A Question and Answer session was held during a Tweetinar on
Spine Problems – Symptoms and Cure,
conducted on the 30th of October 2012.
It was a live discussion with Doctor Sajan K Hegde -Senior Consultant, Spine Surgeon, Apollo Hospitals, Chennai
Implementation of the trend marker protocol results in a unique graphical presentation when a hormone and a symptom are plotted as per the day of menstrual cycle. This presentation will indicate behavior of the hormone in relation to the disease independent of whether the hormone levels are normal or abnormal as per the set laboratory limits.
Immunology of Type I Diabetes: The Journey from Animal Models to Human Therap...Apollo Hospitals
Type I diabetes is primarily induced by an autoimmune process that destroys the pancreatic Beta cells. Genetic and environmental factors interplay to bring about an “insulitis”. Given that antibodies to GAD are detectable years before type I diabetes develops, there is a potential for treating and preventing the onset of this autoimmune process even before there is an irreversible pancreatic dysfunction.
Neurocritical Care Triad - Focused Neurological Examination, Brain Multimodal...Apollo Hospitals
Intensive care is rightly described as “an art of managing intense intricacy” and this situation is further complicated in the care of patients with critical neurological illness. Brain
damage directly related to an insult is primary brain injury (PBI). The cascade of pathobiological events following PBI is known as secondary brain injury (SBI). PBI is most often
irreversible so, the focus of neurocritical care is to prevent, detect and manage SBI.
Predonated Autologous Blood Transfusion in Elective OrthopaedicApollo Hospitals
The use of homologous blood carries significant risk of viral infections and immune-mediated reactions.
Preoperative autologous blood donation is an attractive alternative to homologous transfusion and has become common
in elective orthopaedic surgery.
Implementation of the trend marker protocol results in a unique graphical presentation when a hormone and a symptom are plotted as per the day of menstrual cycle. This presentation will indicate behavior of the hormone in relation to the disease independent of whether the hormone levels are normal or abnormal as per the set laboratory limits.
Immunology of Type I Diabetes: The Journey from Animal Models to Human Therap...Apollo Hospitals
Type I diabetes is primarily induced by an autoimmune process that destroys the pancreatic Beta cells. Genetic and environmental factors interplay to bring about an “insulitis”. Given that antibodies to GAD are detectable years before type I diabetes develops, there is a potential for treating and preventing the onset of this autoimmune process even before there is an irreversible pancreatic dysfunction.
Neurocritical Care Triad - Focused Neurological Examination, Brain Multimodal...Apollo Hospitals
Intensive care is rightly described as “an art of managing intense intricacy” and this situation is further complicated in the care of patients with critical neurological illness. Brain
damage directly related to an insult is primary brain injury (PBI). The cascade of pathobiological events following PBI is known as secondary brain injury (SBI). PBI is most often
irreversible so, the focus of neurocritical care is to prevent, detect and manage SBI.
Predonated Autologous Blood Transfusion in Elective OrthopaedicApollo Hospitals
The use of homologous blood carries significant risk of viral infections and immune-mediated reactions.
Preoperative autologous blood donation is an attractive alternative to homologous transfusion and has become common
in elective orthopaedic surgery.
this dq is due for tomorrow 081818 You are working wit.docxgasciognecaren
this dq is due for tomorrow 08/18/18
You are working with Dr. Lee today. She hands you a triage note from the nurse regarding your next patient, Mr. Payne:
Forty-five-year-old white male truck driver complaining of two weeks of sharp, stabbing back pain. The pain was better after a couple of days but then got worse after playing softball with his daughter. This morning his pain is so bad that he had trouble getting out of bed.
Dr. Lee provides you some background information about low back pain.
TEACHING POINT
Low Back Pain Prevalence, Cost, & Duration
Low back pain (LBP) is the fifth most common reason for all doctor visits. In the U.S., lifetime prevalence of LBP is 60% to 80%. The direct and indirect costs for treatment of LBP are estimated to be $100 billion annually. Fortunately, most LBP resolves in two to four weeks.
