- M. Amin, a 13-year-old boy, presented with fever for 20 days, vomiting blood for 15 days, and bleeding gums for 15 days. His examination showed pallor and low blood counts.
- Investigations revealed pancytopenia, low bone marrow cellularity, and no abnormal cells. This supported a diagnosis of Fanconi's anemia.
- Management included controlling infections, correcting anemia with blood transfusions, and immunosuppression with steroids, antilymphocyte globulin, and cyclosporins. Bone marrow transplantation was not indicated due to the patient not meeting criteria of very low blood counts.
This document discusses mass casualty management and disaster preparedness for hospitals. It provides data on road traffic accidents in Nepal and describes key aspects of managing mass casualty incidents, including establishing triage, conducting primary and secondary surveys, and activating disaster plans. The main points are:
1) Triage is crucial to prioritize patients and direct them to the appropriate level of care. The START method is described.
2) During primary survey, life threats like airway, breathing, and circulation are addressed within 2-5 minutes.
3) Secondary survey thoroughly examines all body systems to identify minor injuries.
4) Hospitals must have clear disaster plans, adequate staff and supplies, and policies to handle surges
This document discusses various modalities of renal replacement therapy in children including peritoneal dialysis, hemodialysis, and continuous renal replacement therapy. It provides details on the principles, procedures, indications, and complications of each modality. The key points are:
- Renal replacement therapy helps clear accumulated solutes, water, or toxins from the blood via diffusion or convection across a semipermeable membrane.
- Peritoneal dialysis can be performed manually or with a machine and involves exchanging dialysate fluid into the peritoneal cavity. Hemodialysis uses an artificial kidney to filter blood outside the body. Continuous renal replacement therapy provides prolonged dialysis without interruption that is better tolerated in critically ill
Postoperative Radioiodine Ablation in Thyroid CancerMamoon Ameen
This document discusses thyroid cancer, including the different types, pathology, clinical presentation, staging, and treatment options. The main types discussed are papillary carcinoma (70-80% of cases), follicular carcinoma (15% of cases), and anaplastic/undifferentiated carcinoma (5-10% of cases). Treatment involves surgery, radioactive iodine therapy, and thyroid hormone suppression. Radioactive iodine therapy utilizes iodine-131 to destroy remaining thyroid tissue or known cancer metastases based on the cancer's ability to uptake iodine. Precautions are needed after radioactive iodine therapy to avoid exposing others to radiation. Long term follow-up with thyroid scans and thyroid biomarker monitoring is important to
This document discusses pre-eclampsia, including its pathophysiology, risk factors, clinical presentation, diagnosis, complications and management. It begins by defining pre-eclampsia as a multisystem disorder characterized by new onset hypertension and proteinuria after 20 weeks of gestation. It then covers the key aspects of the condition over several pages, focusing on trophoblast invasion, the role of the placenta, signs and symptoms, diagnostic testing, magnesium sulfate treatment and delivery management. The document provides a comprehensive overview of pre-eclampsia for medical professionals.
This document discusses fluid management for dengue hemorrhagic fever and dengue shock syndrome. It notes that during the critical phase of dengue hemorrhagic fever, plasma leaks from blood vessels causing fluid loss. Proper volume replacement with crystalloids, at a rate matching fluid loss, is important to prevent shock. For dengue shock syndrome, rapid fluid resuscitation with crystalloids and possibly colloids is needed to compensate for fluid deficit and normalize vital signs. Careful monitoring of fluid balance, hematocrit and vital signs is key to guide appropriate fluid therapy during these critical phases.
Fluid Management in Dengue Hemorrhagic Fever.pptUsmanDastgir4
This document discusses fluid management for dengue hemorrhagic fever and dengue shock syndrome. It notes that during the critical phase of dengue hemorrhagic fever, plasma leaks from blood vessels causing fluid loss. Proper volume replacement with crystalloids, at a rate matching fluid loss, is important to manage this. For dengue shock syndrome, rapid fluid resuscitation with crystalloids and possibly colloids is needed to treat circulatory compromise. Careful monitoring of vital signs and fluid balance is essential during the critical phases of both conditions.
