Information about Inflammatory Bowel Disease by Dr Dhaval Mangukiya.
Details of brief overview of the talk, Surgery in crohn's disease, Scenarios, Localised ileal or ileocaecal disease, Coincidental ileitis, Localised or multifocal colonic disease, Concomitant abscess, Surgical considerations, Anastomotic technique, Laparoscopy etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Gallstones:
Most common biliary pathology
Asymptomatic in majority of cases (>80%)
Approx. 1–2% of asymptomatic patients develop symptoms requiring cholecystectomy per year.
Seminar present the Upper Gastrointestinal Bleeding problems
Edited by : Dr. Inzar Yassen & Dr. Ammar L. Aldwaf
in Hawler Medical Uni. collage of medicine in 14/01/2014
Iraq - Kurdistan - Erbil
Information about Inflammatory Bowel Disease by Dr Dhaval Mangukiya.
Details of brief overview of the talk, Surgery in crohn's disease, Scenarios, Localised ileal or ileocaecal disease, Coincidental ileitis, Localised or multifocal colonic disease, Concomitant abscess, Surgical considerations, Anastomotic technique, Laparoscopy etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Gallstones:
Most common biliary pathology
Asymptomatic in majority of cases (>80%)
Approx. 1–2% of asymptomatic patients develop symptoms requiring cholecystectomy per year.
Seminar present the Upper Gastrointestinal Bleeding problems
Edited by : Dr. Inzar Yassen & Dr. Ammar L. Aldwaf
in Hawler Medical Uni. collage of medicine in 14/01/2014
Iraq - Kurdistan - Erbil
National Comparative Audit of Lower Gastrointestinal Bleeding and the Use of ...Raimundas Lunevicius
This audit shows that there is no such thing as acute upper gastrointestinal (UGI) bleeding or acute lower gastrointestinal (LGI) bleeding. There is acute gastrointestinal (GI) bleeding, which predominantly is one of a few emergency gastroenterological conditions. In other words, a historic agreement between clinical directors to direct a patient presenting with hematemesis to gastroenterology ward & to direct another patient with PR bleed to Emergency General Surgery Ward is not quite logical, as PR bleeding is one of the signs of acute UGI as well as LGI bleeding.
The concentration of patients in one highly specialized unit for GI bleeding management WITHIN GASTROENTEROLOGY CENTRE is the second summary key point of this audit.
I do think that Gastroenterology Ward would be the best Ward to concentrate all patients presenting with signs of GI bleeding, for a mean patient presenting with this problem is:
(1) An elderly patient with significant comorbidities, often taking a so-called ‘blood thinner’ (aspirin, NSAIDs, and even steroids),
(2) Requiring limited volume blood transfusions - sometimes,
(3) Requiring radiological and endoscopic investigations within 24 hours / in a case of clinically significant bleeding,
(4) Not requiring urgent surgery in the absolute majority of the cases (5 emergency laparotomies in all four countries of the UK), and (5) Not having a clinical diagnosis on the day of discharge.
Anders Perner - When to Pull the Transfusion Trigger?SMACC Conference
The management of the septic patient in ICU is a recurrent topic for debate amongst intensivists. The decision of if and/or when to give blood transfusions is one of the key sources of contention. Dr Anders Perner is one of the most qualified people to weigh in on this debate. In this talk from SMACC Chicago, he delivers his stance on when to pull the transfusion trigger.
Dr Anders Perner is an Intensive Care Specialist at Rigshospitalet and a professor in intensive care at Copenhagen University. He is the chairman of the Scandinavian Critical Care Trials Group and the strategic research program “New resuscitation strategies in patients with severe sepsis’. The contents of this talk are based on the findings of the TRISS trial - Transfusion Requirements in Septic Shock. This trial, Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock was published in the NEJM in October 2014. The aim was to evaluate the recommendations from the Surviving Sepsis Campaign regarding transfusion in septic shock. The recommendation is that after the first 6 hours, transfusion threshold should be a Hb <7g /></9g></ 9g/dL) or a lower transfusion threshold group (Hb</ 7g/dL). They each received 1 unit of leukoreduced PRBC when they reached their respective transfusion threshold. The primary outcome was death within 90 days of randomisation. In this SMACC talk, some of the key findings and limitations of the trial are discussed. So check out this talk and then read the full article available here to see if you agree with 7g/dL – the new normal.
What’s your transfusion trigger? Is it time to rethink it?
