Sphenopalatine neuralgia, also known as cluster headaches, is a condition characterized by extremely painful attacks on one side of the head. Episodes typically occur in clusters, with periods of remission in between. Diagnosis is based on the pattern and symptoms of attacks. Treatment involves acute abortive therapies like oxygen and triptans to stop individual attacks, transitional therapies like steroids to control early episodes, and preventative medications like verapamil, lithium, and melatonin to suppress future attacks. While not life-threatening, cluster headaches can severely impact quality of life due to the intensity of pain.
Facial nerve is the nerve of facial expression. Facial nerve disorders can lead to ugly face. This presentation explains the facial nerve disorders in details.
This is a seminar presentation conducted by 4th year medical students under supervision of a lecturer. Reference were not attached here, but all information are from google, few textbooks and also from previous ENT posting's seminar.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Facial nerve is the nerve of facial expression. Facial nerve disorders can lead to ugly face. This presentation explains the facial nerve disorders in details.
This is a seminar presentation conducted by 4th year medical students under supervision of a lecturer. Reference were not attached here, but all information are from google, few textbooks and also from previous ENT posting's seminar.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Facial asymmetry /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
A Complete presentation explaining the complete morphology of Maxillary first molar, for the benefit of people like me who tried and failed to find everything in one package
headache is one of the most common symptoms in the world, many people suffer from it. there are 150 different types of headache. there are red flags in patients with headache.there is algorithm for emergency management. you must know some information about it.
cluster headaches are also called as
Familial cluster headaches
Histamine cephalalgia
Vasogenic facial pain
Horton’s Syndrome
Cluster headache (CH) is a neurological disorder characterized by recurrent, severe headaches on one side of the head, typically around the eye.
A cluster headache commonly awakens paitent in the middle of the night with intense pain in or around one eye on one side of head.Cluster headache often accompanied with eye watering, nasal congestion, or swelling around the eye, on the affected side. These symptoms typically last 15 minutes to 3 hours.
The starting date and the duration of each cluster period might be consistent from period to period. For example, cluster periods can occur seasonally, such as every spring or every fall.
Most people have episodic cluster headaches. In episodic cluster headaches, the headaches occur for one week to a year, followed by a pain-free remission period that can last as long as 12 months before another cluster headache develops
The potentiality of dental professional/ endodontists to carry out routine procedures successfully relies chiefly on the adequacy of local anaesthesia achieved. However, local anaesthetics (including lidocaine, the most commonly used local anaesthetic) have a tendency to cause pain on mucosal infiltration, which adds to patient anxiety during procedures.1 In fact, investigators have reported a more painful skin and subcutaneous infiltration with an epinephrine-containing lidocaine.2
The most probable mechanism of this pain is attributed to the reduced pH of an epinephrine-containing lidocaine compared to a plain lidocaine solution. A weakly basic amide, lidocaine being unstable at pH of 7.9, is made in acidic preparations to to enhance the solubility and prolong shelf life. Moreover, epinephrine is added to lidocaine to extend the half-life of the anesthetic, lessen toxicity, and provide hemostasis. Because epinephrine is only stable for lengthy phases in an acidic environment, the pH of commercially available premixed lidocaine with epinephrine is lower than that of plain lidocaine (pH 3.3-5.5) and the acidity can give rise to tissue irritation which may be felt by patients as a stinging or burning pain. 3,4
Based on the attributed mechanism, most common method for buffering is the alkalinisation of the lidocaine with sodium bicarbonate just before injection. Buffering with sodium bicarbonate (NaHCO3) 8.4%in a 10:1 or 9:1 ratio (10 or 9 parts lidocaine-epinephrine 1% containing 5 microgram/ml to 1 part sodium bicarbonate containing 8.4g/l) more closely matches the neutral pH (around 7.4) in human tissues and has been demonstrated to cause less CDJIpain than unbuffered lidocaine.1, 5-13
Body dysmorphic disorder (BDD), also known as body dysmorphia, body dysmorphia disorder and BDD disorder, is a mental health condition in which people suffer acute distress in response to perceived physical flaws.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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2 Case Reports of Gastric Ultrasound
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.
