Adhesive capsulitis is a condition characterized by a painful and progressive loss of shoulder range of motion. It typically progresses through painful, freezing, and thawing phases over 1-2 years. Treatment involves medications to manage pain, physical therapy to restore range of motion, and in refractory cases, procedures like corticosteroid injections or surgery. While pain is usually transient, some patients may develop permanent loss of range of motion.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
INTRODUCTION OF GBS,
TYPES OF GBS,
INCUDENCE OF GBS,
ETIOLOGY OF GBS,
PATHOLOGY OF OF GBS,
CLINICAL FEATURES OF GBS,
INVESTIGATION OF GBS,
DIAGNOSTIC CRITERIA OF GBS,
PROGNOSIS OF GBS,
TRATMENT OF GBS,
PHYSIOTHERAPY MANAGEMENT IN CASE OF OF GBS,
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
3. Definition
• Primary idiopathic, progressive, painful but self-limited restriction of
active and passive range of motion.
• Insidious onset and progresses through several stages, usually during
the course of 1 to 2 years.
1. Painful phase
2. Freezing or adhesive phase, and
3. Thawing or resolution phase
• Occurs in 2% to 5% of the general population and accounts
for approximately 6% of office visits to shoulder specialists
4.
5. • Preferentially affects women after the age of 50
• Involves the non-dominant shoulder, and develops in the opposite
shoulder in 20% to 30% of cases.
• The primary etiology is unknown, but it is associated with numerous
secondary causes, including immobilization, diabetes,
hypothyroidism, autoimmune disease, and treatment of breast cancer
6. • Pathologic process related to it involves structures both intrinsic to the
glenohumeral joint and surrounding
• It is not clear, stimulation of synovitis leads to fibrosis due to the
activation of various cytokines, including growth factors such as
transforming growth factor-β.
• Pathologic findings ultimately depend on its stage when it is assessed.
1. Painful phase, is characterized by synovitis that progresses to capsular
thickening (particularly in the anterior and inferior portions of the
capsule) with an associated reduction in synovial fluid.
2. Adhesive phase, fibrosis of the capsule is more pronounced, and
thickening of the rotator cuff tendons is common.
3. Resolution phase, the glenohumeral joint space becomes contracted
and often obliterated. Pathologic change is more consistent with
chronic inflammation with resolution of joint space loss during the final
stage.
7. Symptoms
Will depend on the stage of adhesive capsulitis.
• In stage 1 (symptoms lasting < 3 months),
1. Gradual onset of progressive pain
2. Worse during the night
3. Exacerbated by overhead activities
4. gradual loss of motion
• In stage 2 (lasting 9-12 months)
1. progressive increase in pain
2. ROM reduction and decreased use of the affected shoulder
• Stage 3, the “thawing stage,”
1. Gradual decrease in pain and increase in the pain-free ROM
2. Some individuals will return to normal, but not all
8. Physical Examination
• During the painful and adhesive stages there is a:
1. Measurable reduction in both passive and active shoulder ROM
2. Motion is painful, particularly at the extremes of external rotation and
abduction
• This pattern of motion loss is consistent with a capsular pattern of
passive range of motion loss, which demonstrates a greater limitation
in external rotation and abduction followed by an increasing loss of
flexion.
• These signs are similar to those found in osteoarthritis of the
glenohumeral joint, in which there is a similar loss of motion with
shoulder pain.
9. • However, this presentation is in contrast to findings seen in rotator cuff
tears, in which active range of motion is restricted but passive range of
motion may approximate normal values.
• A reduced glenohumeral glide is often noted with adhesive capsulitis,
especially with inferior translation.
• The relationship of glenohumeral joint movements independent of
scapulothoracic motion should also be noted.
• Last, the shoulder is often painful to palpation around the rotator cuff
tendons distally. As symptoms start to improve and the patient enters
the resolution stage, there is a reversal of the loss of motion, with
internal rotation being the last to improve.
10. • Neurologic evaluation findings are usually normal in adhesive capsulitis,
although manual muscle testing may detect weakness secondary to pain
or disuse.
• However, concomitant rotator cuff involvement is common and could
explain true weakness if it is noted on physical examination.
• The combination of myotomal weakness, altered dermatomal sensation,
reflex asymmetry, and positive findings with cervical spine provocative
testing is more suggestive of a neurologic cause of shoulder pain.
11. Functional Limitations
• Patients often experience sleep disruption as a result of pain or inability
to sleep on the affected side.
• Inability to perform activities of daily living (e.g., fastening a bra in the
back, putting on a belt, reaching for a wallet in the back pocket,
reaching for a seat belt, combing the hair) is common.
• Work activities may be limited, particularly those that involve overhead
activities (e.g., filing above waist level, stocking shelves, lifting boards or
other items).
