Cauda equina syndrome (CSE) is classically featured by the compression of the distal lumbar, sacral and coccygeal nerve roots at the deep end of the conus medullaris at the L1 and L2 vertebral level. Although this disease has a low incidence in the population, ranging from 1:33,000 to 1:100,000 inhabitants, its sequela still generate extreme public healthcare costs (Angus et al., 2015).
The clinical signs and peculiar features of the pathology are: severe back pain, often accompanied by sciatica; saddle(joint)anesthesia; sphincter and sexual dysfunction; and lower limb weakness (Balasubramanian et al.,2010).The presence of all these signs simultaneously is not typically required for diagnosis(Cook et al.,2007). The clinical history and the neurological examination pave to the need for diagnostic confirmation through complementary exams such as computed tomography (CT) and the gold standard, magnetic resonance imaging (MRI)
Presented an in-service on the pathophysiology and differential diagnosis of cauda equina syndrome to Arcadia University's 2nd year Doctor of Physical Therapy students.
Presented an in-service on the pathophysiology and differential diagnosis of cauda equina syndrome to Arcadia University's 2nd year Doctor of Physical Therapy students.
Cervical spine clearance lecture given to 1st-year emergency medicine residents at Duke University. Covers indications for applying cervical collar, types of collars, types of imaging of the spine, and when to remove the collar.
Maladaptive movement and motor control impairments as underlying mechanismMeziat
Artigo (5) importante para a preparação para o curso de dor lombar crônica. "Diagnóstico e classificação da dor lombar crônica: Disfunções de movimento e de controle mal adaptativas como mecanismo principal." É antigo, algumas coisas mudaram, mas vale à pena ler.
Cervical spine clearance lecture given to 1st-year emergency medicine residents at Duke University. Covers indications for applying cervical collar, types of collars, types of imaging of the spine, and when to remove the collar.
Maladaptive movement and motor control impairments as underlying mechanismMeziat
Artigo (5) importante para a preparação para o curso de dor lombar crônica. "Diagnóstico e classificação da dor lombar crônica: Disfunções de movimento e de controle mal adaptativas como mecanismo principal." É antigo, algumas coisas mudaram, mas vale à pena ler.
The Battle Sport Traumatology 2023 Castrocaro Terme FC.pdfNicola Taddio
In this presentation the author analyzes the various problems relating to the functional and mechanical instability of the ankle which has suffered a lesion of the lateral ligaments, the complications, failures and short and long term outcomes in order to have a 360 degree vision of the problem , the possible solutions and the correct management to avoid them.
Low Back Pain & Sciatica, a brief epidemiological introduction and review of 2 articles with conflicting findings addressing the prognostic factors and outcome.
Anatomical Descriptive Study of 337 Thoracic Disc Herniationsasclepiuspdfs
Introduction: Conventionally, thoracic disc herniation has been viewed as a very rare pathology, and the few cases considered were considered to have a very low frequency of symptoms. However, new imaging methods show that the frequency of this pathology is quite high and also that its symptoms are encountered much more frequently than expected (since previously only neurological symptoms were taken into account). In view of these considerations, we conducted an anatomical descriptive study of this circumstance.
Abstract: This study was undertaken to characterize pain in
individuals with hereditary multiple exostosis (HME). Two hundred
ninety-three patients with HME completed a questionnaire designed
to assess pain as well as its impact on their life. Eighty-four percent of
participants reported having pain, indicating that pain is a real
problem in HME. Of those with pain, 55.1% had generalized pain.
Two factors were found to be associated with pain outcome: HMErelated
complications and surgery. Individuals who had HME-related
complications were five times more likely to have pain, while those
who had surgery were 3.8 more likely to have pain. No differences
were found between males and females with respect to pain, surgery,
or HME-related complications. The results of this study indicate that
the number of individuals with HME who have pain has been
underestimated and that pain is a problem that must be addressed
when caring for individuals with HME.
Key Words: hereditary multiple exostosis, pain, exostoses, osteochondromas,
support group
(J Pediatr Orthop 2005;25:369–376)
Back pain is one of the most common forms of body pain. Back
pain can be felt in many ways. It can range from mild to severe
pain that can affect the ability to move. Back pain can be felt as
muscle pain, stabbing pain, pain that spreads down the legs, and
as reduced flexibility or range of motion. Back pain can be felt as
tingling or pricking, a dull feeling of pain or sharp pain. Back pain
has a number of causes. Back pain can affect your quality of life.
