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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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Publicaciones del Canal
Repost from N/a
🔴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
| 2 | 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 | 66 |
| 3 |  🔴 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 | 320 |
| 4 | 🔴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) | 334 |
| 5 | 🩺 2026 Guideline Update | Obstetrics & Gynecology
🩸Postmenopausal Bleeding: Updated ACOG Recommendations
🗓Updated: April 2026
What has changed?
Previous recommendation:
Transvaginal ultrasonography (TVUS) alone could be used for the initial evaluation of selected patients with postmenopausal bleeding. An endometrial thickness of ≤ 4 mm was reassuring.
Updated recommendation:
ACOG recommends both transvaginal ultrasonography (TVUS) and endometrial tissue sampling as part of the initial evaluation for most patients with postmenopausal bleeding.
So why is this important?
Relying on ultrasound alone may miss some cases of endometrial cancer. Combining imaging with tissue sampling improves the initial diagnostic assessment.
2026 | 285 |
| 6 | 🔴Diseases Of Pericardium
🔰Acute Pericarditis
▪︎Acute Inflammation Of Pericardium Due To Infectious Or Inflammatory Or Malignant Conditions
🔹Clinical Features
1. Retrosternal Chest Pain That Aggravated By Deep Breathing/Movement/Change Position/Exercise/Swallowing
2. Low Grade Fever
3. Pericardial Effusion
4. Pericardial Friction Rub (Diagnostic)
🔹Dx ➡️ Clinical Features + ECG (Diffuse ST Elevation/PR Interval Depression [Most Specific]/T Inversion)
🔹Mx
1. Pain Relief By Aspirin/Indomethacin
2. Colchicine/Steroids (Reduce Inflammation)
3. AB & PeriCardioCentesis For Purulent Pericarditis
🔰Pericardial Effusion
▪︎Fluid Accumulation Inside The Pericardium Mostly After Pericarditis
🔹Presentation
1. Muffled Heart Sounds
2. Muffled Friction Rub
3. Sensation Of Retrosternal Oppression
4. Large Effusion Causing Cardiac Tamponade
🔹Dx
1. Echo (Confirm Dx)
2. ECG (Decrease QRS Voltage/Electrical Alternans)
3. Chest Xray (Increase Cardiac Silhouette/Globular Heart)
4. Aspiration
🔹Mx ➡️ Aspiration & Pericardial Drain/Surgical Drainage For Viscous/Loculated/Recurrent Effusion
🔰Cardiac Tamponade
▪︎Large Pericardial Effusion Causing Acute HF Due To Cardiac Compression
▪︎Occurs After Pericarditis/Truma/Malignancy/Heart Wall Rupture After Mi
🔹Presentation
1. Hypotension/Tachycardia/Raised JVP
2. Dyspnea & Collapse
3. Muffled (Soft) Heart Sounds
4. Pulsus Paradoxus (Large Fall in BP During Inspiration)
5. Kussmal Sign (Rise JVP During Inspiration)
🔹Dx ➡️ By Echo
🔹Mx ➡️ Emergent Pericardiocentesis | 364 |
| 7 | ▪️وزارة التعليم تنفي إقالة عميد كلية الطب في جامعة البصرة وتؤكد التوصل إلى تفاهم مع الطلبة | 399 |
| 8 | دكاترة دفعة 26 المتخرجين شني وضعكم
لا تبليغات عن تخفيضات سنتنا لا ترجيع باقي المبلغ
شني الممثلين كضيتوهه تدورون شغل وعفتو الوضع؟!
شو سكته
يابه تعلمو شوية من باقي الكليات شجاي تسوي
شلون باجر عكبة تمثلون دفعة كليتنا من نطالب بالتعيين
مو زحمة | 449 |
| 9 | 📌علاج_جرثومة_المعدة :-
(H.pylori Eradication )
📎يعتمد علاج جرثومة المعدة (H. pylori) في عام 2026 على بروتوكولات طبية محددة تهدف إلى القضاء على البكتيريا وتقليل مقاومتها للمضادات الحيوية.
يتضمن العلاج عادةً مزيجاً من الأدوية لفترة تتراوح بين 10 إلى 14 يوماً.
