Surgery in patients with bleeding disorders requires careful evaluation and management to minimize bleeding risks. The document discusses:
1) The physiology of hemostasis including the vessel wall, platelet, and coagulation responses.
2) Evaluation of patients including history, exam, and screening tests to identify bleeding disorders.
3) Four case examples of patients who bled excessively during or after surgery, who were found to have thrombocytopathy, hemophilia, or other disorders.
4) Common bleeding disorders surgeons may encounter including thrombocytopenia, thrombocytopathy, hemophilia A/B, von Willebrand disease, DIC, and liver disease.
5) Guidelines
ATLS is two days course for those who manage trauma patients. These protocols have been followed by hospitals all over the world to treat trauma patients quickly and efficiently.
* Fluid resuscitation is mandatory in shock from traumatic haemorrhage * Massive use of resuscitative fluids following injury is now being disputed * Adequate resuscitation is no longer judged by presence of normal vital signs * Normalcy of organ and tissue specific measured values are to be achieved * Search for a single endpoint that works for all trauma patients, is unrealistic * Resuscitate with appropriate fluid, in appropriate amount, at appropriate time
ATLS is two days course for those who manage trauma patients. These protocols have been followed by hospitals all over the world to treat trauma patients quickly and efficiently.
* Fluid resuscitation is mandatory in shock from traumatic haemorrhage * Massive use of resuscitative fluids following injury is now being disputed * Adequate resuscitation is no longer judged by presence of normal vital signs * Normalcy of organ and tissue specific measured values are to be achieved * Search for a single endpoint that works for all trauma patients, is unrealistic * Resuscitate with appropriate fluid, in appropriate amount, at appropriate time
Seminar present the Upper Gastrointestinal Bleeding problems
Edited by : Dr. Inzar Yassen & Dr. Ammar L. Aldwaf
in Hawler Medical Uni. collage of medicine in 14/01/2014
Iraq - Kurdistan - Erbil
OPEN RIGHT HEMICOLECTOMY- STEP BY STEP OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openrighthemicolectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Open Right Hemicolectomy .
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch all my teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Splenic trauma - Causes, Complications, ManagementVikas V
Splenic Trauma - A detailed Presentation about Splenic Trauma, anatomy of the spleen, Causes of Trauma, Mechanism of Injury, Diagnosis, Management, Surgical management, Steps of Splenectomy, and Complications
INITIAL ASSESSMENT OF TRAUMA PATIENTS....(INSPIRED FROM CTLS AND ATLS GUIDELI...Prerna Biswal
THIS PRESENTATION WAS MADE AT IMA HOUSE IN BHUBANESWAR,ODISHA, BY DR.NIBEDITA PANI,HOD ,DEPT. OF ANAESTHESIOLOGY AND DR.PRERNA BISWAL,PG,ANAESTHESIOLOGY,SCBMCH,CUTTACK,
Surgeons are doing surgeries because of normal blood clotting and wound healing. Suppose if your patient’s blood doesn’t clot properly and you come to know this only on the table, it would be a nightmare to any surgeon irrespective of their subspecialty. In this PPT, I am discussing about how to handle a patient with bleeding diathesis during and after surgery. Indeed it is a challenging and fascinating problem. I hope you will enjoy the video. You can watch all my teaching videos in the following links: surgicaleducator.blogspot.com; youtube.com/c/surgicaleducator.
Seminar present the Upper Gastrointestinal Bleeding problems
Edited by : Dr. Inzar Yassen & Dr. Ammar L. Aldwaf
in Hawler Medical Uni. collage of medicine in 14/01/2014
Iraq - Kurdistan - Erbil
OPEN RIGHT HEMICOLECTOMY- STEP BY STEP OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openrighthemicolectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Open Right Hemicolectomy .
