Journals in Pharmaceutical Science Presently free access:
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Esophageal dysphagia (the feeling of food getting stuck several seconds after swallowing)
Esophargeal Dysphagia
by Jean Paul Font, MD & Michael Underbrink, MD, MBA
http://www.utmb.edu/otoref/grnds/esoph-dysphagia-080206/esoph-dysphagia-slides-080206.ppt
Esophagology and Esophagoscopy
by Benjamin Walton, MD
http://www.utmb.edu/otoref/grnds/esoph-2011-10-27/esoph-slides-2011-10-27.ppt
Dysphagia
by Lianne Beck, MD
http://www.fpm.emory.edu/Family/didactics/powerpint/DYSPHAGIA.ppt
GERD/Barrett's Esophagus, Dysphagia, Hiatal Hernia, and Laparoscopic Antireflux Procedure
by Ben Degner & Dave Yonick
http://www.stritch.luc.edu/surgery/sites/default/files/surgery/Esophagus%20Degner%20Yonick%202011%2010.26.11.ppt
Dysphagia
by Michael Chao, MD
http://www.ent.uci.edu/grand%20round%20archives/Dysphagia%20mcchao.ppt
Management of Oral and Esophageal Disorders
http://www.mac.edu/faculty/christinestaake/Nursing%20330/Lecture%20Notes/Management%20of%20Oral%20and%20Esophageal%20Disorders.ppt
Stricturing of the GI Tract
http://gastro.dom.uab.edu/Fellow_Articles/PowerPoint/George%27s%20Talks/George%27s%20Talks/New%20talk/Stricture.ppt
The Basics of Feeding: A Workshop in Pediatric Dysphagia
Stacy Antoniadis, Lisa McCarty, Julie McCollum Daly, Cindy Straub\
http://www.pitt.edu/~super7/2011-3001/2091.ppt
Gastroesophageal Reflux Disease (GERD)
http://medschool.umaryland.edu/minimed/powerpoint/Fantry_GERD_September7_2nd.ppt
Esophageal Motility Abnormalities
http://www.med.umn.edu/gi/prod/groups/med/@pub/@med/documents/asset/med_96397.ppt
Recent publications:
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Myeloproliferative Disorders
Alice Ma, M.D.
http://www.med.unc.edu/medicine/web/6.11.07%20Myeloproloferative%20Ma.ppt
Polycythemia Vera
http://www.med.unc.edu/medicine/web/2.28.08%20PVC%20Gibbs.ppt
Diagnostic Approach to Myeloproliferative Neoplasms
Stephen Oh, M.D, Ph.D.
http://hematology.wustl.edu/conferences/presentations/Oh20110819.ppt
Chronic Myeloid Leukemia and other Myeloproliferative Neoplasms (MPNs)
by Dale Bixby, M.D., Ph.D
http://open.umich.edu/sites/default/files/2580/011309.DBixby.MyeloproliferativeDisorders.ppt
Hypercoagulable States: Polycythemia Vera
by Chris Caulfield
https://medicine.med.unc.edu/education/internal-medicine-residency-program/files/ppt/10.20.09%20Caulfield%20Polycythemia%20vera.ppt
Neoplastic Disorders of The Bone Marrow
http://instructional1.calstatela.edu/nmcquee/Micro410/Lecture%2013%20-%20Neoplastic%20disorders%20of%20the%20bone%20marrow.ppt
Polycythemia Vera
http://www.medicine.wisc.edu/~williams/polycythemia.ppt
Latest 20 articles
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Valvular Heart Disease
by Kenneth S. Korr M.D.
http://www.brown.edu/Courses/Bio_281-cardio/cardio/Valvular2005.ppt
Valvular Heart Disease
http://www.austincc.edu/nursmods/online/online_lev4/rnsg_2432/documents/ValvulaCardimyopathyAneurysmHrtSur08Copy_000.ppt
Valvular Heart Disease
http://legacy.owensboro.kctcs.edu/jsmith/Valvular%20Heart%20Disease.ppt
Valvular Heart Disease
by Steven R. Bruhl MD, MS
http://www.utoledo.edu/med/depts/medicine/residency/Didactics/pdf/Valvular_Heart_Disease_IM_8-12.ppt
Valvular Disease, Carditis & Cardiomyopathy
http://www.mac.edu/faculty/ChristineStaake/Nursing%20331/lecture%20notes/Valvular%20Disease,%20Carditis%20and%20%20Cardiomyopathy.ppt
Valvular Heart Disease
by Laura Wexler, M.D.
