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A 45-year-old Pakistani man presented with chest pain and was found to have a ventricular septal defect. He required an intra-aortic balloon pump and intubation due to worsening pulmonary edema. On the fifth day of hospitalization, the patient underwent surgical repair of the ventricular septal defect. Post-operatively, the patient developed complications including confusion, renal and hepatic failure, and left-sided weakness.
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This document discusses Acute Radiation Syndrome (ARS), which occurs after exposure to high doses of radiation. There are three classic syndromes - hematopoietic/bone marrow, gastrointestinal, and neurovascular - defined by the specific tissues affected and symptoms that develop. The syndromes progress through prodromal, latent, and manifest phases and can be fatal depending on the radiation dose. Diagnosis is difficult without a history of exposure, but absolute lymphocyte count and time to vomiting provide some indication. Management focuses on symptom relief, supportive care, and stimulating stem cell regeneration with growth factors or transplants for high doses.
papillary thyroid carcinoma ppt
This document discusses the management of complicated papillary thyroid carcinoma through two patient case studies. It provides details on the patients' histories, examination findings, investigations, diagnoses, surgical procedures, post-operative management, and literature review on papillary thyroid carcinoma classification, risk factors, staging, treatment options including surgery, radioactive iodine therapy, and TSH suppression.
Moeez
A 22-year-old female presented with 3 months of fever, productive cough, and shortness of breath. Examination found pallor, lymphadenopathy, and hepatomegaly. Testing showed pancytopenia, blasts in the peripheral smear, and an enlarged liver and spleen on ultrasound. Bone marrow biopsy confirmed the diagnosis of acute myeloid leukemia (AML). Treatment for AML typically involves induction chemotherapy with cytarabine and an anthracycline, followed by consolidation chemotherapy or stem cell transplant to prevent relapse. Supportive care including transfusions, antibiotics, and managing complications is also important.
July 2013 audit presentation ga and lrti
This document discusses the case of an 83-year old man who underwent brain surgery for a meningioma despite having significant medical comorbidities and an active chest infection. He developed severe postoperative respiratory complications requiring a prolonged stay in the intensive care unit. The case highlights the importance of thoroughly assessing high-risk patients preoperatively, acting on abnormal findings, and documenting key details. Literature suggests active chest infections significantly increase the risk of postoperative pneumonia, so delaying this man's surgery may have prevented his complications. Poor documentation and assessment were issues in this preventable case.
Case discussion
This document describes the case of a 22-year-old female patient who presented with fever, difficulty opening her mouth, ear discharge, oral ulcers, breathing difficulties, and cough after a recent tooth extraction. Testing showed sinusitis, oral candidiasis, low lymphocyte counts, and elevated inflammatory markers. A CT scan found lung lesions and the patient was diagnosed with Wegener's granulomatosis based on a positive C-ANCA and lung biopsy showing necrotizing vasculitis. Treatment with steroids and rituximab led to improvement of symptoms. Wegener's is a rare autoimmune disease characterized by necrotizing vasculitis affecting the respiratory tract and kidneys.
Ca Papillary(Thyroid Gland)
1. The patient presented with a swelling in his neck for 2 years that had been gradually increasing in size and causing pain for the past 2 months.
2. Examination and investigations including lymph node biopsy, ultrasound neck, and CT neck revealed metastatic papillary carcinoma of the thyroid.
3. The patient underwent a total thyroidectomy with modified radical neck dissection. Post-operative recovery was unremarkable.
Copd in ICU
Teaching session for ICU team on the subject of COPD. Focus on patient selection and predicting prognosis, and QoL.
Mortality Meet Presentation by Dr. Saumya Agarwal
Mortality Meet Presentation by Dr. Saumya Agarwal Central Institute of Orthopaedics, Safdarjang Hospital and VMMC, New Delhi
This document summarizes a patient mortality meeting discussing a 45-year-old female patient who was admitted unconscious following a road traffic accident. She sustained injuries including a laceration on her right thigh and eye, as well as an intertrochanteric fracture of the right femur. The summary outlines her hospital course, management including surgery, complications including infections, and eventual discharge on day 26 after addressing cerebral salt wasting.Puerperial sepsis
Puerperal sepsis was defined as infection of the genital tract occurring at any time between the onset of rupture of membranes or labour, and the 42nd day postpartum in which two or more of the following are present: Fever (oral temperature 38.5°C/101.3°F or higher on any occasion
Cbp on vt (1)
This patient is a 72-year-old male who presented with ventricular tachycardia. He has a history of ischemic heart disease, myocardial infarction, and coronary artery bypass grafting. Diagnostic tests showed ventricular tachycardia, metabolic acidosis, acute kidney injury, cardiogenic shock, NSTEMI, and aspiration pneumonia. He received treatment including shock, intubation, hemodialysis, and medications. Nursing care involved ongoing monitoring, managing medications and side effects, and patient/family education.
