Dr. Mehdeh

“May this season find you among those you love, sharing in the twin glories of generosity and gratitude.”

~OW







P.S Thanks for being on this platform. More educational contents in 2023.

Good News for Known Diabetes Mellitus Patients..

Sources Confirmed That.......

The US Food and Drug Administration (FDA) has cleared the Dexcom G7 continuous glucose monitoring (CGM) system for people with all types of diabetes aged 2 years and older, and for use during pregnancy.

The G7 has several improvements over the current G6 model, including a 60% smaller size, a 30-minute warm-up period (compared with 2 hours), an all-in-one sensor and transmitter (as opposed to the two separate devices), a mean absolute relative difference (compared with a standard, an assessment of accuracy) of 8.2% (compared with 12.8%), a 12-hour grace period (in contrast to the G6's hard shutoff), and a redesigned mobile app.

It is indicated for wear on the back of the upper arm for people aged 2 years and older or the upper buttocks for ages 2-17 years old.

As an "integrated" CGM, the G7 has the capacity to work as part of automated insulin delivery systems, but that will require further FDA action. "Dexcom is working closely with its insulin pump partners to integrate Dexcom G7 into current and future automated insulin delivery systems as quickly as possible," the company said in a statement.

Like the G6, it requires no fingersticks, scanning, or calibration. It provides real-time glucose readings every 5 minutes to a compatible device, including Apple Watch and other digital health apps, and allows for remote monitoring of data by as many as 10 followers.

Dexcom expects to initiate a US launch of Dexcom G7 in early 2023. To facilitate immediate access to G7 for as many users as possible, the company will have accessible cash payment options in place as the company transitions coverage with availability for G7, the statement says.

The Dexcom G7 was granted a CE Mark (Conformité Européenne) in March 2022, which means it is approved for use in people with diabetes aged 2 years and older, including pregnant women, in Europe.

~Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in The Washington Post, NPR's Shots blog, and Diabetes Forecast magazine. She is on Twitter: .

William Tubman's Birthday in Liberia is held on November 29. This event in the third decade of the month November is annual.

Brief History!

🥂 29 November - William Tubman's Birthday in Liberia.

William Vacanarat Shadrach Tubman, an Americo-Liberian, served 27 years as President of Liberia, longer than any president before or after him. Tubman, who is regarded by some in his country as the “father of modern Liberia,” was born on November 29, 1895 in Harper, Liberia.
He established an economic policy, known as the "porte ouverte" ("open door"), to attract foreign investment. Working to facilitate and encourage foreign businesses to locate in Liberia, he encouraged development. Between 1944 and 1970, the value of foreign investments, mainly from the United States, increased by 200%.

Rest Well Mister President

No moment is priceless than saving lives.

P.S. Doctors deserve more respect and recognition. They're the second reason to your longevity.

Respect Surgeons!

Surgeons perform many of the same duties as other physicians, recording patients' medical histories and diagnosing illnesses, injuries and other conditions.
However, while physicians' therapies typically encourage the body to heal itself, surgeons act directly to correct illnesses, injuries and deformities.
Working through open incisions in the traditional way with scalpels, or with tiny instruments inserted into the body through fine tubes or, increasingly, with the aid of robots, surgeons cut, fuse and reshape the body's tissues to restore proper function.





It's the Weekend!

https://www.sciencedirect.com/science/article/pii/S221475191930324X

Factors that negatively influence the Glasgow Outcome Scale in patients with chronic subdural hematomas. An analytical and retrospective study in a tertiary center Subdural hematomas are one of the most frequent types of intracranial hemorrhage, but there are very few references to explain how different factors c…

In an emergency, what treatment is given by ear? Words of Comfort.

~Abraham Verghese, MD

PS. Another long week in the service of life-saving.

"A surgeon operates as good as his assistant permits".

