This document discusses the principles of medicine and the patient-physician relationship. It emphasizes that medicine is both a science and an art, requiring both medical knowledge and the ability to discern physical signs and interpret data. A good doctor approaches each patient holistically, considering their medical issues in the context of their family and social situation. A thorough patient evaluation includes taking a detailed patient history and performing a complete physical examination, with the goals of understanding the root of the patient's concerns and developing a treatment plan. Building trust and understanding with the patient is essential.
"Medical Doctors are Poor Managers". This presentation has tried to do brainstorming for them how to operate as better Health Managers. Leaders lead from the Front. Managers control from the Behind. A Doctor in a facility needs to play the role of both Leader as well as Manager.
The specialty which deals with population.
Comprises those doctors who try to measure the needs of sick and healthy.
Who plan and administer the services to meet the needs.
Who are engaged in research & teaching in the field.
The Presentation explains basic models of disease causation, to understand the etiology or causes of disease & altered production and helps to understand the applicability of causal criteria applied to epidemiological studies.
I Mr. Omkar B. Tipugade, Assistant Professor, Genesis Institute of Pharmacy, Radhanagari. This chapter notes as written as per MSBTE syllabus. Read all notes carefully and all the best for exam and future.
"Medical Doctors are Poor Managers". This presentation has tried to do brainstorming for them how to operate as better Health Managers. Leaders lead from the Front. Managers control from the Behind. A Doctor in a facility needs to play the role of both Leader as well as Manager.
The specialty which deals with population.
Comprises those doctors who try to measure the needs of sick and healthy.
Who plan and administer the services to meet the needs.
Who are engaged in research & teaching in the field.
The Presentation explains basic models of disease causation, to understand the etiology or causes of disease & altered production and helps to understand the applicability of causal criteria applied to epidemiological studies.
I Mr. Omkar B. Tipugade, Assistant Professor, Genesis Institute of Pharmacy, Radhanagari. This chapter notes as written as per MSBTE syllabus. Read all notes carefully and all the best for exam and future.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
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.
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).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
4. MEDICINE IS BOTH
SCIENCE AND ART
SCIENCE
- technology based on science is the
foundation for solution to clinical
problems
- advances in biochemical methodology
and in biophysical imaging techniques
- innovations in therapeutic maneuvers
5. ART
- ability to extract contradictory physical signs
- ability to discern and interpret laboratory data
- to know whether to treat or watch
- to determine when to pursue a clinical clue or
when to dismiss
- to decide which is of greater risk: treatment
or disease
This combination of medical knowledge,
intuition and judgment is the art of medicine
6. “ Tact, sympathy and understanding are
expected of the physician, for the
patient is no mere collection of
symptoms, signs, disordered functions,
damaged organs and disturbed
emotions. He is human, fearful and
hopeful seeking relief, help and
reassurance.”
- Harrison’s Principle of Medicine
7. PATIENT – PHYSICIAN /
DOCTOR RELATIONSHIP
Individuals whose problems often
transcends their complaints
Whatever the patient’s attitude, the
physician needs to consider the
terrain in which an illness occurs – family and
social background
Approach patients not as “cases” or “diseases”
Primary objective is to discover the root of a
patient’s concern and do something about it
8. HOW TO
EVALUATE
I. PATIENT HISTORY
• “build” a history rather
than “take” one
OBJECTIVES:
• identify problems
• to establish a sense of the patient’s
reliability
• to consider the potential for intentional or
unintentional suppression or underreporting of
certain experiences
9. Setting for the interview:
Make everyone as comfortable as
possible
Make the patient your focal point
Maintain eye contact and a
conversational tone of voice
10. STRUCTURE OF THE
HISTORY
1. General data
2. Chief complaint
3. History of present illness
4. Past medical history
5. Family history
6. Personal and social history
7. Review of systems
11. GENERAL DATA
- identifies the name, date, age, gender,
race, occupation
CHIEF COMPLAINT
- brief statement of the reason the
patient is seeking care
- direct quotes are helpful
12. History of Present
Illness (HPI)
a complete HPI will include
the following:
• chronologic ordering of
events
• state of health just before the onset of the
present problem
• complete description of the first symptoms
• possible exposure to infection, toxic
agents or other environmental hazards
13. • description of a typical attack, including
its persistence
• impact of the illness on the patient’s
usual lifestyle
• medications current and recent including
dosage as well as home remedies
14. Past Medical History
baseline for assessing the present complaint.
• general health and strength
• childhood illnesses: measles, mumps,
chickenpox, etc.
