This document provides an overview of ankle fractures, including:
1. It describes common types of ankle fractures like malleolar fractures and tibial plafond fractures.
2. It outlines the approach to ankle fractures including history, physical exam, imaging, and x-ray interpretation.
3. Classification systems for ankle fractures are discussed like the Lauge-Hansen and Weber systems.
4. Treatment options are covered including surgical techniques, syndesmotic screw usage, and approaches to tibial plafond fractures.
Calcaneum fracture- pathoanatomy & various fracture patternGirish Motwani
DR. GIRISH MOTWANI
Consultant Foot & Ankle surgeon (Paediatric & Adult)
1)Sushrut Hospital, Research Centre & PostGraduate Institute of Orthopaedics, Nagpur west
2)Aman hospital,Nagpur east
3)South point clinic, Nagpur south
Presentation on the Anterolateral Ligament (ALL) with information on diagnosis with ultrasound and treatment using an ultrasound guided, percutaneous, reconstruction and an internal brace
Rotator cuff Repair - New Techniques and ChallengesShoulderPain
This presentation reviews the current challenges and advances in state of the art rotator cuff repair. Learn more at https://www.theshouldercenter.com/
A Comparative Study of the Clinical and Functional Outcome Anterior Cruciate ...TheRightDoctors
A Comparative Study of the Clinical and Functional Outcome Anterior Cruciate Ligament Reconstruction Using Transportal and Transtibial Approach for Femoral Tunnel Drilling-Dr. Adarsh Reddy
Calcaneum fracture- pathoanatomy & various fracture patternGirish Motwani
DR. GIRISH MOTWANI
Consultant Foot & Ankle surgeon (Paediatric & Adult)
1)Sushrut Hospital, Research Centre & PostGraduate Institute of Orthopaedics, Nagpur west
2)Aman hospital,Nagpur east
3)South point clinic, Nagpur south
Presentation on the Anterolateral Ligament (ALL) with information on diagnosis with ultrasound and treatment using an ultrasound guided, percutaneous, reconstruction and an internal brace
Rotator cuff Repair - New Techniques and ChallengesShoulderPain
This presentation reviews the current challenges and advances in state of the art rotator cuff repair. Learn more at https://www.theshouldercenter.com/
A Comparative Study of the Clinical and Functional Outcome Anterior Cruciate ...TheRightDoctors
A Comparative Study of the Clinical and Functional Outcome Anterior Cruciate Ligament Reconstruction Using Transportal and Transtibial Approach for Femoral Tunnel Drilling-Dr. Adarsh Reddy
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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.
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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
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
3. Approach to Ankle Fractures
◈ History
Mechanism
Timing
Soft tissue injury
Bone quality
Pre-morbid
Other injuries
◈ Examination
Deformity
Soft tissue condition
Neurovascular status
6. Ankle Xray Interpretation
◈ Bone - malleoli, talar dome
◈ Medial clear space
◈ Tibio bular overlap
◈ Tibio bular clear space
◈ Shenton line
◈ Dime sign
◈ Talocrural angle
◈ Talar tilt
7. ◈ Medial clear space (MCS)
widest distance between the medial
border of the talar bone and the lateral
border of the medial malleolus
approximately equal to the superior clear
space
Value
◈ 4mm
8. ◈ Tibio bular overlap (TFO)
horizontal distance between the
medial border of the bula and the
lateral border of the anterior tubercle
measured at 1 cm above and parallel to
the tibial plafond
Value
◈ 6mm (AP)
◈ 1mm (Mortise)
9. ◈ Tibio bular clear space (TFCS)
horizontal distance between the
incisura bularis of the tibia and the
medial border of the bula
measured at 1 cm above and parallel to
the tibial plafond
Value
◈ < 6mm (AP, Mortise)
13. Lateral view
◈ The distal bula should be
superimposed by the posterior
part of the distal tibia
◈ The talar domes should be
superimposed
◈ The joint space between the tibia
and the talus should be uniform
15. LAUGE-HANSEN CLASSIFICATION
◈ Two terms
1st
word: position of the foot at the time of injury
2nd
word: direction of the deforming force
◈ Predict the fracture pattern
16. Position of Foot
◈ Supination
Lateral side of foot touch the oor
Tension on lateral side,
compression on medial side
◈ Pronation
Medial side of foot touches the
oor
Tension on medial side,
compression on lateral side
PM Super Late
19. Supination Adduction (SA)
◈ Tension on lateral side, compression on medial
side
◈ Stage 1
Rupture of ATFL/CFL or transverse fracture of
bula (avulsion)
◈ Stage 2
Vertical fracture of medial malleolus
Impaction of anteromedial of distal tibia
37. Pronation Abduction (PAB)
◈ Stage:
1. Medial malleolus transverse fracture or
disruption of deltoid ligament
2. AITFL and PITFL/avulsion of posterior
malleolus
3. Transverse comminuted fracture of the
bula above the level of the syndesmosis
41. Surgical Treatment
◈ Posterior malleolus
Fix or not x: >25% of articular surface on lateral view
◈ Di cult to determine
Stability
◈ Translation of talus
Articular congruency
◈ Stress = force /area => small area, higher stress
Stronger distal tibio bular syndesmosis
44. Syndesmotic Screw
◈ Positioning screw
Reduce fracture rst then put the screw
Tap both bula and tibia
Use full threaded screw
◈ Position of foot
Neutral
◈ Direction of screw
Aim anteriorly 30 degree
45. Syndesmotic Screw
◈ No consensus
Number of screws
◈ 2 in Maisonerve fracture
Size of screws
◈ 3.5 / 4.5mm -> no biomechanical advantage
Number of cortices
◈ 3 -> allow physiological ext rotation of bula during dorsi exion
◈ 4 ->better purchase, more rigid, prone to breakage
Hardware removal
◈ Break -> leave it
47. TIBIAL PLAFOND FRACTURES
◈ Mechanism
High axial loading
◈ Common in male, 30-40 years old
Rotational force
◈ skiing
48. ◈ Pattern of injury
Axial loading
◈ Fragment depends on position
of foot during axial loading
Plantar exion: posterior lip
Dorsi exionL: Anterior lip
Neutral: Anterior and
posterior fragment
◈ Articular communition
49. ◈ Pattern of injury
Rotational
◈ Torsion with varus/valgus force
◈ Larger fragment, less articular
communition
Combination
◈ Pattern depends on the vector force
50. Radiological
◈ X-ray
Other part eg: calcanea;, pelvic, lumbar
◈ CT scan
articular involvement
metaphyseal comminution
fracture displacement
54. Treatment
◈ Conservative
◈ 2 stage surgery
provides stabilization to allow for soft tissue healing and monitoring
capsuloligamentotaxis to indirectly reduce the fracture by tensioning the soft tissues about the ankle
keeps fracture fragments out to length
fractures with signi cant joint depression or displacement
leave until swelling resolves (generally 10-14 days)
◈ ORIF
◈ External xation
◈ Arthrodesis
55. Treatment
◈ Principles
Restoration of bula length
Reconstruction of tibial joint articular surface
Filling of the defect by bone grafting
Final xation by buttress plating.
71. ◈ According to ATLS protocol
◈ Look for other injury -> high energy trauma
◈ Management of open fracture
Wound irrigation
Antibiotics
Wound debridement
◈ Temporary stabilisation with external xation