ABSTRACT- Introduction: Low back pain (LBP) is an important clinical, social, economic, and public health problem
affecting the population indiscriminately. It is a disorder with many possible etiologies, occurring in many groups of the
population, and with many definitions. Nearly everyone will experience some form of back pain in his or her lifetime.
Materials ans& Methods: The current study is a cross sectional study undertaken at Lord Buddha Koshi Medical
College, Saharsa, Bihar, India from Aug 2015 to Dec 2015. The objective of this study was to see the age specific
prevalence of low back pain among 400 subjects visiting the Orthopedics OPD of the hospital. The age range of the study
participants were 25 years to 65 years. The national guidelines of LBP diagnosis is used as diagnostic criteria.
Results: Overall prevalence of LBP was found as 31.25%. The highest prevalence was seen in 55-65 years age group.
Age had positive association & important risk factors of increasing burden of LBP.
Conclusion: LBP is an important health problem & affecting all age groups and it is responsible for a great economic loss
of any country.
Key-words- Low Back Pain, Prevalence, Public Health
Medical Management of Chronic Pelvic Pain: The Evidence.Alex Swanton
Chronic pelvic pain (CPP) is a significant problem for both general practitioners in the primary care setting and gynaecologists alike. The incidence of CPP has often been overlooked due, partially, to an inappropriate referral pattern, but also due to the inherent difficulty in correctly diagnosing the condition.
Abstract
Background: Physiotherapy is multi-dimensional and can treat a vast variety of conditions, ranging from musculoskeletal aches, arthritis, joints problems, paraplegia, hemiplegic, sports injuries and frozen shoulder etc. Apart from culture competency and core medical knowledge a physiotherapist must be competent enough in all physiotherapist medical conditions where physical therapy plays a vital role. This study aims to identify the frequency of common clinical conditions among client presented at Habib Physiotherapy Complex (HPC), Hayatabad during 2010.
Methodology: This was a descriptive study; the data were retrieved from record register of HPC (Indoor and Outdoor patients) recording their presenting complaints and known diagnoses. Data was collected on a structure grid. Data was analyzed using SPSS version 15 and presented in term of frequency and percentages.
Result: The majority of clients (1280 (29%)) were suffering from low back pain. The second common condition 891(20%) was osteoarthritis of the knee joint and cerebrovascular accidents 824(18.4%), while cervical pain accounted for 734(16.4%). The rest of clinical conditions included; frozen shoulder, pelvic inflammation, cerebral palsy, polio effected and paraplegia.
Conclusion: The Study reveals the occurrence of Osteoarthritis (Low Back, Cervical Pain, and Knee Joints Pain) were the most common condition which deteriorated the performance of common individuals in our society.
Similar to Cauda equina syndrome bowel dysfunction (20)
Trends in the geometric size and rated power capacity of offshore wind turbines, the main components of an OWT system, encompassing a typical monopile foundation, the substructure, transition piece, the tower, rotor blades and nacelle (hub). Modern OWTs are installed with either pitch-regulated blades or variable rotational speed systems in order to allow optimisation of the power production over a wide range of prevailing wind speeds. The rotational speed of the main rotor shaft is typically between about 10 and 20 rp. Key electromechanical components of the wind turbine, including the gearbox and the generator (Roberts et al.,2007). The gearbox may cause efficiency losses for the wind turbine and is the particular source of the noise. Recent developments in the design of permanent magnet generators have made it possible to construct some types of wind turbines without the requirement for a gearbox. In this case, the rotor is mainly connected directly to a low-speed multi-pole generator that rotates at the same speed, termed the direct-drive unit. Removing the gearbox mainly removes one of the key components requiring more maintenance, and that is mainly prone to failure. This simplification of the mechanical part allows reductions in size and the mass of the nacelle (Gilling, 2009).
The source of energy captured by plants is the sun, which will be the constant source of energy for the next few billion years. The carbon released from the burning of biofuels is continually cycled rather than being released from the ancient fixed carbon sources, as is the case for fossil petroleum and natural gas. The problem is that the cost of the production of fuels from lignocellulose and plant oils is high and this nascent industry cannot compete with the oil prices. Current progress: For the past two decades, ethanol has been synthesized primarily from cornstarch and cane sugar. Fourteen billion gallons of ethanol were synthesized in the USA from cornstarch in 2014. Approximately 40% of the current USA corn crop is availed to produce ethanol and is not likely to expand anymore, because the remainder of the crop is being availed for animal feed and human food. Ethanol is produced from cane sugar in Brazil at a level of 7.2 billion gallons in the year 2014. The renewable energy source is the major terrain to be considered (Sreeremya, 2019).
