This systematic review analyzed studies on the timing of cholecystectomy after mild biliary pancreatitis. It found that interval cholecystectomy after hospital discharge was associated with a high risk (18%) of readmission for recurrent biliary events like pancreatitis before the surgery. Cholecystectomy during the initial admission appeared safe with no reported readmissions, though selection bias could not be ruled out. Patients who had ERCP had fewer recurrent issues (10% vs 24%), especially less recurrent pancreatitis (1% vs 9%). Operative complications and mortality did not differ between early and interval surgeries.
Background: Nonalcoholic Fatty Liver Disease (NAFLD) is the most common liver disease in the developed countries. Patients with Nonalcoholic Steatohepatitis (NASH), a subset of NAFLD, are at risk for progressive liver disease and in need of effective treatment options. There is a lack of data assessing sleeve gastrectomy and their effect on NAFLD.
Objective: To assess the effects of Sleeve Gastrectomy (SG) on NAFLD.
Methods: An online search of PubMed, Medline, and Google Scholar was independently carried out by two researchers using key words like Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steato-Hepatitis, Bariatric Surgery, Obesity Surgery, Sleeve Gastrectomy and Liver Biopsy, percutaneous liver biopsy, to identify all articles. Articles were also identified from references of relevant articles. All sleeve gastrectomies that had ntraoperative and postoperative liver biopsies were included.
Background: Nonalcoholic Fatty Liver Disease (NAFLD) is the most common liver disease in the developed countries. Patients with Nonalcoholic Steatohepatitis (NASH), a subset of NAFLD, are at risk for progressive liver disease and in need of effective treatment options. There is a lack of data assessing sleeve gastrectomy and their effect on NAFLD.
Objective: To assess the effects of Sleeve Gastrectomy (SG) on NAFLD.
Methods: An online search of PubMed, Medline, and Google Scholar was independently carried out by two researchers using key words like Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steato-Hepatitis, Bariatric Surgery, Obesity Surgery, Sleeve Gastrectomy and Liver Biopsy, percutaneous liver biopsy, to identify all articles. Articles were also identified from references of relevant articles. All sleeve gastrectomies that had ntraoperative and postoperative liver biopsies were included.
Right side diverticulitis, differential diagnosis of complicated appendicitis...Juan de Dios Díaz Rosales
The case of a 23 year-old female patient who had emergency surgery for presumed appendicitis is presented. During surgery, after appendicitis was discarded, diagnosis of cecal diverticulitis with a perforated phlegmon was made, and an ileocecal resection done. Histopathological analysis confirmed a diverticulum with chronic inflammation and acute exacerbation. The objective of this paper is to present a case that could mimic a common diagnosis.
review of literature for transjugular intrahepatic portosystemic shunt placement and balloon occluded retrograde transvenous obliteration in management of patients with varices hemorrhage
Chronic diarrhea as a result of colonic fistulas -two case reports with different origin. When it comes to chronic diarrhea symptom, the first thing
one thinks of is never a surgical cause, but an infectious disease. The aim of this paper is to show 2 different cases of chronic diarrhea, resulting from
benign surgical causes - colonic fistula. The first case is a result of cholecystocolic fistula, while the second is the result of gastrojejunocolic fistula.
Colonic fistulas originate from different causes: malignancy, NSAID, diverticulosis of the colon, cholecystitis, pancreatitis, lymphoma, or after radiation
therapy. They can also result from a trauma, which can be post-surgical.
Introduction:
Cholecystocolic fistula occurs as a result of the inflammation of the gallbladder. It arises from existing adhesions. The incidence rate
is not high, but the complication is not a rarity per se. It is less frequent complication than cholecystoduodenal fistula. The main symptoms are secretory
diarrhea, vitamin K malabsorption and weight loss, and thus suspicion of malignancy is usual. The treatment is surgical removal of the gallbladder,
fistula and part of the colon en bloc.
Case report:
A 73-year old male patient was admitted to the department after 5 months of medical treatment. Laboratory tests, coproculture,
colonoscopy, abdominal ultrasonography, and gastroduodenoscopy were performed - the diagnosis was not established. The diagnosis was made by
means of irrigography and short and narrow cholecystocolic fistula was confirmed. The possibility of malignant disease was not completely excluded.
The patient underwent surgery after parental nutrition-adhesions, gallbladder, and the prepared fistula were removed as well as the longitudinal part
of the transverse colon, which was simultaneously repaired. Ex-tempore diagnosis-the surgical specimen originated from inflammation, not from
malignancy. The post-operative course was uneventful. The first post-operative stool was normal. The patient gained some weight after a few months.