• major adult illnesses: TB, hepatitis,
diabetes, HPN, MI, any surgical or non-
surgical hospitalization
• immunizations
15. • serious injuries
• medications
• allergies and the nature of reactions
especially to medications
• transfusions: reactions, date and number
of units transfused
16. Family History
• blood relatives in the immediate or
extended family with illnesses with
features similar to patient’s
• include in the list of concerns: heart
disease, high blood, pressure, diabetes,
asthma, epilepsy, allergy, thyroid
disease, etc.
• history of cancer
17. Personal and Social History
• PERSONAL STATUS: birthplace, where
raised, home environment, education,
position in family, marital status,
hobbies and interests, sources of stress
and strain
• HABITS: nutrition and diet, regularity
and patterns of eating and sleeping,
quantity of coffee, tea, tobacco, alcohol,
extent of cigarette use reported in “pack-
years”
18. • SEXUAL HISTORY
• OCCUPATION: description and
duration of employment; exposures to
toxins (e.g. lead, arsenic, asbestos)
• RELIGIOUS AND CULTURAL
PREFERENCES
19. Review of Systems
Identify the presence or absence of health-related
issues in each body system.
• general constitutional symptoms
• head and neck
• lymph nodes: enlargement, tenderness
• chest and lungs: pain in respiration, dyspnea,
wheeze, cyanosis
• breasts: development, pain, tenderness,
discharge, lumps
• heart & blood vessels
• peripheral vasculature: thrombosis,
thrombophlebitis, claudication
20. • GIT: heartburn, nausea, vomiting,
hematemesis, regularity of bowels,
constipation, diarrhea, flatulence,
hemorrhoids
• musculoskeletal: joint stiffness, pain,
restriction of motion, swelling, redness,
bone deformity
• neurologic: syncope, seizures, weakness
or paralysis, tremors, loss of memory
• psychiatric: depression, mood changes,
difficulty concentrating, anxiety,
agitation, suicidal thoughts
21. • female: menarche, pregnancies
• males: puberty onset, erectile
dysfunctions, problem in emissions,
testicular pain, libido, infertility
22. TYPES OF HISTORIES
1. Complete History – makes you thoroughly
familiar with the patient
- most often recorded the first time you see
the patient.
2. Inventory History – related to but does not
replace the complete history
- it touches on the major points without
going into detail
3. Problem (or focused) History – taken when
the problem is acute possibly life threatening
4. Interim History – chronicles the events that
have occurred since your last meeting with
the patient
23. • The results should be recorded at the time they
are elicited
• Repeat the physical examination as frequently
as the clinical situation warrants
II. PHYSICAL EXAMINATION
• Physical signs are the objective
and verifiable marks of disease
and represent solid, indisputable
facts
• Physical examination should be
performed methodically and
thoroughly
24. PARTS OF PHYSICAL
EXAMINATIONS
1. Measurement of Vital Signs: baseline
indicators of a patient’s health status
• PULSE – may be palpated in several
areas; however, the radial pulse is
most often used
- note their rhythm, amplitude while
counting
25. • RESPIRATION – observe the rise and
fall of the chest
- Count the respiratory cycles / minute
- Note the depth of respiration and
whether the patient uses accessory
muscles
• BLOOD PRESSURE
• TEMPERATURE – oral, rectal,
axillary and tympanic
- kinds: electronic and tympanic; infrared
axillary thermometers for neonates
26. • OXYGEN SATURATION – estimation
of arterial oxygen saturation
- A healthy person with no anemia or lung
disease has O2 sat. of 97% - 99%
• PAIN – because of its ubiquitous nature,
its universality as a distress signal, it is
more and more often being recognized
as part of the vital sign.
27. 2. Physical Assessment
• INSPECTION
- process of observation
- what is the patient’s gait
- is eye contact made
- is the patient dressed appropriately
for the weather
- color and moisture of the skin
28. • PALPATION
- involves the use of the hands and
fingers to gather information through
the sense of touch
- ulnar surface of the hand and fingers
is the most sensitive area for
distinguishing vibration
- dorsal surface of the hand is best for
estimating temperature
29. • PERCUSSION
- involves striking one object against
another to produce vibration and
subsequent sound waves
- the more dense the medium, the
quieter is the percussion tone
- percussion over air is loud, over fluid
less loud and over solid areas soft
31. CORE VALUES
1. Respect the patient.
2. Achieve the complimentary forces of
competence and compassion.
3. The art and skill essential to history
taking and physical examination are the
bedrock of care; technologic resources are
complements
4. The history and physical examination are
inseparable – they are one.
5. The computer cannot replace you, it is
what you do that builds a trusting, fruitful
relationship with the patient.
6. The relationship can be indescribably
rewarding.