This document discusses renal replacement therapies for acute kidney injury in critical care. It begins by outlining some open questions about optimal therapy use. It then reviews classification systems for AKI severity and evidence that increased severity is associated with higher mortality. The document discusses evidence for relationships between higher therapy dose and better outcomes for intermittent hemodialysis and continuous venovenous hemofiltration. While no definitive evidence establishes the superiority of any one therapy, higher therapy doses are generally associated with better patient outcomes. The document outlines various renal replacement therapy options and their pros and cons.
Neonatal septic shock is a leading cause of neonatal mortality worldwide, especially in resource-limited settings. It occurs when sepsis leads to cardiovascular dysfunction and hypotension. The pathophysiology involves a dysregulated inflammatory response and microcirculatory failure leading to multi-organ dysfunction. Treatment involves early antibiotics, fluid resuscitation, and inotropic support to restore adequate circulation. Inotropes such as dopamine, dobutamine, and norepinephrine target specific cardiac receptors, but their effects in preterm neonates are not well characterized and clinical endpoints of resuscitation are unclear.
The Airway- A mecca of possible complications- edit 1.pptxDwayneWhite10
This document describes the anesthetic management of an 82-year-old female undergoing surgery to remove a multinodular goiter. Key points include:
- The patient had a long history of a neck mass and diabetes.
- Induction was difficult due to the neck mass obstructing the airway, but an endotracheal tube was successfully placed after external neck pressure.
- During surgery, the left recurrent laryngeal nerve was not identified and the right was preserved. Post-operatively, the patient developed stridor and had to be re-intubated.
- In recovery, the patient was breathing spontaneously via a T-piece with bronchial breath sounds and blood-ting
This document discusses renal replacement therapies in critical care. It begins with several questions about what therapy to use, when to start and stop it, how much therapy is needed, and whether outcomes can be improved. It then provides an overview of AKI classification systems and discusses the relationship between AKI severity and mortality. The document reviews evidence on initiating RRT, compares intermittent therapies to continuous therapies, and discusses solute clearance methods, major RRT techniques, and managing risks like hypotension. It also explores RRT as extracorporeal blood purification therapy and hypotheses about cytokine removal.
The document discusses the management of polytrauma patients. It begins with definitions of polytrauma and terms like SIRS, sepsis, and MODS. It then covers the metabolic response to trauma, which occurs in two phases - the ebb phase and the flow phase. The rest of the document details the principles and philosophy of trauma management based on the ATLS approach. This includes concepts like the golden hour, damage control surgery, and the primary and secondary surveys.
This document presents a case study of obstetrical hemorrhage involving placenta previa. It summarizes the patient's history, including previous cesarean deliveries, and current presentation with vaginal bleeding. Ultrasound revealed the placenta was located at the cervical os. The resident discusses management of placenta previa, including expectant care and risk factors for hemorrhage. Complications like placenta accrete syndrome are also reviewed, where the placenta invades the uterine wall, increasing bleeding risks.
This document discusses fluid and electrolytes, including physiology, types of IV fluids, fluid therapy, and electrolyte abnormalities. It provides the following key points:
- Total body water is 60% of body weight, with 2/3 intracellular and 1/3 extracellular fluid divided between interstitial and plasma.
- Crystalloids like NaCl 0.9% and Ringer's lactate are commonly used IV fluids. Colloids remain intravascularly but are more expensive.
- Initial resuscitation of fluid deficit uses 20mL/kg boluses while maintenance is 30-35mL/kg/day. Losses are replaced as needed.