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch all my teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Splenic trauma - Causes, Complications, ManagementVikas V
Splenic Trauma - A detailed Presentation about Splenic Trauma, anatomy of the spleen, Causes of Trauma, Mechanism of Injury, Diagnosis, Management, Surgical management, Steps of Splenectomy, and Complications
INITIAL ASSESSMENT OF TRAUMA PATIENTS....(INSPIRED FROM CTLS AND ATLS GUIDELI...Prerna Biswal
THIS PRESENTATION WAS MADE AT IMA HOUSE IN BHUBANESWAR,ODISHA, BY DR.NIBEDITA PANI,HOD ,DEPT. OF ANAESTHESIOLOGY AND DR.PRERNA BISWAL,PG,ANAESTHESIOLOGY,SCBMCH,CUTTACK,
Surgeons are doing surgeries because of normal blood clotting and wound healing. Suppose if your patient’s blood doesn’t clot properly and you come to know this only on the table, it would be a nightmare to any surgeon irrespective of their subspecialty. In this PPT, I am discussing about how to handle a patient with bleeding diathesis during and after surgery. Indeed it is a challenging and fascinating problem. I hope you will enjoy the video. You can watch all my teaching videos in the following links: surgicaleducator.blogspot.com; youtube.com/c/surgicaleducator.
Carcinoma esophagus is the common cause for dysphagia for solids. These patients usually present too late to do any definitive curative surgical procedure.
Carcinoma of breast is the second common killer disease in women after carcinoma of cervix in developing countries like India whereas it is the number one killer in western world. It can also run in families associated with BRCA1 & BRCA2 genes. Early diagnosis is almost curative and that is why they are doing mass screening like mammogram to pick up this cancer early.
Achalasia cardia is the cause for dysphagia for liquids to begin with and then it will progress to dysphagia to solids as well.The cause for this problem is inadequate relaxation of lower esophageal sphincter. It is directly opposite to GERD where there will be lax lower esophageal sphincter
This is an orientation program for junior surgical clerkship for those undergraduate medical students entering to the surgical wards for the first time. This should be a total transformational learning experience.
Groin swellings is one of the common problems in Surgery. Common causes are Inguinal hernia, femoral hernia and Undescended testis. In this slide presentation I discuss the applied anatomy of the groin region.
Malignant thyroid tumors is not as common as benign swellings of thyroid. However, you have to rule out the possibility of malignancy in all thyroid swellings.
This is the first in the series of 6 presentations on Scrotal Swellings. Scrotal swellings is one of the common surgical problems. The causes are Hydrocele, epididymal cyst, spermatocele, varicocele,torsion testis and testicular carcinoma
Prof. Mridul Panditrao's Peri-operative Management of Jehovah's Witness Patient Prof. Mridul Panditrao
A case report of Emergency Peri-operative Mnagement of a Jehovah's Witness patient.
Because of their peculear religious belief, these patients do not accept Blood and It's products. This can pose serious problems to the Anesthesiologist.
In this presentation I am talking about the overview of So-Hum meditation- the universal mantra.
I have discussed the meaning, how to do it, it's advantages and an advanced visualisation technique.
This is a small handbook on individual surgical disease and its management . I have discussed about Acute Appendicitis and then step by step I explain both open and laparoscopic appendicectomy in this book.
The operative surgery part is very useful for surgical trainees.
POWER OF YOUTUBE IN MEDICAL EDUCATION- Surgical Educator Channel
#powerofyoutube #surgicaleducator #babysurgeon #usmle
Website Link: www.surgicaleducator.com
Dear viewers,
• Greetings from “Surgical Educator’
• In this episode, I am talking about the Power of YouTube in medical education
• I will be discussing the various benefits of using YouTube in medical education. YouTube is definitely revolutionize the way in which we are teaching our students.
• You can enjoy all my videos in the following links:
•
/ surgicaleducator surgicaleducator.com
• Thank you for watching the video.
All my videos are problem-based, because patients are coming to us with problems and not with a diagnosis.
• I have made modules for each surgical problem which consists of
many of my YouTube videos and my PPT slides
• I request you all to watch all the videos in a playlist together, so
that you will become confident in dealing with these problems.
• Links to the Playlists based on the Surgical Problems:
• Module 1: Scrotal Swellings:
https://www.youtube.com/playlist?list...
uXwt0JH0YG8m4JmzgAli9jj
https://www.slideshare.net/babysurgeo...
• Module 2: Groin Swellings:
https://www.youtube.com/playlist?list...
uVaDboG_ddw2S6xInNnB80D
https://www.slideshare.net/babysurgeo...
• Module 3: Abdominal Pain:
https://www.youtube.com/playlist?list...
uUcXb96A3tFpTrWOVa2F7j1
https://www.slideshare.net/babysurgeo...
case-based-learning-82091549
• Module 4: Abdominal Lumps:
https://youtube.com/playlist?list=PLx...
uWBKVnBkhdE4XkW-xEoiIwB
• Module 5: Obstructive Jaundice:
https://www.youtube.com/playlist?list...
uX6MsQnsCTGl8YDFN1TYiQm
https://www.slideshare.net/babysurgeo...