📷 Shot

P.S. Prior to a TURP Procedure shot.
Left to Right
✅Dr. Siaway - Intern
✅Dr. Sando - GS-PGY-3/Chief Resident
✅Dr. Mehdeh - GS-PGY-1
✅Dr. Dolopei - Intern

"Never let the skin stand between you and the diagnosis".

A dream doesn't become reality through magic; it takes sweat, determination and hard work.

~Colin Powell

Today, the Four of Us embark on a vigorous journey to become Specialists in General Surgery.

Left ⏭ Right
Dr. Darley
Dr. Mehdeh
Dr. Moore-Wilson
Dr. Duwanan

Ref: Liberian College of Physicians and Surgeons (LCPS) New Cohort of Residents - General Surgery.

The price of success is hard work, dedication to the job at hand, and the determination that whether we win or lose, we have applied the best of ourselves to the task at hand.

~Vince Lombardi

Saclepea Comprehensive Health Centre remains in my heart.

Red 🔴 White ⚪ & Blue 🔵

Unique colours that define us as a Country. A flag that many fought to represent, a flag like no other flag in the world.
I will always be proud to stand behind these colours anywhere and everywhere.

Happy Flag Day Liberia

Life's most persistent and urgent question is, 'What are you doing for others?'

Martin Luther King, Jr.

P.S. Me? Saving lives 🙏

✅Thank You Nimba County

🙏Today, I bid farewell to this theatre that has hosted me for the past 9months.
Many lives were saved in this single room.
I am grateful for those professionals that assisted during surgical procedures.
🙏The Nurse Anesthetist, Scrub Nurses, Circulating Nurses, Colleagues etc. They were exceptional in providing a stress-free environment.

Father God, I ask You to guide my hands and give me the skill and knowledge to do exactly what is needed to be done, and to avoid further complications when unseen circumstances arise so that I might make wise decisions that could avoid serious implications and I also pray that you steady my hands and give me clear vision with which to perform this surgery. I know that there is no surgery that is truly “minor” because every surgery carries with it risks for the patient. I also ask you to help me give the postoperative advice to the patient’s that is clear, concise, and easy to understand so that the patient will be able to easily follow my instructions. I also thank God for these skilled men and women who often are under great pressure to do what they must do and often in a short amount of time, so give them the ability to do what You have called them to do, and as always, I ask for these things in the name of and for the glory of the great Son of God, Jesus Christ, in Whose name I pray, amen.

✅Thank You Nimba County 🙏
First day of Transitional 2-Weeks of Surgeries at the Saclepea Comprehensive Health Centre, Saclepea City, Nimba County.
Joined in Theatre with Dr Gbengein (Right) (Would-be Resident Doctor) who is expected to replace me while I leave for 3 years of Residency Training in General Surgery - @ the Liberian College of Physicians and Surgeons.

Had the distinct honour to attend the 3rd Graduation Ceremony for Obstetrics and Neonatal Clinicians at the Ford Madden Christian Academy School Auditorium. A National Task Shifting Program under the canopy of the Ministry of Health - Republic of Liberia.

The Ivory Coast–Liberia border is 778 km (483 mi) in length and runs from the tripoint with Guinea in the north down to the Atlantic Ocean in the south. It separates the Liberian counties of Grand Gedeh, River Gee, Maryland and Nimba from the Ivorian districts of Montagnes and Bas-Sassandra.

Liberia 🇱🇷 & Ivory Coast 🇨🇮 have had some good relationships in the past. Today is your Independence Day Ivory Coast. Let's remain hopeful and connected.

Happy Independence Day 🇨🇮

Bulimia Nervosa has been around since the 70s.

To begin, a British psychiatrist named Gerald Russel published one of the first descriptions of bulimia nervosa in 1979.
Based on his contribution to this discovery of a Condition (Bulimia Nervosa), an indirect sign of the condition was named after him. It is called Russell's sign.

📁What is Russel's sign then? It is defined as calluses or thickened marks on the knuckles or back of the hand due to repeated self-induced vomiting over a long period. The condition generally arises from the patient's knuckles making contact with the incisor teeth during the act of inducing the gag reflex at the back of the throat with their finger(s).