Conclusion:
Along with the contemporary diagnostics methods, contrast examination plays an important diagnostic role. When infection is
excluded as the cause of chronic diarrhea, cholecystocolic fistula should be considered. Malignant disease should be excluded before the surgery, or it
may be diagnosed during the surgery, which would determine the course of the treatment. The treatment of benign cholecystocolic fistula is surgical
en bloc procedure.
Primary sclerosing cholangitis (PSC) and inflammatory bowel disease are strongly related, as 71% of patients with PSC have
ulcerative colitis (UC) and it seems that both diseases have shared genetic factors. IBD-PSC has different characteristics than IBD only. In patients with UC and PSC, the more common form of disease is pancolitis, and in Crohn’s disease patients with PSC is colitis. Also, IBD with concomitant PSC is less active and occurs at an earlier age. PSC is an additional risk factor for colorectal neoplasia in IBD patients and IBD increases the risk of developing gallbladder cancer and cholangiocarcinoma in PSC.
Background: The precise evaluation of hepatic fi brosis is crucial in the management of Chronic Hepatitis C (CHC). Multiple noninvasive serological scores and devices have been used in the accurate prediction of fibrosis however; early changes in non-invasive
biomarkers of liver fibrosis following antiviral therapy are widely unknown. We aim to evaluate changes of liver stiffness and 6 noninvasive serological fibrosis scores, easy to calculate particularly in poor areas, following sofosbuvir- based treatment.
Methods: This is a cohort study that included 155 CHC Egyptian patients. Transient elastography values were recorded as well
as Aspartate Aminotransferase-To-Platelet Ratio Index (APRI), FIB-4, Lok score, fibrosis index, King Score and fibro Q score were calculated at baseline and 12 weeks post-treatment.
Right side diverticulitis, differential diagnosis of complicated appendicitis...Juan de Dios Díaz Rosales
The case of a 23 year-old female patient who had emergency surgery for presumed appendicitis is presented. During surgery, after appendicitis was discarded, diagnosis of cecal diverticulitis with a perforated phlegmon was made, and an ileocecal resection done. Histopathological analysis confirmed a diverticulum with chronic inflammation and acute exacerbation. The objective of this paper is to present a case that could mimic a common diagnosis.
review of literature for transjugular intrahepatic portosystemic shunt placement and balloon occluded retrograde transvenous obliteration in management of patients with varices hemorrhage
Chronic diarrhea as a result of colonic fistulas -two case reports with different origin. When it comes to chronic diarrhea symptom, the first thing
one thinks of is never a surgical cause, but an infectious disease. The aim of this paper is to show 2 different cases of chronic diarrhea, resulting from
benign surgical causes - colonic fistula. The first case is a result of cholecystocolic fistula, while the second is the result of gastrojejunocolic fistula.
Colonic fistulas originate from different causes: malignancy, NSAID, diverticulosis of the colon, cholecystitis, pancreatitis, lymphoma, or after radiation
therapy. They can also result from a trauma, which can be post-surgical.
Introduction:
Cholecystocolic fistula occurs as a result of the inflammation of the gallbladder. It arises from existing adhesions. The incidence rate
is not high, but the complication is not a rarity per se. It is less frequent complication than cholecystoduodenal fistula. The main symptoms are secretory
diarrhea, vitamin K malabsorption and weight loss, and thus suspicion of malignancy is usual. The treatment is surgical removal of the gallbladder,
fistula and part of the colon en bloc.
Case report:
A 73-year old male patient was admitted to the department after 5 months of medical treatment. Laboratory tests, coproculture,
colonoscopy, abdominal ultrasonography, and gastroduodenoscopy were performed - the diagnosis was not established. The diagnosis was made by
means of irrigography and short and narrow cholecystocolic fistula was confirmed. The possibility of malignant disease was not completely excluded.
The patient underwent surgery after parental nutrition-adhesions, gallbladder, and the prepared fistula were removed as well as the longitudinal part
of the transverse colon, which was simultaneously repaired. Ex-tempore diagnosis-the surgical specimen originated from inflammation, not from
malignancy. The post-operative course was uneventful. The first post-operative stool was normal. The patient gained some weight after a few months.
