Risk factors for joint infections include previous arthritis, trauma, diabetes mellitus, immunosuppression, bacteremia, sickle cell anemia, and prosthetic joints. The most common pathogens causing joint infections vary by age and risk factors, with Staphylococcus aureus being most common overall except in neonates, who most commonly experience group B streptococcus infections. Joint infections can occur via seeding from a contiguous infection, hematogenous spread, or direct inoculation from surgery, trauma, or joint aspiration.
Tetanus Presentation
77 slides
Including drip rates of muscle relaxants
PDF : http://www.mediafire.com/download/k00ciibf73d7y6p/
For more, visit www.medicalgeek.com
Tetanus, Lock Jaw, Opisthotonus, Tetanus Immunoglobulins, Immunization, Cephalic Tetanus. A much feared topic among residents explained in a simple way.
Tetanus Presentation
77 slides
Including drip rates of muscle relaxants
PDF : http://www.mediafire.com/download/k00ciibf73d7y6p/
For more, visit www.medicalgeek.com
Tetanus, Lock Jaw, Opisthotonus, Tetanus Immunoglobulins, Immunization, Cephalic Tetanus. A much feared topic among residents explained in a simple way.
Presentation on osteomyelitis for physiotherapy students
It includes the explanation along with the treatment for osteomyelitis which may be benefitial for the physiotherapy students
Thank You for watching
viral infection of the nerve cells and surrounding skin, caused by the varicella zoster virus
what we basically see in ths conditions
what basic things to remember always....
Presentation on osteomyelitis for physiotherapy students
It includes the explanation along with the treatment for osteomyelitis which may be benefitial for the physiotherapy students
Thank You for watching
viral infection of the nerve cells and surrounding skin, caused by the varicella zoster virus
what we basically see in ths conditions
what basic things to remember always....
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
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).
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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.
2. Objectives
be able to define septic arthritis
know what factors predispose to development of joint
infection, what bacteria commonly cause joint infections
be able to list most common pathogens causing septic
arthritis by age and risk factor.
be able to distinguish gonococcal arthritis from other forms
of bacterial septic arthritis.
know the common characteristics of viral arthritis and how
these differ from bacterial septic arthritis.
3. JOINTS
A site where two or more bones come together, whether
or
not movement occurs between them, is called ajoint
1-Fibrous Joint
The articulating surfaces of the bones are joined by fibrous tissue
very little movement is possible
e.g : - sutures
- inferior tibiofibular joints
2-Cartilaginous Joint
A primary cartilaginous joint is one in
which the bones are united by a plate or bar of hyaline cartilage.
No movement is possible.
e,g : between the first rib and the manubrium sterni
A secondary cartilaginous joint is one in which the
bones are united by a plate of fibrocartilage and the articular surfaces of the
bones are covered by a thin layer of hyaline
cartilage. Examples are the joints between the vertebral bodies the symphysis pubis. A
small amou nt of movement is possible.
4. 2-Synovial Joints
The articular surfaces of the bones are covered by a thin
.laye r of hyaline cartilage separated by a joint cavity
Synovial (diarthrodial) joints are found at the ends of two adjacent
bones that articulate.
Articular cartilage • Extremely smooth (nearly frictionless)
covering of the bone ends that glide on each other
It can be injured leading to pain, degeneration, or dysfunction
Subchondral bone • Dense bone that supports and is found
directly beneath the articular cartilage
Appears radiodense on plain fi lm x-rays and has low signal
(black) on MR
Synovium • Inner membrane lines the joint capsule
“Makes” (fi lters plasma to produce) synovial fl uid
Synovial folds (plica) form normally but occasionally can be
pathologic
Capsule • Outer layer, surrounds and supports the ends of two
bones in proper orientation
Thickenings of the capsule (capsular ligaments) maintain stability
of the joint
5. Synovial fluid •
- Ultrafiltrate of plasma (synovium fi lters it)
- Composed of hyaluronic acid, lubricin, proteinase, and collagenases.