✅️البروتوكولات_الدوائية_المعتمدة (2026)
تعد الخيارات التالية هي الأكثر شيوعاً وفعالية وفقاً للتحديثات الطبية الأخيرة:
✳️العلاج الرباعي بالبزموث (Bismuth Quadruple Therapy):
يُوصى به كخيار أول في الدراسات الحديثة لعام 2026 نظراً لارتفاع معدلات الشفاء التي تتجاوز 97%. يتكون من:
💊مثبط مضخة البروتون (PPI)(مثل أوميبرازولOmparazol).
💊بزموث سبساليسيلات(Bismith ).
💊مضادين حيويين: مترونيدازول(Metrondazol) وتتراسيكلين(Tetracycline).
✳️العلاج الثلاثي التقليدي (Triple Therapy):
يُستخدم في حال كانت البكتيريا حساسة للمضادات الحيوية، ويتكون من:
💊مثبط مضخة البروتون(PPI).
💊مضادين حيويين: كلاريثروميسين (Clarithamicin) وأموكسيسيلين (Amoxicillin)(أو مترونيدازول Metrondazol ).
✳️العلاج المزدوج المعزز (Dual Therapy):
بروتوكول حديث يعتمد على جرعات عالية من الأموكسيسيلين مع نوع جديد من كابحات الحمض (مثل فونوبرازان).
✅️. نصائح غذائية ومساعدة (علاجات طبيعية)
على الرغم من أن الأعشاب لا تقتل الجرثومة بمفردها، إلا أنها تخفف الأعراض وتدعم العلاج الدوائي:
✳️الشاي الأخضر:
غني بمضادات الأكسدة التي تساعد في تقليل الالتهاب الناتج عن الجرثومة.
✳️زيت الزيتون:
يساهم في تقليل نمو البكتيريا ومنع العدوى.
✳️تجنب المحفزات:
يُنصح بالابتعاد عن الأطعمة الحارة والمشروبات الحمضية والتدخين أثناء فترة العلاج.
✅️حالات_خاصة
✳️ الحوامل:
يُعتبر الأموكسيسيلين Amoxicillin آمناً (فئة B)، بينما يُستخدم الكلاريثروميسين بحذر شديد وتحت إشراف طبي فقط.
✳️ الأطفال:
يحدد الطبيب الجرعات بناءً على الوزن، وعادة ما يستمر العلاج من 10 إلى 14 يوماً.
⚠️ تنبيه_هام:
يجب إجراء اختبار للتأكد من الشفاء (مثل اختبار التنفس أو البراز) بعد مرور 4 أسابيع على الأقل من انتهاء العلاج. | 446 |
| 10 | 🔴Bowel Diverticulae
▪︎Diverticulae Are Small Bulges (Out-Pouching Or Herniation) Of Some Layers Of Bowel Wall Outside The Bowel Lumen Through Weak Points
🔹Types Of Diverticulae
📍1. Congenital
▪︎All The Three Coats Of The Bowel (Mucous & Submucosa & Muscularis Layer) Present in The Wall Of The Diverticulum
▪︎Like Meckel's Diverticulum
📍2. Acquired
▪︎Only Two Bowel Layers (Mucosa & Submucosa) Present in The Wall Of Diverticulum (No Muscularis Layer)
▪︎Like Colonic & Jejunal Diverticulae
🔰Acquired Colonic Diverticulae
▪︎Mostly Occur in Old Ages (70 Years)
▪︎More in Sigmoid & Descending Colon (Left Colon)
▪︎Occurs Due To High Chronic Pressure Over The Bowel Wall
🔹Risk Factors For Colonic Diverticulae
1. Old Age
2. Low Dietary Fibers
3. Obesity & Low Physical Activity
4. Smoking & Alcohol
5. High Red Meat Consumption
6. Bowel Motility Disorders
7. Chronic Constipation
🔹Clinical Features & Complications
📍1. Mostly Asymptomatic
📍2. Mild Symptoms Resemble Irritable Bowel Syndrome (IBS) ➡️ Constipation & Distension & Flatulence & Heaviness Sensation in Lower Abdomen
📍3. Acute Diverticulitis
▪︎Persistent Pain & Tenderness in Lower Abdomen (Left Iliac Fossa LIF)
▪︎Associated With Change in Bowel Habit (Diarrhea Or Constipation) & Fever & Tachycardia
▪︎Tender & Thickened Sigmoid Colon On Palpation
▪︎Tender Mass On Rectal Examination (Abscess Formation)
📍4. Perforation Then Abscess Formation Or Peritonitis
📍5. Bowel Obstruction ➡️ Due To Fibrosis & Stenosis Or Loops Adherence To Each Other
📍6. Painless Profuse & Recurrent Rectal Bleeding (Due To Vessel Erosion Near The Diverticulum)
▪︎Bright Red With Clots ➡️ Bleeding From Sigmoid
▪︎Dark Color ➡️ Right Colonic Bleeding
