This study summarizes the long-term results of 31 patients who underwent bilateral single-port endoscopic thoracic sympathectomy for primary hyperhidrosis between 2010-2014. The average follow-up time was 60.6 months. At follow-up, 10 patients (32.3%) reported their primary complaint of excessive sweating had not been resolved. 15 patients (48.4%) developed compensatory hyperhidrosis, most commonly in the dorsal region. The factors most affecting patient satisfaction were persistence of the primary complaint and development of compensatory hyperhidrosis. 6 patients (19%) reported being dissatisfied with the surgery results long-term.
Bactericidal and Sporicidal Activities against Pathogenic Bacteria of Direct ...science journals
The purpose of this investigation was to examine the bactericidal activity of long lifetime ozone water (LLO water) against pathogenic bacteria of medical, veterinary, and public health interest.
Massage as a therapy has different type of sessions. Swedish massage, Deep tissue massage, Tuina , Zhiya, Asian Massage, Tantric Massage , Oriental Massage, Chinese medicine massage, body to body nudist massage ( a sensual therapy) and more. Before one can enjoy massage's benefit , the safety is one of the most important thing that should not ignored.
Introduction: There is growing evidence that Obstructive Sleep Apnea (OSA) is a risk factor for Pulmonary Embolism (PE). This
association represents a major public health burden.Aims and Objectives: To investigate Computed Tomography Obstruction Index (CTOI) and the Right Ventricular (RV) to Left Ventricular (LV) diameter ratio with OSA severity. Materials and Methods: 46 Patients with (PE) were evaluated for OSA. Pulmonary Artery Obstruction Index (PAOI) and RV/ LV diameter ratio was measured by pulmonary angiography. Pulmonary Embolism Severity Index (PESI) was determined. Epworth Sleepiness Scale (ESS) and Polysomnography (PSG) was performed for all patients. Based on the PAOI, patients divided into (< 15%, 15-50%, > 50%).
Bactericidal and Sporicidal Activities against Pathogenic Bacteria of Direct ...science journals
The purpose of this investigation was to examine the bactericidal activity of long lifetime ozone water (LLO water) against pathogenic bacteria of medical, veterinary, and public health interest.
Massage as a therapy has different type of sessions. Swedish massage, Deep tissue massage, Tuina , Zhiya, Asian Massage, Tantric Massage , Oriental Massage, Chinese medicine massage, body to body nudist massage ( a sensual therapy) and more. Before one can enjoy massage's benefit , the safety is one of the most important thing that should not ignored.
Introduction: There is growing evidence that Obstructive Sleep Apnea (OSA) is a risk factor for Pulmonary Embolism (PE). This
association represents a major public health burden.Aims and Objectives: To investigate Computed Tomography Obstruction Index (CTOI) and the Right Ventricular (RV) to Left Ventricular (LV) diameter ratio with OSA severity. Materials and Methods: 46 Patients with (PE) were evaluated for OSA. Pulmonary Artery Obstruction Index (PAOI) and RV/ LV diameter ratio was measured by pulmonary angiography. Pulmonary Embolism Severity Index (PESI) was determined. Epworth Sleepiness Scale (ESS) and Polysomnography (PSG) was performed for all patients. Based on the PAOI, patients divided into (< 15%, 15-50%, > 50%).
Study on Clinical observation in Patients Presenting With Right Iliac Fossa P...QUESTJOURNAL
ABSTRACT:Patients presenting with pain in the right iliac fossa is common for a surgeon. The causes differ based on the organ of origin. The common conditions include acute appendicitis, right ureteric calculus, mesenteric adenitis or ileocecal tuberculosis and right ovarian cyst. Other causes are appendicular abscess and ascending colon carcinoma. Rare conditions include Non-Hodgkin’s lymphoma, caecal carcinoma, amoeboma, lymph node mass, iliopsoas mass, retroperitoneal mass and Crohn’s disease. This makes it difficult to diagnose and manage these patients. Hence a prospective study on right iliac fossa masses was conducted. Out of a total of 50 patients, the most common cause was of appendicular origin, mainly appendicitis followed by right ureteric calculus. Pain, fever and leucocytosis were predominantly noted in inflammatory conditions whereas weight loss, anaemia and painless mass were noted in neoplastic causes. Appendicular mass patients were treated conservatively followed by interval appendectomy. Appendicular abscess was drained extraperitoneally. Right hemi-colectomy was done for carcinoma in the cecum and ascending colon. Tubercular patients with intestinal obstruction also underwent right hemi-colectomy. Intra-venous antibiotics were administered to all infective cases. Tubercular masses were started on anti-tubercular drugs. Carcinoma patients received adjuvant therapy. Crohn’s disease and non-specific lymphadenitis were treated medically. Hence our study shows that managing right iliac fossa mass patients can be challenging and requires vigilance.
