1. Priapism is classified as ischemic or non-ischemic based on blood flow and oxygen levels in the corpora cavernosa. Ischemic priapism requires emergency treatment due to hypoxic conditions while non-ischemic can often be managed conservatively.
2. Treatment for ischemic priapism involves aspiration of blood from the corpora cavernosa followed by injection of vasoconstrictors if needed. If unsuccessful, surgical shunting procedures are used to drain blood and reestablish outflow.
3. Non-ischemic priapism does not require emergency intervention as it is caused by arterial inflow without venous leakage. Conservative management is attempted initially using ice or observation
The surgical treatment of an injury or defect within the urethra's walls is known as urethroplasty. The three most frequent factors leading to urethral damage that needs to be repaired are trauma, iatrogenic injury, and infections. The gold standard treatment for urethral strictures is urethroplasty, which has a lower recurrence rate than dilatations and urethrotomies. Although recurrence rates are higher for this challenging treatment group, it is likely the only effective treatment option for chronic and severe strictures.
Urethroplasty is not regarded as a small procedure, taking three to eight hours on average in the operating room. Between 20% and 30% of urethroplasty patients may benefit from the ease of going under the knife for a shorter period of time and going home the same day. On average, hospital stays last two to three days. Seven to ten days may be needed for hospitalization for more complicated surgeries.
Fewer than ten percent of patients experience significant complications after urethroplasty, while complications, particularly recurrences, are more frequent in long and complex strictures.
Ureters are retroperitoneal structues which run anterior to psoas muscle and cross lateral to medial.4sites are prone where ureter can be injured and its management
The urethra's main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture.
The surgical treatment of an injury or defect within the urethra's walls is known as urethroplasty. The three most frequent factors leading to urethral damage that needs to be repaired are trauma, iatrogenic injury, and infections. The gold standard treatment for urethral strictures is urethroplasty, which has a lower recurrence rate than dilatations and urethrotomies. Although recurrence rates are higher for this challenging treatment group, it is likely the only effective treatment option for chronic and severe strictures.
Urethroplasty is not regarded as a small procedure, taking three to eight hours on average in the operating room. Between 20% and 30% of urethroplasty patients may benefit from the ease of going under the knife for a shorter period of time and going home the same day. On average, hospital stays last two to three days. Seven to ten days may be needed for hospitalization for more complicated surgeries.
Fewer than ten percent of patients experience significant complications after urethroplasty, while complications, particularly recurrences, are more frequent in long and complex strictures.
Ureters are retroperitoneal structues which run anterior to psoas muscle and cross lateral to medial.4sites are prone where ureter can be injured and its management
The urethra's main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture.
Medical management of cerebro vascular accident a quick reviewkeerthi vasan
if its useful.....comment please....
its helps us have a short quick review about the medical managements of CVA.....
its describe about the types and how as a nurse how to care the patients on the bases of nursing care
Surgery Resident clinical seminar on the management of a 60yr old male with upper gastrointestinal bleeding presented to the department of surgery, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State
Endovascular treatments are minimally invasive procedures that are done inside the blood vessels and can be used to treat peripheral arterial disease. Treatments like Anti Platelets, Anti-Diabetics, Statins, Promote Collaterals, etc.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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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
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
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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.
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
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
5. Ischemic priapism
• Akin to compartment syndrome
• Rigidity with minimal/absent cavernosal artery inflow
• So, anaerobic milieu – hypoxia, hypercarbia, acidosis
• >48 hours – gradual destruction of CC smooth muscle
• >48 hours – thrombus > smooth muscle necrosis > ED
6. Non ischemic priapism
• Increased cavernosal arterial inflow
• Similar to an AV fistula limb
• CC are tumescent but not rigid owing to intact venous drainage
• Usually follows blunt injury to penis/perineum, iatrogenic needle
injury
• CC environment is not anaerobic
• Does not require emergent intervention
7. Stuttering priapism
• Recurrent prolonged erection episodes
• Can progress to ischemic priapism
• Common in SCD
• Stuttering priapism ischemic priapism
8. Epidemiology
• Ischemic priapism – 95% of cases
• Lifetime risk of priapism in sickle cell disease patient : 29-42%
• Risk of priapism after ICI of erectogenic agents : 0.4-35%(risk more
with papaverine than alprostadil)
• Rare in men who take PDE5i
10. Partial priapism
• Priapism limited to crura only
• Very rare
• Aka idiopathic partial thrombosis of penis
• Bicycle riding, erectogenic agents, hematological diseases – have
been implicated
11. Aetiology
• Idiopathic in majority
• Drugs
• Blood dyscrasias
• Trauma
• Malignancy – GU cancers with local infiltration
12.
