Acute suppurative arthritis is a joint infection that can occur through direct invasion, spread from adjacent bone, or hematogenous spread. In children under 4 years old, common causal organisms include Staphylococcus aureus, Haemophilus influenzae, streptococcus, E. coli, and proteus. Left untreated, the infection can spread and cause bone and cartilage destruction, deformity, or ankylosis. Treatment involves aspirating joint fluid, administering antibiotics, draining thick pus, and splinting the joint to rest it. Complications can include damage to growth plates and epiphyses in children.
Colles fracture is the fracture at the distal end of radius, at its
cortico cancellous junction(about 2cm from the distal articular
surface).
It is not just the fracture of distal radius but the fracture
dislocation of the inferior radio-ulnar joint.
Spinal Tuberculosis by Dr. Monsif IqbalMonsif Iqbal
This is the case presentation of a middle aged lady who presented with severe backache for the last one month with topic review after the case presentation
Colles fracture is the fracture at the distal end of radius, at its
cortico cancellous junction(about 2cm from the distal articular
surface).
It is not just the fracture of distal radius but the fracture
dislocation of the inferior radio-ulnar joint.
Spinal Tuberculosis by Dr. Monsif IqbalMonsif Iqbal
This is the case presentation of a middle aged lady who presented with severe backache for the last one month with topic review after the case presentation
SEPTIC ARTHRITIS AS AN INFECTIOUS PROCESS, DESCRIBING THE APPLIED ANATOMY, THE ORGANISMS INVOLVED, STAGES , PRESENTATION ALL THE WAY DOEN TO THE MANAGEMENT PROTOCALS
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This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
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June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
2. • A jt can become infected by;
1. Direct invasion through a penetrating wound, inta-
articular injection or arthroscopy.
2. Direct spread from an adjacent bone abscess.
3. Blood spread from a distant site
• in infants infxn start in the metaphyseal bone then
spread to the jt or vice versa
• Causal organism- staph aureus
• In children btn 1 &4 years old; h influenzae,
streptococcus, E-coli, &proteus,
• Predisposing conditions: rh arthritis, chronic
debilitating disorder, iv drug abuse, aids
3. PATHOLOGY
• Haematogenous spread
• Settle in the synovial membrane
• Acute inflammatory rxn with serous or seropurulent
exudate & an increase in synovial fluid .
• Pus appears in the joint.
• Articular cartilage is eroded & destroyed by bacterial
enzymes & proteolytic enzymes released from synovial
cells, inflammatory cells & pus.
• In infants the epiphysis may be severely damaged
4. • Older children, vascular occlusion may lead to necrosis of
epiphyseal bone
• In adults the effects are usually confined to the articular
cartilage, but in the late cases there may be extensive
erosion due to synovial proliferation & ingrowth.
• If untreated, infection spread to the underlying bone or
burst out of the joint to form an abscess & sinuses.
• With healing there may be
1. Complete resolution & return to normal
2. Partial loss of articular cartilage & fibrosis of the joint
3. Loss of articular cartilage & bony ankylosis
4. Bone destruction &permanent deformity of the joint
5. Clinical features
• Differ according to age of the patient
– NEW BORN INFANT
• Emphasis is on septicemia rather than jt pain
• Irritable &refuses to feed.
• Rapid pulse & fever
• JT;
– FEEL
– Move to elicit local signs of warmth & tenderness.
– Resistance to mvt.
– Examine umbilical cord.
6. CHILDREN
• Acute pain in a single large joint
• Reluctance to move the joint(pseudoparesis)
• Looks ill, rapid pulse & a swinging fever.
• Skin redness & superficial joint swelling
• Local warmth & marked tenderness
• All movements are restricted & often completely
abolished by pain & spasm.
• Source of infxn; septic toe, boil or discharge from
ear.
7. Adults
• Often a superficial joint: knee ,wrist, a finger,
ankle or toe that is painful swollen &
inflamed.
• Warmth & local tenderness.
• Mvt are restricted.
• Pt should be questioned & examined for
gonococcal infection or drug abuse
• Pt on r.a rx may develop a silent jt infxn.
8. imaging
• u/s- reveal joint effusion in early cases.
• X-ray;- usually normal
– watch out for;
– Soft tx swelling
– Loss of tx planes
– Widening of the radiographic joint space
– & slight subluxatiobnbecause of fluid in the joint.
– E-coli- gas
– Narrowing & irregularity if joint space
• Mri & radionuclide imaging in obsure sites e.g
sacroiliac
9. Lab investigations
• Raised wcc & esr.
• Blood culture may be +ve
• SPECIAL INVESTIGATIONS
– aspirate joint & examine joint fluid
• May be purulent
• Early-clear
• Aspirate- wcc & gram stain immediately.
• Normal leukocyte count-<300 per ml.
• >10000per ml in non-infective inflammatory disorders
• >50000per ml are suggestive of sepsis.
• Gram –ve cocci; h influenzae or kingella kingae( in
children)gonococcus in adults.
10. Ddx
• Acute om
• Other types of infxn-psoas abscess/ local pelvic infxn
• Trauma-traumatic synovitis/ haemarthrosis/ jt aspiration.
• Irrtable jt; painful & lack mvt. Child is not ill.
• Rh fever- typically the pain flits from jt to jt
• JRA-gradual onset with less severe systemic symptoms.
• Sickle cell dx
• Gauchers pseudo-osteitis. Acute pain & fever without any organism.
• Gout &pseudogout- acute crystal induced synovitis- aspiration;
turbid jt fluid/ raised wcc/ microscopic exam by oplarized
microscope show xtic crystals
• Rx
11. treatment
• Priority- aspirate joint &examine fluid
• Start rx without further delay & follow the same principles as aom
• If aspirate looks purulent- joint should be drained without waiting
for lab results.
• General supportive care
• Analgesics for pain
• Iv fluids-dehydration.
• Splintage
• To rest joint especially in neonates & infants.
• Hip should be abducted & 30 degrees flexed on traction to prevent
dislocation.
12. antibiotics
• As aho.
• Neonates & infants up to 6 months
– penincillinase resisatant penincillins eg-
flucloxacillin & 3rd generation cephalosporins
– Children from 6 months to puberty –similar
– Older teenagers & adults- flucloxacillin & fusidic
acid
– 3 rd generation cephalosporins- iv for 4-7 days
then orally for 3 weeks.
13. DRAINAGE
• Under anaesthesia
• Jt is opened through a small incision, drained & washed out
with physiological saline.
• A small catheter is left in place & the wound is closed.
• Suction- irrigation is continued for 2-3 days
• Advisable in
1. very young infants
2. Involving hip
3. Very thick pus aspirated
• Older children; repeated closed aspiration may work
• If there is no improvement within 48 hours open drainage
is done
14. complications
• Subluxation & dislocation of the hip
• Instability of the knee
• Damage to cartilagenous physis or epiphysis in growing child.
• Sequelae;
– Retarded growth
– Partial or complete destruction of the epiphysis
– Deformity of the joint
– Epiphyseal osteonecrosis
– Acetabular dysplasia
– Pseudoarthrosis of the hip
– Acetabular cartilage erosion( chondrolysis)is seen in older pts & this
may result in restricted mvt or complete ankylosis of the joint.