This study aims to systematically compare and
contrast the two most commonly used techniques of
tonsillectomy- Cold tonsillectomy and cobilation tonsillectomy.
Three different age group of patients were examined and
operated. The total number of patients was 104. There were 52
patients each of cobilation and cold tonsillectomy. The
specifications being following: 35 patients of age between 3 to 7
years, 6 patients of age 7-12 years and 11 patients of age greater
than 12 years.
The result of this study showed that there is no significant and
noticeable difference between the two procedures of operating
tonsils. However slight differences in the post operative pain and
primary and secondary bleeding was seen. The operation time
was considerably lower in patients of younger age.
journal club and critical appraisal checklist
intensive recruitment versus moderate recruitment strategy in postop cardiac surgery patients to avaoid postop pulmonary complications
EVIDENCE OF POSTTRAUMATIC COAGULOPATHY IN CASE OF THE SEVERE COMBINED THORACI...pijans
Early coagulopathy associated with trauma – result of exaggerate activity during the initiation phase of
coagulation. The aim of this study was to determine the diagnostic value of the coagulopathy markers for
metabolic monitoring of the severe combined thoracic trauma and it’s possibly to help in outcome
prediction. This retrospective study was performed on 73 male polytrauma patients from 20 to 68 years
old. The prothrombin time, fibrinogen concentration and β-Naphthol test were estimated on 1-2-d, 3-4-th
and 5-6-th days after trauma. The results suggest that hypocoagulation occurs early in equal extent for
survivals and non-survivals. Coagulation abnormalities are the result of vital functions disturbances rather
than direct tissue injury.
Influence of Various Factors on the Incentive Spirometry Values in Patients U...Remedypublications1
Background: Pulmonary complications are the most frequently occurring complications following
cardiac surgeries. Chest physiotherapy along with incentive spirometry after surgery is directed
towards maximal inspiration in an attempt to prevent atelectasis. Incentive spirometry is a device
with visual feedback designed to achieve and sustained maximal inspiration. Various factors like
age, gender, pulmonary complications, clinical diagnosis, type of surgery, type of incision, pain,
etc., has an influence on the performance of incentive spirometry.
Objective: To find out factors influencing incentive spirometry values in patients undergoing
thoracotomy.
Methods: Non experimental study design, observational type, 25 subjects with thoracotomy surgery
were approached an inform consent was taken. All the subjects were given incentive spirometer
along with conventional physiotherapy and incentive spirometry values are noted on 1st postoperative
day and 7th post-operative day from the patients.
Outcome measure: Incentive spirometry values.
Results: Statistical analysis was done by using chi-square test which showed statistically no significant
association (p>0.05) between smoking, pulmonary disorders, associated problems, diagnosis, type
of surgery and incentive spirometry values in the thoracotomy patient on 1st and 7th post-operative
day. It shows statistically significant association (p<0.05) of gender with incentive spirometry values
on 7th post-operative.