Viscosupplementation therapy aims to replace hyaluronic acid in the
joint
-Function: 1. Lubrication of joint. 2. Nutrition to articular cartilage (and
menisci, etc)
-Laboratory evaluation is important part of workup of intraarticular
processes
Other
• Joints often have additional structures within them, including ligaments
(e.g., ACL, PCL), tendons
(e.g., biceps, popliteus), supporting structures (e.g., meniscus, articular
discs)
9. Frequency of Joints
• Knee-48%
• Hip-24%
• Ankle-7%
• Elbow-11%
• Wrist-7%
• Shoulder-15%
• Sternoclavicular-8%
10. Joint Infections Mechanism :
Seeding from a contiguous source of
infection
Hematogenous seeding most common
Direct inoculation from surgery, trauma or
joint aspiration.
11.
12. The word arthritis literally means
joint inflammation; but it is often
used to refer to group of more than
100 rheumatic diseases that can
cause pain, stiffness ,and swelling in
the joints.
Arthritis
13.
14. Microbes & Arthritis
Overview and Classification
Class Infection
Live organism
present ?
Microbial
structures
present?
Example
Infection Yes Yes Yes Septic Arthritis
Reactive Yes No Yes
Chlamydia, Yersinia,
Salmonella, Shigella,
Campylobacter
Inflammatory No No No Rheumatoid Arthritis
17. Definition
Inflammation of a synovial membrane with
purulent effusion into the joint capsule, often
due to bacterial infection
Incidence:
. Commonest in middle age. (Liable to trauma).
. 0.2%-0.7% of hospital admissions
. Peak incidence in the first years of 1st decade
and >50 years
. Males>Females
18. Usually hematogenous but may also result
from contiguous spread or direct inoculation
Occurs in all age groups
Most common in children
Usually monoarticular
Polyarticular in less than 10% of pediatric
cases and less than 20% of adult cases
Hip and knee are most frequently affected
19. - Etiology: Staph., strept. "direct, blood"
- C/P: as inf. + night / rest pain + complete
loss of all movements
- Comp.: destruction, Dislocation, Disturbed
growth, Deformity (ankylosis)
- lnvest.: as inf. + imaging "X-ray*"
-TTT: AAA a urgent arthorotomy
Septic arthritis
20. Bacteria are most common
Viruses, fungi and parasites are possible
Staph aureus most common in all ages except
neonates
GBS most common in neonates
H. influenzae b has essentially disappeared as
a pathogen in vaccinated children
Pathogens:
21. Pathogens:
Gonococcal arthritis is the most common
type of septic arthritis in individuals under
30 years old
In the elderly, gram-negative bacteria
account for a higher percentage of cases of
bone and joint infections than in younger
people
MRSA, and VRE have emerged as a
significant microbiologic problem in the
past decade
22. Pathogens
Usually unimicrobial
Polymicrobial (36 to 50%) more likely in
diabetic foot osteomyelitis, posttraumatic
osteomyelitis, chronic osteomyelitis, and
chronic septic arthritis
In children between 1 and 4 years
usually Staphylococcus aureus
23.
24. PATHOLOGY
Pathologic sequence:
In the early stage (a)
there is an acute synovitis with a purulent jointeffusion. (b)
Soon the articular cartilage is attacked by bacterial and cellular enzymes.
If the infection is not arrested,thecartilage may be completely destroyed (c).
Healing then leads to bony ankylosis (d).
(a) (b) (c) (d)
25. . Pathological types:
- Serous:
o Hot, red, tender, swollen joint.
o Fluid is clear.
- Serofibrinous:
o More inflammation,{r manifestations.
o Fluid is turbid.
- Purulent:
o Pure pus in joint.
o Throbbing pain, hectic fever.
o Edema & ulceration of the synovial membrane.
o Erosion then complete separation of
articular cartilage.
26. Clinical features
Symptoms
. General: F A H M.
. Local:
-pain: severe, sudden,
throbbing (later).
- Swelling at the joint area.
- lnability to move the joint
27.
28. Signs
. General: Fever & tachycardia.
. Local:
o lnspection:
- Redness, swelling and discharging sinus
(if neglected).
- Deformity (late)
o Palpation:
- Hotness and tenderness.
o Movement:
- complete loss of all movements
(active & passive
33. Laboratory
Increase ESR and CRP +ve.