- Electrolyte abnormalities can cause arrhythm
Chair and Presenter, Stephen V. Liu, MD, Benjamin Levy, MD, Jessica J. Lin, MD, and Prof. Solange Peters, MD, PhD, discuss NSCLC in this CME/MOC/NCPD/AAPA/IPCE activity titled “Decoding Biomarker Testing and Targeted Therapy in NSCLC: The Complete Guide for 2024.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/4bBb8fi. CME/MOC/NCPD/AAPA/IPCE credit will be available until July 1, 2025.
A comparative study on uroculturome antimicrobial susceptibility in apparentl...Bhoj Raj Singh
The uroculturome indicates the profile of culturable microbes inhabiting the urinary tract, and it is often required to do a urine culture to find an effective antimicrobial to treat UTIs. This study targeted to understand the profile of culturable pathogens in the urine of apparently healthy (128) and humans with clinical UTIs (161). In urine samples from UTI cases, microbial counts were 1.2×104 ± 6.02×103 colony-forming units (cfu)/ mL, while in urine samples from apparently healthy humans, the average count was 3.33± 1.34×103 cfu/ mL. In eight samples (six from UTI cases and two from apparently healthy people) of urine, Candida (C. albicans 3, C. catenulata 1, C. krusei 1, C. tropicalis 1, C. parapsiplosis 1, C. gulliermondii 1) and Rhizopus species (1) were detected. Candida krusei was detected only in a single urine sample from a healthy person and C. albicans was detected both in urine of healthy and clinical UTI cases. Fungal strains were always detected with one or more types of bacteria. Gram-positive bacteria were more commonly (OR, 1.98; CI99, 1.01-3.87) detected in urine samples of apparently healthy humans, and Gram -ve bacteria (OR, 2.74; CI99, 1.44-5.23) in urines of UTI cases. From urine samples of 161 UTI cases, a total of 90 different types of microbes were detected and, 73 samples had only a single type of bacteria. In contrast, 49, 29, 3, 4, 1, and 2 samples had 2, 3, 4, 5, 6 and 7 types of bacteria, respectively. The most common bacteria detected in urine of UTI cases was Escherichia coli detected in 52 samples, in 20 cases as the single type of bacteria, other 34 types of bacteria were detected in pure form in 53 cases. From 128 urine samples of apparently healthy people, 88 types of microbes were detected either singly or in association with others, from 64 urine samples only a single type of bacteria was detected while 34, 13, 3, 11, 2 and 1 samples yielded 2, 3, 4, 5, 6 and seven types of microbes, respectively. In the urine of apparently healthy humans too, E. coli was the most common bacteria, detected in pure culture from 10 samples followed by Staphylococcus haemolyticus (9), S. intermedius (5), and S. aureus (5), and similar types of bacteria also dominated in cases of mixed occurrence, E. coli was detected in 26, S. aureus in 22 and S. haemolyticus in 19 urine samples, respectively. Gram +ve bacteria isolated from urine samples' irrespective of health status were more often (p, <0.01) resistant than Gram -ve bacteria to ajowan oil, holy basil oil, cinnamaldehyde, and cinnamon oil, but more susceptible to sandalwood oil (p, <0.01). However, for antibiotics, Gram +ve were more often susceptible than Gram -ve bacteria to cephalosporins, doxycycline, and nitrofurantoin. The study concludes that to understand the role of good and bad bacteria in the urinary tract microbiome more targeted studies are needed to discern the isolates at the pathotype level.
Chemical kinetics is the study of the rates at which chemical reactions occur and the factors that influence these rates.
Importance in Pharmaceuticals: Understanding chemical kinetics is essential for predicting the shelf life of drugs, optimizing storage conditions, and ensuring consistent drug performance.
Rate of Reaction: The speed at which reactants are converted to products.
Factors Influencing Reaction Rates:
Concentration of Reactants: Higher concentrations generally increase the rate of reaction.
Temperature: Increasing temperature typically increases reaction rates.
Catalysts: Substances that increase the reaction rate without being consumed in the process.