Conclusion: This study concluded that there is association between gender and performance
of incentive spirometry but other factors like pain, age, diagnosis, type of incision, pulmonary
complications does exhibit influence on the performance of incentive spirometer, which can be
demonstrated with extensive study in future
Study on Clinical observation in Patients Presenting With Right Iliac Fossa P...QUESTJOURNAL
ABSTRACT:Patients presenting with pain in the right iliac fossa is common for a surgeon. The causes differ based on the organ of origin. The common conditions include acute appendicitis, right ureteric calculus, mesenteric adenitis or ileocecal tuberculosis and right ovarian cyst. Other causes are appendicular abscess and ascending colon carcinoma. Rare conditions include Non-Hodgkin’s lymphoma, caecal carcinoma, amoeboma, lymph node mass, iliopsoas mass, retroperitoneal mass and Crohn’s disease. This makes it difficult to diagnose and manage these patients. Hence a prospective study on right iliac fossa masses was conducted. Out of a total of 50 patients, the most common cause was of appendicular origin, mainly appendicitis followed by right ureteric calculus. Pain, fever and leucocytosis were predominantly noted in inflammatory conditions whereas weight loss, anaemia and painless mass were noted in neoplastic causes. Appendicular mass patients were treated conservatively followed by interval appendectomy. Appendicular abscess was drained extraperitoneally. Right hemi-colectomy was done for carcinoma in the cecum and ascending colon. Tubercular patients with intestinal obstruction also underwent right hemi-colectomy. Intra-venous antibiotics were administered to all infective cases. Tubercular masses were started on anti-tubercular drugs. Carcinoma patients received adjuvant therapy. Crohn’s disease and non-specific lymphadenitis were treated medically. Hence our study shows that managing right iliac fossa mass patients can be challenging and requires vigilance.
This study aims to systematically compare and
contrast the two most commonly used techniques of
tonsillectomy- Cold tonsillectomy and cobilation tonsillectomy.
Three different age group of patients were examined and
operated. The total number of patients was 104. There were 52
patients each of cobilation and cold tonsillectomy. The
specifications being following: 35 patients of age between 3 to 7
years, 6 patients of age 7-12 years and 11 patients of age greater
than 12 years.
The result of this study showed that there is no significant and
noticeable difference between the two procedures of operating
tonsils. However slight differences in the post operative pain and
primary and secondary bleeding was seen. The operation time
was considerably lower in patients of younger age.
journal club and critical appraisal checklist
intensive recruitment versus moderate recruitment strategy in postop cardiac surgery patients to avaoid postop pulmonary complications
EVIDENCE OF POSTTRAUMATIC COAGULOPATHY IN CASE OF THE SEVERE COMBINED THORACI...pijans
Early coagulopathy associated with trauma – result of exaggerate activity during the initiation phase of
coagulation. The aim of this study was to determine the diagnostic value of the coagulopathy markers for
metabolic monitoring of the severe combined thoracic trauma and it’s possibly to help in outcome
prediction. This retrospective study was performed on 73 male polytrauma patients from 20 to 68 years
old. The prothrombin time, fibrinogen concentration and β-Naphthol test were estimated on 1-2-d, 3-4-th
and 5-6-th days after trauma. The results suggest that hypocoagulation occurs early in equal extent for
survivals and non-survivals. Coagulation abnormalities are the result of vital functions disturbances rather
than direct tissue injury.
Influence of Various Factors on the Incentive Spirometry Values in Patients U...Remedypublications1
Background: Pulmonary complications are the most frequently occurring complications following
cardiac surgeries. Chest physiotherapy along with incentive spirometry after surgery is directed
towards maximal inspiration in an attempt to prevent atelectasis. Incentive spirometry is a device
with visual feedback designed to achieve and sustained maximal inspiration. Various factors like
age, gender, pulmonary complications, clinical diagnosis, type of surgery, type of incision, pain,
etc., has an influence on the performance of incentive spirometry.
Objective: To find out factors influencing incentive spirometry values in patients undergoing
thoracotomy.
Methods: Non experimental study design, observational type, 25 subjects with thoracotomy surgery
were approached an inform consent was taken. All the subjects were given incentive spirometer
along with conventional physiotherapy and incentive spirometry values are noted on 1st postoperative
day and 7th post-operative day from the patients.
Outcome measure: Incentive spirometry values.