http://www.med.uc.edu/pages/courses/icp2/icp%2011%20valve%20II-02.ppt
The Essentials of Valvular Heart Disease
http://www.cardiologyfellows.northwestern.edu/cculectures/The%20Essentials%20of%20Valvular%20Heart%20Disease.ppt
Valvular Stenosis
by Vikram Chhokar MD
http://www.uthsc.edu/cardiology/ppt/AS.ppt
Cardiac Cath Measurement of Stenotic Aortic Valve Area
by Ryan Tsuda, MD
http://tulane.edu/som/tuhvi/upload/cathconf09-14-04.ppt
Latest 20 publications
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Endometrial Biopsy
by Oguchi Andrew Nwosu, MD, FAAFP, Emory Family Medicine
http://www.fpm.emory.edu/Family/didactics/powerpint/Endometrial%20Biopsy%20and%20IUD%20Insertion.ppt
Endometrial Cancer
by Faina Linkov, PhD, University of Pittsburgh Cancer Institute
http://www.pitt.edu/~super4/34011-35001/34071.ppt
Abnormal Uterine Bleeding
by Todd May, M.D.
http://sfghdean.ucsf.edu/barnett/FCM/PGY1/MayUterineBleeding.ppt
Abnormal Uterine Bleeding
by Peter J. Chen, M.D., Hospital of the University of Pennsylvania
http://www.uphs.upenn.edu/obgyn/education/documents/AbnormalUterineBleeding--Studentlecture.ppt
Female Reproductive System
External Female Genitals
External Reproductive Organs
http://www.ed.uab.edu/cpetri/docs/Chapter_2_Female_Reproductive_System.ppt
Sexual Function in the Geriatric Population
by Vinita J. Speir, MD
http://www.meded.uci.edu/reynolds/docs/Sexual%20Function%20in%20Geriatric%20Population.ppt
Abnormal Uterine Bleeding
by Karen Carlson, M.D., University of Nebraska Medical Center
http://www.unmc.edu/obgyn/docs/AbnormalBleeding2010.ppt
Diseases of Vulva
http://www.nova.edu/noteservice/M2/repro/Path%20MT%20Review-incomplete.ppt
Recent published articles
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Dysfunctional Uterine Bleeding
by-Darren Farley, M.D., UKSM-Wichita
http://wichita.kumc.edu/obgyn/slides/farley_DUB.ppt
Surgical Complications of Pregnancy
by - Matthew Voth M.D.
http://wichita.kumc.edu/obgyn/slides/voth_scp.ppt
Mullerian Anomalies
By Elizabeth Diaz
http://wichita.kumc.edu/obgyn/slides/diaz05.ppt
Asthma in Pregnancy
by Timothy Hoskins, M.D.
http://wichita.kumc.edu/obgyn/slides/hoskins05.ppt
Pituitary Disorders
by Jo Choudhry, M.D.
http://wichita.kumc.edu/obgyn/slides/choudhry05.ppt
Recent published articles on Dysfunctional Uterine Bleeding
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Hypercalcemia
By: Ayesha Shaikh
Emory Family Medicine Residency Program
http://www.fpm.emory.edu/Family/didactics/powerpint/Hypercalcemia.ppt
Hypercalcemia secondary to Primary Hyperparathyroidism
by - Emily Kingsley, MD
https://medicine.med.unc.edu/education/internal-medicine-residency-program/files/ppt/1.11.10%20Kingsley%20Hypercalcemia.ppt
Hypercalcemia and Renal Sarcoid
by Jason McClune
http://www.med.unc.edu/medicine/web/9.23.08.%20McClune.%20HyperCa,%20Sarcoidosis.ppt
Hypercalcemia and Multiple Myeloma
http://www.med.unc.edu/medicine/web/7.16.08%20Rometo.%20MM.ppt
Milk-Alkali Syndrome and Evaluation of Hypercalcemia
by: TJ O’Neill
https://medicine.med.unc.edu/education/internal-medicine-residency-program/files/ppt/8.17.09%20ONeill%20Hypercalcemia.ppt
Approach to Hypercalcemia
by Elizabeth George M.D.