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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
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
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
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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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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.
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.
3. • A pain syndrome originally described
by Sluder as a symptom complex
referable to the nasal ganglion.
• The sphenopalatine ganglioneuralgia is
a type of headache or neuralgia, which
was once believed to be attributed to
the irritation of the sphenopalatine
ganglion.
4. • However, there were reports
suggesting that the sensory
information travels rather along
the trigeminal nerve.
5. • An exquisitely painful affliction of the mid
face and upper face, particularly in and
around the eye.
• The name is derived from the fact that the
headache occurs in temporal groups or
‘clusters’ with extended periods of
remisssion between attacks.
7. ETIOLOGY
• The exact cause is not yet known.
• However, evidence strongly suggests that
abnormalities in the hypothalamus may play
a major role in cluster headaches.
• Also related to the body's sudden release of
histamine (chemical in the body released
during an allergy response) or serotonin
(chemical made by nerve cells).
8. • By some not completely understood
mechanism, the trigeminal nerve is also
involved.
• May be caused by blood vessel dilation in the
eye area (caused by excessive release of
histamine). Inflammation of nearby nerves
may give rise to the distinctive stabbing,
throbbing pain usually felt in one eye.
• Hormones - researchers have found that
many people who suffer from cluster
headaches have unusual levels of melatonin
and cortisol during their attacks.
9. Trigger Factors
Alcohol ,
cigarette
smoking
High altitudes Bright light
Exertion
(physical
activity)
Heat (hot
weather, hot
baths)
Foods high in
nitrites (such as
bacon and
preserved meats)
Certain
medicines Cocaine
10. CLINICAL FEATURES
May occur at any age, although it usually affects
persons in the 3rd and 4th decade of life .
M > F (6:1)
They tend to run in families, passed down through
genes.
The pain is described as paroxysmal ( abrupt
onset) and intense, with a burning or lancinating
quality and without a trigger zone.
11. • The pain occurs on one side of the head.
• It may be described as:
Burning
Sharp
Steady
• The pain may occur in, behind, and around one
eye.
• May involve one side of the face from neck to
temples.
• In some cases, the pain is so intense in and
around the eye that the patient feels he should
get rid off that eye.
12. • The pain often begins at the same time and in a
given 24-hour period (Alarm clock headache)
• The attacks may last from 15 minutes- 3 hours
if left untreated.
• During an active cycle, people can experience as
few as 1 attack every other day to as many as 8
(mostly in the night)
• Attack cycles typically last 6 - 12 weeks with
remissions lasting up to 1 year.
• In the chronic form, attacks are ongoing
and there is little remission.
13.
14.
15. Types
Episodic: Occur regularly for 1 week to
1 year, separated by long pain-free
periods that last at least 1 month.
• Between 80 - 90% of patients
Chronic :Attacks occur regularly for
more than 1 year, with pain-free
periods lasting less than 1 month.
• Between 10 - 20%
• Difficult to treat.
19. Diagnosis
• Made from the history.
• The International Headache Society (IHS) guidelines
have suggested the following diagnostic criteria:
1. At least five attacks fulfilling the criteria below:
2. Severe, or very severe, unilateral orbital, supraorbital
and/or temporal pain lasting 15 to 180 minutes if
untreated.
3. Headache accompanied by at least one of: ipsilateral
conjunctival injection and/or lacrimation; ipsilateral
nasal congestion and/or rhinorrhoea;
20. ipsilateral eyelid oedema; ipsilateral
forehead and facial sweating; ipsilateral
miosis and/or ptosis; a sense of restlessness
or agitation.
4. Attacks occur from one every other day to
eight times daily.
5. Not attributable to another disorder.
21. Investigations:
• While no imaging study or specific
blood test can confirm the diagnosis of
cluster headache, an MRI or CT scan of
the brain may be ordered to confirm
that there are no other contributing
factors that may mimic it.