Results: Statistical analysis was done by using chi-square test which showed statistically no significant
association (p>0.05) between smoking, pulmonary disorders, associated problems, diagnosis, type
of surgery and incentive spirometry values in the thoracotomy patient on 1st and 7th post-operative
day. It shows statistically significant association (p<0.05) of gender with incentive spirometry values
on 7th post-operative.
Conclusion: This study concluded that there is association between gender and performance
of incentive spirometry but other factors like pain, age, diagnosis, type of incision, pulmonary
complications does exhibit influence on the performance of incentive spirometer, which can be
demonstrated with extensive study in future
Background: Cerebellopontine Angle (CPA) meningiomas comprise 10% of all intracranial meningiomas and due to their location, are producing different surgical challenges. This study is evaluating surgical management and clinical outcome of CPA meningiomas operated during 15 years.
Extracorporeal shockwave therapy (ESWT) has analgesic and anti-inflammatory effects. With the evolu- tion and comprehension of its biological and physical mechanisms, the application of ESWT on other pathologies has also been studied, especially in musculoskeletal diseases. Recently, studies on animal models have shown its angiogenic capacity and a higher rate of local re-epithelization. These small stud- ies led to few trials using low-energy, radial ESWT to treat problematic chronic skin ulcers. Skin ulcers have diverse etiologies, ranging from pressure ulcers, burns, venous or arterial ulcers, and even diabetic ulcers. Their treatment is usually a challenge, due to the long-term treatment and high costs.
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
Comparison of postoperative complications in benign thyroid disorders: subtot...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
History of Tracheostomy
Techniques Types Tubes of Trachesotomy
Open Vs Percutaneous Dilatational Technique
Early vs Late Trachestomy in ICU Setup
Trachesotomy Care
Suctioning Guidelines Techniques
Humidification
Woundcare
CT-Guided Percutaneous Radiofrequency Thermal Ablation of Osteoid Osteoma-Cri...CrimsonPublishersOPROJ
CT-Guided Percutaneous Radiofrequency Thermal Ablation of Osteoid Osteoma by Pedro Manuel Serrano* in Crimson Publishers: Orthopedic Research and Reviews Journal
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
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
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
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.
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!
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
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.
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
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.
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.
Evaluation of antidepressant activity of clitoris ternatea in animals
The results of a long term follow-up of bilateral single port sympathicotomy in primary hyperhidrosis - should we perform this surgery
1. Research article
The Results of a Long-Term Follow-up of Bilateral Single Port
Sympathicotomy in Primary Hyperhidrosis: Should We Per-
form This Surgery?
Timuçin ALARa*
, İsmail Ertuğrul GEDİKa
Abstract
Background: Hyperhidrosis (HH), which refers to excessive sweating of the body in response to temperature or
emotional stimuli rather than physiological stimuli, can adversely affect quality of life. In this prospective study,
we investigated the long-term effects, development of complications, and patient satisfaction among those who
underwent bilateral single-port endoscopic thoracic sympathecotomy (ETS) for HH.
Methods: Thirty-one patients who underwent bilateral single-port endoscopic thoracic sympathicotomy (ETS)
for HH between January 200 and November 2014 were enrolled in this study. The patients wer1e followed up
until July 2017. Patient satisfaction in terms of the primary complaint (PC) and complications, such as compen-
satory hyperhidrosis (CH), in the short and long term were recorded.
Results: The mean follow-up period was 60.6 ± 12.8 (min: 40, max: 89) mo postoperatively. When both the
short- and long-term results were evaluated together, CH had no effect on patient satisfaction. However, per-
sistence of the PC in both the short (p = 0.020) and long term (p = 0.001) had a significant effect on satisfaction.
Conclusion: The most important factor affecting patient satisfaction was PC persistence. Thus, further studies
should be performed to enlighten this complication. even though it may remit with time. Whether ETS is a per-
manent treatment that cannot successfully treat PC, possible complications and the ability to cope with them
will seem to be open to debate as the most important issues that surgeons will have to face in the near future.
