The document discusses tracheo-esophageal fistula, a birth defect where the trachea and esophagus are connected by an abnormal passageway. It describes the embryology, classification, clinical presentation including signs, anesthetic considerations for repair surgery, surgical repair techniques including conventional open and endoscopic methods, risks, and postoperative care. The prognosis is guarded as recurrent fistulas and long-term complications like esophageal stricture and lung disease are common.
Pre-oxygenation is: safe, simple, cheap, effective, well-tolerated. This article provides a compelling argument in favour of pre-oxygenation prior to all general anaesthesia.
Intro to Hypoxic pulmonary vasoconstriction Arun Shetty
Hypoxic pulmonary vasoconstriction, a seldom heard phenomenon but very effective physiologic property which helps lungs utilise ventilation to the maximum
Pre-oxygenation is: safe, simple, cheap, effective, well-tolerated. This article provides a compelling argument in favour of pre-oxygenation prior to all general anaesthesia.
Intro to Hypoxic pulmonary vasoconstriction Arun Shetty
Hypoxic pulmonary vasoconstriction, a seldom heard phenomenon but very effective physiologic property which helps lungs utilise ventilation to the maximum
Tracheo oesophageal atresia and fistula A-Z for medical students
This powerpoint covers everything you need to know about tracheoesophageal fistula and atresia as a medical student.It is not intended for patients. Covers anatomy, embryology,types ,classification and treatment of tracheo-oesophageal fistula and atresia.
A developmental anomaly is a broad term used to define conditions which are present at conception or occur before the end of pregnancy. In the case of cerebral palsy, a small number also occur after birth. this is also a birth defect.
A Tracheoesophageal fistula is a congenital disease. It is a acquired communication between the trachea and esophagus. Most of the patient with TEF are diagnosed immediately following after birth.TEF are often associated with life threatening complications.
"ASSESSMENT OF RESPIRATORY FUNCTION".pdfDolisha Warbi
ASSESSMENT OF RESPIRATORY FUNCTION, history collection, physical examination, inspection, palpation, percussion, auscultation, diagnostic evaluation, care of the patient in respiratory intensive care and ventilator care, care of the patient with an endotracheal tube, after intubation, after removal of intubation, care of the patient with a tracheostomy tube, ventilator care
TEF is explained in very simple wording and style by the help of a scenario. Easy to remember and present due to interesting pictures. Helpful for medical students, parents having child with TEF and knowledge seekers.
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
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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.
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
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
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2 Case Reports of Gastric Ultrasound
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.
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. Tracheo-esophageal fistula
First noticed in 1697
Incidence: 1 in 3000 live
births
Embryology:
• division of foregut happens at 4th & 5th
week of intrauterine life
• imperfect division results in a
communication –fistula
• associated with other congenital
anomalies-
Vertebral anomalies-hemi-vertebra, hypoplastic vertebra
Anal defects
Cardiac defects-atrial septal defect, ventricular septal defect, tetralogy of fallot
(>15%)
Tracheo-Esophageal, esophageal atresia
Renal defects
Limb defects-hypoplastic thumb, polydactyl, syndactyl, radial aplasia.
6. Tracheo-esophageal fistula-Clinical presentation
• Early indicators
Polyhydramnios
Coiling of the nasogastric tube high up in the
esophagus
choking, cyanosis and coughing on oral feeding. (3
Cs)
Breathing leading to abdominal distension
• Clinical presentation depends on
1. Dehydration-proximal esophagus does not
communicate with stomach
2. Aspiration pneumonia-reflux of stomach contents
through the distal esophagus into the trachea.
8. Tracheo-esophageal fistula-Clinical presentation
1. Dehydration-hydrate adequately, correct
electrolyte imbalance
2. Aspiration pneumonia-if degree of reflex is
high, then a gastrostomy is planned to protect the
pulmonary system
3. Fistula repair is taken up if neonate is in good
health. It consists of ligation of fistula and
approximation of two ends of esophagus at 24-48
hours.
