Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.
Increased intracranial pressure is defined as cerebrospinal fluid pressure greater than 15 mm Hg.
Infections
Tumors
Stroke
Aneurysm
Epilepsy
Seizures
Hydrocephalus
Hypertensive brain injury
Hypoxemia
Meningitis
Due to etiological factors
Components of ICP is disturbed- brain tissue, CSF, blood volume
An increase in the volume of ANY ONE component must be accompanied by a reciprocal decrease in one of the other components.
When this volume-pressure relationship becomes unbalanced, ICP increases.
Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.
Increased intracranial pressure is defined as cerebrospinal fluid pressure greater than 15 mm Hg.
Infections
Tumors
Stroke
Aneurysm
Epilepsy
Seizures
Hydrocephalus
Hypertensive brain injury
Hypoxemia
Meningitis
Due to etiological factors
Components of ICP is disturbed- brain tissue, CSF, blood volume
An increase in the volume of ANY ONE component must be accompanied by a reciprocal decrease in one of the other components.
When this volume-pressure relationship becomes unbalanced, ICP increases.
A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die.
Head injuries top the list of trauma patienrts coming to the casualty. The condition has to be immediately assessed and investigated. Depending upon the findings prompt medical or neurosurgical treatment has to be administered.
A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die.
Head injuries top the list of trauma patienrts coming to the casualty. The condition has to be immediately assessed and investigated. Depending upon the findings prompt medical or neurosurgical treatment has to be administered.
"Trouma" is not a term or concept that I am familiar with. It's possible that you might be referring to something specific or using a term from a different context. Could you please provide more information or clarify your question?
Intracranial bleeding encompasses all bleeds that may occur within the cranial cavity including Epidural, Subdural, Sub arachnoid, intraparenchymal and Intraventricular haemorrhages. all are discussed in these slides and relevant references are provided for detailed information.
It is important to note that medicine is not learnt online but through series of organised events under specialised supervision in recognised institutions of learning.
Intravenous Fluids in Surgical PracticeMonsif Iqbal
its about when, where and to whom intravenous fluids to be given , the method to calculate fluid requirements for a particular patient and also how to calculate the drop rate (very important!)
Hospital Aquired Infections with special consideration to surgical site infections...also case presentation in the begining followed by literature review
Spinal Tuberculosis by Dr. Monsif IqbalMonsif Iqbal
This is the case presentation of a middle aged lady who presented with severe backache for the last one month with topic review after the case presentation
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.
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.
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
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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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
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
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.
7. PERSONAL HISTORY
Non smoker
No history of drug addiction or
dependence.
8. PHYSICAL EXAMINATION:
1. GPE:
A middle aged gentleman, lying in bed
confused and Drowsy
His vitals are;
Pulse: 100/min
B.P: 130/80 mm of Hg
Oxygen Sat: 96%
Temp: Afebrile
Rest of GPE unremarkable.
9. NEUROLOGICAL
EXAMINATION:
GCS 13/15
Pupils – Bilaterally reactive to light
No Obvious injury on the scalp
Rest of the systemic exam ---
unremarkable
10. Investigations on the
day of admission
Xrays Skull AP and lateral views
Blood CP
BSR
18. Subdural Hematoma
A subdural hematoma (SDH)
is a form of traumatic brain
injury in which blood gathers
between the dura and the
arachnoid.
19. Pathophysiology
Unlike in epidural hematomas, SDH usually results from the tears
in veins.
Further expansion due to osmosis
In some subdural bleeds, the arachnoid layer of the meninges is
torn
Local vasoconstrictors
May be reabsorbed, a subdural hygroma may be formed
21. Risk Factors
Extreme of age
Anticogulants
Long term Alcohol Abuse
22. Clinical Features of
A history of recent head SDH
injury
Loss of consciousness or fluctuating levels of consciousness
Irritability
Seizures
Numbness
Headache (either constant or fluctuating)
Dizziness
Disorientation
Amnesia
Weakness or lethargy
Nausea or vomiting
Personality changes
Inability to speak or slurred speech
Ataxia, or difficulty walking
Altered breathing patterns
Blurred Vision
23. Extradural Hematoma Subdural Hematoma
Biconvex or lenticular Diffuse and concave
Temporal or Entire surface of brain
temporoparietal
Middle meningeal artery Tearing of bridging veins
0.5% of all head injured 30% of severe head
pts injuries
“Lucid” interval classically Underlying brain damage
more severe
Outcome related to status Prognosis is worse than
prior to surgery extradural
24. Diagnosis
It is important that a patient receive
medical assessment, including a
complete neurological examination, after
any head trauma. A CT scan will usually
detect significant subdural hematomas.
25. 8.2. Non-contrast CT Brain 8.2 Non-contrast CT Brain
Acute and subacute Subdural CT Density 72.9 HU
Hematoma
32. Management of Mild
Head Injury (GCS
14-15)
About 3% of these patients deteriorate unexpectedly,
resulting in severe neurological dysfunctions unless the
decline in mental status is noticed early
Ideally, a CT scan should be obtained in all head-injury
patients, especially if there is a history of more than a
momentary loss of consciousness, amnesia, or severe
headaches.
33. NICE guidelines for CT
in Head Injury
GCS < 13 at any point
GCS 13 or 14 at 2 hours
Focal Neurological deficit
Suspected open, depressed or basal skull fracture
Seizure
Vomiting > one episode
Urgent CT if none of the above but
Age > 65
Coagulopathy (e.g. on warfarin)
Dangerous mechanism of injury (CT within 8 hours)
Antegrade amnesia > 30 minutes
34. Management of Mild
Head Injury (GCS
14-15) (cont.)
At present, skull x-rays are recommended only in
penetrating head injury or when CT scanning is not
immediately available
X-rays of the cervical spine must be obtained if there is
any pain or tenderness.
35. Management of
Moderate Head
Injury(GCS 9-13)
Approximately 10% to 20% of these patients
deteriorate and lapse into coma. Therefore, they
should be managed like severely head-injured patient
They are not routinely intubated. However every
precaution should be taken to protect the airway
36. Management of severe
Head Injury (GCS 3-8)
In a comatose patient (GCS 8 or below) secure and
maintain the airway by endotracheal intubation
Moderately hyperventilate the patient to reverse
hypercarbia, maintaining the PCO2 between 25 and 35
mm Hg
Treat shock aggressively and look for its cause
(consider DPL)
Resuscitate with normal saline, Ringer’s lactate or
similar isotonic solutions without dextrose. Do not use
hypotonic solutions. Avoid both hypovolemia and over
hydration, achieving a euvolemic state.
37. Perform a neurologic examination after normalizing the
blood pressure and before paralyzing the patent. Avoid
the use of long-acting paralytic agents.
All severe and most modetate head injury patients
require a CT scan to exclude mass lesions
Search for associated injuries. Exclude cervical spine
injuries radiographically and clinically
Contact a neurosurgeon as early as possible. If a
neurosurgeon is not available at your facility, transfer
all moderately or severely head-injured patients
Frequently reassess GCS