طب عام (سنة سادسة)⛧
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قناة تفتح ابوابها لجميع طلبة الطب في العالم تحت اشراف الدكتور المحترم الكبير الاستاذ محمد قاسم للتواصل مع صاحب القناة @Alive332002
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频道帖子
Repost from Act as Pediatrician 👶
🔴Leishmaniasis
▪︎It's A Protozoal Zoonotic Infection (Parasitic Infection Comes From Animals) Caused By Unicellular Flagellated Intracellular Leishmania Family
🔷Method Of Transmission
📍1. Infection Transmitted From Animals (Dogs Act As Reservoir) Through Phlebotomine SandFly Vectors To Humans (Humans Are Incidental Host)
📍2. Then From Those Infected Patients To Other Humans (Humans Also Act As Reservoir)
🔷Types Of Leishmaniasis
📍1. Visceral Leishmaniasis (VL/Kala-Azar)
📍2. Cutaneous Leishmaniasis (CL)
📍3. Mucosal Leishmaniasis (ML)
🔰Visceral Leishmaniasis (VL/Kala-Azar)
▪︎Caused By Leishmania.DonoVani Family (DonoVani/Infantum/Chagasi)
▪︎Affects Internal Body Organs (Spleen/Liver/BM/LN) & Results in Life Threatening Infection
▪︎Usually Affects Small Children & Infants & Immunocompromised Adults (HIV-Co Infection)
🔷Clinical Features & Dx Of VL
📍1. Asymptomatic Stage (Due To Long Incubation Period Weeks-Months-Years)
📍2. Starts As High Fever With Rigor & Chills (1st Sign) Then Starts To Decrease Gradually Over Time (With Episodes Of Fever Relapse But With Less Intensity)
📍3. Progressive SplenoMegaly Over Time Until Becomes Massive
📍4. Moderate HepatoMegaly
📍5. Lymph Nodes Enlargement (Occurs More in Africa)
📍6. Black Skin Discoloration (Advanced Disease)
📍7. Confirm Dx :
🔺I. CBC (PanCytoPenia) :
▪︎Severe Anemia
▪︎Leucopenia
▪︎Thrombocytopenia
🔺II. Elevated Liver Enzymes & Immunoglobulins (IgG Then IgM) & Decrease Albumin
🔺III. +Ve Serology (Stay +Ve Even After Tx/K39 Name Of Serology)
🔺IV. Tissue Biopsy Then Microscopic Examination (To See Amastigotes [Leishman Donovan Bodies]) Or Culture Or PCR ➡️ Best Method To Confirm Dx
🔷Complications Of VL
📍1. Heart Failure (Due To Severe Anemia)
📍2. Bleeding Episodes (Due To Thrombocytopenia)
📍3. Jaundice With Edema & Ascites (Due To Liver Inflammation Or Failure)
📍4. Secondary Bacterial Infections (Risk Of Death)
📍5. Post-Kala-Azar Dermal Leishmaniasis :
▪︎Diffuse HypoPigmented Erythematous Or Nodular Skin Lesions That Usually Affects Face (Around Chin) & Trunks
▪︎Develops Shortly After Tx Or Years Later (6m-3Years After Infection)
📍6. Death If Not Tx Given
🔷DDX Of VL
1. Malaria
2. Typhoid Fever
3. TB (Miliary)
4. Shistosomiasis
6. Brucellosis
7. Infectious Mononucleosis (CMV)
8. Malignancy (Leukaemia/Lymphoma)
9. Ameobic Liver Abscess
🔷Mx Of VL
📍1. Sodium StiboGluconate (Pentostam) & Meglumine Anti-Moniate ➡️ Both 20mg/Kg/Day IV Or IM For 28-30 Days (Repeated As Needed)
📍2. AmphoTericin B (0.75-1mg/Kg Every Day Or Every Other Day For 15-20 Dose) ➡️ Used in Resistant Cases & Recommended For Immunocompromised Patients
📍3. Other Drugs :
▪︎Pentamidine isethionate (4mg/Kg/Day For 2w)
▪︎ParoMoMycin (11-14mg/Kg/Day For 3-4w)
▪︎Miltefosin (Oral Drug 2.5mg/Kg For 28 Days)
▪︎Recombinant Human Interferon-Y
▪︎Drugs Combination (To Prevents Drug Resistant)
📍4. Patients Follow Up For 6-12m (Due To Risk Of Relapse)
| 2 |  ❇️Important DDX of Finger Clubbing | 174 |
| 3 |  ❇️Signs of skull fractures
▪︎CSF (clear fluid) leaking from nose or ear
▪︎Raccoon (Panda) eyes: bruising around the eyes (Fracture of the base of the skull)
▪︎Battle sign: bruising behind the ear over the mastoid process (Fracture in the posterior Cranial Fossa)
▪︎Haemotympanum: blood noted behind the tympanic membrane on otoscopy | 206 |
| 4 |  كلية الطب بجامعة ميسان تعرض حلقة لليوتيوبر صاحب المحتوى الهابط علي شاكر تتناول حياة السيدة فاطمة الزهراء "ع .
