A Lecture Presented to The International Congress of Pediatric Hepatology & Gastroenterology, September 2010

Sepsis is a potentially life-threatening complication of an infection. Sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammatory responses throughout the body. This inflammation can trigger a cascade of changes that can damage multiple organ systems, causing them to fail. If sepsis progresses to septic shock, blood pressure drops dramatically, which may lead to death. Anyone can develop sepsis, but it's most common and most dangerous in older adults or those with weakened immune systems. Early treatment of sepsis, usually with antibiotics and large amounts of intravenous fluids, improves chances for survival. Symptoms & causes Symptoms Many doctors view sepsis as a three-stage syndrome, starting with sepsis and progressing through severe sepsis to septic shock. The goal is to treat sepsis during its early stage, before it becomes more dangerous. Sepsis To be diagnosed with sepsis, you must exhibit at least two of the following symptoms, plus a probable or confirmed infection: Body temperature above 101 F (38.3 C) or below 96.8 F (36 C) Heart rate higher than 90 beats a minute Respiratory rate higher than 20 breaths a minute Severe sepsis Your diagnosis will be upgraded to severe sepsis if you also exhibit at least one of the following signs and symptoms, which indicate an organ may be failing: Significantly decreased urine output Abrupt change in mental status Decrease in platelet count Difficulty breathing Abnormal heart pumping function Abdominal pain Septic shock To be diagnosed with septic shock, you must have the signs and symptoms of severe sepsis — plus extremely low blood pressure that doesn't adequately respond to simple fluid replacement. When to see a doctor Most often sepsis occurs in people who are hospitalized. People in the intensive care unit are especially vulnerable to developing infections, which can then lead to sepsis. If you get an infection or if you develop signs and symptoms of sepsis after surgery, hospitalization or an infection, seek medical care immediately. Causes While any type of infection — bacterial, viral or fungal — can lead to sepsis, the most likely varieties include: Pneumonia Abdominal infection Kidney infection Bloodstream infection (bacteremia) The incidence of sepsis appears to be increasing in the United States. The causes of this increase may include: Aging population. Americans are living longer, which is swelling the ranks of the highest risk age group — people older than 65. Drug-resistant bacteria. Many types of bacteria can resist the effects of antibiotics that once killed them. These antibiotic-resistant bacteria are often the root cause of the infections that trigger sepsis. Weakened immune systems. More Americans are living with weakened immune systems, caused by HIV, cancer treatments or transplant drugs. Risk factors Sepsis is more common and more dangerous if you: Are very young or very old Have a compromised immune system Are already very sick, often in a hospital's intensive care unit Have wounds or injuries, such as burns Have invasive devices, such as intravenous catheters or breathing tubes Complications Sepsis ranges from less to more severe. As sepsis worsens, blood flow to vital organs, such as your brain, heart and kidneys, becomes impaired. Sepsis can also cause blood clots to form in your organs and in your arms, legs, fingers and toes — leading to varying degrees of organ failure and tissue death (gangrene). Most people recover from mild sepsis, but the mortality rate for septic shock is nearly 50 percent. Also, an episode of severe sepsis may place you at higher risk of future infections.

this video show the surgical technique of a perforator propeller flap for the reconstruction of the lower limb.

Gowers' sign is a medical sign that indicates weakness of the proximal muscles, namely those of the lower limb. The sign describes a patient that has to use his hands and arms to "walk" up his own body from a squatting position due to lack of hip and thigh muscle strength. It is named for William Richard Gowers. Gowers' sign is classically seen in Duchenne muscular dystrophy, but also presents itself in centronuclear myopathy, myotonic dystrophy and various other conditions associated with proximal muscle weakness. For this maneuver, the patient is placed on the floor away from any objects that could otherwise be used to pull oneself to a standing position. It is also used in testing paraplegia.

Sexually Transmitted Diseases (STDs) affect millions of people each year. The most common STDs are gonorrhea, chlamydia and trichomoniasis. While even thinking about STDs and whether you may have one is scary, knowing the facts can make a big difference in your long-term health. Here is what you need to know:

People who are sexually active with multiple partners and are not using barrier protection are at most risk. Teenagers are a large part of this group, because they dont always practice safe sex and they are more likely to have multiple partners. It is recommended that women who are sexually active with multiple partners get screened yearly or immediately after they have engaged in unprotected sex. If you discover that you have an STD, both you and your partner would most likely be treated with antibiotics.

Gonorrhea
Approximately 350,000 cases of gonorrhea were reported to the CDC in 2006, but because not everyone is getting tested for STDs, experts believe the actual numbers are twice that.