127314632
• Module 6: Upper GI Hemorrhage:
https://www.youtube.com/playlist?list...
uUtV67AdUQYEUKdhX9vL576
https://www.slideshare.net/babysurgeo...
227888333
• Module 7: Lower GI Hemorrhage:
https://www.youtube.com/playlist?list...
https://www.slideshare.net/babysurgeo...
• Module 8: Thyroid Pathologies:
https://www.youtube.com/playlist?list...
uWg55odQfB_7JT0NYIP8ELp
https://www.slideshare.net/babysurgeo...
benign-diseases-and-carcinoma-thyroid
• Module 9: Breast Pathologies:
https://www.youtube.com/playlist?list...
uVTLcGtam1kFBzjY4NAf7MZ
https://www.slideshare.net/babysurgeo...
diseases-and-carcinoma-breast
• Module 10: Peripheral Arterial Diseases:
https://www.youtube.com/playlist?list...
6VIbQR4g8MdOi0z
https://www.slideshare.net/babysurgeo...
106254612
• Module 11: Venous Diseases:
https://www.youtube.com/playlist?list...
uVf1aYodgILbxVpC-fkdqNo
https://www.slideshare.net/babysurgeo...
127314847
• Module 12: Dysphagia:
https://www.youtube.com/playlist?list...
4DlU1Lp
# Dear Viewers/Friends/Colleagues,
# Greetings from Surgical Educator YouTube channel
# I am sharing an E-book where you can find out the hyperlinks for all my surgery teaching videos and their PPTs
# In this E-book you will learn the purpose of my YouTube channel Surgical Educator, core clinical problems you should master, how to utilize the channel effectively, statistics and analytics for the channel, all the teaching modules with hyperlinks to all my teaching videos and their PPTs and other learning resources created by me like the android app for the channel and other E-books.
In this presentation, I discussed the various liver swellings- both cystic and solid swellings. Cystic lumps are Pyogenic liver abscess, Amebic liver abscess and hydatid cyst. Benign solid swellings are Hepatic adenoma, Focal nodular hyperplasia and Hemangioma. The malignant solid swelings are secondary carcinoma of the liver, primary Hepatocellular carcinoma and Hepatoblastoma.
In this presentation, I have shown how to do open anterior resection both high and low varieties in a step-by-step manner with clear pictures as if reading an atlas of operative surgery.
The surgical causes for jaundice in children- both in neonates and infants- are Biliary atresia, Choledochal cyst, Biliary hypoplasia, Inspissated bile syndrome, and spontaneous perforation of CBD. How to Diagnose & Treat all these causes.
I am sharing a 10 paged e-book that consists of the hyperlinks to all my surgery teaching videos and to all the PPTs used for these videos from SlideShare. You can watch these videos problem based and can become competent to deal with it. You can read this to cover the whole undergraduate curriculum.
In this presentation I discussed 5 scrotal swellings case scenarios with my MBBS students. I have shared these case scenarios prior to the PBL class and asked the students to come prepared to the class. In the class i tested the knowledge gaind by the students by watching my didactic YouTube videos on the subject by asking so many questions. So this online class was highly interactive based on flip class model.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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!
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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
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.
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
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.
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.
3. Surgery In Bleeding Diathesis
Plan
Introduction
Physiology Of Hemostasis
Preop Evaluation
Cases Managed
Common Bleeding Disorders
Surgery In Hemophiliacs
Clinical Decision Making
4.
5.
6. Physiology Of
Hemostasis
FOUR COMPONENTS
VESSEL WALL RESPONSE
PLATELET ACTIVITIES
COAGULATION CASCADE
FIBRINOLYTIC SYSTEM
7.