Keywords: Complication; hyperhidrosis; surgery; sympathicotomy
INTRODUCTION
Hyperhidrosis (HH) can be described as excessive
sweating of the body that exceeds physiological needs
[1]
. Hyperhidrosis may be primary or secondary. Prima-
ry HH is the result of to overactivity of the sympathetic
nervous system, whereas secondary HH is caused by
various factors, such as malignancies, endocrine dis-
orders (e.g., thyrotoxicosis), and some medications [1-3]
.
Primary HH affects facial, palmar, axillary, and plantar
regionsofthebody,exhibitingregionalandsymmetrical
involvement patterns due to sympathetic nervous sys-
tem overactivity [1,2]
.
Hyperhidrosismaybetreatedviamedicalorsurgicalap-
*Corresponding author: Timuçin ALAR
Mailing address: Department of Thoracic Surgery, Çanakkale On-
sekiz Mart University Medical Faculty, Çanakkale Onsekiz Mart
Universitesi Tıp Fakultesi Gogus Cerrahisi Anabilim Dalı Terzioglu
Girisi, Çanakkale,17100,Turkey.
E-mail: timalar@yahoo.com
Received: 24 October 2019 Accepted: 25 November 2019
proaches. Endoscopic thoracic sympathecotomy (ETS)
is the most commonly used type of surgical treatment
today.Thesurgerycanbeperformedinavarietyofways,
such as dissecting the sympathetic chain in the thoracic
region, thermal damage via electrocautery, or clipping.
Among various ETS-related complications, which in-
clude a hemo-pneumothorax, Horner’s syndrome, and
bradycardia,themostimportantintermsofbothpatient
and physician satisfaction is compensatory hyperhidro-
sis (CH) [4,5]
.
In this prospective study, we investigated the rate of
complications, such as CH, and PC persistence in the
long-term postoperative period following bilateral sin-
gle port ETS and the effects of these complications on
patient satisfaction.
METHODS
Patients who had undergone single port ETS between
January2010andNovember2014atÇanakkaleOnsekiz
Mart University Medical Faculty Thoracic Surgery Clinic
were prospectively followed up until July 2017. During
outpatient clinical examinations and telephone inter-
a
Department of Thoracic Surgery, Çanakkale Onsekiz Mart University Medical Faculty, Çanakkale, 17100, Turkey.
Creative Commons 4.0
Clin Surg Res Commun 2019; 3(4): 26-30
DOI: 10.31491/CSRC.2019.12.041
Timuçin ALAR et al 26
2. views, the patients were questioned about changes in
CH and their PC in the postoperative period and their
satisfaction with the operation.
In the 6 mo prior to the single port ETS, all the patients
had received medical treatment. Despite this treatment,
none of the patients experienced improvements in their
PC. Prior to surgery, informed consent was obtained
fromeachpatient.InpatientswithHHaffectingmultiple
areas, only the area most affected was treated. The ETS
was performed using a 10-mm 0-degree thoracoscope
(Karl Storz 26034 AA) with a 6-mm working channel
under general anesthesia via a double-lumen endotra-
cheal tube. After the patient had been positioned in the
lateral decubitus position, a single thoracoport (width:
10.5 mm) was inserted into the thorax through a sin-
gle incision of 11 mm at the intersection of the fourth
intercostal space and mid-axillary line (Figure 1). The
sympathetic chain was cauterized by endoscopic elec-
trocautery from the T2 for fascial hyperhidrosis, T3 for
palmar hyperhidrosis, T4 for axillary hyperhidrosis,
and T5 for plantar hyperhidrosis. In addition, during
the sympathecotomy of the T2-T3, the presence of the
nerve of Kuntz was verified, and the nerve tissue was
cauterized. The rib bed was cauterized laterally for an
additional 2 cm to allow the dissection of possible by-
passing nerve fibers. After hemorrhage control, the air
in the pleural cavity was evacuated via a small catheter.
The incision line was closed by subcutaneous suturing,
and the same procedure was repeated on the other side.
On the postoperative first day, the patients were eval-
uated by a physical examination, posterior-anterior
chest X-ray, hemogram, and blood biochemistry tests.