The symptoms for gonorrhea are burning with urination, abnormal discharge or pelvic pain. Pelvic pain indicates a very severe infection. Untreated gonorrhea can lead to a serious infection as the disease may spread to a womans fallopian tubes and cause infertility.

Chlamydia
There were 1,000,000 cases of chlamydia reported to the CDC in 2006; experts think the actual rate of infection is as high as 2,000,000 cases.

Chlamydia is often called the silent disease because many people with chlamydia have no symptoms. Chlamydia can affect the urethra, the vagina, the cervix and the fallopian tubes. Symptoms include burring with urination, abnormal discharge and pelvic pain. If you are experiencing any of these systems you should see your doctor to determine if you have chlamydia. Women with chlamydia who arent treated are likely to develop pelvic inflammatory disease. Pelvic inflammatory disease occurs when the infection spreads and causes scarring to the uterus and fallopian tubes. Untreated chlamydia can result in infertility.

Trichomoniasis
Trichomoniasis is the most common STD. About 7 million women and men have trichomoniasis. Women who have trichomoniasis will often experience a frothy yellow or green discharge coming from their vagina. But some people wont have any symptoms.

Understanding STDs, what causes them, and how to treat them will help you stay in control of your health.

USMLE Step 2 CS - Pain Seeking This is just preview video. To get full access please visit our website : www.usmletutoring.com

Medications to treat high blood pressure Thiazide diuretics. ... Beta blockers. ... Angiotensin-converting enzyme (ACE) inhibitors. ... Angiotensin II receptor blockers (ARBs). ... Calcium channel blockers. ... Renin inhibitors

Rhabdomyolysis is a condition in which damaged skeletal muscle (Ancient Greek: rhabdomyo-) tissue breaks down rapidly (Greek –lysis). This damage may be caused by physical (e.g. crush injury), chemical, or biological factors. Breakdown products of damaged muscle cells are released into the bloodstream; some of these, such as the protein myoglobin, are harmful to the kidney and may lead to kidney dysfunction. The severity of the symptoms (which may include muscle pains, vomiting and confusion) depends on the extent of the muscle damage, and whether kidney failure develops. The mainstay of treatment is generous intravenous fluids, but could include dialysis or hemofiltration.

Rhabdomyolysis and its complications are significant problems for those injured in disasters such as earthquakes and bombing. Relief efforts in areas struck by earthquakes often include medical teams with skills and equipment for treatment of survivors with rhabdomyolysis. The disease and its mechanisms were first fully elucidated during the Blitz of London in 1941.

Worlds Most Amazing Medical Case

Symptoms of serotonin syndrome include a classic triad of mental status changes (eg, anxiety, delirium, confusion, restlessness), autonomic dysregulation (eg, diaphoresis, tachycardia, hypertension, hyperthermia, diarrhea, mydriasis), and neuromuscular hyperactivity (eg, hyperreflexia, tremor, rigidity, myoclonus, ocular clonus). Serotonin syndrome is clinically diagnosed and laboratory tests are used to rule out other etiologies. It usually occurs due to inadvertent interactions between drugs, therapeutic use of multiple serotonergic agents, or serotonergic medication overdose. Treatment involves discontinuation of serotonergic drugs, supportive measures, and sedation with benzodiazepines. In severe cases, a serotonin antagonist (cyproheptadine) may be used.

The etiology of BOO is diverse and definitely gender specific. Often anatomic causes induce functional abnormality that remains somewhat unique for each individual, regardless of sex. A full appreciation of the possible etiologies of obstruction is necessary in order to identify overt and more subtle scenarios. In women, iatrogenic causes of obstruction are the most common. Other entities account for far fewer of the cases. The obstruction evaluation in women is somewhat more diverse in terms of modalities used, with no single grouping of techniques that are generally apropos. Individualized evaluation remains a tenet of analysis, and urodynamic criteria used to diagnose BOO in women continue to evolve.

Laparoscopic Resection of Ovary Dermoid Cyst

Foreceps Delivery Birth Video

Watch that video to know if you have Trypophobia

A peak flow meter is an inexpensive, portable, handheld device for those with asthma that is used to measure how well air moves out of your lungs. Measuring your peak flow using this meter is an important part of managing your asthma symptoms and preventing an asthma attack.

The clinician performing the procedure should be familiar with the anatomy of the specific joint and cognizant of the relevant landmarks in order to avoid puncture of tendons, blood vessels, and nerves (see the images below).

Histology of GastroDuodenal Junction

Histology of Mucles Skeletal Smooth Cardiac

Diabetic Foot Surgical Debridement

A vasectomy is one of the most effective kinds of birth control out there, and THE most effective method for people with penises and testicles. Vasectomies are almost 100% effective at preventing pregnancy — but not right away. It takes about 3 months for your semen to become sperm-free