8. Physiology of Hemostasis
Platelet Activities
Vessel wall
Platelet
Fibrinogen
GP1b Receptor
Gpi ib -iii a
Complex Receptor
VWBF
Endothelium
10. Coagulation factors
I. Fibrinogen
II. Prothrombin
III.Tissue factor
IV.Ionised calcium
V. Proaccelerin
VII.Proconvertin
VIII.Antihemophilic factor(AHF)
IX.Christmas factor
X. Stuart prower factor
XI.Plasma thrombo plastin antecedent
XII.Hageman factor
XIII.Fibrin stabilising factor
11. INTRINSIC SYSTEM
HMWK
XII XII a
XI XI a
EXTRINSIC SYSTEM
IX IX a+VIII
X Xa +V
VII
Ca
TF
Prothrombin Thrombin
Fibrinogen Fibrin
XIII XIIa
Stable fibrin
clot
13. PRE OP EVALUATION
Thorough personal medical history, family
history drug ingestion history
PHYSICAL EXAM:
SKIN
Petechiae thrombocytopenia
Ecchymoses Hematomas platelet
dysfunction
JOINTS Hemarthrosis severe coagulation
defect
ORGANO
MEGALY
Hepatomegaly coagulopathy of
cirrhosis
Spleenomegaly possible
thrombocytopenia
14. LAB SCREENIG TESTS
Test Normal range Abnormalities
Platelet Count 150-250,000/dl Thrombocytopenia
Thrombocytopenia
Thrombocytopathy
Extrinsic system, factor
VII
Intrinsic system,factors
VIII,IX,XI,XII
Hypofibrinogenemia,
heparin
Bleeding Time 2- 8 minutes
Prothrombin Time 12-14 seconds
Partial Thromboplastin 30-40 seconds
Time
Thrombin time 12-20 seconds
Fibrin Degradation 103gm/ml DIC,fibrinolysis
product assay
15.
16. CCAASSEE NNOO::11
2 Yrs old 1st born male child
Was brought with obstructed RIH
H/O Epistaxiseasy bruisability
Ear boring ceremony resulted in
prolonged bleeding
Emergencyso no extensive workup
was done
18. CASE NO:1 Contd
Only B.T. was prolonged
Provisional Diagnosis:Functional Platelet
problem---------Thrombocytopathy
Emergency Herniotomy with 200 ml of
fresh whole blood
Readmitted after 10 days for prolonged
bleeding from a small cut to upper lip
Managed by multiple WB transfusions
19. CASE NO:1 Contd
Hematological Workup
• Hb--------11.5Gms
• PCV------36%
• Platelets-----2.00.000/cmm
• TC------12.000/Cmm
• DC------N 33 L 43 E 18 M 4
• Bleeding Time----15 mts
23. CASE NO:2
11Yrs old boy , no previous H/O bleeding
underwent Interval Appendicectomy
Excessive bleeding from OP site immediate
postop
B.T.---prolonged,C.T.----Normal, Platelet
count--------Normal
Since no Platelet concentrate was
available,was treated with multiple WB
transfusions
24. CASE NO:3
• 4Yrs old boy came with feverpain abdomen
• O/E Abdomen---Generalised tenderness and
rigidity
• AXR-Erect---Gas under diaphragm +
• Patient known Hemophiliac
• Laparotomyileal perforation closure was
done with 1 unit of AHF
• On 2nd POD –oozing from the wound,one more
unit of AHF Was given
25. CASE NO:4
5Yrs old boy with H/O fall over cycle
bar reported with retention of urine
Perineal HematomaExtravasation of
urine +
With difficulty catheter was passed into
the bladder
Multiple Perineal incisions were made
26. CASE NO:4 Contd
Next day –profuse bleeding from the
perineal incision sites
On subsequent interrogation parents
came out with H/O previous bleeding
episodes
Child was a Hemophiliac
He was treated with AHF repeated
fresh WB transfusions
27. Bleeding Disorders Commonly
Encounter By Surgeons
Thrombocytopenia
Thrombocytopathy
Hemophilia- A
Hemophilia- B- Christmas disease
Von Willebrand Disease
Disseminated Intravascular Coagulation
Liver Disease– Factor vii x deficiency
28. THROMBOCYTOPENIA
Low Platelet Count
Acquired or Inherited
Purpura Ecchymosis----- superficial
bleeding
Labs:B.T P.C PT/PTT- N
Treatment--- Platelet Concentrates
29. THROMBOCYTOPATHY
Functional Platelet Abnormality
Acquired due to drugs like Aspirin and
Uremia
Inherited-----Bernard Soulier Syndrome
due to defective Platelet adhesion,