• Recreational activities (e.g., difficulty serving or throwing a ball, inability
to do the crawl stroke in swimming) are also affected.
12. Diagnostic Studies
• AC is associated with other comorbidities in addition to common
neoplastic processes, routine blood work and radiographs should be
obtained to rule out secondary causes
• Radiographs in patients with AC are generally normal. In advanced
stages, joint space narrowing may be noted on arthrograms as there is a
reduced volume of injectable contrast material into the joint.
• MRI may also prove to be a useful diagnostic tool; studies have
confirmed findings seen at arthroscopy, including thickening of the
coracohumeral ligament and obliteration of the subcoracoid space.
• US allows a dynamic view of the shoulder region with a sensitivity of 91%,
a specificity of 100%, and an accuracy of 92% for detection of AC.
13. Arthrogram of shoulder with advanced
adhesive capsulitis with a contracted
joint space. Note the absence of the
axillaryrecess and the reduced amount
of contrast material injected.
14. Treatment
Initial
• Goals depend on the stage of AC
• General goals are to:
1. Decrease pain and inflammation
2. Increasing the shoulder ROM in all planes.
• Pain and inflammation should be managed with ice, medications, and activity
modifications. NASID’s is generally advocated, although it has not been clearly shown
to have an impact on the resolution of pain.
• A short trial of oral steroids has been shown to more rapidly decrease pain compared
with placebo, but the benefits are not sustained during long-term follow-up.
• Intra-articular injection of corticosteroids (± Lidocaine) has been shown to be helpful
during the early stages of AC compared with placebo, but it does not change long-
term outcomes.
15. Rehabilitation
• The standard of treatment mainly involves physical therapy and home exercises to
restore range of motion for the treatment of adhesive capsulitis.
• The clinician will measure the need for physical therapy versus a home exercise
program and rate of progression of therapy as AC can take months to years to
resolve.
1. Factors affecting the setting and pace of rehabilitation include
2. Severity of the patient’s symptoms
3. Physical examination findings
4. Ability to perform the exercises appropriately, and
5. Compliance with a home exercise program
• Initially, pendulum exercises, overhead stretches, and crossed adduction of the
affected arm should be taught to patients while they are in the physician’s office
once AC is suspected to prevent further loss of function
16.
17.
18.
19.
20. • Others will choose physical therapy early to manage pain, to improve
the pain-free ROM, and to prevent further contraction of the joint
capsule.
• As the patient progresses with physical therapy, a more detailed
home exercise program should be implemented on the basis of the
patient’s understanding of and compliance with the exercises.
• If the patient shows continued progress with less pain and improved
ROM, exercises should be graduated to strengthening of rotator cuff
muscles and periscapular stabilizers.
• Once symptoms resolve, patients should be encouraged to continue
the home exercise program to maintain range of motion and to
prevent recurrence of AC.
21. Procedures
• In the treatment of AC, procedures are often performed in conjunction
with physical therapy sessions and primarily involve pain-alleviating
modalities.
• These procedures may include intra-articular joint injection,
suprascapular nerve blocks, and joint capsule hydrodilation
• Intra-articular injections can be used to break pain cycles.
• Several small studies using suprascapular nerve blocks have also
reported them to be helpful in breaking pain cycles associated with AC.
• Hydrodilation involves glenohumeral injections with saline or lidocaine
to lyse adhesions and to distend the capsule. Unfortunately, more
studies are needed to fully understand its efficacy.
22. Surgery
• The decision to perform surgery is based on failure of conservative
management or an unacceptable QOL.
• Manipulation under anesthesia followed by immediate physical
therapy focusing on improvement of ROM of the glenohumeral joint
can be helpful for refractory cases.
• Arthroscopic lysis of adhesions may be an effective option if all else
has failed
23. Potential Disease Complications
• Pain is usually transient but can persist for months as the condition runs
its clinical course.
• The loss of ROM seen in AC is usually regained, but it has been reported
that as many as 15% of patients develop permanent loss of full ROM.
• ROM loss is often not associated with functional deficits
24. Potential Treatment Complications
• Treatment complications from conservative management are rare but
can include side effects associated with NSAID’s and analgesic
medications; these include GI bleeds, gastritis, toxic hepatitis, and renal
failure.
• Caution should be used in the treatment of patients with CHF and HTN
because of fluid retention associated with the use of NSAID’s.
• Patients undergoing physical therapy could experience significant pain
from too aggressive therapeutic exercises or manipulation.
• In patients undergoing suprascapular nerve blocks, care must be taken
to prevent intraneural and intravascular injections.
• A common surgical complication that can occur is a humeral fracture
during manipulations under anesthesia.