The document discusses laboratory measures for evaluating the diabetic foot, including sensory and vascular assessments. Sensory tests include Semmes-Weinstein monofilament, vibration perception with tuning fork, and biothesiometry. Vascular tests include examination of pulses, ankle-brachial index, and Doppler ultrasound. Other evaluations include foot pressure studies, x-rays, MRI, and wound cultures to guide antibiotic treatment of foot infections in diabetes. Regular foot exams emphasizing sensory and vascular assessments can help prevent costly and life-threatening diabetic foot ulcers and amputations.
The Diabetic Foot: What You Need to KnowOmar Haqqani
Authored by Dr. Jeffrey Stone, DPM. Presented at the First Annual Omar P. Haqqani MD Vascular Symposium, November 10, 2106, Midland Country Club, Midland, MI.
To learn more about diabetic foot wounds visit my website
www.healmyfootwoundfast.com
Educational power point on foot wounds relating to:
1. Obesity in America
2. The Epidemic of Diabetes
3. Complications of Diabetes
4. Cost Realities of Diabetes
5. Chronic Foot Ulcers
Dr. Donald Pelto
299 Lincoln Street Suite 202
Worcester, MA 01605
Arthrocentesis: A bedside procedure in which a sterile needle and syringe are used to drain fluid from the joint, and in some conditions, medication is injected into the joint after fluid removal.
The Diabetic Foot: What You Need to KnowOmar Haqqani
Authored by Dr. Jeffrey Stone, DPM. Presented at the First Annual Omar P. Haqqani MD Vascular Symposium, November 10, 2106, Midland Country Club, Midland, MI.
To learn more about diabetic foot wounds visit my website
www.healmyfootwoundfast.com
Educational power point on foot wounds relating to:
1. Obesity in America
2. The Epidemic of Diabetes
3. Complications of Diabetes
4. Cost Realities of Diabetes
5. Chronic Foot Ulcers
Dr. Donald Pelto
299 Lincoln Street Suite 202
Worcester, MA 01605
Arthrocentesis: A bedside procedure in which a sterile needle and syringe are used to drain fluid from the joint, and in some conditions, medication is injected into the joint after fluid removal.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. LABORATORY MEASURES INLABORATORY MEASURES IN
DIABETIC FOOTDIABETIC FOOT
Dr. Ghanshyam GoyalDr. Ghanshyam Goyal
ILS Multispeciality ClinicILS Multispeciality Clinic
S. K. Diabetes & Research Centre,S. K. Diabetes & Research Centre,
KolkataKolkata
2. Logic of Foot ExaminationLogic of Foot Examination
DFU are expensive, potentially limb/life threatening butDFU are expensive, potentially limb/life threatening but
Highly PreventableHighly Preventable
DFU affect 15% of all Diabetic SubjectsDFU affect 15% of all Diabetic Subjects
Pts. DPN have annual incidence of DFU 7.2%Pts. DPN have annual incidence of DFU 7.2%
DFU account for 20% of Diabetes-related hospitalDFU account for 20% of Diabetes-related hospital
admission (USA)admission (USA)
Cause of DFU : 45 – 60 % Neuropathic, 25 – 45% areCause of DFU : 45 – 60 % Neuropathic, 25 – 45% are
neuro-ischemic, ~10% ischemicneuro-ischemic, ~10% ischemic
3. Priorities of Physical ExaminationPriorities of Physical Examination
Non-Diabetic Subject – English –Non-Diabetic Subject – English –
Head – to – Foot ExaminationHead – to – Foot Examination
Diabetic Subject - Sanskrit -Diabetic Subject - Sanskrit -
ApadaMastakApadaMastak
( Foot – to – head )( Foot – to – head )
Foot Examination is a priority in a DiabeticFoot Examination is a priority in a Diabetic
SubjectSubject
4. High Risk PatientsHigh Risk Patients
Duration of Diabetes > 10 yearsDuration of Diabetes > 10 years
Male > FemaleMale > Female
Poor Blood Glucose ControlPoor Blood Glucose Control
Patients with Cardiovascular, Renal or, RetinalPatients with Cardiovascular, Renal or, Retinal
ComplicationsComplications
John A. Colwell : Diabetes, p.38., 2003John A. Colwell : Diabetes, p.38., 2003
9. Lab MeasuresLab Measures
AA SensationSensation Large fibre: Tuning fork; monofilament &Large fibre: Tuning fork; monofilament &
biothesiometer’biothesiometer’
Small fibre: Pain, TemperatureSmall fibre: Pain, Temperature
BB VascularityVascularity Exam. Of pulses;Exam. Of pulses;
A/B index.A/B index.
CC PressuresPressures
(Planter)(Planter)
Movement – big toeMovement – big toe
Harris matHarris mat
Foot scanFoot scan
DD RadiologyRadiology X-ray; USG; Nuclear scan; MRIX-ray; USG; Nuclear scan; MRI
EE MetabolicMetabolic Hemogram, Sugar, Hba1c, RenalHemogram, Sugar, Hba1c, Renal
parameters, Serum albuminparameters, Serum albumin
FF MIcrobiologyMIcrobiology Wound C/S, Blood C/SWound C/S, Blood C/S
10. Semmes-Weinstein MonofilamentSemmes-Weinstein Monofilament
5 g,5 g, 10 g10 g, 75 g, 75 g
Sites – not standardized (RecommendedSites – not standardized (Recommended
sites : Great toe, heels & MT heads)sites : Great toe, heels & MT heads)
Gently touch skin and apply pressure untilGently touch skin and apply pressure until
filament buckles – ask patientfilament buckles – ask patient
DO NOT apply on ulcersDO NOT apply on ulcers
Corns & Calluses are usually insensitiveCorns & Calluses are usually insensitive
Sensitivity 95%, specificity 87% (10g)Sensitivity 95%, specificity 87% (10g)
11.
