A Review of Atherectomy in Peripheral Arterial Diseaseasclepiuspdfs
Atherectomy involves exciting technology and offers expanded treatment options for PAD. Data are scant so far in most lower extremity territories to support its use over other interventions, but newer results are promising. There is still a financial benefit to choosing atherectomy in the outpatient setting that likely drives much of its popularity among interventionalists. Atherectomy is an exciting technology for peripheral vascular intervention. Its use has greatly increased over the last decade. Data on its superiority to angioplasty or angioplasty with stenting are scant. Here, we review atherectomy techniques and principles along with results and controversy surrounding its use.
Carotid Endarterectomy in Stroke Prevention UpdateDenise Crute
Neurocritical Care lecture on the role of carotid artery surgery in stroke prevention, reviewing the latest studies and evidence-based updates, along with neurosurgical techniques.
Fluoroscopic-assisted placement of cerebrospinal fluid drains (CSFDs)David Hao
A case conference delivered at the Massachusetts General Hospital on Thursday, July 2nd 2020. The vascular anesthesia team describes pearls and pitfalls with implementation of a fluoroscopic-assisted technique for placement of cerebrospinal fluid drains.
A Review of Atherectomy in Peripheral Arterial Diseaseasclepiuspdfs
Atherectomy involves exciting technology and offers expanded treatment options for PAD. Data are scant so far in most lower extremity territories to support its use over other interventions, but newer results are promising. There is still a financial benefit to choosing atherectomy in the outpatient setting that likely drives much of its popularity among interventionalists. Atherectomy is an exciting technology for peripheral vascular intervention. Its use has greatly increased over the last decade. Data on its superiority to angioplasty or angioplasty with stenting are scant. Here, we review atherectomy techniques and principles along with results and controversy surrounding its use.
Carotid Endarterectomy in Stroke Prevention UpdateDenise Crute
Neurocritical Care lecture on the role of carotid artery surgery in stroke prevention, reviewing the latest studies and evidence-based updates, along with neurosurgical techniques.
Fluoroscopic-assisted placement of cerebrospinal fluid drains (CSFDs)David Hao
A case conference delivered at the Massachusetts General Hospital on Thursday, July 2nd 2020. The vascular anesthesia team describes pearls and pitfalls with implementation of a fluoroscopic-assisted technique for placement of cerebrospinal fluid drains.
Diagnosis, management, workup in a case of Takayasu's arteritis. Definition, synonyms, history, epidimiology, pathophysiology, etiology of Takayasu's arteritis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
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
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
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
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.
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.
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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!
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Radiological pathology of transient ischemic attacks
1. Professor Yasser Metwally
www.yassermetwally.com
INDEX
INTRODUCTION
Periventricular white matter
changes (leukoaraiosis)
Cortical-Subcortical
abnormality
Watershed abnormality
Normal MRI
SUMMARY
INTRODUCTION
Most patients with TIAs have normal CT scans. The incidence of associated infarction as
demonstrated by CT has varied from 0 to 20% . These CT abnormalities have frequently
consisted of lacunae or more extensive ill-defined periventricular regions of decreased
density or watershed infarctions. The gray matter enhancement associated with cortical
infarction and cerebral dysautoregulation has been an infrequent finding. Other observed
CT findings have been equally nonspecific, including ventriculomegaly and cortical
atrophy.
The MRI is abnormal in 70% of cases with TIAs. All abnormalities seen by CT are also
visualized by MRI. Moreover, MRI commonly visualized more extensive involvement than
is appreciated by CT. The MRI findings can be divided into four categories according to
their anatomical distribution and morphology as follows.
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2. Professor Yasser Metwally
www.yassermetwally.com
Periventricular abnormality
Cortical-subcortical
abnormality
Watershed abnormality
Normal MRI
Periventricular white matter changes (leukoaraiosis)
This category is composed of the oldest patients (average age 73.8 years) and had the
highest percentage of hypertensives (75%). Of all the groups , this group tended to have a
more Polymorphic appearance, being combined on occasion with cortical and subcortical
abnormalities as well as extending into clear watershed zones. Abnormalities of the
immediate periventricular area, especially bordering the dorsolateral surfaces of the
ventricles, are relatively nonspecific since this region may be injured by a wide variety of
disease states .
The diversity of possible causes (embolic, hemodynamic, and
hypertensive) is present within this group. The incidence of a
cardiac history consisting of arrhythmias (chronic atrial
fibrillation and ventricular arrhythmias), mitral annular
calcifications, and aortic sclerosis, as well as myocardial
infarction and angina is very low in this group. It is of
interest that this group has the lowest degree of
hemodynamically significant carotid stenosis. TIAs and
RINDS in this group is one of the clinical manifestations of
microvascular brain disease.
Figure 1. CT scan image showing leukoaraiosis
Although there are a diverse number of disease states that may cause these periventricular
changes, it seems apparent that the most common etiology would be the vascular changes
associated with hypertension. Such changes perhaps are best illustrated by a common
disease, namely, subcortical arteriosclerotic encephalopathy (SAE). SAE and the high
incidence of lateral periventricular abnormalities encountered have been the topic of much
debate. Although none of the patients in this group have a symptom complex composed of
dementia, stroke, gait disturbance, ventriculomegaly, or urinary incontinence it seems
reasonable to expect that SAE may initially present with TIA or reversible ischemic
neurologic deficit (RIND). This group had the highest percentage of RIND symptoms.
