The document discusses various salivary gland disorders including infections, inflammatory conditions, cysts, tumors and other pathologies. It provides details on:
- Acute and chronic bacterial sialadenitis, most commonly caused by retrograde infection from the mouth. Acute infections more often affect the parotid gland.
- Viral infections like mumps can cause acute non-suppurative sialadenitis. Mumps is spread through droplets and involves the parotid glands.
- Sjögren's syndrome is an autoimmune condition characterized by lymphocytic destruction of exocrine glands causing dry mouth and eyes. Diagnosis involves labial biopsy.
- Common benign sal
This slide is about oral hairy leukoplakia. it is basically a type of oral manifestation of some viral disease like HIV and HSV 4 (Epstein Barr virus )
This slide is about oral hairy leukoplakia. it is basically a type of oral manifestation of some viral disease like HIV and HSV 4 (Epstein Barr virus )
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This presentation on the topic of Mumps. What is the etilogy,how does it spread and what is the classification of mumps. We'll discuss the clinical manifestations along with treatment and prevention of this infectious disease of the children and adults.
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
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.
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
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!
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
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.
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.
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
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5. Pathogenesis
1. Retrograde contamination of the salivary ducts
and parenchymal tissues by bacteria inhabiting
the oral cavity.
2. Stasis of salivary flow through the ducts and
parenchyma promotes acute suppurative
infection.
5
6. Acute Suppurative
More common in parotid gland.
The etiologic factor most associated with this
entity is the retrograde infection from the
mouth.
6
7. Predilection for Parotid
Salivary Composition
The composition of parotid secretions
differs from those in other major glands.
Parotid is primarily serous, the others have a
greater proportion of mucinous material.
7
8. Salivary Composition
Mucoid saliva contains elements that protect against
bacterial infection including lysozymes & IgA
antibodies (therefore, parotid has bacteriostatic activity)
Mucins contain sialic acid which agglutinates bacteria
and prevents its adherence to host tissue.
Specific glycoproteins in mucins bind epithelial cells
competitively inhibiting bacterial attachment to these
cells.
8
9. Parotid Predilection
Anatomic factors
Stensen’s duct lies adjacent to the maxillary
molars and Wharton’s near the tongue.
It is thought that the mobility of the tongue may
prevent salivary stasis in the area of Wharton's that
may reduce the rate of infections in SMG.
9
11. Risk Factors continued…
Neoplasms (pressure occlusion of duct)
Sialectasis (salivary duct dilation) increases the risk for
retrograde contamination. Is associated with cystic
fibrosis and pneumoparotitis
Extremes of age
Poor oral hygiene
Calculi
11
12. Acute Suppurative Parotitis
Sudden onset of erythematous swelling of the
pre/post auricular areas extend into the angle
of the mandible.
Is bilateral in 20%.
12
13. Bacteriology
Purulent saliva should be sent for culture.
Staphylococcus aureus is most common
Streptococcus pnemoniae and S.pyogenes
Haemophilus Influenzae also common
13
14. Treatment of Acute Sialadenitis
Reverse the medical condition that may have
contributed to formation
Warm compresses, give sialogogues (lemon
drops)
External salivary gland massage if tolerated
14
15. Treatment of Acute
Sialadenitis/Parotitis
Antibiotics!
70% of organisms produce B-lactamase or
penicillinase
Need B-lactamase inhibitor like Augmentin or
Unasyn or second generation cephalosporin
Can also consider adding metronidazole or
clindamycin to broaden coverage
15
16. Surgery for Acute Parotitis
When a discrete abscess is identified, surgical
drainage is undertaken
Approach is anteriorly based facial flap with
multiple superficial radial incisions created in the
parotid fascia parallel to the facial nerve
Close over a drain
16
17. Complications of Acute Parotitis
Direct extension
Abscess ruptures into external auditory canal and
TMJ have been reported
Hematogenous spread
Thrombophlebitis of the retromandibular or
facial veins are rare complications
17
18. Complications
Extension of an abscess into the parapharyngeal space
may result in airway obstruction, mediastinitis, internal
jugular thrombosis and carotid artery erosion
Dysfunction of one or more branches of the facial
nerve is rare.
18
19. Chronic Sialadenitis
Causative event is thought to be a lowered
secretion rate with subsequent salivary stasis.
More common in parotid gland.
Damage from bouts of acute sialadenitis over
time leads to progressive acinar destruction
combined with a lymphocyte infiltrate.
19
21. No treatable cause found:
Initial management should be conservative and
includes the use of sialogogues, massage and
antibiotics for acute exacerbations.
Should conservative measures fail, consider
removing the gland.
21
22. Acute viral infection (AVI)
Mumps classically designates a viral parotitis
caused by the paramyxovirus
However, a broad range of viral pathogens have
been identified as causes of AVI of the salivary
glands.
22
23. Viral infection
Mumps is a non-suppurative acute sialadenitis
Is endemic in the community and spread by
airborne droplets
Communicable disease
Enters through upper respiratory tract
23
24. Mumps
2-3 week incubation after exposure (the virus
multiplies in the upper respiratory tract or
parotid gland)
Then localizes to biologically active tissues like
salivary glands, germinal tissues and the CNS.