University of Wisconsin-Madison
http://www2.medicine.wisc.edu/home/files/domfiles/genintmed/George-5-4-05-Hypercalcemia.ppt
Hypercalcemia
http://www.medicine.nevada.edu/residency/lasvegas/internalmed/documents/calciumdisorders.ppt
Disorders of Calcium and Phosphate Metabolism
http://medresidents.stanford.edu/
Calcium homeostasis
http://www.uic.edu/classes/phyb/phyb402dbh/lecture5.ppt
Case Studies in Calcium Metabolism
http://www.hsc.unt.edu/tcom2006/endoQuiz2.ppt
Endocrine Emergencies
William E. Clutter, M.D
http://endo.wustl.edu/conferences/PDFs/Thur-noon-conf/STAT%20Consults_Clutter.ppt
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Peripheral Vascular System
http://legacy.owensboro.kctcs.edu/jsmith/VASCULAR.ppt
Assessment of the Peripheral Vascular and Lymphatic System
http://www.mccc.edu/~martinl/documents/NRS102Week10PeripheralVascularSystem.ppt
Peripheral Vascular System and Lymphatic System
http://www.mccc.edu/~martinl/documents/Chapter_20.ppt
Introduction to Clinical Practice II
Peripheral Vascular Disease
by:Joseph S. Giglia, MD
http://www.med.uc.edu/pages/courses/icp2/ICP-PVD.ppt
Anesthetic Management of Vascular Surgery
by: Dennis Stevens CRNA, MSN, ARNP
http://chua2.fiu.edu/Nursing/anesthesiology
Blood Flow through Vascular System
http://www2.sunysuffolk.edu/pickenc/Vascular%20System.ppt
Vascular and Lymphatic System Pathology
http://www.clt.astate.edu/mgilmore/pathophysiology/Vascular%20System%20Pathology.ppt
Assessment of Peripheral Vascular and Lymphatic System
http://www.mccc.edu/~martinl/documents/NRS102AssessmentofthePeripheralVascularSystem.ppt
Advanced Assessment of the Cardiovascular System
By: Mary Beerman, RN, MN, CCRN
http://faculty.mercer.edu/mitchell_sh/
Regulation of Blood Flow and Pressure
http://instructional1.calstatela.edu/arusson/Biol434/4RegBFandP.ppt
Macro and Microlevel of Noninvasive Examination of the Vascular System
By: Ulyana B. Lushchyk, MD, V.V. Novytskyy, I.P.Babiy, N.G. Lushchyk
http://www.pitt.edu/~super7/43011-44001/43771.ppt
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Branchial Anomalies
by: David Gleinser, MD, Harold Pine, MD
University of Texas Medical Branch (UTMB)
Department of Otolaryngology, Grand Rounds Presentation
http://www.utmb.edu/otoref/grnds/branch-2011-0930/branch-slides-2011-0930.ppt
Surgical Management of Advanced and Recurrent Subglottic Stenosis
by: Andrew Coughlin, MD, PGY-4, Michael Underbrink, MD
The University of Texas Medical Branch (UTMB)
Department of Otolaryngology , Grand Rounds Presentation
http://www.utmb.edu/otoref/Grnds/subglot-steno-2011-1027/subglot-steno-slides-2011-1027.ppt
Frontal Sinus Fractures
by: Leo Martinez, MD, Patricia Maeso, MD
The University of Texas Medical Branch
Department of Otolaryngology, Grand Rounds Presentation
http://www.utmb.edu/otoref/Grnds/sinus-fx-front-101217/sinus-front-fx-slides-101217.ppt
Blunt Neck Trauma and Laryngotracheal Injury
by: Susan Edionwe, MD, Farrah Siddiqui,
University of Texas Medical Branch,
Department of Otolaryngology, Grand Rounds Presentation
http://www.utmb.edu/otoref/grnds/blunt-neck-inj-101217/blunt-neck-inj-slides-101217.ppt
Esophagology and Esophagoscopy
By: Benjamin Walton, MD, Michael Underbrink, MD
University of Texas Medical Branch (UTMB Health)
Department of Otolaryngology, Grand Rounds Presentation
http://www.utmb.edu/otoref/grnds/esoph-2011-10-27/esoph-slides-2011-10-27.ppt
EGFR Targets in Head and Neck Cancer
By: Francisco G. Pernas, M.D., Vicente A. Resto, M.D., Ph.D.