كلية طب تتعلم من شخص محتوى هابط
https://t.me/iraqi1_news | 299 |
| 5 | 🔴Trauma Protocol (ATLAS)
▪︎It's An Injury To Any Part Of The Human Body Due To Energy Transfer From An Inflicting Source
▪︎Major (Severe) Trauma is Injury To >1 Body Region Or Organ Systems & ISS Score >15 (Injury Severity Score)
▪︎Severe Trauma is The Major Cause Of Death in Young Patients
▪︎Most Of Trauma Are Not Life Or Limb Threatening (Mild-Moderate in Severity)
▪︎Sources Of Trauma Could Be :
📍1. Mechanical
📍2. Chemical
📍3. Thermal
📍4. Ionizing Radiation
▪︎Most Common Causes Of Trauma Are :
📍1. Road Traffic Accidents (RTA)
📍2. Fall From Height (FFH)
📍3. Intentional Violence
🔷Mechanisms Of Injury
📍1. Blunt Trauma (Most Common) :
▪︎Direct Blunt Trauma ➡ Damage Localized To The Initial Site Of The Mechanism
▪︎Indirect Blunt Trauma ➡ Damage Occur At Distant Sites Away From The Initial Site Due To Force Transmission
▪︎Usually Due To RTA/FFH/Interpersonal Assault يرگعه بطابوگة
📍2. Penterating Trauma ➡ Occurs Due To Sharp Objects Passing Directly Through The Tissue (Knife/Gunshots)
📍3. Combined Trauma (Blast Injury) Results in : انفجار
▪︎Tissue Penetration From Sharp Fragments
▪︎Tissue Disruption From Shock Wave
▪︎Tissue Burns
▪︎Traumatic Amputation
📍4. Burn Trauma (Leading Cause Of Accidental Death) Mechanisms :
▪︎Thermal Injury
▪︎Chemical Injury
▪︎Electrical Burns
▪︎Frostbite
📍5. Hidden Mechanisms :
▪︎When Patient Not Telling The Truth Due To Criminal Activity Or Abuse
▪︎Theses Are Called Non-Accidental Injuries (NAI)
▪︎Factors Goes With NAI :
🔻I. Signs Of Injuries Not Consistent With The Reported Mechanism
🔻II. Long Bone Fractures in Children (Child Abuse) & Posterior Rib Fractures
🔻III. Patient Changing History & Aggressive Behaviour From Relatives
🔷Mx Of Trauma Patients
🔸A. Primary Survey
▪︎Focus On Rapid Identification & Mx Of The Most Life-Threatening Injuries
▪︎Consist Of cABCDE Protocol :
📍1. Control Haemorrhage From Massive Arterial Bleeding :
▪︎Massive Arterial Bleeding Usually Seen Due To Gunshots & Blasts (Military Practice)
▪︎Mx By :
🔻I. Direct Pressure On The Source Of Bleeding
🔻II. Pack Application
🔻III. Tourniquets Application (Monitor Time Of Tourniquet Application)
📍2. Airway & Cervical Spine Protection :
🔻I. Spine Immobilization (Using Cervical Collar & Log-Rolling Technique For Transfer Of The Patient)
🔻II. Airway Suctioning & Protection From Aspiration
🔻III. Airway Opening Maneuvers :
▪︎Jaw Thrust & Chin Left
▪︎Insertion Of OroPharyngeal Or NasoPharyngeal Tube
▪︎CricoThyroidotomy
▪︎Insertion Of Endotracheal Tube
📍3. Breathing & Ventilation :
🔻I. High Flow Oxygen For All Patients
🔻II. Immediate Mx Of Tension Pneumothorax Or HaemoThorax | 315 |
| 6 |  Early CT Signs of Acute Ischemic Stroke (Part 1)
