This document describes the case of a 46-year-old male patient presenting with weakness, wasting, and numbness in both upper and lower limbs over the past year. Electrodiagnostic testing revealed abnormal findings consistent with a multifocal demyelinating sensorimotor neuropathy. Based on the asymmetric progression and electrodiagnostic results, the patient was diagnosed with Lewis-Sumner syndrome, a chronic relapsing demyelinating polyneuropathy.
Stroke cases are presented and discussed. Students should be able to analyze the cases as presented, explain why the process is a cerebrovascular event, localize the lesion, determine the etiology of stroke and come up with reasonable approach to further evaluation and management.
Case Studies In Stroke Prepared By Arlyn M. Valencia, M.D.guestc179d8
Stroke cases are presented, The students should be able to localize the lesion, come up with probable etiology of the stroke and have a reasonable approach towards further evaluation and management.
Stroke cases are presented and discussed. Students should be able to analyze the cases as presented, explain why the process is a cerebrovascular event, localize the lesion, determine the etiology of stroke and come up with reasonable approach to further evaluation and management.
Case Studies In Stroke Prepared By Arlyn M. Valencia, M.D.guestc179d8
Stroke cases are presented, The students should be able to localize the lesion, come up with probable etiology of the stroke and have a reasonable approach towards further evaluation and management.
references:
1-European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision.
2-Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Its Variants By Kelly Gwathmey, MD
3-Patient Journey in CIDP: Burden, Symptoms, and Diagnosis Jeffrey A. Allen, MD; Richard A. Lewis, MD
Gillian Barrie syndrome An autoimmune disease,
this presentation is a case discussion for actual case includes: demographic data, current history, past history, chief complaint, prognosis, medications, medical treatment, nursing management, disease pathophysiology.
references:
1-European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision.
2-Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Its Variants By Kelly Gwathmey, MD
3-Patient Journey in CIDP: Burden, Symptoms, and Diagnosis Jeffrey A. Allen, MD; Richard A. Lewis, MD
Gillian Barrie syndrome An autoimmune disease,
this presentation is a case discussion for actual case includes: demographic data, current history, past history, chief complaint, prognosis, medications, medical treatment, nursing management, disease pathophysiology.
This Presentation Gives a step by step approach on differential diagnosis of adult neurological cases. Gives a clear insight in understanding better the given topic.
SOAP NOTE
Name: C.M.
Date: 04/08/2016
Time: 10:55
Pt. Encounter #
Age: 52
Sex: Female
SUBJECTIVE
CC:
“My hands are swollen and painful”
HPI:
This is a 51-year-old female who comes to the office with complains of fatigue, general malaise, and pain and swelling in her hands that has gradually worsened over the last few weeks. She reports that pain, stiffness, and swelling of her hands are most severe in the morning. Also, she report weight loss, anorexia, aching, and stiffness. Morning stiffness lasts for as long as 1 to 2 hours.
Medications:
1. Diovan 80mg po daily
2. Singular 10mg po at bed time
3. Tylenol 500mg 1 tab po every 6 hours x pain
4. Albuterol 2 puff every 6 hours as needed
PMH
Allergies: NKA
Medication Intolerances: None
Chronic Illnesses/Major traumas: Hypertension, Asthma.
Hospitalizations/Surgeries: Hysterectomy 5 years ago.
Family History
Mother diagnosed with: Asthma, Hypothyroidism, Rheumatoid Arthritis
Father diagnosed with: HTN, Dementia
Sister diagnosed with: HTN
Social History
Patient has a high school education. She works as a mail carrier for the post office for 15 years. She has been widowed for the last two years. Currently, she lives alone in a rented apartment. She has two living children, who all live close by and have families of their own. She reports her family is supportive and denies any needs at this time. She has adequate shelter and food. She denies any leisure activities. She refuses to practice exercises. She just goes to the local church on Sunday. She eats a diet low sodium. She denies substance use, ETOH, tobacco, marijuana or illicit drugs.
ROS
General
Weight loss and fatigue
Decreased energy level
Cardiovascular
Denies chest pain, palpitations, PND, orthopnea, edema
Skin
Denies delayed healing, rashes, bruising, bleeding or skin discolorations, any changes in lesions or moles
Respiratory
Denies cough, wheezing, dyspnea at this time
Eyes
Corrective lenses
Gastrointestinal
Denies abdominal pain, N/V/D, constipation, hepatitis, hemorrhoids, eating disorders, ulcers, black tarry stools
Ears
Denies ear pain, hearing loss, ringing in ears, discharge
Genitourinary/Gynecological
Denies urgency, frequency burning, change in color of urine, vaginal discharge or STDS. Hysterectomy 5 years ago. Last mammography 1 years ago.
G2, P2, A0
Nose/Mouth/Throat
Denies sinus problems, dysphagia, nose bleeds or discharge, dental disease, hoarseness, and throat pain
Musculoskeletal
Localized symptoms in hand joints: pain, tender, swollen, and decrease range of motion.
Breast
SBE every month, denies lumps, bumps or changes
Neurological
Denies syncope, seizures, transient paralysis, weakness, paresthesias, black out spells
Heme/Lymph/Endo
Denies HIV status, bruising, blood transfusion hx, night sweats, swollen glands, increase thirst, increase hunger, cold or heat intolerance
Psychiatric
Denies depression, anxiety, sleeping difficulties, suicidal ideation/attempts, previous dx
OBJECTIVE
.
