Polyps are benign soft tissue masses found in the nasal cavity and paranasal sinuses. Computed tomography (CT) is the preferred imaging modality to evaluate the anatomy and identify polyps appearing as hypodense rounded masses enlarging the sinus ostia. Magnetic resonance imaging (MRI) may be used if intracranial or orbital extension is suspected. Fungal sinusitis can occur when a sinus infection fails to respond to antibiotics and may invade surrounding tissues. On imaging, it appears as mucosal thickening, bone destruction, and enhancement. MRI is best to assess soft tissue extension.
Case report - discussion about presentation and managements of laryngoceles.
Published in Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 32, April 20; Page: 5586-5591
Abstract: Laryngoceles are rare, cystic dilatation of saccule of ventricle of larynx. Three types are recognized –internal, external and mixed types. Many of the laryngoceles are asymptomatic; few require surgical excision via internal/endoscopic or external approach. Contrast CT is the investigation of choice. A 40year old male presented to our OPD with a neck Scar, later diagnosed as laryngocele. Here is the case report about presentation, diagnosis and management of a large mixed layngocele.
KEYWORDS: Layngocele, Neck swelling, Saccule, Ventricle of larynx.
RETROPHARYNGEAL ABSCESS
Retropharyngeal abscess ia an infection of the retropharyngeal space
Retropharyngeal space is a potential space posterior to the pharynx and the cervical oesophagus
Often presents late, most times in airway obstruction
It is life threatening,adequate care and management is needed
Mortality and morbidity often follows delayed or missed diagnosis
Case report - discussion about presentation and managements of laryngoceles.
Published in Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 32, April 20; Page: 5586-5591
Abstract: Laryngoceles are rare, cystic dilatation of saccule of ventricle of larynx. Three types are recognized –internal, external and mixed types. Many of the laryngoceles are asymptomatic; few require surgical excision via internal/endoscopic or external approach. Contrast CT is the investigation of choice. A 40year old male presented to our OPD with a neck Scar, later diagnosed as laryngocele. Here is the case report about presentation, diagnosis and management of a large mixed layngocele.
KEYWORDS: Layngocele, Neck swelling, Saccule, Ventricle of larynx.
RETROPHARYNGEAL ABSCESS
Retropharyngeal abscess ia an infection of the retropharyngeal space
Retropharyngeal space is a potential space posterior to the pharynx and the cervical oesophagus
Often presents late, most times in airway obstruction
It is life threatening,adequate care and management is needed
Mortality and morbidity often follows delayed or missed diagnosis
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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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.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
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
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
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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.
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!
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
2. Polyps are soft tissue pedunculated masses of
oedematous hyperplastic mucosa lining the
upper respiratory tract…..nasal cavity and
sinuses.
These are benign mucosal lesions.
3. Commonest sites in order of frequency are;
1. Ethmoids
2. Maxillary antra
3. sphenoids
7. SSCT IS THE MODALITY OF CHOICE
CT is of value for determining anatomical landmarks and
variants,to identify erosive changes,e xcellent to determin
intraorbital extension of sinonasal disease upto the ventral
2/3rd of the orbit. when disease approaches apex…MRI is
next step to assess spread to the cavernous sinus and
intracranial extension.
Non enhanced CT is performed…value of NECT is the
following;if u see an opacified sinus with hyperdense
content it is usually a benign disease.hyperdensities are due
to,blood,fungus,inspissated secretions.
FEATURES
1. Hypodense polypoidal,rounded masses in the nasal cavity
and paranasal sinuses enlarging sinus ostium .
8. 2.Expansion of the sinuse,thining of sinus
walls,nasal and ethmoid septa.
3.Bulging of the lamina papyracea leading to
displacement of the eyeballs and hypertelorism
4.Widening of the infundibulum.
5.On post contrast images show peripheral or
occasionally solid
heterogenous enhancement.
6. Erosive changes at anterior skull base.
13. Reserved for difficult cases especially where is
doubt about the pathology on SSCT.
MRI is also useful to assess any intracranial or
orbital involvement.
14.
15.
16. Benign antral polyp which widens the sinus ostium
and extends into nasal cavity;5% of all nasal polyps.
Age
Teenagers and young adults
Features
1. Antral clouding
2. Ipsilateral nasal mass
3. Smooth mass enlarging the sinus ostium
4. No sinus expansion
17.