📍7. Fistula Formation
▪︎Colo-Vesical (Between Colon & Bladder) ➡️ Most Common & Results in Recurrent UTI/PneumaTuria/Faeces in Urine
▪︎Colo-Vaginal ➡️ More Common After Hysterectomy
▪︎Entero-Colic
▪︎Colo-Cutaneous ➡️ After Percutaneous Radiological Intervention
🔹Dx Of Colonic Diverticulae
1. Abdominal CT & CT Colongraphy (Gold Standard)
2. Double Contrast Barium Enema
3. Colonoscopy
🔹DDX Of Colonic Diverticulae
1. Colo-Rectal Cancer
2. IBS & IBD
3. Gastroenteritis
4. Ischemic Colitis
5. Angiodysplasia (Rectal Bleeding)
🔹Mx Of Colonic Diverticulae
🔶A. Mild Uncomplicated Cases
📍1. High Fiber Diet & High Fluid intake
📍2. Laxatives
📍3. Anti-Spasmodics (Mebeverine/Propantheline)
📍4. Elective Surgical Resection Of The Affected Segment (Sigmoid Colectomy) ➡️ Usually Done Laparoscopically For Recurrent Attacks
🔶B. Acute Diverticulitis
📍1. IV Fluids & Analgesics & Antibiotics (Amoxicillin/Gentamycin/Metronidazole)
📍2. Nill By Mouth
📍3. Urine Catheter (Decrease Risk Of Colo-Vesical Fistula)
📍4. If PeriColic Abscess Developed ➡️ Do Percutaneous Drainage (if Not Resolved With AB & Abscess Diameter >5cm)
📍5. Emergent Open Laparotomy
▪︎Indications ➡️ Perforation & Peritonitis/No Response To Medical Tx
▪︎Operation ➡️ Hartmann's Procedure (Sigmoid Resection With LIF Colostomy & Closure Of Rectal Stump)
🔶C. Bleeding
📍1. Mostly Stops Spontaneously
📍2. If Continuous Bleeding
▪︎Do Angiography Then Colonoscopy (To Locate & Stop The Bleeding)
▪︎If Site Of Bleeding Can't Localized ➡️ Do Open Laparotomy & SubTotal Colectomy & Ileostomy
🔶D. Fistula ➡️ Do Resection Of Affected Segment | 325 |
| 11 | 🔹DDX ➡️ Allergic Hypersensitivity Pneumonitis/Asthma/Pulmonary Edema/Vasculitis & Lupus
🔹Complications ➡️
1. ParaPneumonic Pleural Effusion
2. Lung Abscess (Empyema & Pneumatocele)
3. Bronchiectasis & Bronchiolitis Obliterans
4. Unilateral Hyperlucent Lung (Swyer James Syndrome)
5. Respiratory Failure/HF
6. Paralytic Ileus ➡️ Vomiting & Abdominal Distension in Infants
7. Sepsis (Meningitis/Pericarditis)
🔹Mx
🔶A. Oxygen (40-60%)
🔶B. IV Fluids Restriction (Give ⅔ Of Maintenance) ➡️ To Avoid Risk Of SIADH (Syndrome Of Inappropriate ADH Secretion)
🔶C. Empirical AB For 10-14 Days
📍1. Mild Case (At Home)
▪︎Amoxicillin (80-90mg/Kg/Day) ➡️ 1st Line
▪︎Alternative To 1st Line ➡️ Cefuroxime/Amoxiclav
▪︎Macrolides (Azithromycin) ➡️ For Atypical Pneumonia in School Age Children
▪︎Fluoroquinolones (Levofloxacin/Moxi/Gemi) ➡️ in Adolescents
📍2. Moderate-Severe (At Hospital) ➡️ IV Cefotaxime Or Ceftriaxone + Vancomycin Or Clindamycin
🔶D. Change To Specific AB According To Culture
▪︎Streptococcus/H.influenza ➡️ Amoxicillin
▪︎Staph.Aureus ➡️ Vancomycin/Clindamycin/Oxacillin
▪︎Klebsella ➡️ Aminoglycosides
▪︎Afebrile/Atypical/Viral ➡️ Macrolides (Erythromycin/Azithromycin)
🔶E. Oral Zinc (10-20mg/Day)
🔶F. Prevention ➡️ PCV-13 & Influenza Vaccine
🔹Causes Of No Improvement On AB (Slowly Resolving Pneumonia)
1. Complications Developed (Empyema)
2. Bronchial Obstruction (FB/Mucous Plug)
3. Bacterial Resistance To AB
4. Coexisting Diseases Causes Recurrent Pneumonia
▪︎Immunodeficiency/Cystic Fibrosis/Sickle Cell
▪︎Aspiration/GERD/Fistula
▪︎Bronchiectasis/Congenital Heart Disease (ASD/VSD/PDA)
.....