Dr. Lee continues: "There are many causes for LBP. For presenting symptoms that have a broad differential diagnosis, I find it helpful to think of systems of etiologies in which diseases or conditions can be categorized."
TEACHING POINT
Common Causes of Back Pain
Musculoskeletal (MSK) and Non-MSK Causes of Back Pain
MSK Causes
Axial:
Degenerative disc disease
Facet arthritis
Sacroiliitis
Ankylosing spondylitis
Discitis
Paraspinal muscular issues
SI dysfunction
Radicular:
Disc prolapse
Spinal stenosis
Trauma:
Lumbar strain
Compression fracture
Non-MSK Causes
Neoplastic:
Lymphoma/leukemia
Metastatic disease
Multiple myeloma
Osteosarcoma
Inflammatory:
Rheumatoid Arthritis
Visceral:
Endometriosis
Prostatitis
Renal lithiasis
Infection:
Discitis
Herpes zoster
Osteomyelitis
Pyelonephritis
Spinal or epidural abscess
Vascular:
Aortic aneurysm
Endocrine:
Hyperparathyroidism
Osteomalacia
Osteoporosis
Paget disease
Dr. Lee suggests, "Now, let's look a bit more at the risk factors for mechanical low back pain that you can review with Mr. Payne during your history."
Dr. Lee continues, "The major task in treating back pain is to Now that you have a diagnosis of disc herniation with radiculopathy for Mr. Payne, let's discuss what would you like to do for him distinguish the common causes for back pain (95% of cases) from the 5% with serious underlying diseases or neurologic impairments that are potentially treatable."
TEACHING POINT
Risk Factors for Low Back Pain
Prolonged sitting, with truck driving having the highest rate of LBP, followed by desk jobs
Deconditioning
Sub-optimal lifting and carrying habits
Repetitive bending and lifting
Spondylolysis, disc-space narrowing, spinal instability, and spina bifida occulta
Obesity
Education status: low education is associated with prolonged illness
Psycho-social factors: anxiety, depression stressors in life
Occupation: Job dissatisfaction, increased manual demands, and compensation claims
TEACHING POINT
Red Flags For Serious Illness or Neurologic Impairment with Back Pain
Fever
Unexplained weight loss ...
Chronic pain is debilitating to individuals and to our economy, yet most treatments are based on the assumption that it is due to a physical cause. Once it is recognised that chronic pain is caused by our brain and central nervous system as part of a protective stress-processing response, then as this process is reversible, full recovery is possible.
SIRPA Ltd was set up to train health professionals to integrate into their own work the pioneering SIRPA approach, where the emphasis is on recovering from chronic pain, rather than management.
www.sirpauk.com
I was at lunch the other day with my medical biller. I am not her only client and she has a long list of specialties that she serves. I found out over salads that she has been suffering with lower back pain for two to three years. When she asked for my opinion, I requested that she give me a little history.
After six years of intermittent groin pain, Nadine sought medical care when her symptoms became worse. An MRI revealed a cartilage tear in her right hip and she was later diagnosed with bilateral hip dysplasia. When Nadine visited me for a second opinion, I found that her right hip was worse than her left and recommended a right hip periacetabular (Ganz) osteotomy.
In the months since her surgery, Nadine’s right hip pain has been resolved and she’s been able to return to her normal activities.
http://www.davidsfeldmanmd.com/patient-education/case-studies/nadine-hip-dysplasia
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
this dq is due for tomorrow 081818 You are working wit.docxgasciognecaren
this dq is due for tomorrow 08/18/18
You are working with Dr. Lee today. She hands you a triage note from the nurse regarding your next patient, Mr. Payne:
Forty-five-year-old white male truck driver complaining of two weeks of sharp, stabbing back pain. The pain was better after a couple of days but then got worse after playing softball with his daughter. This morning his pain is so bad that he had trouble getting out of bed.
Dr. Lee provides you some background information about low back pain.
