A 35yrs young patient, presented to the hospital with lower extremities neurological deficit, radiological investigation showed bony lesion in the posterior elements of T10 causing severe compression on the cord, emergency surgery was performed to decompress the spinal cord, the microscopic examination revealed that lesion was “ aneurysmal bone cyst”.
Leiomyoma is a benign tumor that originates from smooth
muscle cell. The most common sites are the uterus, gastrointestinal tract & skin. Leiomyoma is a relatively uncommon smooth muscle tumor rarely found in the head and neck. Enzinger and Weiss (1995), analyzed a total of 7748 leiomyomas, 95% of the tumors occurred in the female genitalia (uterus), 3% in the skin, 0.9% in the gastrointestinal tract and the remainder at various sites including skull base.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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 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
3. Adamantinoma
The adamantinoma of bone is an extremely rare primary sarcoma
of bone, accounting for about .3% of all malignant tumors of bone,
and in 90% of the cases it will be seen in the diaphyseal portion of
the tibia, especially in the anterior cortex. It occurs equally in males
and females, typically in the second and third decade of life. The
tissue of origin still remains a mystery but immunohistochemical
stains suggest an epithelial origin that might account for why they
are more common just beneath the skin in the anterior cortex of the
tibia. Radiographically, the adamantinoma takes on the appearance
of a fibrous dysplastic lesion or perhaps osteofibrous dysplasia of
the tibia. The lesion appears benign with a lytic core surrounded by
dense, reactive fibro-osseous bone that frequently dilates the anterior
cortex and may be multiloculated in appearance. The tumor is quite
slow growing and is usually painful, whereas in fibrous dysplasia
and osteofibrous dysplasia, the patients remain asymptomatic. If a
4. so-called fibrous dysplastic lesion continues to grow past maturity,
a physician should suspect adamantinoma, especially if the lesion is
painful, and look for the characteristic nests and cords of epithelial-
looking cells surrounded by fairly benign-appearing fibro-osseous
tissue on histological specimens. It is very rare for this tumor to
metastasize to different sites but occasionally it will metastasize to
regional lymph nodes and the lung.
Treatment for this low grade lesion is purely surgical, consisting
of a wide local resection, frequently a segmental resection of the
mid portion of the tibia, and reconstruction with a large bone
allograft over an intramedullary nail. There have been a few rare
cases in the literature where adamantinoma has arisen out of a pre-
existing osteofibrous dysplastic lesion.
76. Chordoma
The chordoma is a very rare malignant tumor of bone that
accounts for only 4% of all malignant bone tumors. It arises from
the primitive notochord of the axial skeleton and is most commonly
seen in the lower portion of the sacrum, accounting for 50% of the
chordomas. 37% arise in the spheno-occipital area and a small
number occur in the cervical and lumbar spine. The more common
sacral lesions are seen in an older age group between the ages of
40 and 80 years, compared to the spheno-occipital chordomas that
occur in a younger adult age group. The later carry a much worse
prognosis because of the location at the base of the skull. The
chordoma is clinically similar to a mucinous type of chondrosarcoma.
In the sacral area, chordomas are usually attached to the anterior
portion of the distal three segments of the sacrum and grow in the
retroperitoneal space, pressing up against the rectum where
eventually they will present with clinical symptoms related to
constipation and can be picked up on a rectal examination. Because
77. the tumor is very slow growing, it rarely causes significant pain
symptoms. The radiographic findings are frequently not very obvious,
even with large tumors that are better evaluated by soft tissue
technique, such as CT scan or, better yet, MRI. Microscopically, the
chordoma has a mucinous appearance similar to a low grade myxoid
chondrosarcoma, but the diagnostic feature is the “signet ring”
appearance of the physaliferous cells that have a peripheral nucleus,
a large cytoplasmic inclusion of physaliferous mucinous material that
can look a bit like a liposarcoma.
Treatment for the chordoma consists primarily of a wide surgical
resection, which sometimes is very difficult, especially with lesions
extending into the upper sacral segments where the nerve roots
become a problem and may result in significant neurogenic bowel
and bladder complications. Even with surgical treatment, the local
recurrence rate is very high so that post op radiation therapy is
recommended. It has cut the local recurrence rate to about 30%
compared to 65% without RT. Recurrences can occur locally up to
78. fifteen years after the original surgery. Pulmonary metastases are
extremely rare and systemic chemotherapy is not indicated for this
tumor.
79. CLASSIC Case #219
45 year male with chordoma sacrum
176. Eosinophilic Granuloma (Langerhans Histiocytosis)
The so-called benign histiocytoses, sometimes referred to as
histiocytosis X, include various disease conditions such as eosino-
phillic granuloma, Hand-Schuller-Christian disease and Letterer-
Siwe disease. Eosinophillic granuloma is the most benign of the
histiocytic disorders, followed next by Hand-Schuller-Christian
disease that presents with an intermediate diffuse process of both
bone and soft tissue that can be fatal. Letterer-Siwe disease is the
most aggressive and fatal form of the histiocytoses, presenting like
leukemia with a very poor prognosis for survival.