12. Vibration PerceptionVibration Perception
128 Hz Tuning Fork128 Hz Tuning Fork
Large diameter fibersLarge diameter fibers
Sensitivity > 80 %Sensitivity > 80 %
Specificity ~ 60 – 70 %Specificity ~ 60 – 70 %
Site not Standardized – base of great-toeSite not Standardized – base of great-toe
nail and on medial malleolusnail and on medial malleolus
14. Temperature SensationTemperature Sensation
Warmth -- Smallest, unmyelinated CWarmth -- Smallest, unmyelinated C
fibersfibers
Cold – Small, myelinated ACold – Small, myelinated Aδδ fibersfibers
Heating / Cooling detector uses theHeating / Cooling detector uses the
Peltier principle (metal element is heatedPeltier principle (metal element is heated
or, cooled according to the direction ofor, cooled according to the direction of
electric currentelectric current
15. NeurotipsNeurotips
Disposable, made up of plastic with aDisposable, made up of plastic with a
sharp metal end and a blunt endsharp metal end and a blunt end
Marketed by Owen Mumford, Oxford, UKMarketed by Owen Mumford, Oxford, UK
Detects loss of touch sensation (superiorDetects loss of touch sensation (superior
to safety pins, needles or, hat-pins)to safety pins, needles or, hat-pins)
17. Hand-held DopplerHand-held Doppler
Excellent tool for vascular assessment at bed-Excellent tool for vascular assessment at bed-
sideside
Normal sound Biphasic or TriphasicNormal sound Biphasic or Triphasic
Atherosclerotic vessels – monophasicAtherosclerotic vessels – monophasic
Ankle Brachial Index : < 0.9 usually indicatesAnkle Brachial Index : < 0.9 usually indicates
angiogram positive disease (falsely highangiogram positive disease (falsely high
because of high S.P. in atherosclerotic vessels).because of high S.P. in atherosclerotic vessels).
18.
19. Ankle / Brachial PressureAnkle / Brachial Pressure
Index (ABI)Index (ABI)
Normal ABI = 1Normal ABI = 1
Ischemia < 0.85Ischemia < 0.85
Ankle / Brachial PressureAnkle / Brachial Pressure
Index (ABI)Index (ABI)
35. Selected Antibiotics Regimens for Initial Empiric Therapy of FootSelected Antibiotics Regimens for Initial Empiric Therapy of Foot
Infections in Patients with Diabetes MellitusInfections in Patients with Diabetes Mellitus
InfectionInfection Antimicrobial regimenAntimicrobial regimen
Non-limbNon-limb
threateningthreatening
Cephalexin 500mg p.o. q6hCephalexin 500mg p.o. q6h
Clindamycin 300 mg p.o. q8hClindamycin 300 mg p.o. q8h
Amoxicillin-clavulanate (875/125 mg) one q12hAmoxicillin-clavulanate (875/125 mg) one q12h
Dicloxacillin 500 mg p.o. q6hDicloxacillin 500 mg p.o. q6h
Levofloxacin 500-750 mg qdLevofloxacin 500-750 mg qd
Limb threateningLimb threatening Ceftriaxone 1 g IV daily plus clindamycin 450-600 mg IVCeftriaxone 1 g IV daily plus clindamycin 450-600 mg IV
q8hq8h
Ciprofloxacin 400 mg IV q12h plus clindamycin 450-600 mgCiprofloxacin 400 mg IV q12h plus clindamycin 450-600 mg
IV q8hIV q8h
Ampicillin / sulbactam 3 g IV q4-6hAmpicillin / sulbactam 3 g IV q4-6h
Piperacillin / tazobactam 3.375 g IV q4h or 4.5 g IV q6hPiperacillin / tazobactam 3.375 g IV q4h or 4.5 g IV q6h
Fluoroquinolone IV plus metronidazole 500 mg IV q6hFluoroquinolone IV plus metronidazole 500 mg IV q6h
Life threateningLife threatening Impenem cilastatin 500 mg IV q6hImpenem cilastatin 500 mg IV q6h
Piperacillin / tazobactam 4.5 g IV q6h plus gentamicin 1.5Piperacillin / tazobactam 4.5 g IV q6h plus gentamicin 1.5
mg/kg IV q8hmg/kg IV q8h
Vancomycin 1 g IV q12h plus gentamicin plusVancomycin 1 g IV q12h plus gentamicin plus
metronidazolemetronidazole
36. SummarySummary
Periodic Examination of Foot is Mandatory in allPeriodic Examination of Foot is Mandatory in all
Diabetic PatientsDiabetic Patients
Identification of Early foot problems canIdentification of Early foot problems can
prevent major events &prevent major events & CostCost
Identification of High Risk Foot is possible atIdentification of High Risk Foot is possible at
Primary Care SettingPrimary Care Setting
Education of Physician AND Patient is importantEducation of Physician AND Patient is important
for Prevention of Foot Complicationsfor Prevention of Foot Complications