TEACHING POINT
Low Back Pain Prevalence, Cost, & Duration
Low back pain (LBP) is the fifth most common reason for all doctor visits. In the U.S., lifetime prevalence of LBP is 60% to 80%. The direct and indirect costs for treatment of LBP are estimated to be $100 billion annually. Fortunately, most LBP resolves in two to four weeks.
Dr. Lee continues: "There are many causes for LBP. For presenting symptoms that have a broad differential diagnosis, I find it helpful to think of systems of etiologies in which diseases or conditions can be categorized."
TEACHING POINT
Common Causes of Back Pain
Musculoskeletal (MSK) and Non-MSK Causes of Back Pain
MSK Causes
Axial:
Degenerative disc disease
Facet arthritis
Sacroiliitis
Ankylosing spondylitis
Discitis
Paraspinal muscular issues
SI dysfunction
Radicular:
Disc prolapse
Spinal stenosis
Trauma:
Lumbar strain
Compression fracture
Non-MSK Causes
Neoplastic:
Lymphoma/leukemia
Metastatic disease
Multiple myeloma
Osteosarcoma
Inflammatory:
Rheumatoid Arthritis
Visceral:
Endometriosis
Prostatitis
Renal lithiasis
Infection:
Discitis
Herpes zoster
Osteomyelitis
Pyelonephritis
Spinal or epidural abscess
Vascular:
Aortic aneurysm
Endocrine:
Hyperparathyroidism
Osteomalacia
Osteoporosis
Paget disease
Dr. Lee suggests, "Now, let's look a bit more at the risk factors for mechanical low back pain that you can review with Mr. Payne during your history."
Dr. Lee continues, "The major task in treating back pain is to Now that you have a diagnosis of disc herniation with radiculopathy for Mr. Payne, let's discuss what would you like to do for him distinguish the common causes for back pain (95% of cases) from the 5% with serious underlying diseases or neurologic impairments that are potentially treatable."
TEACHING POINT
Risk Factors for Low Back Pain
Prolonged sitting, with truck driving having the highest rate of LBP, followed by desk jobs
Deconditioning
Sub-optimal lifting and carrying habits
Repetitive bending and lifting
Spondylolysis, disc-space narrowing, spinal instability, and spina bifida occulta
Obesity
Education status: low education is associated with prolonged illness
Psycho-social factors: anxiety, depression stressors in life
Occupation: Job dissatisfaction, increased manual demands, and compensation claims
TEACHING POINT
Red Flags For Serious Illness or Neurologic Impairment with Back Pain
Fever
Unexplained weight loss ...
Chronic pain is debilitating to individuals and to our economy, yet most treatments are based on the assumption that it is due to a physical cause. Once it is recognised that chronic pain is caused by our brain and central nervous system as part of a protective stress-processing response, then as this process is reversible, full recovery is possible.
SIRPA Ltd was set up to train health professionals to integrate into their own work the pioneering SIRPA approach, where the emphasis is on recovering from chronic pain, rather than management.
www.sirpauk.com
I was at lunch the other day with my medical biller. I am not her only client and she has a long list of specialties that she serves. I found out over salads that she has been suffering with lower back pain for two to three years. When she asked for my opinion, I requested that she give me a little history.
After six years of intermittent groin pain, Nadine sought medical care when her symptoms became worse. An MRI revealed a cartilage tear in her right hip and she was later diagnosed with bilateral hip dysplasia. When Nadine visited me for a second opinion, I found that her right hip was worse than her left and recommended a right hip periacetabular (Ganz) osteotomy.
In the months since her surgery, Nadine’s right hip pain has been resolved and she’s been able to return to her normal activities.
http://www.davidsfeldmanmd.com/patient-education/case-studies/nadine-hip-dysplasia
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
To interrupt blood supply to the acardiac twin in a case of TRAP sequence of monochorionic diamniotic multiple pregnancy to allow for continuation of the normal twin.
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Turner syndrome (gonadal dysgenesis) is one of the most common chromosomal abnormalities occuring 1 in 2500 to 1 in 3000 live-born girls. It is an important cause of short stature in girls and primary amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This review briefly summarises the current knowledge about the syndrome and the management strategies.