Patients whose physical examination and examination
resultsrevealednoabnormalitiesweredischargedfrom
the hospital on the first postoperative day. The patients
were referred to the outpatient clinic on the seventh
postoperative day and reevaluated via a physical exam-
ination and posterior-anterior chest X-ray. In the third
postoperative month and again in the third postopera-
tiveyear,allthepatientswereinterviewedbytelephone.
They were questioned about their HH status, CH status,
and satisfaction with the operation. They were asked to
rate their HH at the site of the PC from 0 to 10, where 0
represented no sweating, and 10 represented the most
severe sweating.
The follow-up times were from the date of the opera-
tion to the last follow-up date (July 2017), expressed in
months.Subsequently,cutoffvaluesat48,60,and72mo
were coded as a dichotomous variable for those below
and above the follow-up period. The following parame-
ters were coded as dichotomous variables: CH, PC, and
patient satisfaction. In terms of the latter, on the day of
the interview, the patients were asked whether, given
the choice, they would undergo the surgery again. The
CH and PC intensities were coded as continuous vari-
ables ranging from 1 to 10.
The data were then transferred to a digital medium. The
normal distribution matching of the continuous vari-
ables was examined for the frequency and distribution
of variables. The relations between the continuous vari-
ableswereanalyzedusingappropriatecorrelationtests,
and the relations between the dichotomous variables
were analyzed using a chi-square test and, if necessary,
Fisher’s exact test. In all the analyses, statistical signifi-
cance was accepted as a p-value of < 0 .05. The absolute
p values are given for the analysis results.
RESULTS
Thirty-one patients who underwent bilateral single
port ETS at Çanakkale Onsekiz Mart University Medi-
cal Faculty Chest Surgery Clinic between January 2010
and November 2014 were included in the study. Sixteen
(51.6%) of the patients were males, and 15 (48.4%)
were females. The mean age of the patients was 24.13 ±
4.64 (min: 13, max: 34) y. In terms of the site of the PC,
it was craniofacial in 6.5% (n = 2) of cases, palmar-facial
in 12.9% (n = 4) of cases, palmar in 67.7% (n = 21) of
cases, axillary in 9.7% (n = 3) of cases, and palmoplantar
in 3.2% (n = 1) of cases.
The postoperative complications were a pneumothorax
in one patient and a hemopneumothorax in one patient.
Tube thoracostomy was performed in the patient who
developedahemopneumothorax,andairevacuationvia
thoracentesiswasperformedintheotherpatient.Allthe
other patients were discharged on the first postopera-
tive day. Thus, the average duration of the hospital stay
was 1.13 ± 0.56 (min: 1, max: 4) d. The mean follow-up
period was 60.6 ± 12.8 (min: 40, max: 89) mo postop-
eratively.
When the patients were questioned about their PC sta-
tus, 10 (32.3%) of the 31 patients responded that their
Figure 1. Thoracoscope Insertion Through Single Port Incision.
Timuçin ALAR et al 27
ANT PUBLISHING CORPORATION
Published online: 27 December 2019
3. PC was not resolved. The remaining 21 cases respond-
ed that their PC was in remission. Among patients with
a persistent PC, the most frequent site was palmar HH
(Table 1).
When the patients were asked about their CH status in
the postoperative third-month, 15 (48.4%) of the 31
patients reported that they had developed CH. When
questioned about the severity of the CH, the severity
ranged from 3–10, with the most frequent CH site being
the dorsal region (Tables 2 and 3).
At the time of the final interview in July 2017, the pa-
tients were questioned about their satisfaction with the
surgery. Six (19%) of the 31 patients were dissatisfied
withthesurgery,and81%ofpatientsweresatisfied.Five
ofthesix(83%)patientswhowerenotsatisfiedwiththe
surgeryhaddevelopedCH,andthePCwasunresolvedin
five of these six (83%) cases (Tables 4 , 5). In total, sev-
en patients indicated that if given the choice today, they
would not have the surgery. Two of these seven patients
developed CH postsurgery, and the PC was unresolved
in the other five cases. One patient who was satisfied
with the surgery reported that he would not undergo
this surgery today. This patient had some relief from his
PC, but it was not completely resolved.
