1. Pectus excavatum and pectus carinatum are the most common anterior chest wall deformities, with pectus excavatum occurring more frequently.
2. The Ravitch procedure and Nuss procedure are two common surgical techniques used to repair pectus excavatum, with Ravitch being an open resection and Nuss being minimally invasive.
3. Chest wall tumors can be either benign or malignant, with malignant tumors like fibrous histiocytoma and chondrosarcoma requiring wide resection for treatment.
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
physiotherapy management for chronic obstructive pulmonary disease Sunil kumar
role of physiotherapy in chronic obstructive pulmonary disease, principles of physical therapy management in copd, physiotherapy assessing and treatment for copd
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
physiotherapy management for chronic obstructive pulmonary disease Sunil kumar
role of physiotherapy in chronic obstructive pulmonary disease, principles of physical therapy management in copd, physiotherapy assessing and treatment for copd
this presentation discusses how to approach to the neck mass
and important DDx according to the site and age of onset
with clinical points about important etiologies
Highly malignant tumor of mesenchymal origin.Spindle shaped cells that produce osteoid.2nd most common primary malignant bone tumor after MM.Incidence – 1 to 3 per million per year
Treated by chemo,amputation or rotationplasty
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!
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.
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.
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
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
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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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
3. PECTUS EXCAVATUM
Most common anterior chest wall deformity
(1 in 300 to 400 live births)
Positive family history (37%-47%)
4:1 M:F ratio
Progression is expected during growth spurts
Tall, poor posture
Due to excessive misdirected growth of lower costal
cartilages
4. PRESENTATION
Clinical spectrum
Posterior angulation of the body of the sternum
Posterior angulation of the costal cartilages that
meet the sternum
In severe cases posterior angulation of the most
anterior portion of the osseous ribs
Depression may be asymmetric
(carinatum/excavatum deformities)
5. PRESENTATION
Many are asymptomatic
Precordial pain
Pain after sustained exercise
Palpitation (mitral valve prolapse)
Systolic ejection murmur is frequently identified
Shortness of breath
Decreased exercise tolerance
9. PULMONARY FUNCTION
The forced vital capacity and FEV1 is lower than
normal
Exercise tolerance is improved after surgery
10. CARDIAC FUNCTION
Anterior indentation of right ventricle is present.
Elevated right heart pressure.
In pectus excavatum, increased cardiac output on
exertion is due to increased heart rate rather than
stroke volume.
Echo reveals mitral valve prolapse, which can
subside after surgery.
11. INDICATIONS FOR SURGERY
Progressive symptoms
Restrictive disease, decreased work production or
oxygen uptake as demonstrated by PFT’s
Ct scan showing cardiac compression or
displacement
Pulmonary atelectasis
Mitral valve prolapse, bundle branch block
Recurrent pectus excavatum after repair
12. TIMING
Can be performed in younger children with severe
exercise tolerance
Best deferred until after the pubertal growth spur
14. RAVITCH PROCEDURE
Transverse skin incision
Mobilization and retraction of pectoralis and rectus
abdominis muscles
Excision of deformed cartilages leaving the
perichondrium intact
Fracture of the sternum (wedge osteotomy)
Metal strut for stabilization
18. Ravitch vs Nuss
1. Open resection minimally invasive
2.Reoccurrence rate
less more
3. Postoperative complication
(hemo/pneumothorax)
less more
4.Surgery duration
more less
no difference in hospital stay and time of ambulation
in both procedures.
19. COMPLICATIONS
Early:
Pneumothorax
Hemothorax
Wound infection
Pneumonia
Pericarditis
Pleural effussion
Late:
Bar infection
Bar displacement
Recurrence
Repairs performed in children <4years result in impaired growth of
the ribs resulting in a band-like narrowing of the chest the chest
20. POST-OPERATIVE PERIOD
5-7 days in the hospital
Seroma discharge from surgical site
Prolonged duration of Blake drains
Avoid contact sports for 3 months
Not to sleep prone
22. PECTUS CARINATUM
Less frequent than pectus excavatum (1 per 1500 live
births)
M:F 3:1
No known cause
Mild deformity at birth worsens as the child grows
Positive family history in 26%
History of scoliosis in 15%
23. PECTUS CARINATUM
Presentation:
Symmetric or asymmetric protrusion of the sternum
Associated lateral depression of the ribs
Pain in the area
Some patients experience exercise limitation
Rotation of the sternum is often seen
24. 1. Chondrogladiolar (90%)
(1) It is most common pectus
carinatum .
(2) It consists of anterior protrusion of the
body of sternum and lower costal
cartilages.