The University of Texas Medical Branch
Department of Otolaryngology, Grand Rounds Presentation
http://www.utmb.edu/otoref/grnds/EGFR-H&N-Ca-2011-0331/EGFR-H&N-Ca-slides-2011-0331.ppt
Current controversies in the Management of Malignant Parotid Tumors
Francisco G. Pernas, MD, Susan D. McCammon, MD
The University of Texas Medical Branch,
Department of Otolaryngology, Grand Rounds Presentation
http://www.utmb.edu/otoref/grnds/malig-parotid-tumors-2011-02-25/malig-parotid-tumors-slides-2011-02-25.ppt
Unilateral Vocal Fold Paralysis
By: Naren Venkatesan, MD, Michael P. Underbrink, MD
The University of Texas Medical Branch
Department of Otolaryngology, Grand Rounds Presentation
http://www.utmb.edu/otoref/grnds/voc-cord-paral-2011-02-25/voc-cord-paral-slides-2011-02-25.ppt
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Corneal Melt
by Jeremy B. Wingard, MD
http://neuro.pathology.pitt.edu/webstuff/EyePathology/09Wingard%20Pathology%20Case.ppt
Red Eye and Ocular Trauma
Harold E Cross MD PhD
http://www.eyes.arizona.edu/Teaching/medstudents/red%20eye%20&%20trauma.ppt
Conditions Causing Low Vision
http://www.uab.edu/shrpot/Mary%20Warren/OT%20677%20Conditions%20lecture%203.PPT
Clostridium
by Katherine Leon & Dr. Edwin Ginés-Candelaria
http://wcis.mdc.edu/browse/egines/BSC2943L_THE%20BIOSCIENCE%20INTERNSHIP/THE%20BACTERIUM%20CLOSTRIDIUM%20TAENIOSPORUM/POWERPOINT/CLOSTRIDIUM.ppt
Eye Emergencies
by Nikki Waller
http://www.med.unc.edu/emergmed/files/Eye_Emergencies.ppt
Ocular Urgencies and Emergencies
http://www.opt.uab.edu/opt222/Powerpoints/CLAP%202--Rev%20Ocular%20Urgencies%20and%20Emergencies.ppt
The Red Eye
By Charlise A. Gunderson, M.D
http://www.utmb.edu/pedi/ppts/redeye.ppt
Primary Care for the Red Eye
by Alice L. Bashinsky, M.D., Phillip C. Hoopes, Jr, M.D
http://intmedweb.wfubmc.edu/download/redeye.ppt
Recent publications:
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Carpal Tunnel Syndrome (CTS)ppts and publications
Nerve Compression Syndromes
http://osm-web05.orthop.washington.edu/UserFiles/File/cme/leopold2.ppt
Diagnosis of Carpal Tunnel
http://www.biol.wwu.edu/lapsansk/349/carpal_tunnel.ppt
Carpal Tunnel Syndrome
http://www.duke.edu/~ajb11/CTS.ppt
Carpal Tunnel Syndrome
By: Tino Cantu And Maggie Sanchez
http://www.laredo.edu/science/rviswanath/BIOL2401PPT/Carpal%20Tunnel%20Syndrome.ppt
Carpal Tunnel Syndrome
By NathaëlF Hyppolite RIII MF
http://www.pitt.edu/~super7/22011-23001/22951.ppt
Carpal Tunnel Syndrome (CTS)
Rachel M Schutz
https://pantherfile.uwm.edu/seon/www/CTS.ppt
Carpal Tunnel Syndrome (CTS)
http://www.medschool.lsuhsc.edu/neurology/students/docs/Module%20CTS.ppt
Avoiding Carpal Tunnel Syndrome
By Kathy Ames
http://facultystaff.vwc.edu/~kames/carpal%20tunnel%20syndrome.ppt
Latest 20 Publications
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Mucormycosis is a fungal infection of the sinuses, brain, or lungs
Fungal Urinary Tract Infections Diagnosis and Management
by Tristan T. Berry, M4, Medical College of Virginia
http://www.eric.vcu.edu/pub/presentations/fungal_GR/fungal_GR.PPT
Fungal Rhinosinusitis
by Hausin Wong