Most Common Bacterial Cause Of Pneumonia ➡️ Streptococcus Pneumonia
1st Line Antibiotics For Bacterial Pneumonia ➡️ Amoxicillin/Ampicillin | 238 |
| 12 | 🔴Pneumonia in Pediatrics
▪︎Acute Lower RT Infection Affects Lung Parenchyma & Alveolar Spaces & Bronchioles
▪︎Characterized By Lung Consolidation On Chest xray
▪︎Most Common Bacterial Cause ➡️ Streptococcal Pneumonia
🔹Risk Factors For Pneumonia
1. Lung Diseases (Asthma/Cystic Fibrosis) & Immunodeficiency
2. TracheoEsophageal Fistula & GERD & Neurological Disease (Risk Of Aspiration)
3. Foreign Body & Hydrocarbons Aspiration شارب نفط
4. Hospital Admission (ICU)
5. Fall & Winter Seasons
🔹Organisms Causing Pneumonia
📍1. In Neonates (3w-4Years) ➡️
▪︎Streptococcus (Pneumococcal)
▪︎Viral (RSV in Infants/ParaInfluenza & Influenza & AdenoVirus & Human MetaPneumo Virus in Children <5 Years)
📍2. Before School Age (<5 Years) ➡️ Staph.Aureus (Most Dangerous)
📍3. During School Age (>5 Years) ➡️ Atypical Pneumonia (Mycoplasma/Chlamydia)
📍4. At Any Age ➡️ Streptococcus (Pneumococcus)/H.influenza
📍5. Afebrile Pneumonia (No Fever) ➡️ Chlamydia Trachomatis/Mycoplasma Hominis/Ureaplasma Urealyticum/CMV
📍6. in Immunocompromised ➡️ Gram -Ve Enteric Bacteria/Mycobacteria/Asperigillosis/CMV/Pneumocystis Jirovecii
📍7. In Patients With Cystic Fibrosis ➡️ Staph.Aureus (Infants)/Psedomonas & Burkholderia (Older Age)
🔹Clinical Features & Dx
📍1. Prodromal Symptoms Of Rhinitis & Cough
📍2. Then Bad General Condition (Toxemia) & Decrease Feeding
📍3. Cough
▪︎Productive ➡️ Bacterial
▪︎Dry ➡️ Viral/Atypical
📍4. Dyspnea (Nasal Flaring/Muscle Retraction/Grunting)/Tachypnea
📍5. Cyanosis & Lethargy (in Severe Cases)
📍6. Fever
▪︎High Grade ➡️ Bacterial
▪︎Low Grade ➡️ Viral/Atypical
▪︎No Fever ➡️ Afebrile Pneumonia
📍7. Crackles & Wheeze
▪︎Localized ➡️ Typical Pneumonia (Streptococcus)
▪︎Diffuse ➡️ Viral/Atypical/Staph.Aureus
📍8. Chest Dullness To Percussion/Bronchial Breathing/Decrease Breath Sounds
📍9. Lung Infiltration On Chest Xray
▪︎One Or More Lobes ➡️ Lobar Bacterial Pneumonia
▪︎Scattered Bilateral Patchy Infiltration ➡️ Bronchopneumonia
▪︎Diffuse Bilateral Interstitial Infiltration With Hyperinflation ➡️ Viral/Atypical
▪︎Cavity/Air Fluid Level/Effusion/Collapse/Fibrosis/Pneumatocele ➡️ Staph.Aureus Pneumonia
📍10. Conjunctivitis in Chlamydia Pneumonia
📍11. CBC
▪︎Lymphocytosis ➡️ Viral
▪︎Neutrophilia & High ESR & CRP ➡️ Bacterial
▪︎Eosinophilia ➡️ Chlamydia Trachomatis | 295 |
| 13 | الوضع الصحي بالعراق :
المواطن : المريض راح يموت دكتورة
الدكتورة : لحظة خلي أصوره ستوري وسناب قبل لايموت | 335 |
| 14 |  مابقى شي والدكتورة تفتح بث بالتيك توك اثناء فتحها بطن المواطنيين :
دزلي اسد واضرب الرئة
دزلي حوت واخلي المريض يصحى اثناء العملية
السيد عبد الحسين الموسوي وزير الصحة اين دوركم ووجوابكم بهذه القضايا !!!!! | 340 |