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
5. Acute UGI Bleeding unit
Patient Group
(n=900)
SMR 95% conf
interval
All 0.63 0.48-0.78
Low risk
(Rockall 0-3)
0.35 0.00-1.04
Medium risk
(Rockall 4-6)
0.56 0.34-0.78
High risk
(Rockall >7)
0.7 0.49-0.91
Sanders et al. Eur J Gast Hep 2004, 16(5) 487-94
6. Is the patient shocked?
Class I Class II Class III Class IV
Vol loss
(ml)
<750 750-1500 1500-2000 >2000
Vol loss
(%)
0-15 15-30 30-40 >40
Systolic Normal Normal Low V Low
Diastolic Normal Raised Low V Low
Pulse Slight
tachy
100-120 120 thready >120, v
thready
Resp rate Normal Normal >20 >20
Mental
state
Alert Anxious /
aggressive
Drowsy Confused /
unconsciou
s
14. Could it be varices?
Any upper GI bleed with:
Previous history of varices / variceal bleed
Clinical evidence of chronic liver disease or
portal hypertension
NB: most ‘alcoholics’ with GI bleeds do not
have chronic liver disease (or varices)
15. Could it be varices?
Yes……….
Consider airway protection
High risk of aspiration with high mortality
16. Could it be varices?
Yes……….
Reconsider CVP line (if not already)
Avoid over-transfusion
17. Could it be varices?
Yes……….
Correct clotting and platelets
18. Could it be varices?
Yes……….
Commence Terlipressin 2mg 6 hourly
Superior to endoscopic sclerotherapy in
Bleeding control (Cochrane 2002)
20% reduction in 5 day bleeding control
When combined with endoscopic therapy
19. Could it be varices?
Yes……….
Endoscopy at earliest opportunity
It’s not always varices
20.
21. Could it be varices?
Yes……….
Endoscopy at earliest opportunity
Enables endoscopic therapy
22.
23.
24. Could it be varices?
Yes……….
Consider Sengstaken-Blakemore tube
Reconsider airway protection
May be safer to transfuse and await endoscopist
25. What’s the diagnosis?
An 80 year-old woman is brought to
hospital having collapsed in her home.
On arrival of the ambulance she was
hypotensive, grey and sweaty.
The ambulance crew reported ‘coffee
ground vomit’ while en-route.
30. Think….
Is the degree of haemodynamic
compromise consistent with volume of
reported blood loss?
Beware a shocked patient with ‘dark’
vomit
look for an alternative explanation for
hypotension.
42. When to endoscope?
Too soon?
Inadequate resuscitation: higher risk
Poor views (blood in the way)
Aspiration (stomach full of blood)
43. When to endoscope?
Too late?
Ongoing bleeding
Rebleeding
Delay to surgery
44. When to endoscope?
ASAP if:
Evidence of ongoing bleeding
Suspected varices
Suspected early rebleed
Otherwise within 12 hrs is usually OK
45. What about IV PPI?
Clots more stable when pH >4
Clot lysis occurs when pH <4
46. What about IV PPI?
Omeprazole 80mg IV bolus followed by 8mg/hour
infusion for 72 hours reduced early rebleed rate (5 vs
24 rebleeds with placebo, p<0.001)
In patients with endoscopically proven
peptic ulcer with stigmata of haemorrhage
Lau et al. NEJM 2000;343:310-6
47. What about IV PPI?
Limited evidence for
‘empirical’ use of IV PPI
prior to endoscopic
diagnosis in unselected patients
48. What if the patient rebleeds?
Repeat endoscopy
Radiological embolisation
Surgery
49. Repeat Endoscopy
No difference in bleeding control between
surgery and second endoscopic treatment
30 day mortality and transfusion requirements
similar
More complications in group randomised to
surgery
Lau et al N Engl J Med 1999;340:751-756
50. Radiological Embolisation
Equally effective to surgery as
measured by:
Rates of re-bleeding
Rates of mortality
Ripoll et al J Vasc Interv Radiol 2004; 15:447-450
51. What about surgery?
>65 with one ‘rebleed’ or > 4 units blood
required for fluid resuscitation
<65 with 2 rebleeds or >8 units blood
required for fluid resuscitation
52. What about Surgery?
Dependent on:
Type of lesion
Site of lesion
Co-morbidities
Likelihood of continued bleeding
53. Summary
Resuscitate adequately
Exclude varices (and non-GI source of
shock)
Endoscopy within 12 hours if non-
variceal
Intravenous PPI infusion if peptic ulcer
bleed with stigmata of haemorrhage