Morbid obesity
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This document discusses morbid obesity and its treatment. It defines morbid obesity as weighing two or more times the ideal weight and being associated with serious health risks. It provides information on calculating BMI and risk factors for obesity like eating more calories than burned, stress, medications, and genetics. Signs and symptoms are significant weight gain and a BMI over 40. Physical effects include increased risk of stroke, respiratory disease, diabetes, and some cancers. Treatment options discussed are non-surgical approaches like diet and exercise, which often don't work long-term, and various bariatric surgery procedures that are more effective.
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This presentation, authored by Dr. Faiza, Assistant Professor of Physiology at CIMS Multan, delivers an in-depth analysis of heart valves, heart sounds, valvular heart diseases, and congenital heart defects. It begins by distinguishing between normal and abnormal heart sounds, elucidating the timing and causes of the four heart sounds—S1, S2, S3, and S4—and their clinical significance. Detailed explanations are provided on the auscultation sounds that define conditions such as mitral stenosis, mitral insufficiency, aortic stenosis, and aortic insufficiency, with a focus on how these pathological changes affect cardiac mechanics and blood pressure.
The presentation delves into abnormal heart sounds, known as murmurs, categorizing them by their causes, which include valvular lesions, rheumatic fever, aging, congenital heart diseases, viral infections during pregnancy, and hereditary factors. It explores the various types of murmurs, their timing within the cardiac cycle, and their association with specific valvular heart diseases such as stenosis and regurgitation. The intricate relationship between systolic and diastolic murmurs and conditions like anemia and ventricular septal defects is also highlighted.
Further, the presentation covers the pathophysiology of congenital heart diseases, offering a comprehensive review of conditions such as Tetralogy of Fallot and Patent Ductus Arteriosus. It explains the mechanisms of these diseases, their impact on cardiac function, and the clinical manifestations observed in affected individuals. The physiological adjustments of the circulatory system during exercise in patients with valvular lesions are discussed, emphasizing the reduced cardiac reserve and the risk of acute pulmonary edema.
Special attention is given to the compensatory mechanisms of the heart in response to valvular diseases, including the development of concentric and eccentric hypertrophy, increased venous return, and the eventual progression to heart failure. The presentation also examines rheumatic valvular lesions, aging-related aortic stenosis, and the specific challenges posed by these conditions, such as reduced stroke volume and increased metabolic demand.
This thorough exploration of heart sounds, valvular diseases, and congenital defects is designed to enhance understanding and clinical acumen, making it a valuable resource for medical students, healthcare professionals, and educators in the field of cardiology and physiology.
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These simplified lecture slides by Dr Sidra Arshad offer a concise look at the cardiovascular effects of heart failure:
1. Define cardiac failure, its pathophysiology and clinical manifestations
2. Differentiate between the factors causing hyper-effective and hypo-effective heart functions
3. Differentiate between right and left heart failure based on their presentation
4. Outline the physiology of treatment of cardiac failure
Drugs Used in the Treatment of Arrhythmia
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Techniques and Principles of Cleaning and Shaping
Principles of Cleaning
Nonsurgical root canal treatment is a predictable method of retaining a tooth that otherwise would require extraction. Success of root canal treatment in a tooth with a vital pulp is higher than that of a tooth that is necrotic with periradicular pathosis. The difference is the persistent irritation of necrotic tissue remnants, and the inability to remove the microorganisms and their by-products. The most significant factors affecting this process are tooth anatomy and morphology, and the instruments and irrigants available for treatment. Instruments must contact and plane the canal walls to debride the canal.
Morphologic factors such as lateral and accessory canals, canal curvatures, canal wall irregularities, fins, cul-de-sacs, and isthmuses make total debridement virtually impossible. Therefore the goal of cleaning not total elimination of the irritants but it is to reduce the irritants.