• Loss of Gray–White Matter Differentiation
• Insular Ribbon Sign (Loss of Insular Ribbon)
• Lentiform Nucleus Obscuration
العلامات اللي بتظهر بدري في الأشعة المقطعية في حالات السكتة الدماغية
#Radiology #Neuroradiology | 260 |
| 7 |  DDX Of Herina/Lump in the Groin ■ | 278 |
| 8 | 🔴Esophageal Perforation
▪︎Emergent Condition With High Rate Of Morbidity & Mortality Due To Sepsis
🔷Causes Of Perforation
📍1. Iatrogenic (Most Common) Due To
▪︎Endoscopic Dilatation Of Strictures Or Achalasia
▪︎Endoscopic Mucosal Or SubMucosal Resection (EMR/ESR)
▪︎PerOral Endoscopic MyoTomy (POEM)
📍2. Spontaneous Perforation (Boerhaave's Syndrome)
▪︎Due To Violet Vomiting (Sudden Increase in Esophageal Pressure Against Closed Glottis)
▪︎Perforation More On The Left Posterio-Lateral Lower Esophagus (Near Left Pleural Cavity)
📍3. Penetrating Trauma To Esophagus
📍4. Ingestion Of Sharp Foreign Body (Fish Bone)
📍5. Ingestion Of Corrosive Agents (More With Alkaline)
📍6. Esophageal Cancer Perforation
📍7. EosinoPhilic Eosophagitis (EOO) Risk Of Spontaneous Perforation
🔷Clinical Features Of Perforation
📍1. Upper (Cervical) Esophagus
▪︎Neck Pain & Tenderness
▪︎Subcutaneous Emphysema
▪︎Less Sepsis
📍2. Middle (Thoracic) Esophagus
▪︎Retrosternal Chest Pain
▪︎Dysphagia
▪︎Dyspnea & Cyanosis (Due To Pleural Effusion Or Pneumothorax)
▪︎MediaStinitis & Septic Shock
▪︎Most Dangerous Perforation
📍3. Lower (Abdominal) Esophagus
▪︎Peritonitis
📍4. Spontaneous Perforation (Boerhaave's Syndrome)
▪︎Triad Of ➡️ Vomiting & Chest Pain & Subcutaneous Emphysema
▪︎Haematemesis
▪︎Left Pleural Effusion
▪︎Hamman's Sign (Crunching Sound On Heart Auscultation Due To Surgical Emphysema) صوت طحن الاسنان
▪︎DDX Of Spontaneous Perforation (Boerhaave's Syndrome) ➡️ Pneumonia/Myocardial Infarction/Perforated Viscous
📍5. Fever/Tachycardia/Tachypneia/Hypotension (Sepsis)
🔷Dx Of Perforation
📍1. Chest Xray (Erect)
▪︎Exclude Perforated Viscous (No Air Under The Diaphragm)
▪︎Gas in The Soft Tissue (Surgical Emphysema in MediaStinum & Neck)
▪︎Widened MediaStinum
▪︎Pneumothorax & HydroPneumoThorax
▪︎Pleural Effusion
📍2. Contrast CT Or Barium Swallow (GastroGrafin Or Non-Ionic Contrast) ➡️ Confirm Dx & Reveal Site Of Perforation & The Extension
📍3. Endoscopy (Only If Dx In Doubt)
🔷Mx Of Perforation
🔸A. Resuscitation
📍1. Nill By Mouth
📍2. IV Fluids & Electrolytes Correction
📍3. Antibiotics
📍4. Oxygen
📍5. NG Tube ➡️ For Suction & Nutrition
📍6. Chest Tube ➡️ For Large Pleural Effusion & Pneumothorax
🔸B. Mx Of Perforation
📍1. Stable Patient & Limited Perforation (Cervical Esophageal Perforation) ➡️ Only Conservative Tx
📍2. Septic Patient (Thoracic Esophageal Perforation)
▪︎Endoscopic Sealing Of Perforation Using Clips & Metalic Stens
▪︎Surgical Repair Of Perforation
