Bone age assessment is used in pediatrics to evaluate growth, maturity and diagnose disorders. The Greulich-Pyle and Tanner-Whitehouse 2 methods are commonly used, involving left hand and wrist radiographs compared to bone age atlases or scoring systems. Bone age can help diagnose causes of short stature and determine timing of growth hormone treatment. It may also predict pubertal timing, peak height velocity and final adult height. Computerized bone age assessment methods show promise for increased accuracy and usefulness across different populations.
In this presentation we will discuss the bone age assessment mainly focusing wrist radiograph.
we shall also highlights some points in adult bone age
Basically it is an introduction. We shall not discuss its judicial importance
In this presentation we will discuss the bone age assessment mainly focusing wrist radiograph.
we shall also highlights some points in adult bone age
Basically it is an introduction. We shall not discuss its judicial importance
Practical pediatric quiz - Kaun Banega WinnerGaurav Gupta
Interactive quiz based on mentimeter platform for IAP Chandigarh Annual meeting in Dec 2017.
Great success for practising paediatricians in general,
Also a great teaching experience
Rickets is a metabolic disease of growing bone that is unique to children.
It caused by a failure of mineralization of osteoid tissue in a developing skeleton, particularly at the growth plate.
Imperfect calcification typically resulting in soft bones and skeleton deformities.
Practical pediatric quiz - Kaun Banega WinnerGaurav Gupta
Interactive quiz based on mentimeter platform for IAP Chandigarh Annual meeting in Dec 2017.
Great success for practising paediatricians in general,
Also a great teaching experience
Rickets is a metabolic disease of growing bone that is unique to children.
It caused by a failure of mineralization of osteoid tissue in a developing skeleton, particularly at the growth plate.
Imperfect calcification typically resulting in soft bones and skeleton deformities.
The dynamics of the growth of the craniofacial skeleton is a fascinating,complex mechanism.
An understanding of growth events is of primary importance in the practice of clinical orthodontics.
Maturational status can have considerable influence on diagnosis, treatment goals, treatment planning, and the eventual outcome orthodontic treatment.
Various methods have been implemented to measure growth which include measurement on living individual and dry skull and indirect measurement taken by means of virtual reproduction of the craniofacial skeleton.
Essentially,the various study used to assess growth try to find out answers of the following-
pattern of growth
site of growth
amount and rate of growth
direction and factors influencing growth.
Skeletal maturity /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
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The understanding of facial growth and occlusal development plays an important role in orthodontic diagnosis and treatment planning of problems encountered in dental and skeletal malocclusions.
What is Growth? An entire series of sequential anatomic and morphologic changes taking place from the beginning of prenatal life to senility-Meredith.
As Proffit says, growth prediction can never be accurate especially when the child is growing. Growth prediction can be defined as the forecast of growth related changes with the objective of predicting the direction and amount of the growth of the maxilla and particularly the mandible as well as the timing of the adolescent growth period.
orthodontic diagnosis, including medical and dental history, radiographic analysis, functional analysis, micro mini aesthetics, skeletal maturity indicators.
extraoral and intraoral examination. classification of malocclusion.
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
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.
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
- 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
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.
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.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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!
1. Bone age: assessment methods and
clinical applications
By
Dr . Magdy Shafik Ramadan
Senior Pediatric and Neonatology consultant
M.S, Diploma, Ph.D of Pediatrics
2. Introduction
• Bone age assessment is frequently performed not only in pediatric
endocrinology but also in orthodontics and pediatric orthopedics.
• Bone age is an effective indicator for diagnosing various diseases
and determining the timing of treatment.
• The aim of bone age assessment is to evaluate growth and maturity
and to diagnose and manage pediatric disorders.
• Recently, several computerized systems for bone age assessment have
been developed
3. What is Bone Age?
What is Bone Age?
What is Bone Age?
What is Bone Age?
• Bone age is a measure of the degree of skeletal
maturity of a child, i.e. how far the child has
advanced in its development of the skeleton.
4. why to determine bone age?
• 1) important in management of short stature
• bone age < chronological age = growth hormone deficiency or constititutional
delay
• bone age=chronological age = familial short stature
• bone age > chronological age = hypergonadism, cah (con. Adern. Hyper.)
• 2) in deciding when to start and stop growth hormone supplimentation.
• 3) in forensic medicine- minor cant be tried in normal courts (قاصر محاكمة يمكن ال
• 4) replacement therapy for hypogonadism.