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
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!
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.
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.
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. 46 years old male called Sobhy Ahmed , married
, From Kafr El Dawwar Presented with:
1. Flail left upper limb
2. Weakness ,wasting and Numbness of both
upper and lower limbs
3. Gait instability , Heaviness of both Lower
Limbs
3. Condition started 1 year ago by incidious oncet and
Progressive course of Weakness of the right upper limb
**The patient neither can comb his hair nor button his shirt
**No Diurnal variation
**Associated with Dull aching Pain around the am radiating
distally relived by analgesics , (no ppt factors)
** Associated with numbness in his right hand and
forearm
The Patient Sought medical advice . Xray , CT and MRI
Cervical spine was done Revealing : C5-6 Posterolateral
Disc Bulge
4.
5.
6.
7. The weakness and wasting of his right upper limb run through a
• Progressive course over a period of 3 month duration and
his right upper limb become flail with inability to flex
his elbow and associated with severe wasting and
weakness in his right hand and forearm muscles
•
Stationary course for 2 months
•
Then regressive course upon neurotonics and Physical
therapy (the patient attains Partial recovery , regaining
some ability to flex his right elbow )
8. 5 months ago he suffered from the same complaint with
the same pattern on his Left Upper Limb
and Presented with :
1. Flail left Upper limb Inability to flex his left elbow
2. Wasting and weakness of hand and forearm muscles
3. Gait instability associated with Heaviness of both
lower limbs
4. Loss of weight
5. Numbness of the Both upper and lower limbs
6. Pain at his both shoulder , elbow and ankle
The patient was admited to El Hadara University Hospital
9. Flail left Upper limb Inability to flex his left elbow
Loss of weight
14. • The patient is conscious cooperative oriented with normal
intellectual
• Speech and articulation : Normal receptive expressing, naming ,
writing and reading
• Cranial Nerve examination showed ?Tongue fasciculation
• Motor examination:
Tone :
Hypotonia all over
Reflexes : Areflexia all over
Extensor planter : unequivocal bilaterally
Coordination : cannot be assessed due to weakness
Gait : instability , inability to walk on heel or tip of the toes
15.
16.
17. • The patient is Heavy smoker
• Patient is not DM nor HTN nor cardiac / renal / hepatic
•
•
•
•
•
•
•
NO Bulbar Manifestation
No sphincteric complaint
No Cognitive impairment
NO specific drug or sensitivity
No Relevant Cutaneous Manifestation
No history of previous operation
NO family history of similar condition(-ve consanguinity )
36. AFCL = ( F + DL ) - (2 х Proximal latency)
F wave Latency
Distal Latency
----AFCL----13.6 ms
2 х Proximal latency
37. AFCL = ( F + DL ) - (2 х Proximal latency)
Ulnar Nerve :
( 38.6 + 3.6 ) – ( 2 х 11.8 ) = 42.2 – 23.6 =
Median nerve :
( 42.4 + 4.7 ) – (2 х 12.7) = 47.1 – 25.4 =
18.6 ms
21.7 ms
38.
39.
40. 1.Diabetic Poly-Radiculoneuropathy
2.Chronic imf demylinating Polyradiculoneurop.
3.Early Guillian Barre ( Axillary loop block)
4.Severe demylinating peripheral neuropathy
5.Demylinating Brachial Plexopathy(Br. Neuritis)
NB: Axonal Lesion never lead to abnormal Delay in Fwave mylinating
In severe axonal neuropathy or plexopathy F wave is Lost
Single motor Radiculopathy never cause abnormal f wave except
if the lesion is severest
86. •
The Lewis- Sumner syndrome (LSS) is a dysimmune multifocal demyelinating
sensorimotor neuropathy. It should be considered as a clinical asymmetrical variant
(CIDP).
•
Patients with LSS usually present with an asymmetrical involvement of the upper
limb with distal sensorimotor deficit in median or ulnar territories.
1. A purely sensory onset with numbness and paresthesia or pain in median or ulnar
territory is observed 30% of cases.
2. A lower limb onset is present in 30% of patients with a distal and asymmetrical
sensorimotor deficit.
3. Amyotrophy and cranial nerve involvement may be observed in 50% and 20% of
patients,
•
LSS could mimick a nerve entrapment or a vasculitis. The course is progressive or
remitting.
87. • Electrophysiological pattern associates a multifocal motor
demyelination with conduction blocks mostly situated in
the forearm.
• Contrarily to CIDP, other conduction anomalies (reduction
of truncal motor nerve velocities, prolonged distal latencies
or prolonged F waves) occur rarely outside the blocked
nerve territory.
•
Sensory conduction shows a multifocal sensory
involvement.
88. • Sural nerve biopsy in LSS show elements consistent with
a primary demyelination, indistinguishable from that seen
in typical CIDP. However nervous biopsy is not necessary
to establish the diagnosis ( unlike vasculitis ) .
• Serum anti-GM1 antibodies are negative and CSF
protein content is usually normal or mildly elevated with a
mean value of 0.7 g/l. LSS is characterized by a
responsiveness to IVIg and steroids.
• For LSS patients, a treatment similar to that of CIDP,
Plasma exchanges are not recommended in LSS.