Due to pregnancy thyroid economy is affected with changes in iodine metabolism, TBG and development of maternal goiter. The incidence of hypothyroidism in pregnancy is quite common with autoimmune hypothyroidism being the most important cause. Overt as well as subclinical hypothyroidism has a varied impact on maternal and neonatal outcome. After multiple studies also, routine screening in pregnancy for hypothyroidism can still not be recommended. Management mainly comprises of dosage adjustments as soon as pregnancy is diagnosed based on results of thyroid function tests. The aim should be to keep FT4 at the upper end of normal range.
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Advances in the management of thalassemia have led to marked improvements in the life span and quality of life of children and young adults. This poses new challenges for the treating physicians. There is now increasing recognition that thalassemics have impaired bone health which is multifactorial in etiology. This paper aims to highlight the factors that predispose these patients to osteoporosis and suggests measures to minimise the impact on bone health.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Occupational Blood Borne Infections: Prevention is Better than CureApollo Hospitals
Viral infections like HIV, hepatitis Band C virus pose a big risk to the contacts of individuals with high risk behaviour as well as to the attending health care workers. Blood, semen, vaginal and other potentially infectious materials can transmit the infection to the susceptible contacts. Universal precautions should be strictly implemented during clinical examination, laboratory work and surgical procedures to prevent transmission to the health care providers. Health care workers should receive vaccination for hepatitis B infection. An inadvertent exposure should be managed with proper first aid and infectivity of the source and severity of exposure should be assessed. Severity of exposure is based on the nature and area of exposed surface, mode of injury and volume of infective material. Post-exposure prophylaxis (PEP) should be started as soon as possible after a proper counseling about the effectiveness of post-exposure prophylaxis, side effects and risk of carrying the infection to his familial contacts and its prevention.
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Apollo Hospitals
Storage of red cells causes a progressive increase in hemolysis. Inspite of the use of additive solutions for storage and filters for leucoreduction some amount of hemolysis is still inevitable. The extent of hemolysis however should not exceed the permissible threshold for hemolysis even on the 42nd day of storage.
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Apollo Hospitals
Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
Severe skin adverse drug reactions can result in death. Toxic epidermal necrolysis (TEN) has the highest mortality (30–35%); Stevens-Johnson syndrome and transitional forms correspond to the same syndrome, but with less extensive skin detachment and a lower mortality (5–15%). Hypersensitivity syndrome, sometimes called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), has a mortality rate evaluated at about 10%. It is characterised by fever, rash and internal organ involvement. Prompt diagnosis is vital, along with identification and early withdrawal of suspect medicines and avoidance of re-exposure to the responsible agent is essential. Cross-reactivity to structurally-related syndrome caused by Carbamazepine medicines is common, thus first-degree relatives may be predisposed to developing this syndrome. We report a case of DRESS secondary to use of Carbamazepine.
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
The spread of dengue and dengue haemorrhagic fever is increasing, atypical manifestations are also on the rise, although they may be under reported because of lack of awareness. We report two such cases of dengue hemorrhagic fever with hepatitis, intraocular hemorrhage, ARDS and myocarditis.
A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine revealed diffuse ossification of the anterior longitudinal ligament. This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level.
Pediatric Liver Transplant (LT) is now an established procedure for End Stage Liver Disease (ESLD) with biliary atresia being the commonest indication. Intensive pre-transplant evaluation, nutritional buildup and immunization are the fundamental pre-requisites of a successful LT. With improvement in surgical micro-anastomotic techniques and superior immunosuppressive regimens the success rate of pediatric LT is in excess of 90%. Most of the transplants in our country however are Living related, due to which a fairly large number of children expire awaiting a donor liver. There should be a concerted effort to evolve the cadaveric donation program, so that majority of the children are benefitted.
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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of 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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
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.
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.
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
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.