Agroforestry has a high potential for simultaneously satisfying three important objectives viz., protecting and also stabilizing the ecosystems; producing a high level of output of economic goods; and improving the income and basic materials to the rural population. It has helped in the rehabilitation of the degraded lands on the one hand and has increased farm productivity on the other. At present, agroforestry meets almost half of the demand for fuelwood, 2/3 of the small timber, approx. 70-80 per cent wood for plywood, 60 per cent raw material for paper pulp and approx. 9-11 per cent of the green fodder requirement of livestock, besides meeting the subsistence needs of the households for food, fruit, fiber, medicine etc.
Human population genetics aims to study the population in terms of the genetic variation. This variation can be quantified by determining the gene frequencies of the alleles at segregating loci which mainly characterize one population and distinguish with another. Tasting ability to phenylthiocarbamide (PTC) by an individual is mainly considered as a useful and important tool to study the genetic diversity in the human populations. Taste and smell affects the food preferences and dietary habits, thereby directly influencing the eating behavior of an individual. As taste threshold aggrandizes with age, abnormality in taste function may contribute to the poor dietary intake in the elderly. Bitter taste perception is a conserved the chemical sense against the ingestion of naturally toxic substances in mammals. The experience of the bitterness occurs after certain chemicals contact taste receptors located in cells on the surface of the tongue.
Initial corrosion behavior of element copper in atmospheric environmentDr. sreeremya S
Copper and copper-based alloys encompassing brasses (Cu-Zn) and bronzes (Cu-Sn)are widely used in different industrial and the societal applications. They are common engineering materials in modern architecture and primarily availed for roofing and facade cladding due to their significance of visual appearance (important from an architectural perspective in terms of the design or during renovation of modern or ancient cultural building), ductility, malleability, the atmospheric corrosion resistance and long-term performance. When exposed to air, the copper forms a brownish-green or greenish blue corrosion layer, often denoted as the patina. Copper patina is commonly known as an aesthetically pleasing surface, and one reason for the extensive use of the copper metal and copper-based alloys in both the ancient and modern architecture. One of the most famous examples is the Statue of Liberty in the harbor of the New York, US.
Bronze alloys are the family of copper-based alloys traditionally alloyed with tin. Bronze alloys are of the exceptional historic interest and still finds wide applications.
These approaches encompass new synthesis and processes as well as new tools for instructing aspiring chemists how to do the chemistry in a more environmentally benign manner. The pros to industry as well as the environment are all a part of the positive impact that Green Chemistry is having in the chemistry community and in the society in general. It is important that chemists develop novel Green Chemistry options even on an incremental basis. While all the elements of the lifecycle of a new chemical or process may not be environmentally benign, it is nonetheless pivotal to improve those stages where improvements can be made. The next phase of assessment can then focus on the elements of the lifecycle that are still in need of the improvement. Even though a new Green Chemistry methodology does not solve at once every problem allied with the lifecycle of a particular chemical or process, the advances that it does make are nonetheless very key. Green Chemistry that mainly possesses the spirit of sustainable development was booming in the 1990s
Electron transfer activity of the photosystem II significantly decreased after the exposure of the Chlorella cells to all the six chemicals availed. Lipid peroxidation was slightly reduced by the antioxidant propyl gallate, not changed by indium nitrate and very potently simulated by diethanolamine, chloroquine, sodium monofluoroacetate and the bromobenzene. For five of the chemicals studied (not bromobenzene) there is the very good correlation between the cytotoxic effects in Chlorella cells measured by the algal growth inhibition test, and also the inhibition of photosystem II activity (Chapman et al., 1991). The results suggest that one very key effect of these chemicals in the Chlorella cells is the inhibition of photosynthetic metabolism by the blocking of the photosystem II functionality.
Corona virus was first identified as the cause of the common cold in 1960. In one study carried out in Canada in 2001, more than 510 patients presented with flu-like symptoms. Virological analyses showed that 3.7% of these cases were positive for the HCoV-NL63 strain by polymerase chain reaction (PCR). Until 2002, the corona virus was considered a relatively simple, nonfatal virus; however, an outbreak in 2002–2003 in the Guangdong province in China, which resulted in spread to many other countries, encompassing Thailand, Vietnam, Taiwan, Hong Kong Singapore, and the United States of America, causes severe acute respiratory syndrome (SARS) and high mortality rates in over 1000 -1100 patients.