📍3. Delayed Presentation ➡️ Convert The Perforation Into Controlled Fistula Using T-Tube
📍4. Other Methods For Repair
▪︎Esophageal Diversion
▪︎EsophageCtomy (For Extensive Caustic Burns)
🔹Indications For Surgical Intervention
1. Significant Sepsis
2. Large Perforation
3. Thoracic Esophagus Perforation
4. Involved Pleural Cavity
5. Delayed Presentation | 309 |
| 9 |  Postoperative Fever in days | 290 |
| 10 | 🤍🕊️✨
فِي هَذِهِ اللَّيْلَةِ الْمُبَارَكَةِ، لَيْلَةِ الْجُمُعَةِ، أَكْثِرُوا مِنْ ذِكْرِ اللهِ، وَمِنَ الصَّلَاةِ عَلَى الْحَبِيبِ الْمُصْطَفَى صَلَّى اللهُ عَلَيْهِ وَعَلَى آلِهِ الطَّاهِرِينَ، فَمَا مِنْ مُسْلِمٍ يُصَلِّي عَلَيْهِ صَلَاةً إِلَّا صَلَّى اللهُ بِهَا عَلَيْهِ عَشْرًا.
اللَّهُمَّ صَلِّ عَلَى سَيِّدِنَا مُحَمَّدٍ وَآلِ مُحَمَّدٍ.
🤍🕊️✨
#نفحات_إيمانية | 355 |
| 11 | 🔹Prevention Of ARF
📍1. Primary Prevention ➡️ Give Antibiotics During Symptoms Of GAS Pharyngitis (Before Day 9 Of The Symptoms Onset)
📍2. Secondary Prevention (Prevents Recurrence Of ARF) :
▪︎Phenoxy-Methyl-Penicillin (250mg 2x Daily Oral) Or Benzathine Penicillin (Single Dose 1.2M IM Monthly)
▪︎Erythromycin Or Sulfadiazine (Alternative To Penicillin)
▪︎Duration Of Prophylaxis :
I. Healthy Person ➡️ Until Age Of 21 Or 5 Years After The Last Episode
II. Residual Heart Disease ➡️ Continue Prophylaxis 10 Years After Last Episode Or Until Age Of 40 Years
🔹Complications Of ARF
📍1. Heart Failure
📍2. Recurrent Attacks Of ARF
📍3. Chronic RF (Valvular Heart Damage) :
▪︎More in Women
▪︎Mitral Valve (Most Commonly Affected As MS Or Mixed MS/MR)
▪︎Then Aortic Then Tricuspid Then Pulmonary | 338 |
| 12 | 🔴Acute Rheumatic Fever (ARF)
▪︎Rheumatic Fever is Multi-Systemic Disorder Results From Autoimmune Response Attacks The Body Organs In Reaction To GA Streptococcal Pharyngitis Or Skin Infection
▪︎More in Children At 5-15 Years Age in The Developing Countries البلدان الفقيرة
▪︎The GA Streptococcal Antigens Cross Reacts With Cardiac Proteins That Result in Cardiac Inflammation That Produces Heart Valve Damage in The Future
🔹Dx Of ARF (Jones Criteria)
▪︎(Two Major) Or (One Major + Two Minors) + Evidence Of Preceding Streptococcal Infection ➡️ Confirm Dx
▪︎Only Chorea Or Only PancCarditis (All Cardiac Layers Inflammation) Or Recurrent Acute Rheumatic Fever in Highly Risk Patients ➡️ Confirm Dx (No Need To Other Criteria)
📍1. Major Features :
▪︎Carditis
▪︎PolyArthritis
▪︎Chorea
▪︎Erythema Marginatum
▪︎Subcutaneous Nodules
📍2. Minor Features :
▪︎Fever
▪︎Arthralgia (Joint Pain)
▪︎Elevated ESR Or CRP
▪︎Leukocytosis
▪︎Previous Rheumatic Fever
▪︎1st Degree AV Block
📍3. Evidence Of Proceeding Streptococcal Infection :
▪︎+Ve Throat Culture (+Ve Only in 10-25%)
▪︎Recent Scarlet Fever حمى قرمزية
▪︎+Ve Streptozyme Test Or Anti-DNaseB Or Anti-Hyaluronidase
