Various Medicine powerpoint slides


AV Block explained by husband & wife joke

Never seen anyone explain AV blocks in such an easy way!

p wave = wife
qrs = husband
pacer = counseling

normal sinus rhythm:
the wife (p wave) waits at home for the husband (qrs).
the husband (qrs) come homes on time every night.

1st degree AV block:
the wife (p wave) is waiting at home. the husband (qrs) comes home late every night, but he always comes home and its at the same time every night.

2nd degree block type I (Weinkebach):
the wife (p wave) is waiting at home. the husband (qrs) come home later and later every night until one night he doesn’t come at all.
note: husband (qrs) must come home at least 2 nights in a row to see this pattern.

2nd degree AV block type II
the wife (p wave) is waiting at home. sometimes the husband (qrs) comes home, sometimes he doesn’t. when he does come home, its always at the same time.
note: this is usually more serious than type I (Weinkebach) and will sometimes require counseling (pacing).

3rd degree AV block:
wife (p wave) is no longer waiting at home. she and her husband (qrs) are now both on separate schedules and have no relationship and they are no longer talking. each spouse has a regular, individual schedule.
note: this frequently requires counseling in the form of a temporary or permanent pacer.


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Govt won’t issue NORI to doctors to check brain drain: Health Minister JP Nadda

Health Minister J P Nadda today informed Rajya Sabha that the Ministry has revised its guidelines to tackle large scale immigration of Indian doctors to foreign shores.

To tackle brain drain of doctors, the government has decided not to issue ‘No Obligation to Return to India’ certificate to doctors in any circumstances, except to those who are over 65 years of the age.

Health Minister J P Nadda today informed Rajya Sabha that the Ministry has revised its guidelines to tackle large scale immigration of Indian doctors to foreign shores.

“As per the revised guidelines of the Ministry of Health and Family Welfare, ‘No Obligation to Return to India (NORI)’ certificate will not be issued in any circumstance, except for those who are above 65 years of age,” He said.

Nadda was replying to a question whether the country was witnessing a huge brain drain of doctors that directly affect the health sector and whether the government has taken stringent action to stop this.

“During 2010-2014, a total number of 3,947 Statement of Need (SON) Certificates and Exceptional Need Certificates (ENC) were issued by the Health Ministry to Indian doctors to enable them to pursue higher medical studies in the United States of America (USA),” he said.

The government has taken measures to improve the working conditions of the doctors including “considerable” enhancement of pay and allowances of doctors after implementation of the 6th Central Pay Commission, Nadda said.

The other measures include amendment of MCI regulations to provide the age of superannuation for doctors in teaching cadre can go up to 70 years, revision of Assured Career Progression Scheme for faculty of central government institutions to make it more beneficial.

Nadda said that various allowances available to the faculty like Non-Practising Allowance, Conveyance Allowance, Learning Resource Allowance and others have been also been enhanced considerably.

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Appendix – Joke

A nonsurgical noninflammatory chat with the appendix
Interview done
by Srt.😜

Name    :  appendix

Surname   :vermiform
called   :      vestigeal

Address: mcburneys point, right iliac fossa gated community.

Cell numb:ask the pathologist 😝 for cell numb and type.

Email id
(  password:  I think is fecolith😝  )        

facebook status:married to miss o.appendix (mesoappendix)

Watsapp group:adorable abdomen

Fav music:bowel sounds

Fav dance:persistalsa (intestinal salsa dance😜)

Fav tv show:grays  anatomy (very romantic😝😷)

favourite indoor game:hide n seek . Sometimes I hide beneath the liver n in the pelvis to confuse the radiologist .but they hav discovered a cat which can find me there too….CAT scan😪.

Fav subj :maths.
I keep counting the follicles in the ovary, fimbria of the fallopian tube n villi of the intestine.

Fav outdoor game: free style swimming in  formalin solution.

Nature:silent but wen I fight I become red with anger (appendicitis)
And can even create tsunami in the abdomen (peritonitis) and send the owner of the abdomen to motuary n then to obituary .😜

One last message to the viewers:save us from the serial killers ( ie from the  genlsurgeons.)

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Midazolam Nasal Spray for Seizures

A nasal spray formulation of midazolam may diminish repeated seizures and lower the risk of generalized tonic-clonic seizures in hospitalized epilepsy patients, researchers found.

In a retrospective analysis of data from a German university epilepsy center, those given intranasal midazolam during or right after a seizure remained free of seizures longer than those not given the drug (5.83 hours versus 2.37 hours), according to Lara Kay, a doctoral candidate at Philipps University in Marburg in Germany, and colleagues.

Those who didn’t get the drug also had a higher risk of generalized tonic-clonic seizures over the next 24 hours (odds ratio 4.67, 95% CI 1.06 to 2.12), they reported online in Epilepsia.

The researchers noted that it’s important to give anticonvulsants quickly, easily, and safely when managing repetitive and prolonged seizures, both in the hospital and in the community setting.

The gold standard treatment in such cases is intravenous lorazepam, but getting venous access may be a challenge during a seizure, and it may not be possible for a caregiver to do so outside of a hospital in an emergency situation.

Other formulations for home use have included rectal diazepam, which hasn’t had good uptake for a number of reasons, including stigma and shame, the researchers said. There’s also buccal midazolam, which has been approved in Europe.

Intranasal midazolam is an emerging technique for periprocedural sedation and for acute seizure control. The idea is to have a formulation that allows for rapid and easy administration. It’s been studied in home use, with no differences in efficacy or complications when compared with intravenous diazepam.

Now the researchers are looking at its in-hospital effects. Since 2008, the hospital’s epilepsy center has used intranasal midazolam to treat seizures and prevent seizure clusters and tonic-clonic seizures.

Kay and colleagues reviewed the records of 75 patients, mean age 35, who were treated with intranasal midazolam at their center, during or right after an epileptic seizure from 2008 to 2014.

The nasal spray was manufactured by the hospital’s pharmacy, and it delivered a dose of 2.5 mg midazolam per puff. The average dose per patient was 5 mg, or two sprays. It took a median time of 2.17 minutes to give intranasal midazolam.

They found that over the next 12 hours, the number of seizures was significantly lower for those who took intranasal midazolam. The median seizure-free interval was significantly longer for those who had the nasal spray than for those who didn’t (P=0.015).

They noted that the likelihood of a patient developing a subsequent seizure was four higher in first hour and fell gradually after 12 hours (OR 4.33, 95% CI 1.30-14.47 and OR 1.5, 95% CI 1.06-2.12, respectively).

Patients who didn’t receive intranasal midazolam had a much higher likelihood of experiencing a generalized tonic-clonic seizure during a 24-hour observation period than those who didn’t get the drug (P=0.009).

Only four patients (5.3%) had an adverse event. Three patients had nasal irritation, while in the fourth, administration was delayed by the patient’s ictal automatisms and head turning.

There were no serious adverse events and the treatment was generally well-tolerated, the researchers said.

“This study provides evidence that ictal and immediate postictal administration of intranasal midazolam is a well-tolerated procedure and prevents subsequent seizures for a 12-hour period and especially generalized tonic-clonic seizures for a 24-hour period,” they concluded.

They added that intranasal midazolam is “easy to employ, and it can be delivered from any position. Even during a seizure, it takes little time to administer the dose, and patients do not need to be restrained.”

The study was limited by its retrospective, observational nature and lack of randomization, and the results need to be confirmed in larger randomized trials, the researchers said.

Another challenge is that there’s no commercial preparation available, but it still may be an inexpensive way to reduce the costs of morbidity and mortality associated with seizure activity, they concluded.

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