13. Sickle cell disease and Priapism
• Sickled erythrocytes causing venous obstruction
• 1/3rd of priapism cases have SCD as the cause
• Mean age of onset of priapism in SCD = 15 years
• Precipitating events : sexual arousal, sleep, fever and dehydration, cold weather
Pathophysiology:
• Sickled RBCs release arginase, which converts arginine to ornithine and so, NO’s source is lost
• Oxidant radicals also remove NO
So, combo of NO scavenging and decreased production
The same pathophysiology is implicated in pulmonary hypertension, stroke – ASPEN
syndrome(Association of SCD, Priapism, Exchange transfusions and Neurological events)
14. Non ischemic priapism
• Aka arterial/High flow priapism
• Rarer than ischemic priapism
• MCC is trauma – either blunt or penetrating
• Also reported after EIU
Pathophysiology:
• Cavernosal artery laceration which leaks into sinusoids => arteriosinusoidal fistula
• Delay between trauma and HF priapism
• Nocturnal erection dislodges clot>arterial inflow leads to fistula and
pseudocapsule formation
• Also occurs post Rx of LF priapism; the iatrogenic trauma creates a fistula
15. Molecular pathophysiology
• NO imbalance leading to ↑cGMP due to reduced PDE5 and ↓Rho
khinase activity leading to decreased smooth contraction
17. Ischemic priapism Non ischemic priapism
Incidence 95% <5%
Clinical features Painful Painless
Rigid Tumescent
Previous episodes of stuttering
priapism can be present
Previous episodes rare
Association Associated with hematological
abnormalities
Associated with trauma
Diagnosis Hypercarbia, hypoxia, acidotic Normal ABG
Intervention Emergency Elective
18. Corporeal blood gas analysis
pO2 pCO2 pH
Ischemic priapism <30 >60 <7.25
Non ischemic priapism >90 <40 7.4
22. Medical management
• Oral
• Intracavernosal
• Oral medications have no role in ischemic priapism
• Role only in stuttering priapism
23. • ICI of vasoconstrictors
• Aspiration
• Aspiration + ICI of vasoconstrictors
24. ICI of vasoconstrictors
• Intracavernosal injection of vasoconstrictors alone is most useful
when ICI of erectogenic agents are given(diagnostic/therapeutic) and
when the duration of erection is >1 hour but not >4 hours
• Phenylephrine 200 µg injected with an ultrafine needle into the
corporal bodies
25. Aspiration
• Aspiration alone may alleviate priapism in 1/3rd of cases
Technique of aspiration:
• Single large bore 19/18G needle inserted at 3 or 9 O clock at
penoscrotal junction(to avoid DVC)
• Shaft should be held between thumb and index finger just below the
needle
• Compress the shaft and aspirate blood. Then release the shaft
pressure to refill and aspirate again
• Repeat till the blood is bright red in colour
29. Phenylephrine
• Diluted to 100-200 µg/ml
• 1 ml injected every 5 minutes till a maximum of 1000 µg
• Penile shaft is compressed below the needle during injection and
aspiration of blood done between injections
• Monitor patient’s BP due to sympathomimetic effects of the drug
30. Surgical management of ischemic priapism
• After failed ICI adrenergics at least for an hour(International
consultation on sexual medicine, 2004)
• Or can be used in patients who have contraindications for alpha
adrenergics(elderly, patients on MAO inibitors)
• Priapism lasting longer than 24 hours – 90% ED
• International society for Sexual medicine recommends shunting for
LFP of 72 hours or less
• Shunt surgeries done after 36 hours only relieves pain without any
benefit on erectile function
31. Objectives of shunting
• To shunt across the venous obstruction
The shunting can be to:
• Glans/Corpus spongiosum
• Deep dorsal vein
• Saphenous vein
34. Ebbehoj and T shunts
Ebbehoj shunt:
• 11 blade used to make a percutaneous cavernosoglanular shunt
T shunt:
• 10 blade inserted into glans and rotated 900 to make a T shunt
Better done under ultrasound guidance to avoid urethral injury
35.