9. Tracheo-esophageal fistula-Clinical presentation
anesthetic considerations
1. Copious pharyngeal secretions warrant frequent suctioning
2. PPV-to be avoided-gastric distension
3. Awake intubation is safest
4. Avoiding PPV minimizes the risk of gastric distension from inspired gases
flowing through the fistula.
5. Alternatively, inhalational anesthetic may be used with gentle PPV
6. Once ET tube is in place, end-tidal CO2 and Oxygen saturation are monitored.
7. Stomach should be auscultated from time to time to see if there is distension.
10. Tracheo-esophageal fistula-Clinical presentation
anesthetic considerations
8. Placement of ET tube near or into the
fistula is to be avoided
9. Gastrostomy tube can be submerged
under water to see air bubbles as
confirmation that the fistula has been
intubated
10.Operative positions, patient’s anatomy
and surgical manipulation can all disturb
the ET tube position
11.After the fistula is ligated, anesthetist
passes a catheter from the nose into the
esophagus which meets the one from
the stomach
12. Tracheo-esophageal fistula-Repair
Conventional open Tracheo-esophageal closure
1. Tracheal intubation can be done in three ways
Using an inhalation induction with topical spray of lidocaine. Intubating while the
infant is breathing spontaneously.
Intravenous or inhalational induction agents are employed and muscle paralysis
is additionally achieved using relaxants before intubation is attempted.—associated
complication might be in the form of a fistula distending secondary to excessive
PPV. The same sort of dilatation is seen in the stomach. All attempts therefore must
aim at minimising distension of stomach and potential for reflux during controlled
ventilation.
Awake intubation with mild sedation. Advantage being airway is protected from
aspiration.
13. Tracheo-esophageal fistula-Repair
Conventional open Tracheo-esophageal closure…continued
First attempted in 1943
Involves surgical division of fistula and esophageal anastamoses
via right extra pleural thoracotomy with patient in left lateral position.
Precordial + axillary stethoscopes (main bronchus may get blocked)
14. Tracheo-esophageal fistula-Repair
Associated risks
1. ET tube placement just distal to the fistula is beneficial and can be achieved by
initially Intubating one lung and then slowly withdrawing the ET tube until
bilateral chest expansion is witnessed.
2. However, the ET tube might inadvertently enter the fistula during repositioning of
the infant or during surgical manipulation.
3. Difficult ventilation, decreasing levels of oxygen saturation and end tidal carbon-
di-oxide are indicators towards fistula intubation.
4. Immediate steps include stopping the surgery and requesting the surgeon to
feel for the tip of the ET tube.
15. Tracheo-esophageal fistula-Repair
Associated risks
5. The handling of the H type fistula is particularly difficult and calls for the use of
direct laryngoscopy and bronchoscopy.
6. Following this a guide wire is introduced into the trachea and then threaded
through the fistula into the Oesophagus (distal). Then ET tube is intubated into
the trachea taking care not to dislodge the guide wire. Now an endoscopy is
performed and guide wire pulled out through the mouth. Fluoroscopy helps the
surgeon to decide between a cervical or a thoracic approach.
7. During localisation of the fistula, an anaesthesiologist can aid the surgeon by
applying traction to the wire loop.
16. Tracheo-esophageal fistula-Repair
Endoscopic Tracheo-esophageal repair
• The infant is kept spontaneously breathing until the fistula is ligated.
• Spontaneous ventilation is particularly difficult in neonates as their tolerance to
volatile agents is limited.
17. Tracheo-esophageal fistula-Repair
Post operative care
• Need for ventilation arises secondary to
Compression of lung for several hours
Pre-existing aspiration pneumonia
Is always preferred in the backdrop of other coexistent congenital anomalies
Care is taken to avoid neck extension and instrumentation of esophagus which
might disrupt the surgical repair.
Prognosis
• Is guarded. It is not just a anatomical aberration.
Recurrent fistulas are a major concern
Esophageal stricture, reflux disease are seen years down the line.
High incidence of restrictive & obstructive lung disease has been recorded.