▪︎Elevated ASOT (>200U in Adults Or >300U in Children But Anti Streptococcal Antibody Titer Normal in ⅕ Of The Cases)
🔹Clinical Features Of ARF
📍1. Fever With Anorexia & Lethargy & Joint Pain 2-3w After Episode Of GA Streptococcal Pharyngitis
📍2. Arthritis (75% Most Common & Occurs Early) :
▪︎Acute Painful Asymmetric Migratory PolyArthritis Of Large Joints (Affect One Joint Then Move To The Other)
▪︎No Risk Of Deformity
▪︎Good Response To Aspirin
📍3. Carditis (90% At Age Of 3 Years & 30% At Adolescent) :
▪︎Chest Pain & Friction Rub & Tenderness (Due To Pericarditis Or PanCarditis)
▪︎SOB (Due To HF Or Pericardial Effusion)
▪︎Palpitation & Tachycardia
▪︎Cardiac Enlargement (On Xray)
▪︎New Or Changes Murmurs (Due To MR/AR/Valvulitis)
▪︎ECG Changes (ST & T Wave Changes/Accelerated Junctional Rhythm)
📍4. Skin Lesions :
▪︎Erythema Marginatum (5%) ➡️ Red Macules Faded in The Centre & Seen On Trunk & Proximal Limbs
▪︎Subcutaneous Nodules (5-7%) ➡️ Small Painless Firm Nodules Over The Extensor Surfaces Of Bones Or Tendons Seen 3w After The Onset Of Other ARF Features
📍5. Sydenham's Chorea (St Vitus Dance) :
▪︎Emotional Liability With Purposeless Involuntary ChoreiForm Movements (Of The Hands Or Feet Or Face) & Explosive Halting Speech كأنها مخبلة او بيها جني
▪︎Seen More in Females 3m After The Episode Of ARF (Late Neurological Complication When All Other Features Of ARF Disappeared)
▪︎Usually Spontaneous Recovery in Few Months (But Risk Of Developing Chronic RF)
📍6. Pleural Effusion/Pleurisy/Pneumonia
🔹Mx Of ARF
📍1. Bed Rest
📍2. Antibiotics :
▪︎Benzathine Penicillin (Single Dose 1.2M IM)
▪︎Phenoxy-Methyl-Penicillin (250mg 4x Daily For 10 Days Oral)
▪︎Erythromycin Or CephaloSporins (Alternative To Penicillin)
📍3. Cardiac Support (Mx Of HF) :
▪︎Fluid Restriction
▪︎Diuretics
▪︎ACEI
📍4. Aspirin (60-100mg/Kg/Day [Maximum 8g/Day]) :
▪︎Relive The Arthritis Rapidly (in 24-72h)
▪︎Given Continuously Until ESR Decreases Then Gradually Tapered
📍5. Steroids (Oral Prednisolone 1-2mg/Kg/Day) :
▪︎For Carditis Or Severe Arthritis
▪︎Given Continuously Until ESR Decreases Then Gradually Tapered | 347 |
| 13 | 🔹Prevention Of ARF
📍1. Primary Prevention ➡️ Give Antibiotics During Symptoms Of GAS Pharyngitis (Before Day 9 Of The Symptoms Onset)
📍2. Secondary Prevention (Prevents Recurrence Of ARF) :
▪︎Phenoxy-Methyl-Penicillin (250mg 2x Daily Oral) Or Benzathine Penicillin (Single Dose 1.2M IM Monthly)
▪︎Erythromycin Or Sulfadiazine (Alternative To Penicillin)
▪︎Duration Of Prophylaxis :
I. Healthy Person ➡️ Until Age Of 21 Or 5 Years After The Last Episode
II. Residual Heart Disease ➡️ Continue Prophylaxis 10 Years After Last Episode Or Until Age Of 40 Years
🔹Complications Of ARF
📍1. Heart Failure
📍2. Recurrent Attacks Of ARF
📍3. Chronic RF (Valvular Heart Damage) :
▪︎More in Women
