Dr. Walinjom Joshua presented on persistent truncus arteriosus, a congenital heart defect where a single arterial trunk arises from the heart, supplying the systemic circulation, pulmonary circulation, and coronary arteries. The key features are a large ventricular septal defect below the arterial trunk and a commonly incompetent truncal valve with two to four leaflets. Patients typically present within the first two weeks of life with cyanosis and congestive heart failure. Diagnosis is made using echocardiography, chest x-ray and electrocardiogram. Surgical repair is usually performed within the first month of life to separate the pulmonary and systemic circulations.
Persistent truncus arteriosus (or patent truncus arteriosus), also known as Common arterial trunk, is a rare form of congenital heart disease that presents at birth. In this condition, the embryological structure known as the truncus arteriosus fails to properly divide into the pulmonary trunk and aorta. This results in one arterial trunk arising from the heart and providing mixed blood to the coronary arteries, pulmonary arteries, and systemic circulation
Persistent truncus arteriosus (or patent truncus arteriosus), also known as Common arterial trunk, is a rare form of congenital heart disease that presents at birth. In this condition, the embryological structure known as the truncus arteriosus fails to properly divide into the pulmonary trunk and aorta. This results in one arterial trunk arising from the heart and providing mixed blood to the coronary arteries, pulmonary arteries, and systemic circulation
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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!
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. Plan
• Definition
• Epidemiology
• History
• Embryology
• Anatomy and classification
• Pathophysiology
• Presentation
• Workup
• Treatment
• Conclusion 3
4. • Congenital cyanotic cardiac defect with a
single common arterial trunk giving rise to
systemic, pulmonary and coronary circulations
proximal to brachiocephalic branches
• Associated with a large perimembranous VSD
below the truncus
4
5. Epidemiology
TA is responsible for 0.21%-0.34 % of congenital heart
defects
Incidence has been found to be 0.03-0.05/1,000 live
births.
5
9. 1798 – Wilson documents 1st case
1942 –Basic morphologic criteria - Lev
and Safir 1949 – Collet & Edwards
Classification
1962 – Ist Intracardiac repair conduit University of
Michigan
1967 – Ascending aortic allograft and valved conduit -
McGoon et al.
1971 – first conduit repair in infancy by Barratt-Boyes 9
13. Blood islands of cardiogenic
plate
Left and right endocardial tubes
Intra embryonic coelom (early
pericardial cavity)
Coalesc
e at
20
days
within
13
14. Left & right endocardial
tubes
Bulbous cordis
Fus
e at
23
days
14
19. Truncal septum divides
aorta from
Pulmonary artery and Conal
septum
Supraventricular crest and
subpulmonic infundibulum
19
20. Day
37Fusion of conal septum
with
endocardial cushions
establishes
ventricular separation
20
21. Anatomic Defects
• Single aortopulmonary trunk from base of heart
• Large perimembranous VSD (obligatory) below truncus
• Truncal valve – bi, tri or quadricuspid and often incompetent.
• Pulmonary artery arise in several patterns
• Truncal overriding equally in 60 – 80%,
to right in 10-30%,
left in 4 – 6%
21
22. • Anatomic Defects
• There is a single truncal valve with two, three,
or four leaflets. It is often incompetent,
resulting in regurgitation (backflow of blood).
• A large perimembranous ventricular septal
defect (VSD) is present directly below the
truncus in all cases. This allows for mixing of the
pulmonary and systemic venous blood and
equal pressures in both ventricles.
22
23. • The coronary arteries are frequently abnormal.
• 30% have a right aortic arch
• 33% of individuals with truncus have DiGeorge
syndrome.
23
24. • Anatomic Defects
• Truncal valve – bi, tri or quadricuspid and often incompetent.
24
26. Coronary anomalies
• Stenotic ostia,
• Single ostium
• high & low take off,
• abnormal branching & course
anterior descending from RCA & cross RV
circumflex from RCA
RCA from LAD
intramuscular course
26
27. • Right aortic arch – 30%
• Interrupted aortic arch – 10% (distal to left common carotid)
• Di George syndrome with hypocalcemia - 33%
• PFO
• OS-ASD
• Tricuspid valve lesions
• 22q11 chromosome deletion
27
28. Classification
Type 1
single pulmonary trunk from the left lateral aspect of the
common trunk,
with branching of the left and right pulmonary arteries from the
pulmonary trunk
28
41. Type A3 (hemitruncus)
• one branch pulmonary artery (usually the right) from the
common trunk
• The other branch pulmonary artery from the aortic arch (a
subtype of Collett and Edwards type III) or by systemic to
pulmonary arterial collaterals
41
45. Cyanotic al heart disease with increased pulmonary blood
flow
Fetal pulmonary blood flow less than 10%
PVR falls in early infancy improving PBF hence good
oxygen saturation
Hypoxia in this period implies pulmonary arterial narrowing
Equilibration of RV LV pressures
45
46. The physiology of TA is largely related to the
volume of blood flowing to the pulmonary circuit.