Cortical-Subcortical abnormality
This is the largest Population of abnormalities found, representing 43% of all abnormal
studies. The average age of this group was 66.6 years, which is considerably lower than that
of the periventricular group. This group also had a relatively large percentage of
www.yassermetwally.com
3. Professor Yasser Metwally
www.yassermetwally.com
hypertensive individuals (61%). The incidence of a cardiogenic source for the emboli such
as atrial fibrillation, ventricular arrhythmias, prolapsed mitral valve, atherosclerotic heart
disease with angina, and recent myocardial infarction is low. The incidence of significant
carotid stenosis defined as greater than 80% by carotid ultrasound or angiography is also
very low in this group. CT scans might be abnormal in this group demonstrating
periventricular lacunae or focal gray matter enhancement. This group has the lowest
percentage of recurrent TIAS. TIAs and RINDS in this group is one of the clinical
manifestations of microvascular brain disease.
Watershed abnormality
This category has an average age of 70.3 years and, interestingly, the lowest percentage of
hypertension (58%), comparable to the cortical-subcortical group. All of these patients
have abnormalities lying in a deep posterior wedge distribution extending posteriorly and
dorsally from the lateral ventricles. Some of them have abnormalities extending along the
dorsolateral aspect of the lateral ventricles. Others have the abnormality extending along
the cortex and subcortical region between the anterior and middle cerebral arteries.
Abnormalities within watershed zones, within the cerebellum and between the distributions
of the posterior inferior and superior cerebellar arteries is occasionally demonstrated.
Many of these patients have significant carotid stenosis with or without coronary artery
stenosis. Myocardial infarctions or ventricular arrhythmias are occasionally present. This
group has the highest percentage of multiple or recurrent TIAs (67%).
Normal MRI
This group has the youngest average age (58.6 years), the second highest percentage of
hypertensives (67%), and the second highest number of recurrent TIAS. incidence of
significant carotid disease or cardiac disease is very low.
SUMMARY
Type Incidence Age Carotid Hypertension Possible aetiology
stenosis
Periventricular Common in 73.8 Low 75% Microvascular brain
white matter Egypt incidence disease
changes
(leukoaraiosis)
Cortical- Common in 66.6 Low 61% Microvascular brain
Subcortical Egypt incidence disease
Watershed Rare in 70.8 High Low Carotid bifurcation
Egypt incidence disease
Normal Common in 58.6 Low 76 % Microvascular brain
Egypt incidence disease
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4. Professor Yasser Metwally
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References
1. Bhatt DL, Kapadia SR, Yadav JS, Topol EJ: Update on clinical trials of antiplatelet
therapy for cerebrovascular diseases. Cerebrovasc Dis 2000; 10 Suppl 5: 34-40.
2. Bots ML, van der Wilk EC, Koudstaal PJ, et al: Transient neurological attacks in
the general population. Prevalence, risk factors, and clinical relevance. Stroke 1997
Apr; 28(4): 768-73.
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ischemic stroke: an algorithm for evaluation and treatment. Mayo Clinic Division of
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7. Feinberg WM, Albers GW, Barnett HJ, et al: Guidelines for the management of
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Management of Transient Ischemic Attacks of the Stroke Council of the American
Heart Association. Circulation 1994 Jun; 89(6): 2950-65.
8. Forbes CD: Antiplatelet therapy for secondary stroke prevention. Scott Med J 1999
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9. Gross SB: Transient ischemic attacks (TIA): current issues in diagnosis and
management. J Am Acad Nurse Pract 1995 Jul; 7(7): 329-37.
10. Gustafsson D, Elg M: The pharmacodynamics and pharmacokinetics of the oral
direct thrombin inhibitor ximelagatran and its active metabolite melagatran: a
mini-review. Thromb Res 2003 Jul 15; 109 Suppl 1: S9-15.
11. Henneman PL, Lewis RJ: Is admission medically justified for all patients with acute
stroke or transient ischemic attack? Ann Emerg Med 1995 Apr; 25(4): 458-63.
12. Johnston SC, Gress DR, Browner WS, Sidney S: Short-term prognosis after
emergency department diagnosis of TIA. JAMA 2000 Dec 13; 284(22): 2901-6.
13. Landi G: Clinical diagnosis of transient ischaemic attacks. Lancet 1992 Feb 15;
339(8790): 402-5.
14. Lanska DJ: Review criteria for hospital utilization for patients with cerebrovascular
disease. Task Force on Hospital Utilization for Stroke of the American Academy of
Neurology. Neurology 1994 Aug; 44(8): 1531-2.
15. Shiozaki T, Hayakata T, Taneda M, et al: A multicenter prospective randomized
controlled trial of the efficacy of mild hypothermia for severely head injured
patients with low intracranial pressure. Mild Hypothermia Study Group in Japan. J
Neurosurg 2001 Jan; 94(1): 50-4.
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Curr Atheroscler Rep 2000 Mar; 2(2): 104-9.
17. Zweifler RM: Management of acute stroke. South Med J 2003 Apr; 96(4): 380-5.
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