P.S. See the image below.

✅Bulimia Nervosa - literally means disease of hunger affecting the nervous system.
📁It is an eating disorder marked by binge eating i.e. control eating, followed by purging, such as vomiting, taking laxatives, and/or excessive activity to prevent the individual from gaining weight.
Note: It is a long and huge lecture notes, we will go more deeper on our next post.
Keep following this page!

What this Profession requires and demands:
🤲This is the task of our life - to place people at our mind's altar and serve them with all our heart.





🤝🤝🤝🤝📁

https://www.medscape.org/viewarticle/974041?sso=true&uac=259013MT&src=mkmcmr_driv_stan_mscpedu_220729-OUS-OBGY-974041-cta

Genetic Testing in Ovarian Cancer: Patient Impact and How to Handle These Difficult Scenarios Did you know that 50% of ovarian cancer patients have genetic alterations which can be targeted with therapy?

Ovarian Cysts (a glance)

✅Ovarian cysts are fluid-filled sacs within the o***y.

📁 Types of Ovarian Cysts
👨‍💻Functional ovarian cysts
Functional cysts result from a disruption in the development of follicles or the corpus luteum and often resolve on their own.

👨‍💻Follicular cyst of the o***y (most common ovarian mass in young women)
Develops when a Graafian follicle does not rupture and release the egg (ovulation) but continues to grow and it eventually develops into a large cyst (∼ 7 cm) lined with granulosa cells. It is Associated with hyperestrogenism and endometrial hyperplasia.

👨‍💻Corpus luteum cyst
Enlargement and buildup of fluid in the corpus luteum after failed regression following the release of an o**m. It produces progesterone, which may delay me**es. It is associated with progesterone-only contraceptive pills and ovulation-inducing medication. Finally, it is
Common during pregnancy.

👨‍💻Theca lutein cysts
Often multiple cysts that typically develop bilaterally. Result from exaggerated stimulation of the theca internal cells of the ovarian follicles due to excessive amounts of circulating gonadotropins such as β-hCG. It os
Strongly associated with gestational trophoblastic disease and multiple stations and Usually, resolve once β-hCG levels have normalized.

👨‍💻Nonfunctional ovarian cysts
A group of ovarian cysts that do not produce hormones.
📁Chocolate cysts
📁Dermoid cysts
📁Cystadenoma (serous or mucinous)
📁Malignant cysts (a form of ovarian cancer): higher risk in postmenopausal women.

©AMBOSS

The independence holiday provides our nation with a time to celebrate its independence and freedom. Our national heroes who fought and laid down their lives to secure our independence as a nation deserve to be remembered not only on Independence Day but always. Politicians often use the occasion to promise to preserve the liberties and freedom we enjoy, work toward improving the welfare of the masses, and continue building a great nation that we all can rely on and be proud of.

Happy Independence Day Liberia 🇱🇷

✅Necrotizing enterocolitis (NEC)

👨‍💻Hemorrhagic necrotizing inflammation of the intestinal wall.
👨‍💻Most commonly affects the distal ileum and proximal colon.
___________________________________

👨‍💻NEC is the most common cause of acute abdomen in premature infants.
👨‍💻Peak incidence: 2nd–4th week after birth.

__________________________________
The causes of necrotizing enterocolitis are not fully understood but multiple factors contribute to the development of the condition.
👨‍💻Intestinal wall perfusion and motility disorders.
👨‍💻Defective or underdeveloped immune system.
👨‍💻Intestinal microbial overgrowth
Formula feeding.
👨‍💻Rapid increase of enteral nutrition.

_________________________________
Bell Staging Criteria explains the Clinical Features of NEC in three stages.
Stage I Suspected
Stage II Proven
Stage III Advanced

Note: Review the image.

