A POWER POINT PRESENTATION BY DR.SANGEETA CHOWDHRY & DR.SUNIL SHARMA, DEPARTMENT OF FORENSIC MEDICINE & TOXICOLOGY, GOVT. MEDICAL COLLEGE, JAMMU (JAMMU AND KASHMIR)
A POWER POINT PRESENTATION BY DR.SANGEETA CHOWDHRY & DR.SUNIL SHARMA, DEPARTMENT OF FORENSIC MEDICINE & TOXICOLOGY, GOVT. MEDICAL COLLEGE, JAMMU (JAMMU AND KASHMIR)
Children at very low risk of brain injuriesSun Yai-Cheng
Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study
Lancet 2009; 374: 1160–70
Children at very low risk of brain injuriesSun Yai-Cheng
Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study
Lancet 2009; 374: 1160–70
C-Spine Collar Clearance In The Obtunded Adult Blunt Trauma PatientSun Yai-Cheng
Cervical Spine Collar Clearance In The Obtunded Adult Blunt Trauma Patient A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma
J Trauma Acute Care Surg. 2015;78: 430-441.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
BLAST INJURIES, An approach towards a patient that has suffered a blast injury.Dr. RIFFAT KHATTAK
"A blast injury", is a complex type of physical trauma resulting from direct or indirect exposure to an explosion. Blast injuries range from internal organ injuries, including lung and traumatic brain injury (TBI), to extremity injuries, burns, hearing, and vision injuries. Explosions cause familiar trauma .There may be LOTS of casualties with LOTS of injuries. Secondary blast trauma is the biggest killer. The efficiency of the Emergency Response Teams, in how quickly they could identify the injuries and their ability to shift the patients the a proper healthcare facility for timely surgical interventions can save lives.
Management of Heart Failure in the ED Setting:
An Evidence-Based Review of the Literature
J Emerg Med, 2018 Sep 26.
doi: 10.1016/j.jemermed.2018.08.002
Diffusion-weighted imaging or computerized tomography perfusion assessment with clinical mismatch in the triage of wake up and late presenting strokes undergoing neurointervention with Trevo (DAWN) trial methods
Int J Stroke. 2017 Aug;12(6):641-652.
Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct
N Engl J Med. 2018 Jan 4;378(1):11-21.
A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3)
Int J Stroke. 2017 Oct;12(8):896-905.
Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging
N Engl J Med. 2018 Feb 22;378(8):708-718.
The European Guideline on Management of Major Bleeding and Coagulopathy Follo...Sun Yai-Cheng
The European Guideline on Management of Major Bleeding and Coagulopathy Following Trauma: Fourth Edition
Rossaint et al. Critical Care (2016) 20:100
DOI 10.1186/s13054-016-1265-x
ACEP Policy for Fever Infants and Children Younger than 2 Years of Age in EDSun Yai-Cheng
Clinical Policy for Well-Appearing Infants and Children Younger Than 2 Years of Age Presenting to the Emergency Department With Fever
Ann Emerg Med. 2016;67:625-639
2015 AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment
Stroke. 2015;46:3020-3035.
With the Proliferation of Mobile Medical Apps, Which Ones Work Best in the Emergency Department?
Annals of Emergency Medicine, August 2015 Vol. 66, Issue 2, A13–15
Use of tPA for the Management of Acute Ischemic Stroke in the ED: ACEP PolicySun Yai-Cheng
ACEP Clinical Policy
Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department
Ann Emerg Med. 2015;66:322-333
Evaluation and Management of Acute Aortic Dissection: ACEP PolicySun Yai-Cheng
ACEP Clinical Policy
Evaluation and Management of Adult Patients With Suspected Acute Nontraumatic Thoracic Aortic Dissection
Ann Emerg Med. 2015;65:32-42
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.
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.
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
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.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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.
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
1. Primary Blast Injury: Update on diagnosis and treatment Crit Care Med 2008; 36:[Suppl.]:S311–S317
2. Primary blast injuries: injuries due solely to the blast wave Secondary blast or explosive injury: primarily ballistic trauma resulting from fragmentation wounds from the explosive device or the environment Tertiary blast or explosive injury: result of displacement of the victim or environmental structures, is largely blunt traumatic injuries Quaternary explosive injuries: burns, toxins, and radiologic contamination Injuries from explosions are traditionally classified into:
3. The blast wave enters the body creating two types of energy, stress waves and shear waves. Stress waves are longitudinal pressure forces that move at supersonic speeds and create a “spalling” effect at air–tissue interfaces, much like boiling water, resulting in severe microvascular damage and tissue disruption. Shear waves are transverse waves that cause asynchronous movement of tissue and possible disruption of attachments. Pathophysiology
4. The organs most likely affected by primary blast injury are the ears, lungs, and colon or gas-filled organs with the damage originating at the tissue–gas interface. Ruptured tympanic membrane, ossicular disruption, alveolar hemorrhage, cerebral, coronary, retinal and lingual air emboli, ruptured viscus with pneumoperitoneum, and vagally mediated bradycardia, apnea, and hypotension are among the early signs of severe primary blast injury. Pathophysiology
5. The absence of perforation of the tympanic membrane and lack of petechiae in the oropharynx have been said to mediate against primary blast injury of internal organs in the majority of cases. The presence of oral petechiae and perforated tympanic membrane together, this can be a valuable triage tool to alert the physician to keep a patient for further observation. Pathophysiology
6.