Glanzman`s Thrombasthenia due to
defective Platelet aggregation
31. HEMOPHILIA----A
Factor viii procoagulant deficiency
Sex linked recessive inheritance
Deep tissue bleedhemarthrosis
Labs:B.T,P.C,P.T---N;PTT--
Specific Factor Assays
Treatment:AHF 1U/Kg raise the level
by 2%.For 5Kg child 250u for 100%
raise
32. Hemophilia-B—Christmas Disease
Factor ix deficiency
Sex linked recessive inheritance
Deep tissue bleedHemarthrosis
Labs:B.T,P.C,P.T—N,PTT--
Specific Factor Assays
Treatment:Factor ix Concentrates or FFP
33. Von Willebrand`s Disease
Factor viii vwf deficiency
Autosomal Dominant Inheritance
Epistaxis,easy bruising prolonged
bleeding from dental extraction
Labs:B.T P.C—N,P.T—N,PTT--
Specific Factor Assays
Treatment: FFP or Cryoprecipitate
34. Disseminated Intravascular
Coagulation—(D.I.C)
Thrombohemorrhagic disorder
Acquired:Abruptio placenta,Septic
abortion,Toxemia,Gram-ve sepsis,snake
bite,Massive tissue injury etc
Activation of Coagulation Cascade—
Microthrombi throughout microcirculation
Consumption of Coagulation factors,Platelets
and Fibrin
Activation of Fibrinolytic System
35. Disseminated Intravascular
Coagulation--------contd
Mucosal bleed,Ecchymosis,oozing from
wound sites
Labs:B.T P.C PT/PTT
T.T F.S.P Fragmented RBCs +
Treat the underlying cause
FFPPlatelet Concentrates
Role of Heparin is controversial
36. LLIIVVEERR DDIISSEEAASSEE
Acquired
Factor vii x deficiency
Epistaxis,MenorrhagiaHemarthrosis
Labs:B.T—N,P.C—N, Factor x—PT/PTT
Factor vii----P.T P.T.T----N.,Specific Factors
Assay
Treatment-------FFP
37.
38. Surgery In Hemophiliacs
Minor Surgery
Give dose calculated to bring patient’s
plasma level to 100% 1 hour prior to
surgery(50 units/kg q12h)
Maintain plasma level above 60% for 4
days
Maintain plasma level above 20% for
subsequent 4 days
Assay daily prior to dose
39. Surgery In Hemophiliacs
Major Surgery
Give dose calculated to bring patient’s
plasma level to 100% 1 hour prior to
surgery(50 units/kg q12h)
Maintain plasma level above 60% for 4
days
Maintain plasma level above 40% for
subsequent 4 days or until all drains
sutures are removed
Assay daily prior to dose
41. Surgery In Hemophiliacs
Orthopedic Surgical Procedures
If patient is casted, discontinue replacement
until rehabilitation program is begun
If not casted, maintain above 20 % for
ambulation
For rehabilitation program ,maintain 10%
for three weeks
42. Clinical DDeecciissiioonn MMaakkiinngg
CCaassee NNoo::1
40yrs old man c/o bleeding PR
Colonoscopy revealed single polyp
in descending colon
Colonoscopic snare polypectomy
was done
Postop profuse bleeding+
Labs:only B.T
Diagnosis Treatment ?
43. Clinical Decision Making
Case No:2
3 months old congenital Biliary
Atresia baby
Was brought with purpuric skin
lesionsoozing from gums
Labs:PTPTT
Diagnosis Treatment ?
44. Clinical Decision Making
Case No:3
3 days old baby was brought with
H/O hemetemesis melena
O/E Well baby
Labs: Hb –N;B.T,P.C,PT,PTT----N.
Diagnosis--?
45. Clinical Decision Making
Case No:4
• 60 yrs old man a case of ESRD on
chronic hemodialysis
• Called to see him for profuse oozing
from puncture site @ AV fistula
• Labs:B.T,P.C,P.T---N,PTTTT
• Diagnosis and Treatment?
46. Clinical Decision Making
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Case No:5
12 yrs old girl on chronic
hemodialysis for ESRD
Uremia developed because of
temporary interruption of
dialysis
Developed brisk epistaxis
Labs:BUN-164 mgms, BT20mts
Diagnosis Treatment?
47. Clinical Decision Making
Case No:6
50 yrs old lady with severe burns injury
became febrile toxic
Epistaxis, Hemetemesis melena
Wound Swab--Gram –ve sepsis
Labs:BT PC PTPTT TT
Diagnosis Treatment?