| 15 |  +1دكتورة تستقبل هدايا اثناء قيامها بعملية لمواطن داخل مستشفى حكومي وتنشر ذلك من خلال ستوري وتنشر مشهد آخر لمواطن وهو بحالة خطرة بدلاً من انقاذه نشرت ستوري للتغزل بزوجها .
وين وزير الصحة سلملي على البكتريا والتلوث والنظافة | 326 |
| 16 | 🔷Mx Of PCOS
🔸A. Life Style Modifications
📍1. Weight Loss (Orlistat/Bariatric Surgery)
📍2. Exercise
📍3. Stops Smoking
📍4. Healthy Diet
📍5. Metformin جوكر ➡️ Improves Insulin Resistance & Hyperandogenism & Anovulation
🔸B. Tx Of Menstrual Irregularities (Oligomenorrhoea Or Amenorrhea)
▪︎By ➡️ Restoring Estrogen/Progesterone Balance
📍1. Combined Oral Contraceptives (COCPs) ➡️ Decrease LH/FSH/Androgens & Increase Sex Hormone Binding Globuin (SHBG)
📍2. Cyclical Oral Progesterone (10mg For 10 Days MedroxyProgesterone Acetate) ➡️ Regulates MC & Protects Endometrium
🔸C. Tx Of Hirsutism
▪︎By ➡️ Inhibits Androgen Overproduction
📍1. Cyproterone Acetate (Progesterone & Anti-Androgen Effect)
📍2. Combined Oral Contraceptives (COCPs)
▪︎Dianette (Cyproterone + Estrogen)
▪︎Yasmin (Drospirenone + Estrogen)
📍3. SpirononLactone (Anti-AldoSterone & Anti-Androgen Effects)
📍4. Flutamide (Anti-Androgen Effects)
📍5. Finasteride (Anti-Androgen Effects)
📍6. Local Tx :
▪︎Eflornithine Hydrochloride Cream (Applied 2x Per Day For 8w To Inhibits Epidermal Androgenic Activity)
▪︎Depilatory Creams كريم ازالة الشعر
▪︎Hair Shaving حلاقة بالمكينة
▪︎Laser Hair Removal بالليزر
▪︎Electrolysis Hair Removal بالكهرباء
🔸D. Tx Of Subfertility (Anovulation)
▪︎By ➡️ Ovulation Induction By Restoring LH/FSH Balance
📍1. Letrozole (Aromatase Inhibitor That Blocks Estrogen Synthesis) ➡️ 1st Line For Ovulation Induction
📍2. Clomiphene Citrate (Blocks Estrogen & Increase FSH Secretion) ➡️ 2nd Line For Ovulation Induction
📍3. Exogenous GonadoTrophins (FSH) ➡️ 3rd Line For Ovulation Inductions
📍4. Laparoscopic Ovarian Drilling (LOD)
▪︎Destroy The Ovarian Stroma By Making 4-6 Punctures in The Surface Of Each Ovary For 45 Seconds
▪︎No Risk Of Multiple Pregnancy Or Ovarian HyperStimulation Syndrome (These Risks Seen With Drugs Tx)
📍5. Ovulation Induction + Intra-Uterine Insemination (IUI)
📍6. in-Vitro-Fertilization (IVF)
📍7. Tamoxifen (Anti-Estrogenic Effects At Breast & Estrogenic Effects At Endometrium)
فضلاً وليس أمرا انضموا وشاركوا القناة للاستفادة وحتى يستمر النشر والابداع | 313 |
| 17 | 🔴Polycystic Ovary Syndrome (PCOS)
▪︎Syndrome Of Ovarian Dysfunction + Features Of HyperAndogenism + Polycystic Ovary Morphology
▪︎Affects 5-10% Of Women At Reproductive Age (Most Common EndoCrine Abnormality)
▪︎25% Of Polycystic Ovaries Seen On US
▪︎Idiopathic Aetiology (20-40% 1st Degree Relatives Affected)
▪︎Clinical Symptoms Start To Develop At Age Of Puberty
🔷Diagnostic Criteria Of PCOS (Rotterdam Criteria)
