This document summarizes subglottic stenosis, which is a narrowing of the windpipe just below the vocal cords. It can be congenital, meaning present at birth, or acquired later due to trauma, infection, or intubation. Symptoms include shortness of breath, stridor, and cough. It is graded based on the percentage of obstruction. Treatment depends on the grade but may include observation, endoscopic procedures like dilation or laser treatment, stents, or open procedures like tracheostomy, laryngotracheal reconstruction, or partial cricotracheal resection. The goal is to restore an open airway while minimizing scarring.
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
Inner ear malformations and ImplantationUtkal Mishra
This slide vividly describes relevant anatomy & embryology of cochlea. It gives the reader insights into various cochlear malformations & implantation.
Inner ear malformations and ImplantationUtkal Mishra
This slide vividly describes relevant anatomy & embryology of cochlea. It gives the reader insights into various cochlear malformations & implantation.
TONSILLECTOMY-INDICATIONS, CONTRAINDICATIONS,METHODS,SURGICAL STEPS AND COMPL...VASUDHAKALYANHOSPITA
This presentation is mainly for medical students to prepare for their practical examination and VIVA ,OSCE.
This covers the topic of TONSILLECTOMY-INDICATIONS, CONTRAINDICATIONS,METHODS,SURGICAL STEPS AND COMPLICATIONS.
Hope this is useful for you.
All the best .
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
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
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
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
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.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. SUBGLOTTIC STENOSIS
• It is characterized by the narrowing of subglottis (portion of wind
pipe , just below vocal cords narrows ).
• It is usually characterized by inflammation and fibrosis such as scar
tissue in the area .
• Subglottic stenosis can affect newborn , babies and adults .
• People are either born with the condition or they develop it as
complication later on .
• Statistically , idiopathic subglottic stenosis affects females about 98
percent .
3. Types of subglottic stenosis :
• Congenital subglottic stenosis :
• Occurs when a baby is born with an airway smaller than
usual .
• Acquired subglottic stenosis :
• Not present at birth . It develops later because of trauma ,
infection or complications due to intubation etc.,
4. Symptoms of subglottic stenosis
• Shortness of birth
• Stridor
• Hoarseness of voice
• Increased mucous production
• Cough
• Symptoms common in infants :
• Cyanosis
• Poor weight gain
• Croup or lung infections
• Respiratory distress
5. Grading of subglottic stenosis :
• The classic grading of subglottic stenosis was proposed by
COTTON and is accepted world wide .
• Modified COTTON – MEYER grading scale was introduced in
1994 based on percentage of obstruction calculated by
passing an endotracheal tube through stenosis resulting in
approximation of stenotic diameter divided by age
appropriate endotracheal tube size .
• Grade 1 stenosis but with not bilateral vocal cord immobility,
treatment of stenosis will not result an adequate airway .
6. • A severe stenosis that consists of thin scar web is easily
treated endoscopically where as long but narrow segment
may be resistant to endoscopic procedures .
7.
8. Signs and symptoms
• The symptoms of subglottic stenosis in children
are closely related to degree of narrowing .
• Grade 1 is usually asymptomatic until an URTI
occurs
• Grade 2 and 3 causes biphasic stridor , air
hunger ,dyspnea ,and suprasternal ,intercoastal
and diaphragmatic retractions.
• It is important to recognize that compromised
airway in a child can lead to rapid deterioration
and requires rapid intervention to avoid
catastrophic outcome .
9. Evaluation :
• Relevant history includes birth weight , stridor , quality of cry and
voice ,feeding difficulties ,aspiration ,prior pulmonary and
cardiac status .
• Physical examination should include thorough head and neck
examination and assessment of craniofacial abnormalities
,micrognathia , macroglossia , laryngomalacia and choanal
atresia .
• Awake flexible fiberoptic laryngoscopy
• Direct laryngoscopy and rigid bronchoscopy with video
assistance under GA with spontaneous ventilation is gold
standard for diagnosis of subglottic stenosis .
10. Imaging
• CT neck or MRI usually not recommended in children in most
children .
• Magnetic resonance angiography – stenosis caused by
vascular anomaly or tumor.
• CT OR MRI is indicated when direct laryngoscopy shows
complete or near complete obstruction of subglottis in order
to measure the length of stenotic segment and asses
framework defects .
11. Congenital subglottic stenosis:
• It is the 3rd most common congenital disorder in larynx .
• Subglottic diameter if less than 4mm or in preterm it is less
than 3mm.
• In severe cases stridor present at birth , while in milder cases
symptoms present only after a few months .
• Congenital anterior glottic webs are frequently associated
with subglottic stenosis due to malformed cricoid ring .
• It is occasionally reported in children with Downs syndrome .
12. Acquired subglottic stenosis :
• It is usually due to endotracheal intubation
in children .
• The epithelium lining the subglottis is
delicate and is easily injured by
endotracheal tube .
• Secondly the cricoid cartilage is complete
circular ring , the edema caused by trauma
or pressure directly impinges on internal
diameter
• Third , subglottic region is the narrowest
area of airway in children .
13. • Next , significant edema can develop in subglottic region
quickly because of loose areolar tissue that comprises the
submucosa in the region .