18. . A sphenochoanal polyp is a solitary mass of low
attenuation on computed tomographic (CT) scans
that arises from the sphenoid sinus and extends
through the sphenoid ostium, across the
sphenoethmoid recess, and into the choana (the
boundary between the nasal cavity and
nasopharynx). Contiguous axial or coronal
magnetic resonance and CT images help clearly
differentiate the rare sphenochoanal polyp from
the more common antrochoanal polyp. The sinus
of origin is important to identify, as the surgical
approach depends on the target sinus.
19.
20. Sinusitis(air fluid levels,total
opacification,enhancement
pattern,hyperintense secretion on T1WI,rim
enhancement on post gad)
Cancer(solid central enhancement).
Fungal disease(focal or diffuse areas of
increased attenuation on ct,signal voids on
mri,rim enhancement on mri).
Juvenile angiofibroma(involvement of
pterygopalatine fossa).
22. Mucocele is end stage of a chronically
obstructed sinus…………an
obstructed,airless,mucoid filled expanded
sinus.
Location;
Frontal(60%),ethmoid(30%).maxillary(10%),sphen
oid (rare)
CAUSES. The most common causes of mucoceles are chronic
infection, allergic sinonasal disease, trauma and previous surgery.
23. Soft tissue density mass….having mucoid
attenuation.
Sinus cavity expansion
Bone demineralisation+remodelingat late stage
but No bone destruction(DDx from neoplasm)
Surrounding zone of bone
sclerosis/calcification of edges of mucocele(ch
sinusitis).
24. Macroscopic calcification in 5%(superimposed
fungal infection)
Uniform thin rim enhancement.
Protrusion into orbit displacing medial rectus
muscle laterally.
Expansion into subarachnoid space…. resulting
in CSF leaking.
31. X-ray ;will show an expansion of the sinus
cavity with loss of the scalloped margin of the
normal sinus.
Sinus is opaque than normal due to secretions
but may on occasions appear more radiolucent
if bone destruction is marked.
CT;will show the full extent of expansion and is
usually enough to make the diagnosis.
MRI;may be used to assess the intracranial
extent.
32. Clinically more obvious as palpable mass at
medial canthus of
eye,proptosis,epiphora..expansion on lacrimal
sac.
Majority are found in the anterior ethmoid
cells,expansion of the posterior ethmoid cells
are less common and are associated with
sphenoid mucoceles.
33. Rare
Involvement of optic nerve,cavernous sinus and
3rd nerve is common due to proximity to these
structures.
Imaging plays a key role in diagnosis and its
important that condition be recognized by the
radiologist at an early stage and dealt surgically
before vision is compromised.
CT and MRI show rounded or partially rounded
expansion of the sphenoid sinus as opposed to the
destruction of bone in situ caused by malignancy.
34. Signal intensity varies with state of
hydration,protein content,hemorrhage,air
content,calcification,fibrosis.
Hypointense on T1W1+signal void on T2W1
due to inspissated debris+fungus.
Hydrated secretions are hypo on T1W1 and
hyperintense on T2W1.
Peripheral enhancement pattern(DDx
neoplasm).
35.
36. Fungal disease of the paranasal sinuses is
usually diagnosed when an apparent routine
infection fails to respond to normal antibiotic
treatment.
Acute invasive fungal sinusitis;is the most
aggressive form of fungal sinusitis.it is seen in
immunocompromised patients and source of
morbidity and mortality.
Clinical features;are rapid development of
fever,facial pain,nasal congestion and epistaxis.
37. Extension into orbit,cavernous sinus and
intracranial compartment results in decreased
vision.proptosis and neurological deficits.
Pathology ;originates in the nasal cavity mostly
in the middle turbinate with subsequent spread
into the paranasal sinuses.a number of fungal
agents are implicated..
1. Aspergillus
2. Rhizopus
3. Mucor
4. Absidia
38. Ethmoids,maxillary antra are commonly
involved,sphenoid sinus may be occasionally
involved,frontal sinuses are rarely affected.
Mucosal thickening:hypoattenuating
Bone destruction:extensive/subtle
Fat stranding outside of
sinus..intraorbital,pterygopalatine
fossa,masticator space.
Punctate calcifications….diffuse,nodular or
linear
44. MRI is the modality of choice to asses soft tissue
extension. The findings within the sinus itself are
variable, and range from mucosal thickening, to
complete opacification of the sinus.
T1 : intermediate low signal
T2
fungal mass is of intermediate to low signal
often associated with fluid / blood elsewhere in the
paranasal sinuses
T1 C+ (GAD) : peripheral enhancement only
Hypointense on all sequences due to paramagnetic
effect of heavy metals …… high fungal mycelial
iron,magnesium,manganese content from amino acid
metabolism…DDx from inspissated
secretions/polypoid disease.
Low signal on T1 and T2 when there is fibrosis.