1. Surgical management of obstructive sleep apnea involves procedures to address three major areas of obstruction - nasal, retropalatal, and retrolingual.
2. Common nasal procedures are septoplasty, turbinate reduction, and sinus surgery, though nasal surgery alone is unlikely to significantly improve OSA.
3. Procedures for the retropalatal area include uvulopalatopharyngoplasty (UPPP), uvulopalatal flap, palatal implants, and laser assisted uvuloplasty. Tongue base procedures target the retrolingual area and involve partial glossectomy, lingualplasty, and radiofrequency tongue base ablation.
Surgical options for Obstructive sleep apnoea syndromeGirish S
OBSTRUCTIVE SLEEP APNEA SYNDROME- REVIEW AND VARIOUS SURGICAL OPTIONS IN DETAIL.. based on Cummings & Scott new edition.. MS OTORHINOLARYNGOLOGY...
complete and detailed review of each operations like uvulopalatoplasty,epiglottoplasty, pillar implantation, tongue base reduction, laser and coblation techniques.. .
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 .
Surgical options for Obstructive sleep apnoea syndromeGirish S
OBSTRUCTIVE SLEEP APNEA SYNDROME- REVIEW AND VARIOUS SURGICAL OPTIONS IN DETAIL.. based on Cummings & Scott new edition.. MS OTORHINOLARYNGOLOGY...
complete and detailed review of each operations like uvulopalatoplasty,epiglottoplasty, pillar implantation, tongue base reduction, laser and coblation techniques.. .
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 .
Sinus tymapni shape and depth can influence surgical approach in cholesteatoma surgery. In the case of a shallower ST, an exclusive endoscopic exploration is chosen; while in the case of a deeper ST, a retrofacial approach is usually preferred.
Cavity obliteration is a procedure done at the end of Mastoidectomy to get a cavity-less mastoid cavity thus solving the problem of discharging post-operative cavity.
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.
Maxillectomy and craniofacial resection Mamoon Ameen
all maxillectomy types in detail and maxillofacial resection ,indications ,contraindications ,preoperative asssessment and detail techniques and rehabilitations
Sinus tymapni shape and depth can influence surgical approach in cholesteatoma surgery. In the case of a shallower ST, an exclusive endoscopic exploration is chosen; while in the case of a deeper ST, a retrofacial approach is usually preferred.
Cavity obliteration is a procedure done at the end of Mastoidectomy to get a cavity-less mastoid cavity thus solving the problem of discharging post-operative cavity.
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.
Maxillectomy and craniofacial resection Mamoon Ameen
all maxillectomy types in detail and maxillofacial resection ,indications ,contraindications ,preoperative asssessment and detail techniques and rehabilitations
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
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
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
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
9. NASAL SURGERY
• Nasal obstruction - poor sleep quality, snoring, and
OSA.
• Septoplasty, turbinate reduction, nasal valve surgery,
and sinus surgery .
• However, nasal procedures are unlikely to
significantly improve OSA when used alone.
• Initial step in OSA management so as to facilitate
better CPAP adherence.
13. Z - palatoplasty
• Friedman M, Ibrahim H, Vidyasagar R. Z-palatoplasty (ZPP): a technique for patients without tonsils. Otolaryngol
Head Neck Surg 2004;131:89–100; with permission. Copyright 2004 The American Academy of Otolaryngology–
Head and Neck Surgery Foundation Inc
21. GENIOGLOSSAL ADVANCEMENT
• The rectangular geniotubercle osteotomy modification
offers excellent tension on the genioglossus muscle with
a minimal fracture risk. The geniotubercle fragment is
rotated enough to allow bony overlap. A single inferiorly
placed miniscrew is used to fix the fragment.
26. Surgical Treatment Success
• apnea-hypopnea index less than 20 with a
reduction greater than 50% and few desaturations
less than 90% with improvement of subjective
symptoms.
1923-pierre robin french surgeon
2014 AADSM american association for dental sleep medicine
Position report defining effective oral appliance
Dual arch design,adjustable >5mm,lifespan -3yrs,optimum fit and comfort
Efficacy – CPAP >MAD but compliance MAD>CPAP
Combination therapy
Uars--- not meeting criteria of OSA but pt have respiratory effort related arousals and excessive day time somnolence
An anatomically-based staging system is made to identify areas of obstruction, and
helps in tailoring the appropriate surgical treatment for each individual.