When the long-term follow-up of the cases was exam-
ined, the PC was resolved in two patients, and CH devel-
opedinthreepatients.Intotal,therewere8(25%)cases
of PC persistence and 18 (58%) cases of CH persistence.
PersistenceofthePCaffectedpatientsatisfactioninboth
the short (p = 0.007) and long term (p = 0.001). In con-
trast, CH had no effect on patient satisfaction in either
the short (p = 0.083) or long term (p = 0.359).
DISCUSSION
Although the precise pathophysiological mechanism in
HH is not known, excessive stimulation of thermoregu-
latory and emotional sweating control centers or exces-
sive secretion of acetylcholine by the sympathetic ner-
vous system in response to stimulation of these centers
may play a role [3]
. Individuals with primary HH, which
usually begins in childhood or adolescence, generally
consult a physician because of psychosocial problems
caused by HH [6]
.
Medical therapy options for HH include topical or sys-
temic antiperspirants, iontophoresis, botulinum toxin
injections, laser therapy, and microwave therapy[6]
. Top-
ical antiperspirant agents consist of a 20% solution of
aluminum hydrochloride [7]
. Topical and systemic forms
of anticholinergics include glycopyrrolate and oxybu-
tynin [7]
. Iontophoresis is the treatment of choice for
palmoplantar HH. The treatment is based on the prin-
ciple that the palmoplantar zone is kept in tap water
in which a low voltage electrical current is applied for
about 30 min [8,9]
. Botulinum toxin A injections are used
as a treatment for both palmoplantar and axillary HH.
These provide a longer remission time than any other
medical treatment, with remission of HH for about 6 mo
Region n %
Craniofacial 1 10
Palmar 5 50
Axillary 3 30
Plantar 1 10
Total 10 100
Table 1. Regional Distribution of Ongoing Hyperhidroses.
Severity n %
3 1 6.8
4 2 13.3
5 2 13.3
6 2 13.3
7 3 20
8 3 20
10 2 13.3
Total 15 100
Table 2. The Distribution of the Severity of Compensatory
Hyperhidrosis.
Location n %
Dorsal 9 60
Abdomen 3 20
Chest 3 20
Total 15 100
Table 3. The Regional Distribution of Compensatory Hyperhidrosis.
Primary complaint
- + Total
Satisfaction
No 1 5 6
Yes 20 5 25
Total 21 10 31
Table 4. Primary Complaint versus a Satisfaction Cross Table.
*p > 0.05, Fisher’s exact test value 0.007.
Compensatory Hyperhidrosis
- + Total
Satisfaction
No 1 5 6
Yes 15 10 25
Total 16 15 31
Table 5. Compensatory Hyperhidrosis versus a Satisfaction.
*p > 0.05, Fisher’s exact test value 0.083.
Timuçin ALAR et al 28
DOI: 10.31491/CSRC.2019.12.041
Clin Surg Res Commun 2019; 3(4): 26-30
4. post-treatment [10]
. In terms of laser treatment, a neody-
niumyttriumaluminumgarnetlaserisusedforHH[11]
.In
microwave therapy, thermolysis of eccrine sweat glands
is conducted. The main difference of this method is that
it is irreversible [12]
. The main disadvantage of medical
treatments for HH as compared to surgical treatment is
that medical therapy offers only a temporary solution
to an ongoing problem, and the treatments have to be
repeated. An important advantage of medical therapy
versus surgical treatment is the absence of CH, which is
acomplicationofsurgery.Forthisreason,allHHpatients
are advised to receive medical treatment for at least 6
mo before considering surgery. If the medical treatment
is unsuccessful, with success defined as patient satisfac-
tion, surgery is an option. In the present study, none of
the patients had satisfactory outcomes prior to under-
going surgery.