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Bleeding in paediatric surgery - case presentations
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JetBlue has strengths in effective aircraft operations, positioning in New York, and active marketing with low distribution costs. However, it has weaknesses such as high debt obligations, sluggish profits, and low margins. External opportunities include recovery of the US airline industry and benefits to low-cost carriers in a weak economy, but threats include intense price competition, industry consolidation, terrorism, and increased government regulations.
PPT5
My cousin helped me buy my first car after graduating and finding a job. We had an intense negotiation with the dealer that lasted all day before finally agreeing on a price the next morning. The experience taught me lessons about not rushing into big purchases, being influenced by others, and choosing negotiating partners wisely.
PPT2
JetBlue has strengths in effective aircraft operations, strong positioning in the New York metropolitan area, and active marketing with low-cost distribution channels. However, JetBlue also has weaknesses such as high debt and fixed obligations, sluggish profits and margins. External threats include intense competition from low-cost airlines, industry consolidation, terrorism, and increased government regulations. The recovery of the US airline industry works in JetBlue's favor.
PPT1
Peritonitis in patients undergoing peritoneal dialysis is commonly diagnosed based on symptoms of fever, abdominal pain, and nausea, along with lab findings of increased white blood cells over 100 cells/mm3 with neutrophil predominance. Infections are often gram positive or gram negative bacteria but about 20% have no growth on culture. Fungal infections are rare but Candida is the most common cause. Noninfectious complications include GERD, vomiting, electrolyte abnormalities like hypokalemia, and potentially fatal acute mesenteric ischemia.
Test Presentation
The document discusses strategies for foreign market entry, including overcoming liability of foreignness, understanding factors that influence internationalization, and a comprehensive model for foreign market entries. It addresses questions of where, when, and how to enter foreign markets, analyzing location-specific advantages, timing of market entry, and options for entry modes. Key tradeoffs between equity and non-equity entry modes like exports, licensing, and foreign direct investment are also summarized.
Thyroid and the Heart
This document discusses syncope, which is a transient loss of consciousness due to temporary reduced blood flow to the brain. It notes that syncope accounts for around 1% of emergency department visits and is a common cause of hospitalization for those over 65. Establishing the exact cause is difficult as the patient has usually recovered by the time they are examined. The document then discusses various causes of syncope and nonsyncopal attacks that can be mistaken for syncope. It provides breakdowns of common causes by age group and discusses the natural history and risk stratification of syncope of unknown cause in the emergency department.
Myocardial Viability - the STICH Trial NEJM May 2011
This study examined whether testing for myocardial viability can identify patients with coronary artery disease and left ventricular dysfunction who benefit most from coronary artery bypass grafting (CABG) compared to medical therapy alone. Of over 1200 patients enrolled in the main trial, 601 who underwent viability testing by single-photon emission computed tomography (SPECT) or dobutamine echocardiography were included in this substudy. Patients who had viability testing were more likely to have certain risk factors and worse heart function. The study aimed to determine if viability testing could identify which patients would have improved survival rates with CABG versus medical therapy.
Flail Leaflet
This document discusses flail mitral leaflet, which is a cause of mitral regurgitation requiring surgical correction. It occurs when the chordae tendineae connecting the mitral leaflet to the papillary muscles rupture. This causes the mitral leaflet to flail or balloon into the left atrium during systole. If left untreated, it can lead to complications like congestive heart failure, atrial fibrillation, thromboembolism and death. Surgical repair or replacement of the mitral valve is usually required to treat significant flail mitral leaflet.