How to Give Better Lectures: Some Tips for Doctors
Spine Problems – Symptoms and Cure
1. TWEETINAR: Queries and Answers.
Topic : Spine Problems – Symptoms and Cure
Date : 30th October 2012
Dr. Dr.Sajan K Hegde
A Question and Answer session was held during a Tweetinar on
Spine Problems – Symptoms and Cure,
conducted on the 30th of October 2012.
It was a live discussion with Doctor Sajan K Hegde -Senior Consultant, Spine Surgeon, Apollo
Hospitals, Chennai
Some Questions Asked:
1) Jyotshana Maurya: Dear sir, my relative is suffering from gallbladder carcinoma for the last 8 months;
what’s the reason for the pain?
ANS: Dear Ms Jyotshana, Carcinomas (cancers) can spread to the spine and cause back pain and weakness
of the nerve supplies by a particular group of nerves. So it would be wise to rule out any spread of the
cancer to the bones. Please contact a spine surgeon to get further test.
2) Payel Sinha: Sir, I am suffering from pain below my right rib cage & upper right hip portion since Feb
2011. Last 2 months it has become chronic. Please suggest whom to consult - an orthopaedic or neuro? It’ll
be great if you can suggest any doctor's name -Kolkata.
ANS: Dear Ms Payel, Lumbar disc slips as they are commonly called can cause severe back pain with pain
radiating down the legs. More often than not they are relieved by medications and physiotherapy. Rarely
do they require surgery. So if your symptoms are bothering you too much inspite of medicines and
physiotherapy, you might need a surgery. However, the decision has to taken after being seen by a spine
surgeon.
3)Satyabrata Shatpathi: Sir, my mother has same problem at her waist. This is chronic disease for her. I had
taken her to many doctors but nothing happened. What can I do now give me the suggestion please.
ANS:Mr. Shatpathi, pain at the waist can be due to a variety of reason, including from the spine. If the
pain is from the low back region with any pain going down the legs and difficulty in walking, then it
would be wise to be seen by a spine surgeon who will probably take x-rays after an examination to
determine the exact nature of the problem.
4)Shayeka Sayyed: My mother is 50yrs of age, she has a spinal cord problem , from 1 year 2 months, what is
the best suggestion to treat this problem?
ANS:Mr. Sayyed, your question is a bit vague and suggests that you are probably
2. referring to low back pain. It would be nice if you can get back to us with the exact nature of the problem.
5)Shiva Kumar: After spinal cord operation(d1,d2,d3), my dad, 54years old, is not able to walk. What is the
solution for him?
ANS:Dear Mr Kumar, Please mention as to what the nature of the disease for which the surgery was
done, if your father had inability to walk before surgery? We will be in a better position to advise you if
we can see your dad and all the necessary reports.
6)Lokesh Jagwani: Sir, my lumbar vertebrae(L4 and L5)are bigger than normal size(acc to an orthopaedics,
sacralisation of lumber due to which there is severe pain. What's the treatment?
ANS: Dear Mr Jagwani, sacralisation is a normal phenomenon in many individuals. As such they do not
cause any pain. If at all there is pain in the low back it could be because of any adjoining degeneration
that is a normal occurrence with age. It would be good to consult a spine surgeon for appropriate
treatment.
7) Namrata Sharma: My mother is 65. She is having nerve compression at L4 and L5. She is not able to
balance herself. Surgery is suggested please advice
ANS: Dear Ms Namratha, Nerve compression by a degenerated disc especially can be quite bothersome, if
not relieved by medications and physiotherapy. Kindly get back with further details regarding the
duration of the pain and exact reports. We will be definitely able to help treat the problem.
8) Sangbou M Kangshou:
Is there any possibility to cure curve spinal cord at your hospital?
ANS: Dear Sir/Ms. Definitely there is a treatment for the condition you are mentioning. Scoliosis or
curvature of the spine can be treated surgically with the correction of the deformity to the extent
possible. But to suggest specifically we would like to see the x-rays of the patient and the patient too.
However the advent of latest technology like robotic guided surgery has made this surgery much more
accurate and safer. Please send the details and we shall do accordingly.
9) Prasoon Bharghav:
My father has spine problem, sir please give a solution?