▪︎Mitral Valve (Most Commonly Affected As MS Or Mixed MS/MR)
▪︎Then Aortic Then Tricuspid Then Pulmonary | 1 |
| 14 | 🔹Prevention Of ARF
📍1. Primary Prevention ➡️ Give Antibiotics During Symptoms Of GAS Pharyngitis (Before Day 9 Of The Symptoms Onset)
📍2. Secondary Prevention (Prevents Recurrence Of ARF) :
▪︎Phenoxy-Methyl-Penicillin (250mg 2x Daily Oral) Or Benzathine Penicillin (Single Dose 1.2M IM Monthly)
▪︎Erythromycin Or Sulfadiazine (Alternative To Penicillin)
▪︎Duration Of Prophylaxis :
I. Healthy Person ➡️ Until Age Of 21 Or 5 Years After The Last Episode
II. Residual Heart Disease ➡️ Continue Prophylaxis 10 Years After Last Episode Or Until Age Of 40 Years
🔹Complications Of ARF
📍1. Heart Failure
📍2. Recurrent Attacks Of ARF
📍3. Chronic RF (Valvular Heart Damage) :
▪︎More in Women
▪︎Mitral Valve (Most Commonly Affected As MS Or Mixed MS/MR)
▪︎Then Aortic Then Tricuspid Then Pulmonary | 3 |
| 15 | فضلاً وليس أمرا شاركوا القناة مع الاخرين وانضموا إليها | 171 |
| 16 | انضموا للقناة شباب 👆 | 249 |
| 17 | 🔴Achalasia
▪︎Failure Relaxation Of Lower Esophageal Sphincter (LOS) Due To Selective Loss Of Inhibitory Neurons in The Lower Esophagus (Loss Of Ganglionic Cells From Myenteric Auerbach's Plexus) With Absent Peristalsis in Body Of Esophagus
▪︎Most Common Esophageal Motility Disorder
▪︎Idiopathic Aetiology
▪︎More in Middle Age Females (30-40 Years)
🔹Clinical Features Of Achalasia
📍1. Start As Slowly Progressive Dysphagia (1st For Solids Then For Fluids)
📍2. Frequent Regurgitation Of Undigested Food
📍3. Halitosis (Bad Mouth Odour)
📍4. Weight Loss
📍5. Recurrent Chest Infections & Night Cough (Due To Food Aspiration)
📍6. Retrosternal Chest Pain That Decrease in Severity Later (Esophageal Peristalsis Diminished Over Time)
🔹DDX Of Achalasia
1. Chagas Disease ➡️ Chronic Infection With Trypanosoma Cruzi Results in Degeneration Of Myenteric Plexus
2. PseudoAchalasia ➡️ Malignant Tumors Of GIT (Adenocarcinoma Of Cardia/Pancreatic Tumors) & Bronchial Tumors Can Cause Obstruction At Lower Esophageal Sphincter
🔹Dx Of Achalasia
📍1. Endoscopy ➡️ Tight LOS & Food Residues in The Esophagus
📍2. Barium Swallow ➡️ Proximal Esophageal Dilatation With Distal Smooth Narrowing (Inverted Bird Beak Or Rat Tail Shape)
📍3. Esophageal ManoMetry (HRM Gold Standard)
▪︎No Relaxation Of LOS On Swallowing
▪︎No Esophageal Body Peristalsis
▪︎Raise in Esophageal Resting Pressure
🔹Mx Of Achalasia
📍1. Pneumatic Dilatation (75-85% Successful) ➡️ Using Plastic Balloon To Stretch & Dilates The LOS Gradually Over Weeks
📍2. Heller's MyoTomy (90% Successful) With Partial Anterior Fundoplication ➡️ Cutting The Muscle Of LOS & Cardia
📍3. Pre-Oral Endoscopic MyoTomy (POEM) ➡️ Creating SubMucosal Tunnel in Middle Part Of Esophagus