Eosinophillic granuloma, now referred to as Langerhans histio-
cytosis, is a benign histiocytic disorder that frequently presents in
children between the ages of 5 and 15 years with a clinical picture
that can masquerade as a malignant neoplasm such as Ewing’s
sarcoma. It occurs twice as often in males than females. It is
usually a monostotic disorder of the skeletal system, however, in
177. 10% of cases it will be seen in two or three separate sites. The
etiology of this histiocytic process is still unknown but some have
postulated a viral etiology. Patients present with inflammatory pain,
more severe at night, that may be associated with a low grade fever
or elevated sed rate. The most common location is in the skull,
followed next by the ribs, pelvis, maxilla, vertebral body, clavicle
and scapula, in that order. Besides flat bone involvement, it is
commonly seen in the diaphyses of long bones where it can
masquerade as Ewing’s sarcoma, but can also occur in metaphyseal
bone and is found least commonly in epiphyseal bone. In young
children, the condition can be extremely permeative and destructive
in nature, taking on the appearance of Ewing’s sarcoma, metastatic
neuroblastoma, or acute osteomyelitis.
On x-ray, eosinophillic granuloma has an onion-skin appearance
similar to a Ewing’s sarcoma. In an older age group, the condition
tends to be more focal and more granulomatous in appearance with
less permeative change. Microscopically, there are large, pale-
178. staining histiocytes speckled with small, bright-staining eosinophils
and an occasional giant cell. Eosinophillic granuloma tends to
involute spontaneously without treatment and therefore symptomatic
treatment should be conservative--simple curettement for diagnostic
purposes and perhaps cortical steroid injections can be beneficial to
inhibit the inflammatory process. In more difficult parts of the body,
such as the spine or pelvis, very low grade radiation therapy can be
considered, realizing that this could convert the process to a malignant
sarcoma at a later date. In more aggressive forms with multi-focal
involvement, especially if there is soft tissue involvement of the skin,
lymph nodes or lung, a low dosage chemotherapy program can be
considered. Sometimes the low grade eosinophillic granuloma
histiocytosis can upgrade to a more aggressive and dangerous form
such as Hand-Schiller-Christian disease or even Letterer-Siwe disease.
With spinal lesions, spinal cord compression can result in paraparesis
requiring laminectomy decompression. However, kyphotic deform-
ities in younger patients tend to correct spontaneously without surgery.
247. Case #439
19 year male with EG collapse new collapse
at 3 different levels but at
different times old
The lower levels show height
restoration as a spontaneous
healing process seen in children
old
248. Case # 440
7 year female with
healing collapsed
lumbar vertebra
261. Hand-Schiller-Christian Disease
Hand-Schiller-Christian disease is the intermediate form of
histiocytosis-X that involves predominantly children, two-thirds of
the cases being younger than five years of age. The classic triad
for this syndrome is diabetes insipitus, exophthalmos, and single
geographic lesions involving mostly the skull and pelvic bones.
The initial lesions appear like eosinophillic granuloma and, in fact,
eosinophillic granuloma can progress into a Hand-Schiller-Christian
type syndrome as the disease advances. It is common to have soft
tissue involvement of lymph nodes, liver, spleen, lung, brain and
kidney as well as skin changes that can be seen in eosinophillic
granuloma. Histologically, the same histiocytic cells as are seen
with eosinophillic granuloma are present, along with eosinophils. In
the later stages, foam cells and cholesterol deposits are typical.
as the disease progresses and more and more soft tissue organs are
affected, the prognosis worsens with an overall fatally rate of
262. 10-30%. Treatment consists of local surgical treatment plus systemic
treatment consisting of therapeutic protocols similar to those used in
leukemic patients.
263. CLASSIC Case # 445
5 year male with HSC disease skull
274. Letterer-Siwe Disease
Letterer-Siwe disease is the least common of the histiocyoses
comprising about 10% of all histiocytic disorders. It is a pro-
gressive, acute syndrome in children under three years of age,
involving multiple visceral organ systems, such as the spleen,
lymph nodes and skin, associated with purpura, bleeding gums,
and multiple lesions similar to those seen in Hand-Schiller-
Christian disease. The skull and pelvis are frequently involved.
The skeletel lesions tend to be more diffuse than with the other
histiocytoses and take on a picture similar to that of leukemia or
diffuse lymphoma. These patients usually die of bacterial infections
within one or two years of their acute clinical onset because of bone
marrow suppression. Histologically, the lesions look very similar
to eosinophillic granuloma or Hand-Schuller-Christian disease,
although it is unusual to see foam cells in this form of histiocytosis.
Treatment consists of chemotherapeutic agents similar to those
used in leukemia.
275. CLASSIC Case #447
3 year female with LS disease skull
290. Sinus Histiocytosis
Rosai-Dorfman’s Disease
Sinus histiocytosis is a rare and new variant of the histiocytoses
which is characterized by enlarged lymph nodes in the head and
neck area in 80% of cases along with bony involvement in 40%
of cases. It is an aggressive form of the histiocytoses that is seen in
teen agers and young adults. Symptoms may include fever, weight
loss and malaise. The bony lesions may be solitary or multifocal
and suggest inflammatory disease such as chronic osteomyelitis or
EG. The pathology shows mononuclear or multinuclear giant cells
with lymphs in the cytoplasm of the giant cells. Other inflammatory
cells such as plasma cells, lymphocytes and foamy histiocytes may
be seen. 10% of those with bone lesions die of the disease from extra-
skeletal involvement of the lungs and kidneys.
291. Case #450.1 Rosai-Dorfman’s disease
52 year old female with knee pain for 1 year