http://www.ent.uci.edu/grand%20round%20archives/Fungal%20Rhinosinusitis.ppt
Meningitis and Enchephalitis
by: Donnette O'Neill, Suzanne Brydges, Mónica Richardson
http://www.plu.edu/~richarml/doc/meningitis-encephalitis.ppt
Deep Neck Space Abscesses and Life-Threatening Infections of the Head and Neck
by Carl Schreiner, MD, F. B. Quinn, MD
http://www.utmb.edu/otoref/Grnds/Neck-infect-980225/Neck-infect-980225.pps
Mucous Membrane and Deep Organ Fungal Infections
by: Dr. John R. Warren
http://www.pathology.northwestern.edu/Education/20072008/MedicalMicrobiology/13-Mucous_Membrane_and_Deep_Organ_Fung____al_Infections.ppt
Latest research articles:
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Vogt-Koyanagi-Harada Syndrome
by Laura S. Gilmore, MD, Department of Ophthalmology
http://www.ttuhsc.edu/som/ophthalmology/lectures/presentations/11.12.04GrandRoundsVKH.ppt
Primary Intraocular Lymphoma – Uveitis Masquerade Syndrome
http://hematology.wustl.edu/conferences/presentations/Waqar20090116.ppt
Unexplained Visual Loss
by Laura S. Gilmore, MD, Grand Rounds
http://www.ttuhsc.edu/som/ophthalmology/lectures/presentations/9.9.05GrandRounds.ppt
Latest 20 publication on Uveitis
1: Babu K, Kini R, Mehta R, Philips M, Subbakrishna DK, Murthy KR.
Predictors For Tubercular Uveitis: A Comparison Between Biopsy-Proven Cases of Tubercular and Sarcoid Uveitis. Retina. 2011 Dec 5. [Epub ahead of print] PubMed PMID: 22146129.
2: Peralta-Calvo J.
Vitrectomy as anti-inflammatory treatment in intermediate uveitis.
Arch Soc Esp Oftalmol. 2011 Dec;86(12):421. Epub 2011 Sep 9. English,
Spanish. PubMed PMID: 22117744.
3: Fonollosa A, Adán A.
Uveitis: a multidisciplinary approach.
Arch Soc Esp Oftalmol. 2011 Dec;86(12):393-394. English, Spanish. PubMed PMID: 22117737.
4: Oltra EZ, Morris C, Birnbaum AD, Tessler HH, Goldstein DA.
Chronic anterior uveitis in common variable immunodeficiency.
Ocul Immunol Inflamm. 2011 Dec;19(6):448-9. PubMed PMID: 22106916.
5: Erckens RJ, Mostard RL, Wijnen PA, Schouten JS, Drent M.
Adalimumab successful in sarcoidosis patients with refractory chronic non-infectious uveitis. Graefes
Arch Clin Exp Ophthalmol. 2011 Nov 27. [Epub ahead of print] PubMed PMID: 22119879.
6: Rosenzweig HL, Woods A, Clowers JS, Planck SR, Rosenbaum JT.
The NLRP3 inflammasome is active but not essential in endotoxin-induced uveitis.
Inflamm Res. 2011 Nov 26. [Epub ahead of print] PubMed PMID: 22119862.
7: Cohen AE, Assang C, Patane MA, From S, Korenfeld M; Avion Study Investigators.
Evaluation of Dexamethasone Phosphate Delivered by Ocular Iontophoresis for Treating Noninfectious Anterior Uveitis.
Ophthalmology. 2011 Nov 22. [Epub ahead of print] PubMed PMID: 22115712.
8: Willermain F, Rosenbaum JT, Bodaghi B, Rosenzweig HL, Childers S, Behrend T, Wildner G, Dick AD. Interplay between innate and adaptive immunity in the development of non-infectious uveitis. Prog Retin Eye Res. 2011 Nov 22. [Epub ahead of print] PubMed PMID: 22120610.
9: Işık M, Kılıç L, Doğan I.
Recurrent uveitis due to sildenafil usage in a patient with Behçet's disease. Rheumatol Int. 2011 Nov 18. [Epub ahead of print] PubMed PMID: 22095394.