Currently there are no reliable methods to assess cleaning. The presence of clean dentinal shavings, the color of the irrigant, and canal enlargement three file sizes beyond the first instrument to bind have been used to assess the adequacy; however, these do not correlate well with debridement. Obtaining glassy smooth walls is a preferred indicator. The properly prepared canals should feel smooth in all dimensions when the tip of a small file is pushed against the canal walls. This indicates that files have had contact and planed all accessible canal walls thereby maximizing debridement (recognizing that total debridement usually does not occur).
Principles of Shaping
The purpose of shaping is to
1) facilitate cleaning and
2) provide space for placing the obturating materials.
The main objective of shaping is to maintain or develop a continuously tapering funnel from the canal orifice to the apex. This decreases procedural errors when cleaning and enlarging apically. The degree of enlargement is often dictated by the method of obturation. For lateral compaction of gutta percha the canal should be enlarged sufficiently to permit placement of the spreader to within 1-2 millimeters of the corrected working length. There is a correlation between the depth of spreader penetration and the apical seal.5 For warm vertical compaction techniques the coronal enlargement must permit the placement of the pluggers to within 3 to 5 mm of the corrected working length.6
As dentin is removed from the canal walls the root is weakened.7 The degree of shaping is determined by the preoperative root dimension, the obturation technique, and the restorative treatment plan. Narrow thin roots such as the mandibular incisors cannot be enlarged to the same degree as more bulky roots such as the maxillary central incisors. Post placement is also a determining factor in the amount of coronal dentin removal.
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Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdf
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Morbid obesity
- 1. DONE BY :- HAMAD EMAD THUHAYR SUPERVISOR BY :- DR. AHMED AND DR. OTHMAN 2ST BGM SOEPLE 3 Morbid obesity
- 2. Contents Introduction How to calculate BMI Risk factor Sings and Symptome Physical Effects of Obesity Treatment References
- 3. Introduction morbid obesity the condition of weighing two or more the ideal weight; so called because it is associated with many serious and life-threatening disorders.
- 4. How to calculate BMI
- 5. Risk factor When you eat more, the result of too much fat being stored in your body. stress, anxiety, and lack of sleep, can lead to weight gain. People who quit smoking often experience temporary weight gain. Women may also have trouble losing the weight they gain during pregnancy or gain additional weight during menopause. Certain medications, such as birth control pills and antidepressants, can cause weight gain. Genetic factors can play a role in how your body stores energy, but this relationship has not been fully researched. Current research is investigating the relationship between genetics and body weight.
- 6. Signs and Symptomes The symptoms of obesity are weight gain and a body mass index (BMI) above 40 Body fat distribution Apple shaped obesity .
- 7. Body fat distribution Apple shaped obesity Women cm >88 cm (80cm) = Increased risk Men >102 cm (90cm) = Increased risk Lean MEJ et al. Lancet; 1998; 351:853-6
- 8. Physical Effects of Obesity Stroke Respiratory disease Gall bladder disease Cardiovascular Diabetes Osteoarthritis Hormonal abnormalities gout Cancer
- 9. Treatment 1. Non-Surgical: Diet, Exercise, and Behavior Modification Traditional weight loss programs rely on a combination of diet, exercise, and behavior modification. Unfortunately, even the best programs only work for a small percentage of people—like less than 5% achieve long-term success. According to the National Institutes of Health NIH, more than 90% of all weight loss program participants regain their weight within one year. And it's even more difficult for morbidly obese patients. We recommend considering surgical weight loss options for these patients. In fact, the risk of death from not having surgery is greater than the risks of surgery.
- 10. Cont….. 2. Bariatric Surgery Purely Restrictive Sleeve Gastrectomy Gastric Balloons Gastric adjustable banding Restrictive > Malabsorptive Short-limb/Roux-en-Y gastric bypass Malabsorptive > Restrictive Biliopancreatic diversion (BPD) BPD with duodenal switch Long limb Roux-en-Y gastric bypass
- 13. Refferences Oxford Handbook of Clinical Medicine www.wikipedia.org www.emedicinehealth.com CECIL , GOLDMAN 26 EDETION.