary vasodilation, and optimizing cardiac function and hemodynamics often guided by echo and using vasodilators like iNO, prostaglandins, and milrinone along with inotropes. Refractory cases may require extracorporeal membrane oxygenation.
Reexpansion pulmonary edema is a serious complication after sudden expansion of collapsed lung.Re-expansion pulmonary edema is an uncommon complication following drainage of a pneumothorax , pleural effusion or removal of any space occupying lesion.
The incidence referred is less than 1%, andmortality can reach up to 20%.
Reexpansion pulmonary edema is a serious complication after sudden expansion of collapsed lung.Re-expansion pulmonary edema is an uncommon complication following drainage of a pneumothorax , pleural effusion or removal of any space occupying lesion.
The incidence referred is less than 1%, andmortality can reach up to 20%.
This ppt is prepared from content of braunwald, and some latest international journals. In account it make more clear concept about pulmonary hypertension.
it also contain latest ESC 2022 guidelines of pulmonary hypertension.
Anaesthetic implication of laparoscopic surgery will help medical students as well as doctors performing safe anaesthesia practice in laparosc opic surgery.
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 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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
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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.
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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
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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
- 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
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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.
2. Case study
• Female, 35+4, singleton, PPROM since 20 weeks
• Profound hypoxemia , on HFOV @ 100%FiO2 , MAP 15
• Refractory hypotension on day 1
• Dopa +Dobu, Hydrocortisone. Multiple fluid boluses.
• MAP- 28-30mm,
• Bedside echo ..
3.
4. Magnitude of the problem
• Neonatal respiratory failure affects 2% of all live births and
is responsible for 1/3rd of neonatal mortality
• PPHN (Persistent pulmonary hypertension) complicates
10% of all neonatal respiratory failures
• Severe PPHN - 2/1000 live births
• Even with appropriate therapy, the mortality for PPHN
remains between 5-10%.
• Approximately 25% of infants with moderate or severe
PPHN will exhibit significant neurodevelopmental
impairment at 12-24 months
5. Physiological mechanisms
mPAP = (PBF XPVR) + PCWP
L-R Shunts LV Dysfunction
Pulmonary vascular dysregulation
Abnormally constricted pulmonary vasculature due
to lung parenchymal diseases- MAS, RDS,
TTN,acute asphyxia
normal parenchyma and remodeled pulmonary
vasculature, also known as idiopathic PPHN. eg-
antenatal exposure to NSAID, SSRIs
Hypoplastic pulmonary vasculature- CDH,chronic
asphyxia
6. Clinical presentation- understanding hemodyanmics…
Low cardiac
output state
Hypotension
Metabolic
acidosis
Pre-post
ductal
difference
in PaO2,
SPO2
STATE OF IMPAIRED OXYGENATION AT PULMONARY AND
TISSUE LEVEL
7. Clinical evaluation & diagnosis
• Early onset hypoxemic respiratory failure with hypotension
secondary to underlying primary causes
• Careful assessment of history including maternal drugs, possibility of early
onset sepsis, meconium and perinatal asphyxia
• Pulmonary parenchymal cause vs vascular cause ? (difficult to rule out)
• 2 limb SPO2 (rt upper-lt lower ), hyperoxia, CXR- rule out CDH
• Are you missing a congenital duct dependent heart lesion ?
Duct dependent congenital cyanotic lesions like TAPC,
DORV & Hypoplastic Left Heart syndrome maybe be
worsened by strategies to reduce PVR and should be
excluded with confidence !!
8. Role of functional echo in PPHN
Assessment of PA
pressure & resistance
Assessment of RV
function
Assessment of LV
function
Quantitative:
Calculation of RV systolic
pressure from TR jet
RV contractility :
TAPSE
Tissue Doppler derived
myocardial velocity
LV preload:
Doppler flow across mitral
valve
Semiquantitative :
Serial monitoring of
PA systolic flow dopplers-
PA acceleration time/ejection
time
RV output calculation LV contractility :
EF, FS Simpson’s method
Qualitative :
Characteristics of motion &
shunt- septal motion, shunt
across PDA,PFO
LV output calculation
Jain, McNamara. 2015
9. Therapeutic approach…
• Treating the problem and not the consequence
• A-B-C approach
• Effective lung recruitment
• Selective pulmonary vasodilation
• Achieve normal CO and supra pulmonary systemic pressure (
essential to optimize contractility before aiming high MAP-
increased after load will be counterproductive )
• START REFERRAL PROCESS SIMULTANEOUSLY IF IN A
PERIPHERAL CENTRE
13. Physiological approach to PPHN
Identifying the underlying pathology
Primary parenchymal
disease, e.g.: MAS,
RDS,pneumonia
• Optimal ventilation &
lung recruitment, HFOV
• Avoid hyperoxemia
(paO2>80) & allow
permissive
hypercapnia
(paCO2=40-60mm)
• Surfactant
• Adequate sedation /
paralysis
• Monitor Oxygenation
Index (OI) >25- i NO,
>40- ECMO
Primary vascular
disease
• Selective pulmonary
vasodilators/ non
selective dilators
RV/LV dysfucntion
• Optimize
hemodynamics with
judicious use of
inotropes
14. Pulmonary vasodilators- cellular pathways and
options…
Its not a
piece of
cake !!!