22. Differential Diagnosis
• Headaches that may be most commonly
confused with CH include:
1. Chronic paroxysmal hemicrania (CPH)
2. Migraine
3. Short-lasting unilateral neuralgiform
headache
4. Trigeminal neuralgia
25. Abortive therapy
• Goal- fast, effective and consistent relief.
• Should work within 10-15 minutes to be considered
adequate therapy.
1. Oxygen
• Excellent abortive for cluster
• Safe and easy to use
• Typical dosing — 100% oxygen given via face mask
(nasal cannula not effective) at 7-10 liters/minute for
20 minutes. Pain relief typically occurs after 10-20
minutes
• Can be used daily
26. 2. Sumatriptan
• Has been effective in cluster headache.
• Injectable form — most effective, often giving
complete relief within 15 minutes after injection
• Because triptans are not appropriate for
daily use and certainly not multiple times
each day, this treatment must be reserved
for only the most serious attacks
3. Dihydroergotamine (DHE)
• Available in injectable and nasal spray preparations
• Usually given intravenously; relief is slower with
intramuscular or subcutaneous formulations
• Can be used for several days in a row but not
endlessly
27. Transitional therapy
• Short-term preventive treatment that
bridges the time between cluster diagnosis
and when a true preventive agent becomes
effective.
• When the transitional agent is tapered off
(typically in one to two weeks) the
maintenance preventive will have kicked in,
thus the patient will have no gap in headache
prevention.
28. 1. Steroids (e.g., prednisone, dexamethasone)
• best transitional therapy
• Effective within 24 to 48 hours of administration
• Usually discontinued after 8-10 days of treatment
when main preventive agent has started to become
effective
• Long-term use not recommended
2. Dihydroergotamine (DHE)
• Can be used here also
• Best given intravenously .
• Typically relieves pain in 1-2 days of repetitive
treatment; pain may not return for days to months
which allows time for a preventive(s) to become
effective.
29. 3. Naratriptan
• Dose — 7 days at 2.5 mg twice daily while
transitioning to a preventive program
Drawback — if an attack occurs when a cluster patient
is on naratriptan, sumatriptan cannot be used as an
abortive; however, oxygen therapy can be used in this
case
4. Occipital nerve blockade
• Injection of anesthetic agent and a small dose of
steroid into the region of the greater occipital nerve
(base of skull) can provide relief averaging 13 days
• Can be performed in an outpatient setting with
minimal discomfort for the patient.
30.
31. Preventive therapy
• Starts at the onset of the cluster episode with the goal
of suppressing attacks.
1. Calcium channel blockers.
• Verapamil is often the first choice
• Often used in conjunction with other medications.
• Occasionally, longer term use is needed to manage
chronic cluster headache.
2. Corticosteroids. Inflammation-suppressing drugs
called corticosteroids, such as prednisone, are fast-
acting preventive medications
• Effective if the attack has started recently
32. 3.Melatonin
• A safe and promising addition to the list of
prophylactic agents for nocturnal attacks.
4. Lithium carbonate.
• When other medications fail.
• While you're taking this medication, your blood will
be checked regularly for the development of more-
serious side effects, such as kidney damage.
33. 5. Ergots.
• Ergotamine, available as a tablet that you place
under your tongue, can be taken before bed to
prevent night time attacks.
6. Sodium valproate –
• Has also been used for prophylaxis, usually in
chronic CH
34. Outlook (Prognosis)
• Cluster headaches are not life threatening
and usually cause no permanent changes to
the brain.
• However, they are chronic and often painful
enough to interfere with work or lifestyle.
• Rarely, the pain may be so severe that some
people may consider harming themselves.
35. General advice
• Be prepared for attacks. Patients should be
encouraged to have both acute and
preventative treatments available.
• Avoid smoking, alcohol use, certain foods,
and other things that trigger your headaches
• Maintain a regular sleep routine and good
sleep hygiene (avoiding tea, coffee, etc).