2. Mixed with excavatum and carinatum (9%)
It consists carinatum on one side and
excavatum on another side.
25. 3. Chondromanubrial (1%)
(1) It is the most uncommon pectus carinatum.
(2) It consists protrusion of manubrium,
2nd and 3rd costal cartilages with
relative depression of the body and
sternum.
28. Poland’s Syndrome
It refers congenital absence of the pectoralis major
and minor muscles, ribs, breast abnormality, chest
wall depression and syndactyly or brachydactyly.
It is present in 1/30000 per live birth.
The etiology is unknown but vascular pathogenetic
mechanism is suggested.
29.
30. Treatment : Ravitch procedure
Breast reconstruction with implants and latissimus
dorsi flaps.
Chest wall reconstruction : autologous reconstruction
with tensor fascia lata, omental flaps.
Alloplastic –prosthetic implantable materials
Mesh implants- PPKM ,PTFE,PMMA
Bioprosthetic materials : HADM, Alloderm
Xenografts : surgisis, permacol , totopatch
31. Jeune syndrome
Asphyxiating thoracic dystrophy
Rare genetic disorder that affects the way a child’s cartilage
and bones develop
Affects the child's rib cage, pelvis, arms and legs
Rib cages (thorax) are smaller and narrower than usual. This
can keep the child's lungs from developing fully or expanding
when the child inhales
Breathe rapid and shallow
About 60% to 70% of children with this condition die from
respiratory failure as babies or young children
It occurs when a child inherits from both parents the gene that
causes Jeune syndrome
Jeune syndrome occurs in about 1 of every 100,000 to
130,000 per live birth
36. Clinical presentation
Slow enlarging asymptomatic masses.
Pain usually occurs on overgrowth due to
suppression of side by structures.
Patient complains of neuritis or musculoskeletal
pain.
CT/MRI/PET require for exact location, extend and
metastasis.
Needle biopsy for malignancy.
37. Benign tumors
Osteochondroma : most common benign
neoplasm with 50% incidence of all benign tumors.
M:F – 3:1
Arises from metaphyseal region of rib and presented
as bony protuberance with cartilaginous cap.
If detected after puberty or in adult should be rsected
surgically.
38. Chondroma : 15% of all benign neoplasm of rib
cage
Occur at costochondral junction anteriorly
Expansile lesion causing thinning of bone cortex
Gross appearance is as lobulated mass and
microscopically are lobules of hyaline cartilage.
All chondromas should considered for malignant
change and treated by surgical resection.
39. Desmoid : mostly occurs in shoulder and chest wall
laterally.(20% of all chest wall tumors.)
Encapsulation of brachial plexus and vessels of arm-neck
are common , may extend to pleural cavity.
Can produce paresthesias, hyperesthesia and motor
weakness.
Gross examination tumor originates in muscle an tissue
planes and microscopy shows monotonous pattern of
spindle shape cells
Treatment : enucleation of tumor from side by structures
followed by radiotherapy.
40. Malignant tumors
Fibrous histiocytoma: occurs mostly in adults
between 50 to 70 years.
M:F- 3:1
Painless slowly enlarging mass
Present with fever, leukocytosis with neutropenia or
eosinophilia
Resistant to chemo and radio therapy
Should be treated with wide resection
41. Chondrosarcoma : 30% of all primary chest wall
tumors
Arising from costochondral arches or sternum.
Commonly occurs in 3rd or 4th decade of life.
Due to degeneration of benign cartilaginous tumors.
Excisional biopsy for definitive diagnosis.
Treatment : wide resection with 4cm margin of
normal tissue.
42. Rhambomyosarcoma : 2nd most common
tumor of chest wall neoplasm.
Frequently occur in children.
Non tender and painful but shows rapid growth.
May show secondary changes like hemorrhage and
necrosis
Treatment : wide resection followed by radiation and
chemotherapy.
43. Ewing’s sarcoma : 17% of all malignant chest wall
tumors.
2/3rd cases below 20 years of age.
Present as enlarging mass associated with fever,
leukocytosis, anemia
Onion skin appearance of bony surface.
Diagnosis by incisional or core needle biopsy.
Treatment systemic chemotherapy with primary site
radiotherapy and resection.
44. References : 1.Surgery of chest, Sabiston &
Spencer(8th edition)
2.General thoracic surgery, Shields (7th edition)
3.Stabilization of the chest wall: autologous and
alloplastic reconstructions.(Raman Chaos
Mahabir,MD & Charles E. Butler ,MD),Semin Plast
Surg 2011;25:34-34