Physical State of Reactants: The surface area and physical state (solid, liquid, gas) of reactants can affect the reaction rate.
EXPERIMENTAL STUDY DESIGN- RANDOMIZED CONTROLLED TRIALRishank Shahi
Randomized controlled clinical trial is a prospective experimental study.
It essentially involves comparing the outcomes in two groups of patients treated with a test treatment and a control treatment, both groups are followed over the same period of time. Prepare a plan of study or protocol
a. Define clear objectives
b. State the inclusion and exclusion criteria of case
c. Determine the sample size, place and period of study
d. Design of trial (single blind, double blind and triple blind method)
2. Define study population: Most often the patients are chosen from hospital or from the community. For example, for a study for comparison of home and sanatorium treatment, open cases of tuberculosis may be chosen.
3. Selection of participants by defined criteria as per plan:
Selection of participants should be done with precision and should be precisely stated in writing so that it can be replicated by others. For example, out of open cases of tuberculosis those who fulfill criteria for inclusion may be selected (age groups, severity of disease and treatment taken or not, etc.)
Randomization ensures that participants have an equal chance to be assigned to one of two or more groups:
One group gets the most widely accepted treatment (standard treatment/ gold standard)
The other gets the new treatment being tested, which researchers hope and have reason to believe will be better than the standard treatment
Subject variation: First, there may be bias on the part of the participants, who may subjectively feel better or report improvement if they knew they were receiving a new form of treatment.
Observer bias: The investigator measuring the outcome of a therapeutic trial may be influenced if he knows beforehand the particular procedure or therapy to which the patient has been subjected.
Evaluation bias: There may be bias in evaluation - that is, the investigator(Analyzer) may subconsciously give a favorable report of the outcome of the trial.
Co-intervention:
participants use other therapy or change behavior
Study staff, medical providers, family or friends treat participants differently.
Biased outcome ascertainment:
participants may report symptoms or outcomes differently or physicians
Investigators may elicit symptoms or outcomes differently
A technique used to prevent selection bias by concealing the allocation sequence from those assigning participants to intervention groups, until the moment of assignment.
Allocation concealment prevents researchers from influencing which participants are assigned to a given intervention group.
All clinical trials must be approved by Institutional Ethics Committee before initiation
It is mandatory to register clinical trials with Clinical Trials Registry of India
Informed consent from all study participants is mandatory.
A preclinical trial is a stage of research that begins before clinical trials, and during which important feasibility and drug safety data are collected.
Following points high.
High Profile"*Call "*Girls in Kolkata ))86-075-754-83(( "*Call "*Girls in Kol...Nisha Malik Chaudhary
High Profile "*Call "*Girls in Kolkata ))86-075-754-83(( "*Call "*Girls in Kolkata Available
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Hepatocarcinoma today between guidelines and medical therapy. The role of sur...Gian Luca Grazi
Today more than ever, hepatocellular carcinoma therapy is experiencing profound and substantial changes.
The association atezolizumab (ATEZO) plus bevacizumab (BEVA) has demonstrated its effectiveness in the post-operative treatment of patients, improving the results that can be achieved with liver resections. This after the failure of the use of sorafenib in the already historic STORM study.
On the other hand, the prognostic classification of BCLC is now widely questioned. It is now well recognized that the indications for surgery for patients with hepatocellular carcinoma are certainly narrow in BCLC and no longer reflect what is common everyday clinical practice.
Today, the concept of multiparametric therapeutic hierarchy, which makes the management of patients with hepatocellular carcinoma much more flexible and allows the best therapy for the individual patient to be identified based on their clinical characteristics, is gaining more and more importance.
The presentation traces these profound changes that are taking place in recent years and offers a modern vision of the management of patients with hepatocellular carcinoma.