10: Kim TW, Kang JS, Kong JM, Bae S, Yu Y, Chung H, Yu HG.
Maturation profiles of peripheral blood dendritic cells in patients with endogenous uveitis.
Immunol Lett. 2011 Nov 15. [Epub ahead of print] PubMed PMID: 22108236.
11: Heiligenhaus A, Michels H, Schumacher C, Kopp I, Neudorf U,…
Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis.
Rheumatol Int. 2011 Nov 15. [Epub ahead of print] PubMed PMID:
22083610.
12: Gül A, Tugal-Tutkun I, Dinarello CA, Reznikov L, Esen BA, Mirza A, Scannon P, Solinger A.
Interleukin-1β-regulating antibody XOMA 052 (gevokizumab) in the treatment of acute exacerbations of resistant uveitis of Behcet's disease: an open-label pilot study.
Ann Rheum Dis. 2011 Nov 14. [Epub ahead of print] PubMed PMID: 22084392.
13: Cantarini L, Simonini G, Frediani B, Pagnini I, Galeazzi M, Cimaz R. Treatment strategies for childhood noninfectious chronic uveitis: an update.
Expert Opin Investig Drugs. 2011 Nov 11. [Epub ahead of print] PubMed PMID: 22074394.
14: Esterberg E, Acharya NR. Corticosteroid-sparing therapy: practice patterns among uveitis specialists. J Ophthalmic Inflamm Infect. 2011 Nov 6. [Epub ahead of print] PubMed PMID: 22057810.
15: Gallagher A.
Leptospirosis in a dog with uveitis and presumed cholecystitis.
J Am Anim Hosp Assoc. 2011 Nov;47(6):e162-7. PubMed PMID: 22058365.
16: Batmanabane V, Chidambaranathan GP, Rathinam S.
Spectrum of Leptospira species identified in patients with leptospiral uveitis in an ophthalmological institute in South India.
Indian J Med Microbiol. 2011 Oct;29(4):444-5. PubMed PMID: 22120817.
17: Santos FF, Commodaro AG, Souza AV, Pinho JR, Sitnik R, Garcia C, Ribeiro AL, …
Real-time PCR in infectious uveitis as an alternative diagnosis.
Arq Bras Oftalmol. 2011 Aug;74(4):258-61. PubMed PMID: 22068852.
18: Hunter RS, Lobo AM.
Dexamethasone intravitreal implant for the treatment of noninfectious uveitis.
Clin Ophthalmol. 2011;5:1613-21. Epub 2011 Nov 11. PubMed PMID: 22140307; PubMed Central PMCID: PMC3225458.
19: Pratap DS, Lim LL, Wang JJ, Mackey DA, Kearns LS, Stawell RJ; …
The role of toll-like receptor variants in acute anterior uveitis.
Mol Vis. 2011;17:2970-7. Epub 2011 Nov 16. PubMed PMID: 22128242; PubMed Central PMCID:
PMC3224833.
20: Yang MM, Lai TY, Tam PO, Chiang SW, Chan CK, Luk FO, Ng TK, Pang CP.
CFH 184G as a genetic risk marker for anterior uveitis in Chinese females.
Mol Vis. 2011;17:2655-64. Epub 2011 Oct 13. PubMed PMID: 22065918; PubMed Central PMCID:
PMC3209418.
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Acute respiratory failure - A physiologic approach
By: Robert Paine, M.D
http://www.med.umich.edu/lrc/students/m2/respiratory/resources/Paine-AcuteRespiratoryFailureSlides.ppt
Acute Respiratory Failure
By: Cindy Kin
http://scalpel.stanford.edu/ICU/presentations/Acute%20Resp%20Failure.ppt
Critical Care Board Review
By: Sachin B. Patel, M.D.