Fat versus Fit
This study examined the association between cardiorespiratory fitness, adiposity, and mortality in older adults. It found that higher fitness levels were associated with lower mortality rates regardless of body composition. Specifically, even obese individuals had lower mortality if they were fit compared to unfit normal-weight or lean individuals. The study also found a J-shaped relationship between BMI and mortality both before and after adjusting for fitness levels.
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Cardiac MR and viability
This document describes a case of an 80 year old female patient with a history of hypertension, hyperlipidemia, diabetes, and prior stroke who presented with 2 weeks of continuous chest pain. She was found to have left bundle branch block of unknown duration on EKG. Cardiac enzymes were negative. The patient was transferred for further cardiac management.
LFT Review
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This document summarizes methods for predicting the functional effects of amino acid substitutions, including SIFT (Sorts Intolerant From Tolerant), which uses sequence conservation to predict whether an amino acid substitution will affect protein function. SIFT has similar prediction accuracy to tools using protein structure. Case studies on disease genes like MSHR, PPARα, and MTHFR show SIFT can distinguish pathogenic from benign variants and detect variants under balancing selection. Focusing genetic association studies on predicted functional variants in genes and conserved non-coding regions improves the direct approach to finding disease loci.
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Clostridium difficile infection rates in the US increased from 30-40 per 100,000 in the mid-1990s to 84 per 100,000 in 2005, and in Britain C. diff became the primary cause of an increasing number of deaths from 499 in 1999 to 3393 in 2006. While metronidazole and vancomycin have been the standard treatments since the 1970s, failure rates for metronidazole increased significantly to 18.2% since 2000. Metronidazole is recommended as the first line treatment for mild cases, but vancomycin should be used for more severe infections. The ultimate goal in treating recurrent C. diff infections is to discontinue all antibiotics
test
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
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Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
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1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
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Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
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- 7. South Asians and CV risk
- 9. Laboratory Assessment 8.5 8.5 – 10.5 Calcium (mg/dl) 136 70 - 110 Glucose (mg/dl) 1.5 0.6 – 1.5 Creatinine (mg/dl) 20 8 – 25 Urea nitrogen (mg/dl) 22 23.0 – 31.9 Carbon dioxide (mmol/liter) 102 100 – 108 Chloride (mmol/liter) 5.4 3.4 – 4.8 Potassium (mmol/liter) 137 135 – 145 Sodium (mmol/liter) CHEMISTRY ON ADMISSION REFERENCE RANGE TEST
- 10. Laboratory Assessment 0 2-8 Bands 1.1 11.3 – 13.3 INR 13.9 22.1 – 35.1 Partial-thromboplastin time (sec) 269 150,000 – 300,000 Platelet Count (per mm 3 ) 11 4 – 11 Monocytes 15 22 – 44 Lymphocytes 74 40 – 70 Neutrophils Differential Count (%) 15.0 4,500 – 11,000 White-cell count (per mm 3 ) 41.3 41.0 – 53.0 Hematocrit (%) 13.9 13.5 – 17.5 Hemoglobin (g/dl) HEMATOLOGY ON ADMISSION REFERENCE RANGE TEST
- 35. The Evolution of an MI 7 - 10 d 3 - 4 d 30 m - 4 h 10 - 14 d 2 -8 wk Dense collagenous scar >2 mo Increased collagen deposition, with decreased cellularity 2–8 wk Well-established granulation tissue with new blood vessels and collagen deposition 10–14 days Well-developed phagocytosis of dead cells; early formation of fibrovascular granulation tissue at margins 7–10 days Beginning disintegration of dead myofibers, with dying neutrophils; early phagocytosis of dead cells by macrophages at infarct border 3–7 days Coagulation necrosis, with loss of nuclei and striations; brisk interstitial infiltrate of neutrophils 1 to 3 days Ongoing coagulation necrosis; myocyte hypereosinophilia; marginal contraction band necrosis; early neutrophilic infiltrate 12 to 24 hrs Early coagulation necrosis; edema; hemorrhage 4 to 12 hrs Variable waviness of fibers at border 30 min to 4 hrs Relaxation of myofibrils; glycogen loss; mitochondrial swelling 0 to 30 min Morphological Changes Time
Editor's Notes
- 4 main risk factors associated w/ increased risk is smoking, high Apo protein, history of hypertension, and diabetes. In this study they also found that the rates of fruit and vegetable consumption were quite lower