24
25. Virology
Caused by paramyxovirus, an RNA virus
Others can cause acute viral parotitis:
Coxsackie A & B virus, cytomegalovirus and
adenovirus
HIV involvement of parotid glands is a rare
cause of acute viral parotitis
25
26. Clinical presentation
30% experience prodromal symptoms prior to
development of parotitis
Headache, anorexia, malaise
Onset of salivary gland involvement is
preceeded by earache, gland pain, dysphagia and
trismus
26
27. Physical exam
Glandular swelling (tense, firm) Parotid gland
involved frequently, SMG & SLG can also be
affected.
May displace pinna
75% cases involve bilateral parotids, may not
begin bilaterally (within 1-5 days may become
bilateral)….25% unilateral
Low grade fever
27
29. Complications
Orchitis, testicular atrophy and sterility in
approximately 20% of young men
Oophoritis in 5% females
Aseptic meningitis in 10%
Pancreatitis in 5%
Hearing loss <5%
Usually permanent
80% cases are unilateral
29
30. Immunologic Disease
Sjögren’s Syndrome
Most common immunologic disorder
associated with salivary gland disease.
Characterized by a lymphocyte-mediated
destruction of the exocrine glands leading to
xerostomia and keratoconjunctivitis sicca
30
31. Sjögren’s syndrome
90% cases occur in women
Average age of onset is 50y
Published in 1933 by Sjögren, a Swedish
ophthalmologist
31
32. Sjögren’s Syndrome
Two forms:
Primary: involves the exocrine glands only
Secondary: associated with a definable
autoimmune disease, usually rheumatoid
arthritis.
80% of primary and 30-40% of secondary involves
unilateral or bilateral salivary glands swelling
32
34. Sjögren’s Syndrome
Keratoconjuntivitis sicca: diminished tear production
caused by lymphocytic cell replacement of the lacrimal
gland parenchyma.
Evaluate with Schirmer test. Two 5 x 35mm strips of
red litmus paper placed in inferior fornix, left for 5
minutes. A positive finiding is lacrimation of 5mm or
less. Approximately 85% specific & sensitive
34
36. Sjögren’s Lip Biopsy
Single 1.5 to 2cm horizantal incision labial mucosa.
Not in midline, fewer glands there.
Include 5+ glands for identification
Glands assessed quantitatively to determine the
number of foci of lymphocytes per 4mm2/gland
36
38. Sialadenosis
Non-specific term used to describe a noninflammatory non-neoplastic enlargement of a
salivary gland, usually the parotid.
May be called sialosis
The enlargement is generally asymptomatic
Mechanism is unknown in many cases.
38
39. Related to…
a.
b.
Metabolic “endocrine sialendosis”
Nutritional “nutritional mumps”
a.
b.
c.
Obesity: secondary to fatty hypertrophy
Malnutrition: acinar hypertrhophy
Any condition that interferes with the absorption
of nutrients (uremia, chronic pancreatitis)
39
41. Radiation Injury
Low dose radiation to a salivary gland causes an
acute tender and painful swelling within 24hrs.
Serous cells are especially sensitive and exhibit
marked degranulation and disruption.
41
42.
Continued irradiation leads to complete
destruction of the serous acini and subsequent
atrophy of the gland.
Similar to the thyroid, salivary neoplasm are
increased in incidence after radiation exposure.
42
43. Granulomatous Disease
Primary Tuberculosis of the salivary glands:
Uncommon, usually unilateral, parotid most
common affected
Believed to arise from spread of a focus of infection
in tonsils
Secondary TB may also involve the salivary
glands but tends to involve the SMG and is
associated with active pulmonary TB.
43
44. Granulomatous Disease
Sarcoidosis: a systemic disease characterized by
noncaseating granulomas in multiple organ systems
Clinically, SG involvement in 6% cases
44
45. Cysts
True cysts of the parotid account for 2-5% of
all parotid lesions
May be acquired or congenital
Branchial arch cysts are a duplication anomaly
of the membranous external auditory canal
45
48. Salivary Gland Neoplasms
Diverse histopathology
Relatively uncommon
2% of head and neck neoplasms
Distribution
Parotid: 80% overall; 80% benign
Submandibular: 15% overall; 50% benign
Sublingual/Minor: 5% overall; 40% benign
48
49. Pleomorphic Adenoma
Most common of all salivary gland neoplasms
70% of parotid tumors
50% of submandibular tumors
45% of minor salivary gland tumors
6% of sublingual tumors
4th-6th decades
F:M = 3-4:1
49
66. Monomorphic Adenomas
Basal cell is most common: 1.8% of benign
epithelial salivary gland neoplasms
6th decade
M:F = approximately 1:1
Caucasian > African American
Most common in parotid
66
67. Basal Cell Adenoma
1- Solid
Most common
Solid nests of tumor
cells
Uniform,
hyperchromatic, round
nuclei, indistinct
cytoplasm
Peripheral nuclear
palisading
67
81. Mucoepidermoid Carcinoma
Treatment
Influenced by site, stage, grade
Stage I & II
Wide local excision
Stage III & IV
Radical excision
+/- neck dissection
+/- postoperative radiation therapy
81
82. Adenoid Cystic Carcinoma
Overall 2nd most common malignancy
Most common in submandibular, sublingual
and minor salivary glands
M=F
5th decade
Presentation
Asymptomatic enlarging mass
Pain, paresthesias, facial weakness/paralysis
82