• Minor injury causes a greater narrowing that compromises
the airway in children .
• Other causes are high tracheostomy causes damage to
cricoid ,emergent cricothyroidotomy , smoke inhalation ,
caustic ingestion , burns and trauma .
• Neoplasms can also causes subglottic stenosis commonly
subglottic hemangioma less commonly chondroma or
fibroma .
14. • Other causes include :
• Wegener’s granulomatosis, pemphigoid , relapsing
polychondritis , amyloidosis , aphthous ulcerations and
laryngo oculo cutaneous syndrome .
• Chronic infections such as tuberculosis and syphilis can also
lead to subglottic stenosis .
15. Management of subglottic stenosis :
• The treatment paradigm is based on presenting clinical
severity of breathing , vocal cord mobility ,comorbidities
including neurological and developmental aspiration and
coexisting airway lesions .
• Findings on direct laryngoscopy and tracheoscopy are
necessary in order to make appropriate treatment decisions .
16. Immediate interventions :
• Infant presenting to emergency in respiratory distress
requires immediate attention and intervention .
• The most important sign of impending disaster is increased
effort of breathing despite normal oxygen saturation levels .
• Child can decompensate suddenly .
• Therefore when there is stridor and increased effort of
bleeding , a quick decision of safest way to secure airway
must be made .
17. • The safest place for securing the airway in this situation is OT
room where direct laryngoscopy can be performed if
endotracheal intubation is difficult .
• Set up for emergent tracheostomy should be prepared as a
backup if attaining the airway is unsuccessful.
• As a stabilizing measure on the way to definitive treatment ,
inhalation of nebulized adrenaline with saline can help
reduce child’s work of breathing while preparing for airway
intervention .
• Cricothyroidotomy is unsafe in children due to size and
collapsibility of airway .
18. Observation :
• Children with grade I or a mild grade II may not require
surgical treatment and can be observed .
• Another reason for watchful waiting and avoiding surgical
intervention is a “ reactive larynx” due to inflammatory
process with edema and granulation tissue is identified .
• Children tend to heal poorly after surgery and hence open
airway reconstruction should be deferred until the larynx is
no longer reactive .
19. • Reconstructive airway surgery is relatively contraindicated in
children with low weight less than 10 kg , aspiration causing
recurrent pneumonia , in children been mainstay of airway
management .
• CO2 lasers , holmium lasers can be used to treat subglottic
stenosis .
• Laser tissue removal or incision and dilation can actually
increase scar formation and worsen the lesion .
• Alternatives such as microdebrider , balloon dilations have
emerged ., as they causes tendency to cause less amount of
scarring .
20. • Microdebrider :
• Suitable for laryngeal endoscopic surgery .
• Advantage is the accuracy of tissue removal without thermal
damage to adjacent tissues .
• Balloon dilation :
• Endoscopic balloon dilations have gained as an effective
alternative to open reconstructive procedures .
• Bougie dilations .
21. Adjuvant treatment :
• Mitomycin C has been used to prevent scarring and
granulation tissue formation so as to improve outcomes of
endoscopic procedures .
• It is applied directly to stenotic area towards the end of
procedure using cottonoids .
• Intralesional steroids
• Antireflux medications .
22. Open surgery :
• Tracheostomy , Laryngotracheoplasty ,laryngotracheal
reconstruction .
• Tracheostomy :
• Safest way to secure airway in children
• Serve as a bridge before reconstructive surgery becomes
feasible .
• Anterior cricoid split : alternative to tracheostomy in
premature neonates .
• Endoscopic anterior cricoid split combined with balloon
dilations are reported to have 80% success rate .
23. Laryngotracheal reconstruction and
laryngotracheoplasty :
• Includes splitting the cricoid cartilage the , the
lower third of thyroid cartilage and the first
tracheal ring and expanding the framework with
cartilage grafts , harvested from one of the
coastal ribs , preferably on the right side .
• Single or two step procedure .
• Single stage LTP is defined as not leaving a
tracheostomy tube at the end of surgery and
placing a nasotracheal tube as a stent for a
period of 5-7 days .
• Two stage LTP is defined as tracheostomy tube at
end of procedure that is removed several weeks
after the primary procedure .
24. • The decision to perform single or two
stage LTP is based on many variables
should be tailored individually .
• Also it can be decided based on direct
laryngoscopy that precedes the LTP/R.
• When single stage LTP is performed ,
nasotracheal tube is kept in place
throughout and after the surgery .
• In a two stage LTP various stent have
been used as adjuncts and kept in place
for 3-6 wks .
• To prevent scar contracture Montgomery
T tube is used as it has advantage of
serving both as a stent and as
tracheostomy tube .
25. Partial CTR :
• Seperation of trachea from esophagus , mobilization of upper
tracheal rings , excision of stenotic segment with preservation of
posterior cricoid plate .
• Next supralaryngeal release is performed followed by
thyrotracheal end to end anastomosis .
• It can be performed either single stage or two stage procedure
with or with out stenting .
• The procedure requires surgical expertise due to risk of damage
to recurrent laryngeal nerve and high precision that
thyrotracheal anastomosis requires .