CBC
Blood culture
Histopathology:
Joint aspiration +/-
U/S guidance :
o Diagnostic:
- Confirm the diagnosis.
- Culture & sensitivity.
o Therapeutic.
After aspiration, the joint should be splinted
34.
35. Radiology
. X-ray
- Early: soft tissue shadow.
- Later: decreased joint space then
complete obliteration bony ankylosis
U⁄S
accurate for detection of effusion
44. General supportive measures
Analgesics are given for pain and intravenous
fluids for dehydration.
SPLINTAGE
The joint should be rested, and for neonates
and
infants this may mean light splintage; with hip
infection,
the joint should be held abducted and 30
degrees
flexed, on traction to prevent dislocation.
47. Septic Arthritis: Adults
Septic Arthritis Pathogen Antibiotics
Adults (native joint
+/- penetrating
trauma)
S. aureus, P.
aeruginosa
Cloxacillin or
cefazolin +/-
gentamicin
Gonococcal N. gonorrhoeae Cefotaxime
Rheumatoid arthritis S. aureus, Strep sp,
Enterobacteriaceae
Cefazolin +/-
gentamicin
Prosthetic joint S. aureus, S.
epidermidis, others
Vancomycin +
gentamicin
IVDU S. aureus, P.
aeruginosa
Cloxacillin or
cefazolin +/-
gentamicin
48. Septic Arthritis: Kids
Septic Arthritis Pathogen Antibiotics
Neonates GBS, S.
aureus,
Enterbacteriac
eae
Cloxacillin +
Cefotaxime
Children S. aureus,
Strep sp.,
rarely H. flu
<5yrs:
cefuroxime
>5yrs:Cloxacilli
n or cefazolin
Sexually active N.
gonorrhoeae
Cefotaxime
49. . Washout of the infected ioint:
- ln knee, ankle and shoulder joints
arthroscopic washout or open arthrotomy + washout
- ln hip joint sepsis
only open arthrotomy.
. lf eroded cartilage
arthrotomy then traction for weeks.
. lf completely separated cartilage
arthrodesis.
Surgical drainage
50. Indications for Surgery
• Aspiration vs. debridement
• Joint does not respond to serial aspirations
• No improvement in 48hrs of ttt
• Frank pus is aspirated
• Loculations noted on MRI or U/S
• Documented Hip and SI septic arthritis
should be debrided surgically
• No change in morbidity between
arthroscopic vs. arthrotomy of knee
51. Gonococcal Arthritis
• Typically seen in young adults
• The most common cause of septic arthritis in
sexually active populations
• More common in females (asymptomatic
carrier state)
58. Viral Arthritis
Parvovirus B19
• Diagnosis
• Usually seronegative for RF
• RFand anti-Lymphocyte antibodies can be
seen
• anti-B19 IgM antibodies may be elevated for up
to 2 months after acute infection.
59. Viral Arthritis
Hepatitis B
• Sudden onset
• Symmetric polyarthritis, (hands and knees are
most common)
• Urticarial rash
• Arthritis usually goes away before onset of
jaundice
60. Viral Arthritis
Rubella Arthritis
• Post-pubertal females
• Sudden onset
• Symmetric polyarthritis
• Tenosynovitis (carpal tunnel syndrome)
• May occur with some live attenuated virus
vaccines.
61. Clinical impression
septic arthritis
Patient Presents With Acute Increase In Pain +/- Swelling In One Or More Joints
G.P
Refer for urgent A&E
or specialist
assessment
Definite
alternative
diagnosis
Inflammatory
arthritis
Crystal arthritis
Haemarthrosis
Trauma
Bursitis/Cellulitis
Treat as
appropriate
No definite
alternative
diagnosis but
could be septic
Self referral to
A&E
MUST ASPIRATE
and other
investigations
History
Examination
History
Examination
Diagnosis SEPTIC ARTHRITIS
Empirical antibiotic treatment (as per local protocol)
Alter if necessary once results available
NOT
SEPTIC
62. Thank you for not sleeping
NOW you can go to
sleeping