36. • Winter, Ebberhoj and T shunt can be done under penile block
• Deoxygenated blood milked out and glans closed if necessary with
absorbable sutures
• Patient can be discharged if the penis remains flaccid for 15 minutes
39. Burnett corporal snake technique
• Less invasive than Al ghorab
• Combination of T shunt and Al ghorab
• T shunts made and 20Fr dilators inserted down to the crura
41. Open proximal corporospongiosal shunt/
Quackles shunt
• Trans scrotal or perineal approach
• If done bilaterally, should be done in a
staggered fashion to avoid urethral stricture
formation
45. Post operative care
Like AV fistula care
• Avoid compressive dressings to penis
• Patient should periodically compress and release the distal penis to
maintain the patency of the shunt created
• Anticoagulation(Heparin/aspirin)
47. Immediate penile prosthesis insertion
• Priapism lasting longer than 36 hours
• MRI evidence of corporal fibrosis/smooth muscle necrosis
• Failure of distal/proximal shunts
Merits:
• Fibrosis has not fully established which makes the procedure easy
• Penile length is preserved
Demerits:
• Higher complication rate
• Device extrusion higher, especially in region of previous shunting
48. Management of HFP
• HFP is not an emergency
• It is nothing but a vascular fistula
• 2/3rd will spontaneously resolve
• And so, only priapism type where conservative management can be
tried – Ice application to perineum
• Aspiration, ICI have no role in the treatment of LFP
49. Arterial embolisation
• Patients demanding immediate relief can be subjected to
angioembolisation
• Recurrence rate of 30%
• So, may require retreatment
51. Management of stuttering priapism
• Oral adrenergics
• Hormonal therapies
• Ketoconazole
• 5α reductase inhibitors
• Baclofen
• PDE5i
• ICI of adrenergics at home
52. Oral adrenergics
• Etilefrine
• 100 mg/ day maximum
• Started at 25 mg at bedtime and increased up to 100 mg/day
• Only FDA approved drug for stuttering priapism
53. PDE5i and stuttering priapism
• Seems counterintuitive
• But regular PDE5i can cause PDE5 upregulation and can decrease
cGMP levels( Burnett et al, 2006)
• Should not be started during a priapism episode
• Efficacy seen after a week or more
54. ?PRIAPISM
↓
Rigid and painful/tender Non tender and tumescent but not rigid
↓ ↓
Ischemic Non ischemic
↓ ↓
Hematology consult ← Previous similar episodes of stuttering priapism
Examination
History for blood dyscrasias
Previous trauma history
↓ ↓
CDU and blood gas analysis
↓ ↓
Ischemic Non ischemic
↓ ↓
Document baseline IIEF score
↓ ↓
Cavernosal aspiration Conservative vs
angioembolisation/fistula closure
↓
Normal saline irrigation
↓
ICI of adrenergics for an hour
← ←
↓
↓
↓ ↓
Success Failure → Percutaneous distal shunt under LA
Complete detumescence Partial detumescence ↑ ↓
↓ ↓ ↑
Discharge IP and CDU/corporal
gas repeat
→ ↑ Open distal shunt under GA:
Al ghorab
Corporal snake if clots could not be evacuated by al
ghorab
↓
Proximal shunt
↓
MRI
↓
Corporal fibrosis
↓
+ -
Immediate penile prosthesis Observation
55. Priapism after ICI
• If it less than 1 hour, ICI of phenylephrine alone is enough
• If more than 4 hours, treat as in ischemic priapism
56. Summary
• Differentiate priapism clinically and along with CDU/corporal blood
gas analysis
• Because the entire treatment pathway varies
• Because ischemic – emergency; non ischemic – elective
• Treatment of ischemic priapism is aspiration and fistula(shunt
)creation
• Treatment of non ischemic priapism is fistula closure
57. References
• Campbell 11th edition
• Priapism EAU guidelines
• Urological emergencies – a practical guide, Hunter and McAninch
• Outcome and erectile function following treatment of priapism: an
institutional experience, Pal et al, 2015