• 5) gnrh for precocious puberty.(Gondortophic rleasing hormones)
• 6) prediction of final height.
5. In Newborns
• only indication is congenital hypothyroidis epiphysis at lower
end of femur and upper end of tibia should be present in a
normal newborn.
• Their absence indicates delayed bone age of intrapartum
cause. Mc is hypothyroidism
8. • A primary ossification center is the first area of a bone to start
ossifying. It usually appears during prenatal development in the
central part of each developing bone.
• In long bones the primary centers occur in the diaphysis/shaft and in
irregular bones the primary centers occur usually in the body of the
bone.
• A secondary ossification center is the area of ossification that appears after the
primary ossification center has already appeared –
• most of which appear during the postnatal and adolescent years.
• Most bones have more than one secondary ossification center.
• In long bones, the secondary centers appear in the epiphyses.
9. Bone Growth and Maturation
• Bone age
• Bone age represents the degree of secondary ossification in long and short
bones, which are formed by endochondral ossification.
• A cartilaginous growth plate between the epiphysis and metaphysis is
responsible for postnatal linear bone growth .
• Chondrocytes in the growth plate not only proliferate but also differentiate.
The resting zone consists of undifferentiated chondrocyte progenitors,
which differentiate into proliferative chondrocytes and then into
hypertrophic chondrocytes.
• Finally, hypertrophic chondrocyte apoptosis occurs after blood vessels
invade into the hypertrophic zone, and osteoblasts then migrate into the
cartilage matrix to form bone.
10. • it has been demonstrated that estrogen is essential for growth plate
closure in both men and women.
11. • Delayed and accelerated bone age
• Chondrocyte proliferation and differentiation and the conversion of
chondrocytes to osteoblasts are accelerated by GH, IGF-I, thyroid
hormone, estrogen and androgen and suppressed by glucocorticoid
.Therefore, deficiencies in GH, IGF-I, thyroid hormone, estrogen and
androgen and excess glucocorticoid cause both growth impairment and
bone age delay.
• In contrast, overproduction of GH, IGF-I, thyroid hormone, estrogen
and androgen causes both overgrowth and bone age advancement.
Bone age advancement is often recognized in children with obesity.
• It has been reported that bone maturation was accelerated after puberty
onset in obese children compared with nonobese children .
• It has also been suggested that hyperestrogenemia contributes to the
advancement of bone maturation in obese boy
12.
13. Bone Age Assessment Methods
• The most commonly used bone age assessment methods are the
Greulich-Pyle (GP) and Tanner-Whitehouse 2 (TW2) methods, both of
which involve left hand and wrist radiographs.
• Radiographs of the hand and wrist are suitable for bone age
assessment because the hand and wrist possess many bones and
taking radiographs of the hand and wrist is easy.
• Reasons for using left hand and wrist radiographs for bone age
assessment rather than right hand and wrist radiographs. One reason is
that most people are right-handed, and therefore, the right hand is
more likely to be injured than the left hand
14. • The hand and wrist bones consist of the radius, ulna, 19 short bones (5
metacarpals and 14 phalanges) and 7 carpals.
• GP (Greulich-Pyle)
method
• The GP method is an atlas method in which bone age is evaluated by
comparing the radiograph of the patient with the nearest standard
radiograph in the atlas.
• The GP method was developed using radiographs of upper-middle class
Caucasian children between 1931 and 1942.
• It has recently been reported that secondary sex characteristics in current
boys and girls begin earlier than they did several decades ago; therefore, it
may be difficult to assess bone age accurately in current children using the
GP method.
• Bone age App Bone Age App
• Digicity incMedical
•
15. TW2 methods
• There are actually three different TW2 methods: the radius-ulna-
short bones (RUS) method for evaluating the 13 long or short bones
(i.e., the radius, ulna and short bones of the first, third and fifth
fingers), the carpal method for evaluating the 7 carpals and the 20-
bones method for evaluating the 13 long or short bones and 7 carpals.
• The TW2 method is a scoring method. Firstly, the maturity level of
each bone is categorized into a stage (from stage A to H or I).
Afterwards, each stage is replaced by a score, and a total sore is
calculated. Finally, the total score is transformed into the bone age.