📍4. Endoscopic Injection Of Botox Into The LOS ➡️ Results in Transient Relaxation Of LOS & Need To Be Repeated Every Months
📍5. CCB (SubLingual Nifedipine) ➡️ Transient Symptomatic Relief Until Definitive Tx Done
🔹Complications Of Achalasia
🔶A. Preoperative
📍1. Aspiration Pneumonia
📍2. Esophageal Cancer (Squamous Carcinoma Of Esophagus)
🔶B. Postoperative
📍1. Perforation Of Esophagus (After Pneumatic Dilatation)
📍2. GERD (After Heller's MyoTomy)
📍3. Failed Dilatation Or Recurrent Stenosis
🔴Diffuse Esophageal Spasm (Jackhammer Or Nutcracker Or HyperContractile Esophagus)
▪︎incoordinated & Irregular Repetitive Esophageal Spasms (Peristalsis) More in Distal ⅔ Of Esophageal Body
▪︎More in Middle Age & Elderly Males
▪︎Idiopathic Aetiology
🔹Clinical Features
📍1. Intermittent Dysphagia
📍2. Acute Retrosternal Chest Pain Induced By Eating (DDX Angina)
🔹Dx
📍1. Barium Swallow ➡️ Corkscrew Shape Of Esophagus (Due To incoordinated Diffuse Contraction)
📍2. Esophageal ManoMetry ➡️ Diffuse HyperTonicity (400-500mmHg) & incoordinated Peristalsis During The Attack (Normal Peristalsis If No Attack Present)
📍3. Endoscopy & Biopsy ➡️ Hypertrophy Of Esophageal Circular Muscles
🔹Mx
📍A. Medical
▪︎CCB
▪︎SubLingual Nitrate
▪︎PPI
📍B. Surgical
▪︎Esophageal Endoscopic Dilatation
▪︎Long MyoTomy | 391 |
| 18 | WHO 2026 | أحدث إرشادات السمنة لدى الأطفال والمراهقين 🥞
2026 7th of October
أحد أهم الأمور الي أوصت بيها منظمة الصحة العالمية هو
1️⃣ life style modification 🏃🏻♀️
Structured dietary interventions
Physical activity and sedentary behaviour
Sleep
Behaviour-changing interventions
Digital health interventions
في النقاط أعلاه تبين ان هناك علاقة كبيرة جدا بين الحرمان من النوم و فرط السمنة حيث قلة النوم عند الاطفال إلى أقل من 4 ساعات هي عامل و مسبب حقيقي لفرط السمنة بنسبة 20%
2️⃣ Pharmacological treatment💊
﴾ treatment with approved medicines may be considered when a supervised, multimodal lifestyle programme has not achieved the desired results ﴿
فقرة تحتها الف خط الغالبية السكانية تبلش مباشرة ب الأدوية رغم ان منظمة الصحة توصي بالاعطاء حسب الحاجة و لحالات محددة فقط راح اذكر ب اختصار بعض من هذه النقاط
- Medication is not the automatic first step.
- Lifestyle treatment should be structured and supervised, not merely general advice to lose weight.
- The decision must consider age, eligibility, contraindications, potential adverse effects, local approval, and the adolescent's clinical circumstances.
- Medication should be integrated with ongoing nutritional, physical activity, and behavioural support.
و غيرها الكثير و كل هذا دا اشوف hazard باستخدام الأدوية عادي و اذا عنده renal impairment المهم يضعف 😶
3️⃣ Bariatric surgery✂️
It's considered for adolescents with severe obesity under strict conditions, It is not routine treatment for all adolescents with obesity.