This is affected by:
1.The degree of pulmonary vascular resistance
2.The degree of truncal valvular insufficiency
3.The severity of any aortic arch abnormalities
46
47. 1. Pulmonary vascular resistance
•At birth the pulmonary vascular resistance is high
enough to prevent left-to-right shunting, which
restricts the amount of blood that can flow to the
pulmonary system.
•As this resistance drops more blood flows to the
pulmonary system, the amount of fluid overloads the
system, and heart failure begins. 47
48. Heart failure can begin within several
weeks of birth and present by
6 months of age in patients with TA.
48
49. 2 . Truncal valvular insufficiency
•The degree of regurgitation or stenosis of
the truncal valve causes additional ventricular
volume.
•The myocardium then requires greater amounts
of oxygen, which leads to coronary artery
ischemia and ventricular dysfunction.
•Together, this also contributes to the onset and
severity of heart failure. 49
50. 3. Aortic arch abnormalities
•Patients with interrupted aortic
• arches or coarctation require
•the ductus arteriosus for
• alleviating pressure overload
•in the ventricles and allowing for
• blood flow distally
50
51. • The magnitude of pulmonary blood flow (PBF) is
determined by the size of the pulmonary artery.
• If PBF is excessive, congestive heart failure
(CHF) may occur as a result of volume overload
placed on the ventricle.
• If PBF is small, the infant may appear more
cyanotic (blue) with no CHF symptoms.
51
52. • Most infants present with cyanosis or symptoms
of CHF within the first two weeks of life if not
diagnosed prenatally.
• Truncus arteriosus occurs in less than 1% of
congenital heart defects.
52
53. Cyanotic congenital heart disease with increased pulmonary
blood flow
Fetal pulmonary blood flow less than 10%
PVR falls in early infancy improving PBF hence good
oxygen saturation
Hypoxia in this period implies pulmonary arterial narrowing
Equilibration of RV LV pressures
53
54. As the PBF increases PAH
Increased pulmonary venous return
CCF
54
55. History
• Cyanosis at birth
• Early CCF
• Failure to thrive,
• Respiratory tract infections
55
56. . Cyanosis in patients with TA is due to the mixing of pulmonary
and systemic blood.
. Most patients with TA are diagnosed within one week of birth –
after pulmonary vascular resistance decreases and the ductus
arteriosus closes.
Patients present with cyanosis and respiratory distress from
pulmonary congestion and onset of heart failure.
56
58. .Some patients also present with a murmur.
.Pulmonary congestion and heart failure can manifest as:
.Poor feeding
.Lethargy
.Respiratory distress (tachypnea, subcostal retractions, nasal
flaring, grunting)
.Tachycardia
.Hyperdynamic precordium
. Hepatomegaly
58
59. Bounding peripheral pulses and a wide pulse pressure are
present.
An early diastolic murmur of truncal regurgitation may be heard.
Occasionally,
a harsh, regurgitant systolic VSD murmur may be heard along
the left sternal border.
59
60. A systolic click
may be heard at the apex and upper left sternal border and S2
is single.
If pulmonary blood flow is excessive, an apical diastolic
rumble with or without gallop rhythm may be present.
60
62. Survival
50% survival in 1 month
18% survival in 6 months
12% survival in 1 year
Modes of death
. Congestive heart failure in early life
. SBE, cerebral abscess → Eisenmenger syndrome (death in 3rd
decade)
. Adversely affected by truncal regurgitation, IAA, CoA
. Survival is favorably affected by PS
62
63. Prenatal and early postnatal diagnosis common
Proper evaluation of cyanotic infants clinches diagnosis
ABG
Pulse oximetry
ECG
CXR
TTE,
TOE
63
64. Diagnostics:
Chest X-ray: Cardiomegaly (enlarged heart) with
increased pulmonary vascular markings.
EKG: Normal QRS axis. Biventricular hypertrophy is
present in 70% of children.
Echocardiogram: Diagnostic.
64
72. 72
Patients with TA are initially medically managed to stabilize
them for surgery.
Medications include:
• Diuretics to manage volume overload
• Inotropes (e.g. dobutamine or dopamine) for cardiac
contractility,
• ACE inhibitors to reduce afterload
Ventilation
• Prostaglandin E1 is given to patients with severe aortic
coarctation to maintain patency of the ductus arteriosus.
73. 73
Surgery is usually performed within 30 days of birth.
A typical procedure:
1.Removes the pulmonary arteries from the truncus and
reattaches them to the right ventricle
2. Opens and repairs the truncus
3. Closes the VSD..
74. 74
Perioperative mortality is 10%
The risks of not intervening are so great that most patients
undergo primary surgical repair.
Long-term survival:
90% at 5 years after primary repair
85% at 10 years
83% at 15 years
75. 75
After surgery, all patients with TA are followed by pediatric
cardiologists.
Prognosis for patients with unrepaired TA is poor and
patients usually do not survive without surgical
intervention.
For patients without repair, the mean age of survival is 5
weeks and 85% do not survive to 12 months of age.