ANS: Dear Mr Bhargav, the question is too vague and does not indicate which region of the spine he is
affected with. Please furnish more details about the nature of the problem like the history and the
reports available so that we can have a look at them and revert back to you regarding the treatment
aspects possible.
3. 10) Minaal Iyer:
A friend of mine has a continuous lower back pain, which is intense, also have difficulty in sleeping.
ANS: Dear Ms Iyer, your friend could be suffering from degenerative disc disease which is a age related
process and aggravated by certain activities. Our suggestion would be to consult a spine surgeon so that
after appropriate tests and examination, a treatment can be suggested. Majority of the times the pain
subsides with medications and a good physiotherapy.
11) Nasir Ul Islam:
I have Schmorl's node formatio in L3 and L4. Please suggest some treatment.
ANS: Dear Mr Nasir, Schmorls node can be a normal incidental finding on the MRI. However it would be
wise to see what it the cause of the back pain if any.
12) Shashi Prabha:
My son is suffering from ankyolising spondo arthorightice. Is there some medicine?
ANS: Dear Ms Prabha, Ankylosing spondylitis is chronic gene related arthritis of multiple joints of the
body, which can lead to stiffness and deformity. The treatment has to be medical, physiotherapy, and
surgery if required for the correction of the spine deformity and for the mobilisation of the joints. Please
do get back to us with further details, so that we can advise you more suitably. But there are definitely
medications to slow the progression of the disease process and improve the quality of life.
13) Babali Dhamecha:
My father is 70 years-old and suffering from spinal cords problem. Doctor said L4/L5 between 2 vertebra a
pad is slash that was Nerve press there, as shown in MRI.
ANS :Dear Mr Dhamecha, L4-5 disc slip as it commonly called is a pressure on the nerves coming to the
leg by the disc and might require a surgery if the symptoms are not relieved by the medications and
physiotherapy. However the decision to operate shall depend on the localisation of the pain source and
how bothersome the symptoms are to the patient. So I would like to see the reports and the patient once
before proceeding further.
14) Leena George:
I have pain at the back of my neck i.e. in cervical region. What should I do for that?
ANS: Dear Ms Leena, you require a thorough evaluation of the neck with a x-ray and further test if
required.
4. 15) Nilofar Neemz:
Please give some suggestions to relieve pain from slip disc. Why is the pain more severe in winter?
Dear Ms Nilofar, pain from disc degeneration is often treated with medications and physiotherapy.
However specifically in your case I will be able to suggest only after examining you and the reports.
16) Jayanta Majumdar:
Name of patient- Rina(F), age-3 MRI Report dated 13/9/12 MRI of Lumbo-Sacral Spine reveals1.
1) Circumferential disc bulge at L4-L5 level. Posterocentral & B/L L5 nerve roots, more on right side.
2). Minimal posterior disc bulge at L5-S1 levels. What is her remedy?
ANS: The report you have enclosed in the question is a vague indicator of the problem as often the
findings on the MRI and the symptoms of the patient do not match and so it is imperative to see the
patient once, listen to their complaints and see the films of the MRI before taking a decision on the
nature of the treatment.
17) Vismay Chavda: What is treatment for LBP due to L5 lysis.
ANS. Lbp due to lysis of the L5 is a common occurrence in young adults though it can be seen in any age.
It often causes back pain and radiation down the legs, again the treatment of the problem is based on the
symptoms of the patient and the trouble caused rather than the x ray findings. However the risk of one
vertebra slipping over the other is always there and has to watched out for.
18) Baquer Zaidi: Please tell me what is the management of cervical spendolosis?
ANS: Cervical spondylosis is a broad term encompassing the whole spectrum of the degenerative
changes in the cervical spine causing the pain in the neck radiating down in to the arms, numbness
tingling and unsteadiness in walking in severe cases. It requires a thorough examination and appropriate
tests to find out the exact nature of the degeneration and the treatment necessary for the same. Please
feel free to contact us.
