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A 45-year-old Pakistani man presented with chest pain and was found to have a ventricular septal defect. He required an intra-aortic balloon pump and intubation due to worsening pulmonary edema. On the fifth day of hospitalization, the patient underwent surgical repair of the ventricular septal defect. Post-operatively, the patient developed complications including confusion, renal and hepatic failure, and left-sided weakness.
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2. Examination and investigations including lymph node biopsy, ultrasound neck, and CT neck revealed metastatic papillary carcinoma of the thyroid.
3. The patient underwent a total thyroidectomy with modified radical neck dissection. Post-operative recovery was unremarkable.
Copd in ICU
Teaching session for ICU team on the subject of COPD. Focus on patient selection and predicting prognosis, and QoL.
Mortality Meet Presentation by Dr. Saumya Agarwal
Mortality Meet Presentation by Dr. Saumya Agarwal Central Institute of Orthopaedics, Safdarjang Hospital and VMMC, New Delhi
This document summarizes a patient mortality meeting discussing a 45-year-old female patient who was admitted unconscious following a road traffic accident. She sustained injuries including a laceration on her right thigh and eye, as well as an intertrochanteric fracture of the right femur. The summary outlines her hospital course, management including surgery, complications including infections, and eventual discharge on day 26 after addressing cerebral salt wasting.Puerperial sepsis
Puerperal sepsis was defined as infection of the genital tract occurring at any time between the onset of rupture of membranes or labour, and the 42nd day postpartum in which two or more of the following are present: Fever (oral temperature 38.5°C/101.3°F or higher on any occasion
Cbp on vt (1)
This patient is a 72-year-old male who presented with ventricular tachycardia. He has a history of ischemic heart disease, myocardial infarction, and coronary artery bypass grafting. Diagnostic tests showed ventricular tachycardia, metabolic acidosis, acute kidney injury, cardiogenic shock, NSTEMI, and aspiration pneumonia. He received treatment including shock, intubation, hemodialysis, and medications. Nursing care involved ongoing monitoring, managing medications and side effects, and patient/family education.
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Bleeding in paediatric surgery - case presentations
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ppt6
JetBlue has strengths in effective aircraft operations, positioning in New York, and active marketing with low distribution costs. However, it has weaknesses such as high debt obligations, sluggish profits, and low margins. External opportunities include recovery of the US airline industry and benefits to low-cost carriers in a weak economy, but threats include intense price competition, industry consolidation, terrorism, and increased government regulations.
PPT5
My cousin helped me buy my first car after graduating and finding a job. We had an intense negotiation with the dealer that lasted all day before finally agreeing on a price the next morning. The experience taught me lessons about not rushing into big purchases, being influenced by others, and choosing negotiating partners wisely.
PPT2
JetBlue has strengths in effective aircraft operations, strong positioning in the New York metropolitan area, and active marketing with low-cost distribution channels. However, JetBlue also has weaknesses such as high debt and fixed obligations, sluggish profits and margins. External threats include intense competition from low-cost airlines, industry consolidation, terrorism, and increased government regulations. The recovery of the US airline industry works in JetBlue's favor.
PPT1
Peritonitis in patients undergoing peritoneal dialysis is commonly diagnosed based on symptoms of fever, abdominal pain, and nausea, along with lab findings of increased white blood cells over 100 cells/mm3 with neutrophil predominance. Infections are often gram positive or gram negative bacteria but about 20% have no growth on culture. Fungal infections are rare but Candida is the most common cause. Noninfectious complications include GERD, vomiting, electrolyte abnormalities like hypokalemia, and potentially fatal acute mesenteric ischemia.
Test Presentation
The document discusses strategies for foreign market entry, including overcoming liability of foreignness, understanding factors that influence internationalization, and a comprehensive model for foreign market entries. It addresses questions of where, when, and how to enter foreign markets, analyzing location-specific advantages, timing of market entry, and options for entry modes. Key tradeoffs between equity and non-equity entry modes like exports, licensing, and foreign direct investment are also summarized.