_________________________________
Laboratory tests
👨‍💻Complete blood count:
Neutrophil counts < 1500/μL are associated with a poor prognosis.
👨‍💻The degree of thrombocytopenia correlates with the severity of NEC.
👨‍💻↑ Inflammatory markers
Check for signs of DIC → see disseminated intravascular coagulation
👨‍💻Arterial blood gas analysis: Metabolic acidosis is associated with advanced NEC.
👨‍💻Blood culture

__________________________________
✅Imaging
Abdominal Xray
🎗Pneumatosis intestinalis: bubbles of gas within the wall of the intestine
🎗Portal venous gas (pneumatosis hepatis)
🎗Increased intestinal wall thickness
🎗Dilated intestinal loops
🎗Air‑fluid levels
🎗Pneumoperitoneum as a result of intestinal perforation

Abdominal Ultrasound

__________________________________
Treatment should be initiated promptly when NEC is suspected to prevent complications such as perforation, peritonitis, and sepsis.

Supportive care:
🎗Stop enteral feeding → parenteral feeding and substitution of fluids
🎗Gut decompression via nasogastric tube
🎗IV broad-spectrum antibiotics: e.g., ampicillin, gentamicin, and metronidazole for anaerobic coverage.
🎗Radiographic monitoring: plain supine abdominal radiographs every 6–12 hours in the initial phase of the disease
🎗Surgery: primary peritoneal drainage and/or laparotomy with necrotic bowel excision
Indications: perforation, peritonitis and/or clinical worsening despite medical therapy.

___________________________________
Complications:
👨‍💻Intestinal perforation:
👨‍💻Short bowel syndrome
👨‍💻Peritonitis
👨‍💻Sepsis

___________________________________

©AMBOSS

✅Ulcerative Colitis

Ulcerative colitis is a diffuse inflammatory disease of the colon and re**um with unknown etiology.

Unlike Crohn’s disease, surgical removal of the entire colon and re**um provides a complete cure. Nonetheless, many patients are treated successfully with medical therapy including corticosteroids and can avoid the potential complications of surgery and lifelong ileostomy.

Ulcerative colitis usually presents as bloody diarrhea, fever, and abdominal pain. The disease process begins in the re**um, advances proximally in a contiguous fashion, and affects the superficial layers of the colon wall.

Crohn’s disease is located anywhere from the mouth to a**s, has skip lesions, and is transmural in nature.

Histologically, superficial inflammation with crypt abscesses is most indicative of ulcerative colitis, whereas deeper involvement with granulomas and fissures are most characteristic of Crohn’s disease. Both diseases may present with extraintestinal manifestations such as arthritis, skin lesions, and hepatic dysfunction, but perianal disease with fistula formation is characteristic of Crohn’s disease.

Patients with ulcerative colitis have a 10–20% risk of developing colon cancer within 20 years after diagnosis. The incidence is also increased in those with Crohn’s disease but to a lesser extent. Surveillance colonoscopy is essential in patients with long-standing disease.

©TelegramSurg.

Familial adenomatous polyposis (FAP)

FAP is a rare autosomal dominant inherited form of colorectal cancer that results from a germline mutation in the APC gene.
The disease is characterized by the presence of >100 polyps in the large intestine, as well as extraintestinal manifestations such as epidermoid cysts, desmoid tumours, and osteomas.
All patients with FAP will develop colorectal cancer if left untreated. The average age of diagnosis is 29 and the average age of the development of cancer is 39. Once diagnosed, the most definitive treatment requires complete removal of the entire colon and re**um in a timely fashion.
Surveillance colonoscopy is not protective against the development of cancer regardless of the frequency.
The surgical procedure of choice is a proctocolectomy with permanent ileostomy or the creation of an ileoanal anastomosis with an ileal reservoir such as a J-pouch.
Abdominal perineal resection with sigmoid colectomy leaves a significant portion of the colon in situ with a subsequent risk of developing colon cancer.

©TelegramSurg

Thank You!