http://www.med.unc.edu/medicine/web/6.9.08%20Patel%20Crit%20Care%20Board%20Rev
Respiratory Failure Vent Support
http://faculty.msugf.edu/caykob/Documents/RC%20171..ENT%20SUPPORT.ppt
Respiratory Failure and ARDS
By: Nancy Jenkins
http://www.austincc.edu/nursmods/cec/cec_lev4/rnsg_2432/documents/RESP09.PPT
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Thyroid Disorders - Hyperthyroidism
http://www.mccc.edu/~martinl/documents/EndocrineDysfunctionTHYROIDandParathyroidDISORDERSs2009student.ppt
Thyroid, Parathyroid, and Adrenal
http://academicdepartments.musc.edu/surgery/education/basic_science/2009-10/Thyroid_Parathyroid_and_Adrenal.pps
Nutrition and Metabolism Dysfunction: Thyroid and Adrenal Disorders
http://employees.csbsju.edu/mbyrne/322/ThyroidAdrenalSummary.ppt
Renal Failure and Treatment
http://www.austincc.edu/nursmods/cec/cec_lev4/rnsg_2432/documents/CRDstudentversionKelleHowardlecture_001.ppt
Endocrine Disorders
http://faculty.mccneb.edu/DBlum3/NURS2150/Endocrine_and_Hepatic_Disorders1.ppt
Endocrine and Hepatic Disorders
by: Kimberley McComb-Meisinger RN-BC MSN
http://faculty.mccneb.edu/DBlum3/NURS2150/Endocrine_and_Hepatic_Disorders.ppt
Alterations of Hormonal Regulation
http://faculty.felician.edu/Goldbergb/Classes/Spring%202009/Pathophysiology/Powerpoint%20Pathophysiology/Chapter18.ppt
Introduction to the Endocrine System
http://faculty.spokanefalls.edu/InetShare/AutoWebs/GaryB/AP%20243/Unit%204/Endocrine%20System.ppt
Endocrine and Nervous Systems
http://faculty.ccri.edu/jgluck/MEDL-Endocrine%20and%20Nervous%20Systems.ppt
Renal Failure and Treatment
http://www.austincc.edu/cmorse/2410/renal/renal_lecture/Renal_Failure_Treatment.ppt
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What is Occiput Posterior?
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Free Access to some Wiley Journals
Several Wiley-Blackwell journals offer free access to their backfiles on Wiley Online Library. All content prior to a given date is made free online to all.
JOURNAL TITLE FREE ACCESS CONTENT AVAILABLE TO ALL USERS
Academic Emergency Medicine: Content older than 12 months back to Jan 1st 1997
Acta Crystallographica Section E (Electronic): Full Open Access
Acta Ophthalmologica: Content older than 2 years back to Jan 1st 1997
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Female Genital Cutting
By:Safa Magid
Female Genital Cutting(FGC)
* Also known as: female circumcision & female genital mutilation
* Female circumcision is the term preferred by cultures who practice this custom
FGC -Definition
* Procedure involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious, or other non-therapeutic reasons.
WHO Classification of FGC
* Type 1: Excision of prepuce w/ or w/o excision of all of the clitoris
* Type 2: Clitoridectomy and partial or total excision of labia minora
* Type 3: Infibulation, includes removing all or part of ext. genitalia and re-approximation of remnant labia majora, leaving a small interoitus for passage of urine and menstrual blood
* Type 1 and Type 2 are the most common forms
* Type 1 and Type 2 account for 80% of the cases
* Infibulation accounts for 15% of the cases
FGC
* Currently ~ 130 million women and girls have had the procedure
* An estimated 2 million girls worldwide are at risk per year
FGC in the US
* Data from 2000 census suggests:
228,000 women and girls are with or at risk for FGC in the United States
* CA, NY, and MD have the most female immigrants and refugees from countries where FGC is prevalent.
* Occurs mostly in 28 sub-Saharan African countries
* FGC is practiced by Christians, Muslims, and adherents to traditional African religions
* Also practiced in Middle East and Asia
Origins and History
* Origins remain unclear
* FGC practiced in Pre-Islamic Arabia, ancient Rome, and Tsarist Russia
* Female circumcision was discovered in ancient Egyptian mummies in 200 B.C.
* Practiced in the United States until the 1970’s to tx hysteria, lesbianism, and erotomania
FGC and Religion
* Christianity:
FGC is not an obligatory religious requirement
* Islam:
FGC is not an obligatory religious requirement
FGC-Procedure
* Performed between the ages of 5-10, or prior to marriage
* Performed by a member of community who is not a healthcare worker
* Often performed w/o anesthesia
* However in metropolitan areas the use of anesthesia is more common
FGC Procedure
* Performed w/o surgical instruments. Razor blades or other instruments which may or may not be sterile are used
* Depending on socio-economic factors FGC may also be performed in a health care facility by qualified health personnel
* WHO is opposed to medicalization of all types of female genital mutilation.