In the modern times pollution has become the biggest menace for the survival of the biological species. There are different types of pollution e.g. air, water, soil, sound and mental pollution. Earth was the beautiful landscape but man has ruthlessly exploited for his greed specially, in the last century. With sporadic industrialization and random urbanization environmental pollution has become the serious problem. Over exploitation of open spaces, ever-increasing number of automobiles and the demographic pressure has further aggravated the problem. There are different ways and means to mitigate the urban environmental pollution. Plan-ting of trees and the shrubs for abatement of pollution and improvement of environment is a much effective way and well recognized throughout the world. Earlier, the purpose of planting trees in the urban areas was purely aesthetic (Sheldon et al., 1988a). The incessant increase of urban environmental pollution has necessitated to typically reconsider the whole approach of urban landscaping and its orientation in the order to achieve duel effect i.e. bio-aesthetics and mitigation of pollution.
Relation between haemorrhoids and constipationDr. sreeremya S
Patients frequently complain of bleeding with or without the defecation, a swelling, mild discomfort or irritation. Other symptoms may include soilage or the mucous discharge, pruritis, difficulties with the hygiene, and a sense of incomplete evacuation. Internal hemorrhoids are otherwise painless unless they are mainly thrombosed, prolapsed with edema, or strangulated. External hemorrhoids result in pain when the thrombosis occurs and bleeding if ulceration occurs from pressure necrosis. Skin tags may form from the prior acutely edematous or the thrombosed external haemorrhoids (Johanson et al., 1990
Given the rapid aggrandize, it has been postulated the environment has a key role in the causation of obesity. Factors such as the neighborhood-scale features (referred to as the built environment) have been mainly identified as influencing diet and physical activity (2). Of particular the importance to this framework are features of the food environment (FE), thus constituting barriers and opportunities to food sources of the varying nutritional quality and energy density (3). The FE is delineated as the physical presence of food that can mainly influence a person’s diet (4). Contributing to the FE is the proximity to food store locations such as mainly the restaurants (fast-food, full service, and bars and pubs) and the retail outlets (food markets/grocery stores and liquor stores). Fast- food establishments generally have foods of lower nutritional quality and higher caloric density than the home-prepared foods (3). Early studies have reported fast-food restaurants to be more common in the neighborhoods with a higher prevalence of obesity. However, more recent studies have been melanged,
Adverse conditon provided for influenza virus (mutatedDr. sreeremya S
THIS MUTATED INFLUENZA VIRUS CAN BE TREATED IN PH1-2 . TO CHECK THE LYSIS OF THE VIRUS
SIMULATING THE INTERFERON ACTIVITY HAS TO BE DONE SIMULTANEOUSLY.
Although 76-90% of the BMW is non-hazardous and harmless as any of the other municipal waste, the remaining 10-26% is hazardous to humans or animals and deleterious to environment. Inappropriate handling of the BMW may have serious public health consequences and the significant impact on the environment. Major hospitals contribute substantially to the quantum of generation of the BMW. Smaller hospitals, the nursing homes, clinics, the pathological laboratories and blood banks also have major contribution to BMW. The common methods adopted for the BMW disposal are incineration and land filling. However, these methods are mainly considered more expensive and less ecofriendly due to their main negative impact on the environment
Corona virus current scenario (theoretical outlook)Dr. sreeremya S
Corona virus(COVID-19) is RNA virus. Which has proved to be pandemic.It causes respiratory disease called Severe Acute Respiratory Syndrome(SARS). Currently it is a deadly disease which is killing hundreds of people day by day from late 2019 to till date. There is only few studies regarding the corona virus infection in animals. Studies are still progressing to find remedies like variolation, RNA silencing or boosting human interferon’s to decrease the affect of the disease.
INTRODUCTION
As people have seen, the giant industrial wind farms, small household wind turbines, and also everything in between are erecting all over the places. In 2012, the electricity capacity from the wind power in the total electric capacity is about 7.2% in EU, 2.0% in China, and 3.6% in US. Nevertheless, most people agree that wind energy should claim much greater share of the future energy supply. For eg:-, the United States is working on an ambitious target of 21% total electricity capacity by 2030. Indeed, wind energy is one of the fastest growing energy sources today and also in the foreseeable future. However, findings a suitable site to build the wind farm or simply set up the wind turbine is not always easy. The wind must be strong and must be consistent; the tower cannot obstruct the view; and the noise cannot disturb the local residence. Due to the fast growth of the population, it is aggrandizingly difficult to find a suitable place that is proper for a wind turbine yet will not interfere with the people’s everyday life (Srensen et al., 2002).