Why Does Seminal Vesiculitis Causes Jelly-like Sperm.pptxAmandaChou9
Seminal vesiculitis can cause jelly-like sperm. Fortunately, herbal medicine Diuretic and Anti-inflammatory Pill can eliminate symptoms and cure the disease.
Chair and Presenter, Stephen V. Liu, MD, Benjamin Levy, MD, Jessica J. Lin, MD, and Prof. Solange Peters, MD, PhD, prepared useful Practice Aids pertaining to NSCLC for this CME/MOC/NCPD/AAPA/IPCE activity titled “Decoding Biomarker Testing and Targeted Therapy in NSCLC: The Complete Guide for 2024.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/4bBb8fi. CME/MOC/NCPD/AAPA/IPCE credit will be available until July 1, 2025.
Pharmacotherapy of Asthma and Chronic Obstructive Pulmonary Disease (COPD)HRITHIK DEY
This PowerPoint presentation provides an in-depth overview of the pharmacotherapy approaches for managing asthma and Chronic Obstructive Pulmonary Disease (COPD). It covers the pathophysiology of these respiratory conditions, the various classes of medications used, their mechanisms of action, indications, side effects, and the latest treatment guidelines. Designed for students, healthcare professionals, and anyone interested in respiratory pharmacology, this presentation offers a comprehensive understanding of current therapeutic strategies and advancements in the field.
2. Audit
• Ward 23
Admissions + Transfer in – 355
Mortality - 02
• Ward 29
Admissions + Transfer in – 322
Mortality - 02
• Clavien – Dindo Classification – Grade II
3. Mrs P G Lasanthi, 34yrs old female from Kahathuduwa
Thyroid goiter for 4 months
USS – L/S Thyroid nodule +Level III LN
FNAC - ? Medullary/Hurthle cell CA
S.Ca2+
S.Calcitonin NAD
24hr Urinary Metanephrines
USS Abd
4. Total Thyroidectomy + L/S Selective Neck
Dissection done
• Level VI
LN clearance done
• L/S Level II, III, IV, Vb
• 2 drains placed – Thyroid bed & Posterior Triangle
• Histology – Papillary CA + 5/25 LN positive
5. • Post op Day 1 – No voice change
No hypocalcemic features
Drain = 95ml
• Post op Day 3 – Drain = 315ml
? Chyle leak
• Post op Day 5 – Drain = 650 ml – High output chyle leak (>500ml)
6. Conservative Management
• Prop up – 45o
• S/C Octreotide 100 mcg tds
• Nutritional referral – Medium chain fatty acid diet
• IV Cefuroxime 750mg tds
• Lactulose
• Tight dressing
• Suction drain
• Hydration
• No hyponatremia, hypochloremia & clotting derangement
8. • Post op Day 8 – Drain = 300 ml
• Post op Day 12 – Drain = 120 ml
• Post op Day 21 – Drain = Nil
• Post op Day 23 - Discharged
9. Root Cause Analysis
T.T + L/S
Functional Neck
Dissection
Chyle Leak
(High out put)
Conservative
Management
Chyle leak
persists
Chyle leak
persists
Surgical
exploration
1)Transabdominal
embolization
2)Thoracoscopic
ligation
1)Low Fat Diet
2)Remove drain
3)Octreotide
additional 2 days
Yes No
10. Literature Review
• Intraoperative identification
Valsalva maneuver
Manual abdominal compression
• Conservative management
Diet – MCFA + Orlistat
TPN – High out put
Compression dressing – controversial
Octreotide
• Topical agents – Sclerosing agents
Fibrin glue
11. Literature Review cont
• Surgical interventions – High out put > 5days/ no prompt response to medical Mx
Re-exploration Ligation of Thoracic duct
Cover with muscle flap
Distal embolization – success rate 45-70 %
Thoracoscopic ligation of Thoracic duct
12. Literature Review cont.
• Retrospective study
• Octreotide therapy appears superior to
traditional conservative measures
• Reduce hospital stay
• 1st line conservative management