• The severity of disease is a secondary factor, which plays a role in determining the
need for treatment.
• TS 0 - post-tonsillectomy patients.
• TS 1 implies tonsils hidden within the pillars.
• TS 2 represents tonsils that extend to the pillars.
• TS 3 refers to tonsils that extend beyond the pillars, but not all the way to the
midline,
• TS 4 tonsils (‘‘kissing tonsils’’) reach the midline.
FTP I - the entire uvula, tonsils, and tonsillar pillars.
• FTP II allows visualization of the uvula, but not the tonsils.
• FTP III allows visualization of the soft palate, but not the uvula
• FTP IV allows visualization of the hard palate only
body-mass index (BMI) >40 kg/m(2) or
with BMI >35 kg/m(2) and 1 or more significant comorbid conditions
type II diabetes (T2DM),hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease,osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.
Ikematsu – snoring 1964
Fujita popularised in 1980s
Complications – initially –nasal regurg due to velopharyngeal insufficiency,dryness, discomfort,speech prob,
late – permanent vp insuff, nasopharyngeal stenosis
The techinique of uppp has changed over the time .
Radical uppp is not more effective than conservative (preserve velar muscles ) instead has more complication rate.
Friedman 2,3
Goal is to change the scar contracture tension line in a anterolateral vector
By splitting the soft palate and retracting it anterolaterally,
an effective anterolateral pull is created, which actually continues
to widen the airway as healing and contracture occur. None of the
palatal musculature is resected, in spite of the aggressive palatal shortening,
thereby addressing and minimizing the risk for permanent velopharyngeal
insufficiency (VPI)
1.Exposure of the palatopharyngeus (vertical fibers).
2. Elevation of the palatopharyngeus.
3. Rotation and tunnelling of the palatopharyngeus
toward the hamulus. Or sutures are put from velar muscles and palatopharyngeus
4.Suture suspension and approximation.
Grade 2, 3 …or if uppp and z plasty fails
1-cm portion of the hard palate is removed, and the soft palate is then advanced
and secured medially and laterally in the tensor aponeurosis, which enlarges the
retropalatal region.
minimally invasive, single-step procedure
• useful for mild OSA.
• Polyethylenterephthalat (PET)
• Three rod-shaped implants are inserted in the soft palate.
• The implants themselves and the surrounding scarring induce a stiffening of the soft
palate, reduce snoring sounds.
Developed to reduce pain, cost & morbidity of UPPP , in mild OSA
• Complication – partial implant extrusion
• Advantage – single office visit, minimal morbidity, reduce snoring.
RADIOFREQUENCY TONGUE BASE
ABLATION (RFA)
volumetric reduction in tonguebase
Tissue
465 KHz
coagulation necrosis and healing by scar.
OP setting under LA
• Require multiple treatments to achieve the desired results.
Repose , encore -brands
Permanent suture is passed through the paramedian tongue
musculature along the length of the tongue, through the
tongue base, and then back through the length of the tongue
musculature.
• It is then anchored to the screw to pull the tongue base
anteriorly.
Result in an enlarged retrolingual airway by fixing the major dilators of the
pharyngeal airway forward.
• Usually done along with GA
Medtronic AIRvance
Siesta medical – encore device
Titanium screws near canine on post aspect of mandible with a special drill
Mobilizing the maxilla and mandible to achieve anterior displacement, after intraoral
osteotomy.
• The maxilla and mandible are stabilized with titanium plates in the advanced
position.
Lefort 1 maxillary osteotomy with bilateral saggital split mandibular osteotomy with minimum 1cm advancement
strategies that increase activity in the pharyngeal dilator muscles should be effective for patients who have dysfunction in these muscles.8 Thus, a concept is emerging that personalized medicine may be applied to obstructive sleep apnea on the basis of underlying mechanisms
Results equal to cpap with better adherance.
randomized, therapy-withdrawal trial provide reassurance that the benefits from hypoglossal-nerve stimulation observed by Strollo et al. were real.
Includes a wide variety of procedures that vary in their invasiveness and success
rates.
t/t philosophy – 1.site specific surgery 2.treat to cure 3. staged surgical procedures 4. full pt disclosure of options and risks 5.follow up