* Reasons currently practiced:
o Rite of passage to womanhood
o Maintains chastity
o Ensure marriageablity
o Belief that it improves hygiene
o Social pressure to adhere to custom
o Belief that it is a religious requirement
Complications
* Prevalence of complications is unknown
* Rate of complications increase with severity of procedure( i.e. women with type III have > complications that women w/type I)
* A study of 120 Somalian women suggests rate of complications are inversely proportional to the age of the child when FGC was performed
* Women who had FGC btwn the ages of 5-8, had more complications than their 9-12 y.o counterparts
* Long and short term complications
* Some women with FGC do not experience complications
Short term complications
* Hemorrhage
* Severe pain
* Shock
* Infection
* Urine retention
* Ulceration of genital region injury to adjacent tissue
* HIV?-Possibly transmitted due to use of unsterilized equipment
Long Term Complications
* Cysts and abscesses
* Post-partum fistulaes: vesico-vaginal
* Keloid scar formation
* Damage to the urethra resulting in urinary incontinence
* Dyspareunia and sexual dysfunction
* Infertility
* Difficulties with labor.
Case Report
* 16 y.o female presents w/severe dysmenorrhea
* PE revealed the absence of a clitoris and fused labia majora with a 1cm opening
* Physicians initially thought pt had corrective surgery for ambiguous genitalia
* Later determined that while visiting Africa with her mother she had FGC performed
* Perinealography revealed:
o Filling of the vagina,urethra, and bladder simulating a urogenital sinus.
o Dilated vagina suggested obstruction
Perinealography
Case Report
* Defibulation procedure was performed
* The patients symptoms of dysmenorrhea eventually resolved
FGC and Obstetric outcomes
* WHO Study
FGC & Length of maternal hospital stay
* FGC and length of maternal hospital stay
o FGC Type I- RR: 1.15
o FGC Type II-RR:1.51
o FGC Type III-RR:1.98
FGC and Mental Health
* Anxiety
* Depression
* PTSD
* Feeling of incompleteness
Defibulation
* Corrective procedure
* Involves division of the fused labia majora with suturing of each labia for hemostasis
* Thus the infibulated scar, which is a flap obstructing the introitus and urethra, is removed
* WHO Indications for defibulation:
* Urinary retention
* Recurrent UTI’s or kidney infections
* Dysmenorrhea
* Dyspareunia or apareunia
* Prior to coitus
* Prior to labor
* It is also reasonable that defibulation can be performed to alleviate any mental health consequences for women who do not meet the WHO indications
Approach to patients with FGC
* Some physicians remain unfamiliar w/FGC & have expressed their shock during PE
* Some women report being reprimanded by physicians for having the procedure done
* Despite the fact the majority had FGC while they were children and were not given a choice
Patients perspective of FGC
* Many pts w/FGC who have immigrated to the West do not feel as if they abused
* Some feel that FGC was done “for them” and not an attack against them
Patients perspective of FGC
* 1st generation pts born in the West who had FGC while traveling abroad often have very different views than their foreign born counterparts
* HC workers may need to modify their approach depending on the pts perspective
Legality of FGC
* U. S. passed a law in March 1997:
* Made performing any medically unnecessary surgery on the genitalia of a girl younger than 18 years of age a federal crime.
* Reinfibulation was not included as a federal crime, so it may be performed with absorbable sutures in a running fashion if a woman chooses the procedure
Resources for pts and HC providers
* African’s Women’s Health Center
o Established in 1999 by Dr. Nawal Nour a Sudanese-American OB/GYN
o Goal of clinic is to provide culturally appropriate holistic care to African women who are refugees who may or may not have undergone FGC
o Defibulation is performed at this clinic
Resources for pts and HC providers
* WHO
* Website with information about FGC
* Includes fact sheet about FGC and guidelines for healthcare workers
* http://www.who.int/topics/female_genital_mutilation/en/
* http://www.who.int/reproductive-health/publications/rhr_01_18_fgm_policy_guidelines/index.html
Dedicated to all of my sisters who have had FGC.
To those who have suffered physical or mental consequences, I am inspired by your courage and strength.
References
Female Genital Cutting.ppt
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