▪︎Patients Must Have 2 Of 3 :
📍1. Oligomenorrhoea Or Amenorrhea (Chronic Anovulation)
📍2. Biochemical (Elevated Testosterone/DHEAS) Or Clinical (Hirsutism & Acne) Evidence Of Hyperandogenism
📍3. Polycystic Ovaries Seen By US :
▪︎{≥8 SubCapsular (Peripheral) Folllicular Cysts} {<10mm in Diameter} {With Increase Ovarian Stroma}
▪︎Or {At Least 12 Follicles} {2-9mm in Diameter} {And Or Ovarian Volume (Ovarian Stoma) >10cm³}
🔷Hormonal Changes in PCOS
1. Increase in GnRh Secretion Results in LH Hypersecretion (Increase LH/FSH Ratio)
2. Male Androgen Overproduction (From The Thecal Cells Of The Ovary & Adrenal Glands Due To High LH Levels)
3. High Androgens Results in Excessive Growth Of Small Ovarian Follicles
4. Insulin Resistance Results in Hyperinsulinemia & Increase IGF-1 (Insulin-Like Growth Factor-1)
5. Increase Estrogen Levels (From Conversion Of Testosterone & Andostenedione To Estrogen)
6. Decrease Progesterone (No Follicles Maturation So No Corpus Luteum To Produce Progesterone)
7. Decrease Hepatic Sex Hormone Binding Globuin (SHBG) Results in More Free Testosterone
🔷Clinical Features Of PCOS
📍1. Menstrual Irregularities (75% Oligomenorrhoea Or Amenorrhea Due To Chronic Anovulation)
📍2. Subfertility (75%)
📍3. Obesity (40%)
📍4. Hirsutism & Acne & Andogenic Pattern Of Alopecia تفقد شعر الرأس مثل الذكور الكبار بالعمر
📍5. Recurrent Miscarriage (50-60%)
📍6. Acanthosis Nigricans (Dark Skin Pigmentations In Axillae & Flexures Due To Insulin Resistance)
📍7. Asymptomatic (Only Polycystic Ovaries On US)
🔷Long Term Complications Of PCOS
1. Type II DM
2. Cardiovascular Diseases (Hypertension & Hyperlipidemia)
3. Endometrial Hyperplasia & Cancer (Prolonged Exposure To Estrogen Unopposed By Progesterone)
4. Psychological Changes (Depression/Anxiety)
5. Obstructive Sleep Apnea (OSA)
🔷DDX Of PCOS
1. HyperProlactinaemia
2. Congenital Adrenal Hyperplasia
3. Cushing's Syndrome
4. Tumours Producing Androgens (Ovarian & Adrenal Tumour)
5. Exogenous Androgen Intake
6. Hypothyroidism | 263 |
| 18 | 🔰Complications Of Peptic Ulcer
🔶A. Perforation
▪︎More in Middle Age & Elderly
▪︎Mostly Due To NSAIDS
▪︎Mostly Anterior Duodenal Perforation
🔹Clinical Features Of Perforation
📍1. Hx Of Peptic Ulcer
📍2. Then Sudden Onset Severe Generalised Abdominal Pain & Board-Like Rigidity (Acute Peritonitis)
📍3. Shock & Tachycardia & Shallow Respiration Then Pyrexia (Bad General Condition)
📍4. Abdomen Not Move With Respiration & Absent Bowel Sounds
📍5. Shoulder Tip Pain (Diaphragmatic Irritation) & Vomiting
📍6. Mild Symptomatic Improvement After Few Hours (Due To Omental Localisation Of Perforation)
🔹Dx Of Perforation
📍1. Clinical Features
📍2. Erect Chest Xray ➡️ Free Gas Under The Right Diaphragm
📍3. CT Scan (Most Accurate)