Thyroid and the Heart
This document discusses syncope, which is a transient loss of consciousness due to temporary reduced blood flow to the brain. It notes that syncope accounts for around 1% of emergency department visits and is a common cause of hospitalization for those over 65. Establishing the exact cause is difficult as the patient has usually recovered by the time they are examined. The document then discusses various causes of syncope and nonsyncopal attacks that can be mistaken for syncope. It provides breakdowns of common causes by age group and discusses the natural history and risk stratification of syncope of unknown cause in the emergency department.
Myocardial Viability - the STICH Trial NEJM May 2011
This study examined whether testing for myocardial viability can identify patients with coronary artery disease and left ventricular dysfunction who benefit most from coronary artery bypass grafting (CABG) compared to medical therapy alone. Of over 1200 patients enrolled in the main trial, 601 who underwent viability testing by single-photon emission computed tomography (SPECT) or dobutamine echocardiography were included in this substudy. Patients who had viability testing were more likely to have certain risk factors and worse heart function. The study aimed to determine if viability testing could identify which patients would have improved survival rates with CABG versus medical therapy.
Flail Leaflet
This document discusses flail mitral leaflet, which is a cause of mitral regurgitation requiring surgical correction. It occurs when the chordae tendineae connecting the mitral leaflet to the papillary muscles rupture. This causes the mitral leaflet to flail or balloon into the left atrium during systole. If left untreated, it can lead to complications like congestive heart failure, atrial fibrillation, thromboembolism and death. Surgical repair or replacement of the mitral valve is usually required to treat significant flail mitral leaflet.
Fat versus Fit
This study examined the association between cardiorespiratory fitness, adiposity, and mortality in older adults. It found that higher fitness levels were associated with lower mortality rates regardless of body composition. Specifically, even obese individuals had lower mortality if they were fit compared to unfit normal-weight or lean individuals. The study also found a J-shaped relationship between BMI and mortality both before and after adjusting for fitness levels.
Cardiac MR and viability
An 80 year old female with a history of hypertension, hyperlipidemia, diabetes, and prior stroke presented with 2 weeks of continuous chest pain and was found to have a left bundle branch block. Cardiac enzymes were negative. She was transferred to the hospital for further management and evaluation.
Cardiac MR and viability
This document describes a case of an 80 year old female patient with a history of hypertension, hyperlipidemia, diabetes, and prior stroke who presented with 2 weeks of continuous chest pain. She was found to have left bundle branch block of unknown duration on EKG. Cardiac enzymes were negative. The patient was transferred for further cardiac management.
LFT Review
The document discusses several cases presenting with abnormal liver function tests (LFTs). Case 1 shows a mild isolated transaminitis. Case 2 involves severe hepatocellular injury and mild cholestasis in an alcoholic patient. Case 3 examines LFT patterns in an alcoholic cirrhotic with possible alcoholic hepatitis.
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This document summarizes methods for predicting the functional effects of amino acid substitutions, including SIFT (Sorts Intolerant From Tolerant), which uses sequence conservation to predict whether an amino acid substitution will affect protein function. SIFT has similar prediction accuracy to tools using protein structure. Case studies on disease genes like MSHR, PPARα, and MTHFR show SIFT can distinguish pathogenic from benign variants and detect variants under balancing selection. Focusing genetic association studies on predicted functional variants in genes and conserved non-coding regions improves the direct approach to finding disease loci.
Hypertrophic Cardiomyopathy
This document summarizes a 56-year-old African American man who presented to the hospital after an abnormal stress test. He has a history of hypertension and was previously diagnosed with left ventricular hypertrophy. A recent stress test found ventricular tachycardia and imaging showed an apical aneurysm and small inferior wall ischemia. He is currently taking medications for hypertension and has a family history of coronary artery disease.