Conclusion:
Along with the contemporary diagnostics methods, contrast examination plays an important diagnostic role. When infection is
excluded as the cause of chronic diarrhea, cholecystocolic fistula should be considered. Malignant disease should be excluded before the surgery, or it
may be diagnosed during the surgery, which would determine the course of the treatment. The treatment of benign cholecystocolic fistula is surgical
en bloc procedure.
Primary sclerosing cholangitis (PSC) and inflammatory bowel disease are strongly related, as 71% of patients with PSC have
ulcerative colitis (UC) and it seems that both diseases have shared genetic factors. IBD-PSC has different characteristics than IBD only. In patients with UC and PSC, the more common form of disease is pancolitis, and in Crohn’s disease patients with PSC is colitis. Also, IBD with concomitant PSC is less active and occurs at an earlier age. PSC is an additional risk factor for colorectal neoplasia in IBD patients and IBD increases the risk of developing gallbladder cancer and cholangiocarcinoma in PSC.
Background: The precise evaluation of hepatic fi brosis is crucial in the management of Chronic Hepatitis C (CHC). Multiple noninvasive serological scores and devices have been used in the accurate prediction of fibrosis however; early changes in non-invasive
biomarkers of liver fibrosis following antiviral therapy are widely unknown. We aim to evaluate changes of liver stiffness and 6 noninvasive serological fibrosis scores, easy to calculate particularly in poor areas, following sofosbuvir- based treatment.
Methods: This is a cohort study that included 155 CHC Egyptian patients. Transient elastography values were recorded as well
as Aspartate Aminotransferase-To-Platelet Ratio Index (APRI), FIB-4, Lok score, fibrosis index, King Score and fibro Q score were calculated at baseline and 12 weeks post-treatment.
COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY (STUDY OF 50 ...KETAN VAGHOLKAR
Background: Laparoscopic cholecystectomy is a new alternative to the traditional open approach for
treating calculous cholecystitis. It is, therefore, necessary to assess the efficacy of laparoscopic cholecystectomy over the
open cholecystectomy. Objectives: To compare the surgical outcomes of laparoscopic cholecystectomy with those of open
cholecystectomy. Materials and methods: 50 patients diagnosed as symptomatic cholelithiasis proven by radiological
investigations were distributed into two groups of 25 each. Group A patients were subjected to laparoscopic cholecystectomy, and group B patients underwent open cholecystectomy. The surgical outcomes were studied prospectively.
Intraoperative complications and postoperative care parameters were evaluated. Results: Mean age of patients in group
A was 46.68±13.6 years, and in the group, B was 42.64±14.1 years. Majority of patients were in the age group of 41 to 60
years. Patients who had diabetes in group B developed wound infections, whereas diabetic patients in group A did not
develop any infection. Significant bleeding necessitating blood transfusion occurred in one patient belonging to group B.
The duration of postoperative analgesia required was 3.16 days in group A and 5.16 days in group B. The duration of
postoperative antibiotics administered in laparoscopic and open cases was 1.48 and 4.8 days, respectively. One of the
patients in group A developed a postoperative biliary leak, whereas none in group B had any such complication. The
commencement of oral feeds and after that return of bowel movements was earlier in group A than group B. The mean
hospital stay was 4.5 days in group A as compared to 6.3 days in group B. Conclusion: Laparoscopic cholecystectomy
is superior to open cholecystectomy regarding reduced postoperative discomfort and pain, antibiotic and analgesic
requirement, early commencement of oral feeds, and shorter duration of hospitalization
Surgical vs Conservative Management of Colonic DiverticulitisVedica Sethi
Abstract Colonic diverticulitis is an undeniably common Western disease related with a high mortality and cost of treatment. Improvement in the comprehension of the medical aspect as well as the surgical procedures, alongside progression in the conclusion and clinical administration has prompted ongoing changes in treatment proposals. The common history of diverticulitis is more severe than recently suspected, and current patterns favor increasingly traditionalist, less intrusive administration. In spite of current proposals of progressively prohibitive signs for medical procedure, practice patterns demonstrate an expansion in elective procedures being performed for the treatment of diverticulitis. Because of variable presentation of the disease introduction, much of the time, ideal careful treatment of intense diverticulitis stays muddled as to persistent choice, timing, and specialized methodology in conservative, medical, elective and urgent settings. This paper reviews the treatment proposals for careful management of diverticulitis, a comparative study between present management of Diverticulitis. Key Words: Diverticulitis, conservative, medicine, surgery
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.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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
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.