When Heart Failure has to do with Past Abdominal Surgery

A 70-year-old woman, with a past medical history of permanent atrial fibrillation, cholecystectomy for symptomatic gallstones and obesity (54 kg/m2 body mass index), was admitted to the hospital for rapidly increasing dyspnea (NYHA class III). At admission, heart rate was 110 beats per minute(bpm) and blood pressure was 125/73 mmHg. Physical examination revealed clinical signs of right heart failure including major peripheral oedema, hepatomegaly, bilateral pleural effusion, and ascites with no signs of portal hypertension or hepatocellular insufficiency.

On the first transthoracic echocardiogram, preserved left ventricular ejection fraction with normal diastolic function was noticed. Interestingly, a major dilatation of the right ventricle, the right atrium, and the inferior vena cava (45 mm) were observed. Systolic pulmonary artery pressures were estimated as high as 60 mmHg with the tricuspid regurgitation, and cardiac index was increased, reaching 4.8 L/min/m2. Pulmonary assessment on the six-minute walk test was satisfying at 255 meters, and a small restrictive impairment was documented on a pulmonary function test (assigned to obesity). Finally, no perfusion defect was found on the ventilation/perfusion lung scan.

Assessment of Superordinate Categorization in 2-4 years Typically Developing Children

Classification is a powerful cognitive process, allowing us to organize a great deal of information efficiently and flexibly. When we form classes, we highlight important similarities among objects and events, treating very different items as equivalent for certain purposes, since a particular item could be a member of many different classes.

For example, an apple can be classified under ‘fruit’, ‘food’, ‘physical object’, etc. These classes are hierarchically organized and they honor inclusion relations.

Taxonomic categorization involves classification of items into groups based on similarities in the characteristics, structure, origin etc of the stimuli.In taxonomic categorization, it is often expected that items in a group have a strong association between them.

PDF LINK

Frequency and Etiology of Community-Acquired Bloodstream Infection in Hospitalized Febrile Children

Bloodstream infection is a severe problem that needs immediate attention and treatment as it can lead to morbidity and mortality. Fever is often the most common reason for presentation to the hospital in developing countries.

Most patients with febrile illness have selflimiting viral infections, but some have a serious bacterial infection that needs urgent and appropriate antimicrobial therapy advance in blood culture technique have resulted in efficient and reliable techniques for detection of bacterial and fungal pathogens.

Blood stream infection is a cause of high mortality especially if caused by multidrug-resistant bacteria. Bacteriologic culture to isolate the offending pathogen and knowledge about sensitivity pattern of isolates remains the mainstay of definitive diagnosis and management of bloodstream infection.

PDF LINK

Use of Smokeless Tobacco in Medical Students and Hypertension

Tobacco is being used in various forms including cigarette, shisha, cigar and bidi smoking and smokeless tobacco. Smokeless tobacco constitutes various forms of tobacco i-e paan/ betel quid, tobacco with lime, naswar, gutka, qiwam, tobacco tooth powder, minpuri, areca nut (supari).

Qiwam consists of thick paste of boiled tobacco mixed with powdered spices such as saffron, cardamom, aniseed and aroma, while paan/ betel quid is a mixture of the leaf of the Piper betle vine, aqueous calcium hydroxide paste [slaked lime].

Smokeless tobacco is commonly used in South Asia, where it has become part of South Asian culture. Furthermore, South Asia is a major producer and exporter of tobacco and over one-third of tobacco consumed in South Asia is smokeless.

PDF LINK

Practice Management Role in Monitoring Family Medicine Residents Adherence to ACGME-I Standards in Qatar

One of ACGME-I requirements was the practice management curriculum, Practice management curriculum is an essential tool, which can help in several ways, Besides training schedule, physician alert system, and several other innovative aspects of monitoring resident’s performance and prearranged activities, this will also reflect with equal measure on any training institute as well.

Practice management report is a tool used to evaluate practice activity and productivity for each resident. It also monitors their practice performance progression.

individuals/practice productivity which includes total number of patient visits seen by the resident in continuity care clinics , total number of visits to hospitalized patients, patient visits distribution by gender, patient visit distribution by age , patient visits distribution by presenting illness, and chart (SOAP) documentation.

PDF LINK

Top 15 Tips on Becoming an Effective Medical Simulation Performer

Medical simulation has become an important platform for medical education by allowing learners to be exposed to rare but challenging clinical and social situations in a targeted, simulated learning environment.

While high-fidelity simulation incorporates advanced programming software with life-like manikins that can blink, sweat, or even bleed, technology’s ability to replicate real-time human interactions remains limited.

The use of human actors/standardized patients can add significant constructive tension and realism to a case, and permits exploration of complex patient-provider dynamics.

PDF LINK

Tessier 30 Facial Cleft- Median Cleft of Upper and Lower Lip, Lower Alveolus and Mandible, Ankyloglossia and Cervical Teratoma

Cleft lip and palate are common, whereas median mandibular clefts are extremely rare anomaly found in cleft no. 30 in Tessier’s classification. This anomaly was first time reported by Couronne in 1819. So far upto 70 cases have been described in history.

Associated anomalies are lower lip hemangioma, facial anomalies, ankyloglossia, cleft palate, cervical dermoid cyst, hyoid bone agenesis, laryngeal cartilage malformation, epiglottis aplasia, cardiac malformation and chromosomal abnormalities, which further worsen the prognosis.

Failure of union of the first branchial arch in midline results in lower midline facial cleft defect whereas failure of fusion of the lower branchial arch elements are thought to lead to associated deformities of the neck.

PDF LINK