بالوصول إلى الجراحة التجميلية لعلاج السمنة هي بحد ذاتها اخر خيار كون المريض راح يمشي وفق protocol صارم جدا يتعلق بالغذاء و الأودية و الجانب النفسي و غالبية المرضى صعب الالتزام للمدى البعيد ﴿ في العراق على سبيل المثال الكثير من الحالات تنتهي بالوفاة كون المريض راح يعاني من مشاكل كثيرة تتمثل على مستوى electrolyte disturbing و undernutrition لذلك هذا الخيار جدا صعب و يحتاج إلى team متكامل لاتخاذ القرار ﴾
< لذلك السمنة ليست مجرد زيادة في الوزن، ولا يمكن اختزالها في الطعام وحده؛ بل هي اختلال معقّد تتداخل فيه الوظائف الحيوية والعوامل الهرمونية والنفسية والسلوكية والبيئية >
Prevention is bitter than treatment | 418 |
| 19 |  🔴 مجلس الوزراء يوافق على مشروع قانون التعديل الرابع لقانون تدرج ذوي المهن الطبية والصحية رقم (6 لسنة 2000) والذي دققه مجلس الدولة واحاله إلى مجلس النواب | 459 |
| 20 | 🔴Pleural Effusion
▪︎Fluid Accumulation Inside The Pleural Space (Between Visceral & Partial Pleura)
🔹Common Causes Of Pleural Effusion
1. Pneumonia
2. TB Infection
3. Heart Failure (HF)
4. Pulmonary Infarction
5. Malignancy
6. Subphrenic Abscess
7. Pancreatitis
🔹Types Of Pleural Fluid
📍1. Transudate (Protein <25g/L)
▪︎Clear Fluid Low in Protein & Cells
▪︎Due To Increase Hydrostatic Pressure (HF) Or Decrease Oncotic Pressure (Liver & Kidney Diseases/Malnutrition/HypoAlbuminaemia)
📍2. Exudate (Protein >35g/L)
▪︎Yellow Or Cloudy Fluid High in Protein & Cells
▪︎Due To Increase Microvascular Capillary Permeability By Infection Or Inflammations (Pneumonia/TB/Malignancy/Abscess/Lupus/Rheumatoid Arthritis/Uremia/Asbestos)
📍3. Chyle ➡️ Milky Fluid High in Lipids Due To Obstruction Of Lymphatic Drainage
📍4. Bloody ➡️ Due To Malignancy/Pulmonary Infarction/Traumatic Needle Tip
🔹Clinical Features Of Pleural Effusion
📍1. Small Amount (<300 ml) ➡️ Asymptomatic
📍2. Symptomatic Pleural Effusion (>500 ml) :
▪︎Pleuritic Chest Pain & Dyspnea
▪︎Pleural Rub
▪︎Stony Dullness Over The Effusion
▪︎Decrease Breath Sounds
▪︎Asymmetric Chest Expansion
🔹Dx Of Pleural Effusion
📍1. Chest Xray (Detection After 200ml Fluid Accumulation) :
▪︎Meniscus Sign
▪︎Obliteration Costophrenic Angle
📍2. US (Very Sensitive & Can Detect Small Amounts Of Fluid As 20 ml) ➡️ HypoEchoic Or Anechoic Lower Margin Of Pleural Space
🔹Mx Of Pleural Effusion
📍1. Therapeutic Aspiration (Remove 400-500 ml Fluids)
📍2. Tube Thoracotomy Indications :
▪︎Heart Or Pulmonary Diseases
▪︎Recurrent Effusion
▪︎High Viscosity Fluid
▪︎Urgent Drainage Of Infected Fluid
🔰Empyema
▪︎Pus Accumulation in Pleural Space Contain Large Amounts Of Neutrophils
▪︎Due To Infection in Neighbouring Structures (Bacterial Pneumonia/TB/Haemothorax Infection/Esophageal Rupture/SubPhrenic Abscess Rupture)
🔹Complications Of Empyema
📍1. BronchoPleural Fistula & PyoPneumothorax (Abscess Rupture into Bronchus)
📍2. Subcutaneous Abscess (Empyema Necessitans
📍3. Abscess Rupture Into Chest Wall
📍4. Pleural Effusion
🔹Clinical Features Of Empyema
📍1. Severe Pleuritic Chest Pain
📍2. High Remitting Or Persistent Pyrexia
📍3. Dyspnea With Cough & Sputum
📍4. Rigor/Sweating/Weight Loss
📍5. Increase WBCS & CRP
🔹Dx Of Empyema
📍1. Chest Xray ➡️ D-Shape Shadow/Air Fluid Level
📍2. Fluid Aspiration ➡️ Thick Turbid Fluid/Glucose <60 mg/PH <7/LDH >1000 IU
🔹Mx Of Empyema
📍1. Wide Bore InterCostal Tube Insertion
📍2. Antibiotics For 2-4w (IV Co-Amoxiclav/Cefuroxime/Metronidazole)
📍3. Surgical Removal (If Pus Is Thick & Loculated) | 464 |