📍4. Serum Amylase (Slight Elevation) ➡️ To Exclude Pancreatitis
📍5. Barium Swallow ➡️ Confirm Leakage
🔹Mx Of Perforation
📍1. Fluids & Analgesics
📍2. Antibiotics
📍3. LifeLong PPI
📍4. NG Tube Suction
📍5. H.pylori Eradication After Surgery
📍6. Emergent Laporatomy
▪︎Mostly Upper Midline Incision
▪︎Do Peritoneal Washing (Lavage)
▪︎Duodenal Perforation ➡️ Do Suturing Only
▪︎Gastric Perforation ➡️ Do Local Ulcer Excision Or Partial Gastrectomy Then Suturing (To Exclude Malignancy)
🔶B. Gastric Outlet Obstruction (Pyloric Stenosis)
▪︎Stenosis At The 1st Part Of Duodenum Or The Pylorus Of The Stomach
▪︎Mostly Due To Longstanding Duodenal Ulcer Near The Pylorus Or Gastric Cancer
🔹Clinical Features & Dx Of Pyloric Stenosis
📍1. Bowel Obstruction(Persistent Non-Biliary Vomiting/Nausea/Abdominal Distension)
📍2. Weight Loss & Dehydration
📍3. +Ve Succession Splash 4h After Last Eat Or Drink
📍4. Visible Gastric Peristalsis
📍5. HypoChloremic Metabolic Alkalosis
▪︎Low Cl & K (Due To Vomiting)
▪︎High Bicarbonate & Urea
▪︎Paradoxical AcidUria
📍6. Endoscopy (Confirm Dx)
🔹Mx Of Pyloric Stenosis
📍1. NG Tube Gastric Decompression
📍2. Fluid & Electrolytes Correction (NS + Potassium)
📍3. PPI To Heal Ulcer & Relive Pyloric Edema
📍4. Surgery After 7 Days
▪︎Endoscopic Balloon Dilatation
▪︎Partial Gastrectomy
▪︎GastroEnteroStomy
🔶C. Upper Git Bleeding (Chronic Or Acute)
🔶D. Malignancy (Mostly Gastric Lymphoma) | 233 |
| 19 | 🔴Peptic Ulcer Disease
▪︎Breach in Mucosal Lining Of The Digestive Tract Due To Gastric Acid Exposure
▪︎Ulceration Occurs After Imbalance Between The Mucosal Defence Mechanisms & Gastric Acid Secretions
🔹Risk Factors For Peptic Ulcer
📍1. H.pylori Infection/NSAIDS/Smoking/Alcohol
📍2. Stress Ulcer (Due To Chronic Anxiety Or Severe Illness Or Trauma)
📍3. Genetic Factors/Hyperparathyroidism/Group O Blood
📍4. Zollinger Ellison Syndrome 👇
▪︎EndoCrine Tumour Produces Gastrin Hormone (Gastrinoma) That Stimulates More Acid Secretion From The Stomach
▪︎Results in Persistent Peptic Ulceration/Diarrhea/Steatorrhea
▪︎The Tumour Mostly Present in Duodenal Loops/Head Of Pancreas/Stomach
▪︎Dx Of Zollinger Ellison Syndrome
•Ulcers At Unusual Sites
•Ulcer Persistent
•High Gastrin Levels
•Young Ages
•CT Or MRI Or Angiography For Tumor Localisation
▪︎Mx Of Zollinger Ellison Syndrome ➡️ Surgical Resection
🔹Common Sites For Ulcers
1. 1st Part Of Duodenum
2. Lesser Curvature Of Stomach
3. On The Stoma After Gastric Surgery
4. In Esophagus
5. In Meckel's Diverticulum (Ectopic Gastric Tissue)
🔹Most Common Ulcers
🔶A. Duodenal Ulcer
▪︎More Common
▪︎More in Young Ages Males (25-30 Years)
▪︎More in 1st Part Of Duodenum (50% On The Anterior Wall) & Mostly Solitary (Single)
▪︎Less Risk Of Malignancy