• Bone age App
16. Comparison between the GP and TW2
methods
• The scoring method of the TW2 method is more objective than the
atlas method, and therefore, the TW2 method is considered to have
higher reproducibility than the GP method
17. Other methods
• Recently, new methods for bone age assessment have been developed,
including
• ultrasonographic,
• computerized and magnetic resonance (MR) imaging method
19. Ultrasonographic method
• an armrest between two transducers to support the subject’s hand
and wrist, and ultrasonic waves pass through the subject’s distal radius
and ulnar epiphysis. Afterwards, software is used to calculate the bone
age using an algorithm based on measurements of sound velocity and
the distance between the two transducers
20. Computerized method
• Several computerized systems for bone age assessment have been
reported. Some of these systems were developed based on the TW
method .One example is the computer-assisted skeletal age score
(CASAS) ,in which an image is digitized and represented by several
mathematical coefficients. These coefficients are then compared to
those generated by each stage of the TW standards, and the closest
match is determined
21. MR imaging method
• Terada et al. . reported the usefulness of bone age assessment using
MR images of the hand and wrist compared with radiographs. They
used an open compact MR imager with a permanent magnet that was
newly developed as a pediatric hand scanner to evaluate bone age.
Although MR imaging is a noninvasive method, one can requires a
long time (2 min and 44 sec). Therefore, this method may not be
suitable for some subjects, especially young children, due to body
movement.
23. Clinical Applications of Bone Age
• Relationship between bone age and indicators of puberty
• Bone age at puberty onset: Flor-Cisneros et al. (41) reported that the
onset of central puberty occurred at an abnormal chronological age but
at a normal bone age in boys with congenital adrenal hyperplasia,
familial male-limited precocious puberty and idiopathic short stature.
Therefore, they suggested that the hypothalamic-pituitary-gonadal axis
maturation might be regulated by somatic growth and maturation in
the bone itself or in nonskeletal tissues that paralleled bone growth and
maturation.
• it may be difficult to predict the timing of pubertal onset in normal
children using bone age.
24. • Bone age at peak height velocity: Predicting the timing of peak
height velocity (PHV) is important in patients with scoliosis, kyphosis
and slipped capital femoral epiphysis for determination of the timing
of surgical treatment and in patients with growth disorders for
prediction of adult height and modification of treatment.
• Although further examinations are needed, bone age may be a
predictor for the timing of peak height velocity (PHV) .
25. • Bone age at menarche:
• menarche occurred after cervical vertebral maturation stage (CVMS)
III based on lateral cephalometric radiographs in orthodontic patients.
• The onset of menstruation was at a bone age of approximately 12 yr,
as evaluated by the Japanese TW2-RUS method in Japanese girls,
regardless of the chronological age at the onset of puberty.
• This bone age was equivalent to the mean chronological age (12 yr
and 4 mo) at menarche in Japanese girls.
• Bone age may be one of the indicators for predicting the timing of
menarche.
26. Prediction of adult height
• Prediction of adult height is very important in pediatric endocrinology.
• The commonly used methods for adult height prediction based on
bone age are the Bayley-Pinneau and TW mark II (2) methods
• new adult height prediction method based on BoneXpert bone age.
In this method, the predicted adult height (Hraw) is calculated using
height, chronological age, and bone age based on the same concept as
the Bayley-Pinneau method
27. • The final predicted adult height is then obtained after modifying
Hraw using the parents’ heights or the population standard height, and
the weight and body mass index (BMI) of the patient. It has been
reported that this new method performs significantly better than the
Bayley-Pinneau method in children with idiopathic short stature
28. • https://bonexpert.com/ahp
• The tool gives four different adult height predictions
• AHP(x-ray) is the prediction based on age, bone age and
height
• AHP (parental) is the prediction based solely on the parents’
heights. This is similar, but not identical, to the conventional
“target height” (which is mid-parental height ± 6.5 cm), but it is
more accurate, because it includes a drawing towards the
population height
• AHP(x+p) is the prediction based on age, bone age, height and
parental height
• AHP(x+m) is the prediction based on age, bone age, height
and height at menarche
32. Conclusions
• An automated bone age determination method (BoneXpert) was
developed and validated in Caucasian children with various growth
disorders. Moreover, this method has been reported to be useful for
bone age assessment in other ethnic groups by calibration to other
ethnic standards, which in turn increases the usefulness of bone age.
• Bone age has already been used as an indicator for diagnosis and
treatment and as a predictor for adult height.
• Bone age may become a predictor for the timing of pubertal peak
height velocity and menarche.