19) Johnson Philem: Hello sir, I'm a paraplegic & the cause of my injury is by a bullet. My level is T12. It’s
been about 12 years old & I'm still taking pain killers. But it’s not helping still. I want to know more about
nerve block. I am thinking of coming to Apollo. I am losing a lot of hair this year. I don’t know what to do. I
am taking a very heavy dose of pain killers.
5. ANS: Dear Mr Philem, pain in paraplegia can be due to a variety of reasons. And hair fall is not a
connected problem. Having said that, we would be glad to help you in determining the cause of your pain
and better rehabilitation if you can come down with all the reports.
20) Eiffer Goetz: My friend has severe scoliosis. Kindly suggest.
ANS: Dear Mr Goetz, Scoliosis of that degree needs to be corrected. Please furnish further details or come
down so that we can have a look and treat you better.
21)Chanambam Sarita: 62 years old man have a problem between D10-L5. Either it needs surgery or
medicine. How to improve? Please suggest.
ANS: Dear Ms Sarita, the question is vague and needs further details please do mail in further details and
will deal with the problem accordingly.
22) Vishav Puri: Whenever my acidity increases, the next day when I wake up that time my back pains. Any
suggesting sir? One more thing sir I also suffered from disc problem last year till now I feel pain on that
place.
Ans: Dear MR Puri, back pain has to be evaluated and not neglected. Please consult us or any nearby
spine surgeon for further course of action.
23) Rama Krushna Behera: Father (60) is suffering from severe spondilytis and my Mother (45) also suffering
from nil pain since 5 years, I'm practicing at my lab as pathological L.T. and practicing medical practitioner
(R) ,so share some suggestion for my parents.
ANS: Dear Mr Behera, both the conditions can be better treated if we can have a look at the patients and
the MRIs. Kindly furnish more details in terms of reports or further history so that I can suggest further
line of treatment.
24) Chandra Singh: Sir, I have some problem in back Bone since last 2 year? What to do?
ANS : Dear Mr. Singh, Kindly furnish more details in terms of reports or further history so that I can
suggest further line of treatment
25) Innocent Chorey:
My mom is suffering with spinal cord & back pain.
ANS: Back pain has to be evaluated and not neglected. Please consult us or any nearby spine surgeon for
further course of action
26) Yeshika Achumeh: My back hurts a lot, so any tips?
6. ANS : Back pain has to be evaluated and not neglected. Please consult us or any nearby spine surgeon for
further course of action
27) Nabin Sarkar: I have two problems. 1 year ago I got injury in my hip joint at the right side during long
jump. Then I gave up my practice. Now I have started my practice again and there is no problem there. But
now I am facing a new problem. Now I cannot bend in front. I feel pain in joints of spinal cord & waist.
ANS: Dear Mr Sarkar, you can always drop in to Apollo hospital Road Chennai or contact one of our web
moderators for further assistance.
28) Amit Wadhwani: Want to know any treatment for FSHD ( Fascio Scapulo Humeral Dystrophy) in India or
in other countries?
ANS: Dear Mr Wadhwani, there are multiple issues regarding the treatment of FSHD, please give more
details and report copies.
29) Kuldeep Kumar: I have spinal pain, kindly suggest some remedy
ANS:Dear Mr Kumar, Lumbar disc slips as they are commonly called can cause severe back pain with pain
radiating down the legs. More often than not they are relieved by medications and physiotherapy. Rarely
they require surgery. So if your symptoms are bothering you too much inspite of medicines and
physiotherapy, you might need a surgery. However, the decision has to taken after being seen by a spine
surgeon.
30). Manas Ranjan Nayak manasrn: Not me but my father in law does have Osteoporosis in his lumbar and
suffers acute pain at times. Any tips for relief.
ANS: Dear Mr Manas, Osteoporosis needs aggressive medical, management to improve the strength of
the bones and decrease the pain on the back and the bones all over the body. Please get your father in
law down to the clinic once for appropriate management of the osteoporosis and any related issues. But
overall, osteoporosis is a condition requires prompt medications and a good physical therapy to avoid
complications like fractures of the wrist, hip, spine and also decreased mobility.
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