▪︎Kissing Ulcer ➡️ When There's Ulcer On The Anterior & Posterior Walls Of Doudenum At The Same Time
▪︎Anterior Duodenal Ulcer ➡️ More Risk Of Perforation
▪︎Posterior Duodenal Ulcer ➡️ More Risk Of Bleeding (GastroDuodenal Artery Erosion)
🔶B. Gastric Ulcer
▪︎Less Common
▪︎More in Older Ages (50 Years)
▪︎More On The Lesser Curvature Of The Stomach (Specially incisura Angularis) & Mostly Solitary (Single)
▪︎More Risk Of Malignancy
▪︎Associated With Duodenal Ulcers in 10% Of Cases
🔹Clinical Features Of Peptic Ulcer
📍1. Abdominal Pain
▪︎Localized To Epigastrium
▪︎Recurrent (Intermittent Episodes)
▪︎Related To Food
▪︎Gnawing in Nature شعور حفر او قضم
▪︎Relieved By Antacids & Vomiting
▪︎Pain On Hunger ➡️ Duodenal Ulcer
▪︎Pain On Eating ➡️ Gastric Ulcer
📍2. Periodicity Of Symptoms ➡️ Symptoms Disappear For Weeks Or Months Then Return Again (Due To Spontaneous Healing)
📍3. Weight Changes (Gain in Duodenal Ulcer/Loss in Gastric Ulcer)
📍4. Iron Deficiency Anemia (Chronic Bleeding)
📍5. Intermittent Vomiting/Nausea/Heartburn/WaterBrash
📍6. Silent Ulcer Or Only Vague Epigastric Discomfort (More in Elderly)
🔹Dx Of Peptic Ulcer
📍1. Endoscopy With Multiple Biopsies
📍2. H.pylori Detection Using
▪︎CLO Test During Biopsy
▪︎Urea Breath Test
▪︎Faecal Ag Test
🔹Mx Of Peptic Ulcer
📍1. Stop Smoking & Alcohol & Avoid NSAIDS
📍2. Medical Tx
▪︎PPI + Antibiotics (Amoxicillin/Clarithromycin/Metronidazole) ➡️ Given High Dose & Twice Daily For 10-14 Days (At Least 7 Days)
📍3. Surgical Tx
▪︎PyloroPlasty ➡️ For Gastric Outlet Obstruction After Failure Of Endoscopic Dilatation
▪︎Type I Partial Gastrectomy ➡️ For Gastric Ulcer
▪︎Type II Partial Gastrectomy Or VagoTomy Or Rationale ➡️ For Duodenal Ulcer
🔹Causes Of Failure Ulcer Healing
1. Poor Compliance To Tx
2. Bacterial Resistant (Persistent H.pylori)
3. Zollinger Ellison Syndrome
4. Continuous NSAIDS Ingestion
5. IgG4 Autoimmunity
****
Pain After Hunger Then Weight Gain ➡️ Duodenal Ulcer
Pain After Eating Then Weight Loss ➡️ Gastric Ulcer
Anterior Duodenal Ulcer ➡️ Perforation
Posterior Duodenal Ulcer ➡️ Bleeding
Gastric Outlet Obstruction ➡️ HypoChloremic Metabolic Alkalosis | 313 |
| 20 | 📋 برنامج المؤتمر الطبي الشامل في ذي قار
📅 غدًا | تبدأ الفعاليات الساعة 10:00 صباحًا، وينتهي تقريبا ١٢ ونصف
1:00 ظهرا،
1. قراءة القرآن الكريم: أحمد صادق.
2. النشيد الوطني العراقي.
3. كلمة مؤسسة تجمع العافية التطوعية بالتعاون مع مديرية الرعاية الصحية: د. ميثم البكاء.
4. ورشة الإعلام الطبي: د. علي فاضل.
5. ورشة الإسعافات الأولية: د. حسين علي، د. سامي رحيم، أ. جابر حربي.
6. تكريم متطوعي المفارز الطبية
لزيارة الأربعين: د. ميثم البكاء.
7-التدريب العملي : ست زهراء فليح
📌 تنويهات مهمة
• نرجو الالتزام بموعد المؤتمر والحضور قبل الساعة العاشرة صباحًا.
• نرجو من الأخوات المشاركات الالتزام بالحشمة والزي المحتشم، بما يتناسب مع طبيعة الأجواء | 355 |