SILDENAFIL
MILRINONE
ADENOSINE
Bosentan
i NO
Prostaglandins- Inhaled
(Iloprost), iv- Treprostanil
MgSO4
16. nitric oxide..the magic molecule?
• Selective pulmonary vasodilator acting via CGMP pathway
• Selectively acts on aerated alveoli so optimal ventilation is a pre requisite
• Usual starting dose- 20ppm, weaning protocol.
• Short half life— forms MetHb with oxyHb. MetHb levels need monitoring on
long term use
• Few relative contraindications- rule out CCHD , qualitative platelet
dysfunction
• Relatively ineffective in chronic remodelled pulm vasculature unless
combined with other dilators as chronic use
17. Inotropes in PPHN- a random choice or evidence
based?
Dopamine vs Dobutamine ?
• Dopamine increases both SVR
and PVR in a dose dependent
manner
• A review by Barrington et al
concluded that Dopamine might
not be the ideal inotrope to start
in PPHN settings
• If using Dopamine DO NOT
exceed 10mic/kg/min
• Dobutamine is a better
cardiotrope as first line , might
require additional Epi/Norepi to
counter diastolic hypotension
• Problems??- Tachycardia—
impaired diastole— impaired
CO
Milrinone ?
• Mcnamara et al have shown in
their sentinel paper efficacy of
Milrinone in improving OI &
systemic BP
• Dose : Bolus @50mic/kg over
1 hr, titrate - (0.25-
0.9mic/kg/min)
• Problems: Systemic
hypotension, used in
combination with Epi/Norepi
• Milrinone+ Nor Epi - standard
accepted first line in PPHN in
UK
Mcnamara, Laique et al, Clin Res Ped
Vasopressin ?
• Low-dose AVP—
selective
vasodilatation in
pulmonary, renal,
coronary, and cerebral
vasculature under
hypoxic conditions
while causing
vasoconstriction in
other vascular beds
• V1 receptors induces
eNO
• Can be used in nitric
refractory PPHN
• Dose: 0.0002
u/kg/min
18. If reqmnt >10mic/kg/min , PPHN
confirmed- switch to Dobu/Milri+Nor Epi
If unsure of diagnosis, hypotensive-
start Dopamine
Add Milrinone (if not added in
previous step)
Vasopressin
Alternate vasodilators:
• NG sildenafil - 0.5-1mg/kg/dose Q6H
• MgSO4- 200mg/kg loading,50-100mg/kg/h
• Adenosine- 50mcg/kg/min
• Prostacyclin
Echo
Hydrocortisone
19. Key points when handling inotropes…
Rising lactate + cold extremities - consider easing off on adrenergic
drugs/ adding indicators like Milrinone
DO NOT aim for MAP> estimated PAP, aim for hemodynamic stability,
good perfusion and physiological lactates
Try to maintain HR <180, tachycardia impairs CO
Fluid balance should be titrated- overzealous bolus might damage
If available bedside Echo should be used to fine tune
20. PDA in severe PPHN-valve to the pressure cooker
• PDA acts as a “pop-off valve” to the ailing RV
• Sudden closure of the PDA in acute PPHN might decompensate
RV causing sudden increase in afterload
• Judicious use of Prostin at low doses is a standard in conditions
like CDH to keep the PDA open.
21. Key points in management of PPHN in resource limited
settings…
ABCDE
of
PPHN
Effective resuscitation
Alveolar recruitment
Managing hemodynamics (Echo guided)
• Obtain an arterial line
• Optimize ion balance- Ca, Mg
• Maintaining supra-pulmonary SBP
• Minimal boluses
• Inotropes- Choose wisely, Dobu+ NEpi
• Alternative& effective dilators-
• MgSO4 might be used early
Sedation- Fentanyl is
preferable
Paralysis- Continuous
infusion of Vecuronium
Quite surroundings
Minimal handling
23. TR jet- explanation, measurement and fallacies
• Bernoulli’s principle: PG=4v2
• Pulm pressure=4v2 + RA pressure
• Found in 60-70% cases
• Dependent on respiratory cycle-
Right sided filling
• Dependent on RV-RA pressure
gradient, may be falsely decreased in
high RA pressures
• Affected by tachycardia, arrhythmia