7. 10% of all blast survivors have significant eye injuries. Symptoms of ocular injury include pain or irritation, altered vision, periorbital swelling, contusion, or foreign body sensation in the case of injury resulting from fragments. Ophthalmic physical examination findings include conjunctivalhemorrhage, diminished visual acuity, hyphema, globe rupture, presence of foreign body, or lid lacerations. Ocular Injury
8. Ophthalmology consultation should be obtained for suspected globe injuries, corneal foreign bodies or abrasions, orbital fractures, retinal detachments, hyphema, intraocular foreign bodies, corneal or eyelid burns, lid lacerations, subconjunctival hemorrhage, or head injuries that involve the orbit or may compromise vision Ocular Injury
9. Tympanic membrane rupture is the most common primary blast injury, 9-47% of explosion-injured patients had tympanic membrane rupture. The most common symptoms of auditory injury are hearing loss, tinnitus, pain, and dizziness. All explosion victims should be evaluated with an otoscopic examination not as a means of screening for other primary blast injuries, but simply to diagnose tympanic membrane rupture and ensure proper evaluation and treatment. Aural Injury
10. Blast lung injury is the most common fatal injury among initial survivors of explosions. The incidence of pulmonary blast injury ranging from 3% to 14%. This may result in minor or massive parenchymal hemorrhage, pulmonary edema, pneumothorax, or air embolism from alveolovenous fistulas. Symptoms and signs include tachypnea, dyspnea, cyanosis, and hemoptysis. On physical examination, the patient may have diminished breath sounds and crepitance resulting from subcutaneous air. Hypoxia (oxygen saturation <90% on room air) is present and reaches its nadir within the first 24 hrs. Blast Lung Injury
11. Clinical diagnosis of blast lung injury is based on the presence of respiratory distress, hypoxia, and “butterfly” or batwing infiltrates. CXR findings of the batwing (bilateral central) lung infiltrates were the most common radiographic finding. The central location of infiltrates may help distinguish blast lung injury from blunt etiologies of pulmonary contusion, which usually causes peripheral lesions. Additionally, radiographs may reveal pneumothorax or pneumomediastinum Blast Lung Injury
12. The management of blast lung injury are to avoid positive pressure ventilation, if possible, minimize positive end-expiratory pressure ventilation, and use judicious fluid resuscitation strategies. Pressure-limited, volume-controlled ventilation with permissive hypercapnia has been advocated in patients sustaining blast lung to minimize mean airway pressure and the chance of air embolism as well as to reduce the risk of further pulmonary trauma. When all else fails, the physician may resort to salvage methods like ECMO. Blast Lung Injury
13. Primary blast injury to the gastrointestinal tract is rare with an incidence of 0.3% to 0.6%. Patients with primary blast injury to abdominal viscera may present with abdominal pain, nausea, vomiting, hematemesis, melena, and peritoneal signs of injury. Hemodynamic instability may also be seen in the case of mesenteric hemorrhage or solid organ injury. Intestinal Blast Injury
14. Radiographic evidence of abdominal blast injury on computed tomography includes pneumoperitoneum, free intraperitoneal fluid not consistent with blood, and a “sentinel clot” seen adjacent to bowel wall or mesentery. Mesenteric or mural hematoma in hemodynamically stable patients without peritoneal signs may be managed with NPO, NG tube decompression, and resuscitation. Massive hemorrhage or obvious hollow viscus perforation should be treated with laparotomy for hemostasis and control of spillage of enteric contents. Intestinal Blast Injury
15. Triad of immediate bradycardia, hypotension, and apnea that is a partially vagally mediated response to thoracic blast. The most common blast-induced arrhythmias are bradycardia, premature ventricular contractions and asystole. Hypotension has been associated with low cardiac index and stroke volume but normal systemic vascular resistance. Cardiovascular Effects of Blast
16. Physician should be aware that hemorrhaging explosion-injured patients may not have the expected compensatory tachycardia and may become hypotensive without rapid resuscitation. Atropine may be a useful adjunct in patients with blast-induced bradycardia who do not respond as predicted to resuscitation efforts. Cardiovascular Effects of Blast
17. Principles of management of the combat-injured extremity such as early tourniquet use should be applied in the care of these patients regardless of precise mechanism of injury. Clinicians should have a high clinical suspicion for occult explosive injuries to the CNS, thorax, and abdomen in these patients and should search for them in the patient who does not respond appropriately to resuscitation once control of extremity hemorrhage is achieved. Traumatic Amputations
18. Kinetic energy of the blast wave transferred to the CNS causes shearing, resulting in diffuse or focal axonal injury and initiating secondary injury mechanisms that may result in both acute and delayed symptoms of post-concussion syndrome or PTSD. Symptoms of CNS injury may be psychologic, such as excitability, irrationality, retrograde amnesia, apathy, lethargy, poor concentration, insomnia, psychomotor agitation, depression, anxiety, or physical such as fatigue, headache, back and diffuse pains, vertigo, transient paralysis, and “heavy” feeling extremities. Traumatic Brain Injury
19. Physical examination should include a thorough neurologic examination to include checking for positive Romberg’s sign as well as funduscopy to look for evidence of air emboli. CT scan should be used to search for evidence of blunt head injury and ICH. Traumatic Brain Injury
20. Focused history to risk stratification for primary blast injury Explosive device details: type and weight of explosive, improvised vs. commercially available, suicide bomber, time of detonation Geography: device location, open vs. closed space detonation, surrounding structures (urban vs. rural setting) Victim: distance of the victim from the detonation center, specific location of the victim with orientation of body in relation to explosive and surrounding structures, personal protective equipment Status of other casualties: cause of any on-scene deaths, primary blast injury in other surviving victims Patient Risk Stratification