C. diff presentation
Clostridium difficile infection rates in the US increased from 30-40 per 100,000 in the mid-1990s to 84 per 100,000 in 2005, and in Britain C. diff became the primary cause of an increasing number of deaths from 499 in 1999 to 3393 in 2006. While metronidazole and vancomycin have been the standard treatments since the 1970s, failure rates for metronidazole increased significantly to 18.2% since 2000. Metronidazole is recommended as the first line treatment for mild cases, but vancomycin should be used for more severe infections. The ultimate goal in treating recurrent C. diff infections is to discontinue all antibiotics
test
The document provides an overview and introduction to the key features and functionality of the Android 2.3 mobile operating system. It describes how to perform basic tasks like starting up Android for the first time, getting familiar with the home screen and user interface, managing notifications, using applications and more. The guide is organized by topic, with each section providing details on a different aspect of the Android system like calls, contacts, browsing the web, and changing system settings.
Hemostasis and Thrombosis
This lecture describes the basic pathophysiologic and pharmacologic basis of hemostasis and thrombosis
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The document discusses the use of an intra-aortic balloon pump (IABP), including appropriate timing of inflation in the cardiac cycle, risks of premature or late deflation, and guidelines for weaning a patient from the device. It notes that the IABP has applications in cardiac failure, refractory angina, cardiogenic shock, and as a bridge to transplantation. Risks include limb ischemia, thrombosis, emboli, bleeding, and aortic complications. Weaning should occur over 24-48 hours with decreasing inotropic support and pump ratios monitored closely.
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Myocardial Viability - the STICH Trial NEJM May 2011
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safari test
- 7. South Asians and CV risk
- 9. Laboratory Assessment 8.5 8.5 – 10.5 Calcium (mg/dl) 136 70 - 110 Glucose (mg/dl) 1.5 0.6 – 1.5 Creatinine (mg/dl) 20 8 – 25 Urea nitrogen (mg/dl) 22 23.0 – 31.9 Carbon dioxide (mmol/liter) 102 100 – 108 Chloride (mmol/liter) 5.4 3.4 – 4.8 Potassium (mmol/liter) 137 135 – 145 Sodium (mmol/liter) CHEMISTRY ON ADMISSION REFERENCE RANGE TEST
- 10. Laboratory Assessment 0 2-8 Bands 1.1 11.3 – 13.3 INR 13.9 22.1 – 35.1 Partial-thromboplastin time (sec) 269 150,000 – 300,000 Platelet Count (per mm 3 ) 11 4 – 11 Monocytes 15 22 – 44 Lymphocytes 74 40 – 70 Neutrophils Differential Count (%) 15.0 4,500 – 11,000 White-cell count (per mm 3 ) 41.3 41.0 – 53.0 Hematocrit (%) 13.9 13.5 – 17.5 Hemoglobin (g/dl) HEMATOLOGY ON ADMISSION REFERENCE RANGE TEST
- 35. The Evolution of an MI 7 - 10 d 3 - 4 d 30 m - 4 h 10 - 14 d 2 -8 wk Dense collagenous scar >2 mo Increased collagen deposition, with decreased cellularity 2–8 wk Well-established granulation tissue with new blood vessels and collagen deposition 10–14 days Well-developed phagocytosis of dead cells; early formation of fibrovascular granulation tissue at margins 7–10 days Beginning disintegration of dead myofibers, with dying neutrophils; early phagocytosis of dead cells by macrophages at infarct border 3–7 days Coagulation necrosis, with loss of nuclei and striations; brisk interstitial infiltrate of neutrophils 1 to 3 days Ongoing coagulation necrosis; myocyte hypereosinophilia; marginal contraction band necrosis; early neutrophilic infiltrate 12 to 24 hrs Early coagulation necrosis; edema; hemorrhage 4 to 12 hrs Variable waviness of fibers at border 30 min to 4 hrs Relaxation of myofibrils; glycogen loss; mitochondrial swelling 0 to 30 min Morphological Changes Time
Editor's Notes
- 4 main risk factors associated w/ increased risk is smoking, high Apo protein, history of hypertension, and diabetes. In this study they also found that the rates of fruit and vegetable consumption were quite lower