CH, a complication of ETS, refers to excessive sweating
affecting various parts of the bodys. The mechanism un-
derlying the development CH is not known. Although
some authors have argued that this condition develops
because of negative feedback stimuli of the sympathetic
chain cannot reach the hypothalamus, there is no scien-
tific evidence to support this hypothesis [13,14]
. Approxi-
mately 3–98% of patients develop CH after ETS, and it
is most commonly observed in the trunk area. It is not
possible to predict who may develop CH and how severe
it may become [4,5,13,15]
. Although some studies showed
that a sympathecotomy at the T2 level or a sympathec-
tomy at multiple levels and older age increased the risk
of developing CH, other studies contradicted these find-
ings [13,16-18]
. In our study, in the short term, the rate of
CH was 48%, whereas it was 58% in the long term. CH
developed most commonly in the trunk region, similar
to the scientific literature on this subject.
Previous research reported that the development of CH
and PC persistence were the two most important fac-
tors affecting patient satisfaction after ETS operations.
In the literature, the reported rates of PC persistence
range from 0 to 21.4% [13,17,19]
. The rates in the present
study were comparable to those found in the literature,
with rates of 32% in the short-term follow up and 25%
in the long-term follow up. An interesting finding in the
present study was that PC persistence was the most im-
portant factor affecting patient satisfaction in the long
term.
In previous studies on HH, the postoperative follow-up
period was less than 1 y, with most follow-ups lasting
approximately 6 mo. Thus, knowledge is limited on the
status of HH among these patients over the long term.
In the present study, the patients were followed up for
a mean of 60 mo. As shown by the results, an increase
in the rate of CH did not increase patient satisfaction. In
contrast,whileadecreaseinPCwasobserved,therewas
alsoadecreaseinthepatientsatisfaction.Thus,themost
important factor affecting patient satisfaction was con-
tinuation ofthePCincontrasttoourcurrentknowledge.
Accordingtoapreviousstudy,theresultsofintermittent
unilateralETSforreducingCH,whichaffectspatientsat-
isfaction in the short term, are promising, although the
duration of the follow-up in the study was only 1 y [20]
.
However,thehospitalcostsassociatedwithintermittent
unilateralETSseemtobedisadvantages,withtheproce-
dure requiring two surgeries, two anesthesia sessions,
and two hospitalizations. We believe that the primary
goal of surgery should be complete resolution of the PC.
Self-remission of the PC with age should also be seen as
a disadvantage for the ETS [21]
. The possibility that the
PC may regress in time, combined with the fact that PC
persistence rather than CH affects patient satisfaction,
casts doubts on the feasibility of ETS for HH.
The present study has some limitations. The number
of cases (N = 31) may be considered low as compared
with that in other studies on ETS. In addition, we did
compare the ETS method with medical treatment meth-
odsintermsofpatient satisfaction.Furthermore,wedid
not use standardized questionnaires to assess quality
of life and patient satisfaction with ETS. Thus, the an-
swers we obtained in our interviews may be considered
“subjective.” As with all forms of “satisfaction,” the term
“patient satisfaction” is subjective. The development of
standardized questionnaires on quality of life and pa-
tientsatisfactionwithETSwouldimprovetheobjectivity
of patient responses.
CONCLUSION
ForHH,ETSistheonlytreatmentthathasbeenprovento
be successful in the long term. The two most important
factors affecting patient satisfaction after ETS are the
continuation of the PC and CH. Intermittent unilateral
ETS may be considered an alternative surgical approach
for CH, although the likelihood of CH may increase in the
long term. Furthermore, the PC of HH may regress with
age. This treatment should be described as temporary
(at least until the end of the adolescence period) rath-
er than permanent. The decision whether to perform
this surgery is up to the surgeon. However, the decision
whether to be treated with surgery for HH should be the
patients after all these data have been conveyed.
DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and de-
sign of the study and performed data analysis and inter-
pretation: Alar T and Gedik İ E.
Performed data acquisition, as well as provided admin-
istrative, technical, and material support: Alar T and
Timuçin ALAR et al 29
ANT PUBLISHING CORPORATION
Published online: 27 December 2019
5. Gedik İ E.
Conflicts of interest
Allauthorsdeclarethattherearenoconflictsofinterest.
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