INTRODUCTION
A lot of basic concepts, technologies and pioneering solutions aiming on very high power densities were mainly developed within the last 20 years. Sometimes this is denoted as the mechatronic system integration or simply as mechatronics. Besides many of the technical aspects, the movings within the value chain represent the great challenge in this process. This is because traditionally defined between electronic device and the power module manufacturers, electronics assemblers, and the metalworking industry will blur or slowly disappear. However, the pressure to go this path increases. If one thinks, e.g., about the hybrid drive as an upgrade option for conventional passenger cars, one is directly faced with the lack of construction space as one of the main serious problems (Alkuhayli et al., 2012).
Pellagra may also occur as the result of a variety of (relatively rare) conditions affecting tryptophan metabolism and as a side-effect of the number of drugs that inhibit tryptophan metabolism. In alcoholics, it is unclear whether pellagra is the result of an impairment of tryptophan and the niacin metabolism directly attributable to alcohol, or whether it reflects general under nutrition among the people who obtain a considerable proportion on their energy needs from alcohol, and hence have the low intake of (nutrient rich) foods(Goldberger et al.,1922a).
SYMPTOMS
The major symptoms of pellagra are dermatitis, dementia, and diarrhea. This is because niacin deficiency is most noticeable in the body parts with high rates of cell turnover, such as the skin or gastrointestinal tract (Goldberger et al., 1923).
The growing interest in the environmental stress has been accompanied by a rapid accumulation of evidence indicating that the environment can elicit substantial stress in people living in urban environments. Furthermore, it is widely conceived that the natural environment can enhance human health. There have been several questionnaire studies and investigations on the psychological effects of forest environments. A previous study found an enhancement of the positive emotions among subjects who were shown pictures of natural environments. Moreover, other researches have also found that forest environments improve the psychological wellbeing of people
As the techniques that have enabled us to analyses and assess a biopsy become ever more sophisticated, we have realised the limitations of looking at the single snap-shot of the tumour. This single-biopsy bias was highlighted in which it was mainly demonstrated that a portion taken from different parts of a primary tumour and its metastases showed and proved extensive intertumoural and intratumoural evolution. This tumoural heterogeneity mainly highlights the difficulty of dictating a therapeutic course of action based on the single biopsy, as it is likely to underestimate the ramification of the genomic landscape of the tumour (Chomczynski et al., 2016).Having established that there is mainly considerable tumour heterogeneity, taking multiple biopsies from the patients‘ primary tumour and the metastases would seem to be the most obvious next step. There are so much difficulties in obtaining the tissue biopsy— including the discomfort suffered by the patient, the inherent clinical risks to the patient
Rivivna humilis berry extract as fungal sourceDr. sreeremya S
The introduction of the mankind had marked the continuous exploitation of the plants as organisms and their products for the pharmacological prospects and key features (Guha et al., 1999). In most of the agronomic domains around the globe, the conventional modes of the treatment are still in exercise and also in upcoming research (Srivastava et al., 2003).
These approaches most commonly exploit the various dynamics and much specific potential and applications of plant extracts (Bonde et al., 2007) . The distinctions of the first and foremost large-scale screening of the green plants evaluate and also assess the antimicrobial activity of 2,300 plants (Nautiyal et al., 1984).
Dyeing is an ancient and traditional art which predates written records. It was practised specifically during the Bronze Age in Europe (Sreeremya, 2016). Conventional dyeing techniques encompassed sticking plants to fabric or rubbing crushed pigments into cloth.
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
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
- 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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
2. • Cauda equina syndrome (CSE) is classically featured by the
compression of the distal lumbar, sacral and coccygeal nerve roots
at the deep end of the conus medullaris at the L1 and L2 vertebral
level. Although this disease has a low incidence in the population,
ranging from 1:33,000 to 1:100,000 inhabitants, its sequela still
generate extreme public healthcare costs (Angus et al., 2015).
• The clinical signs and peculiar features of the pathology are: severe
back pain, often accompanied by sciatica; saddle(joint)anesthesia;
sphincter and sexual dysfunction; and lower limb weakness
(Balasubramanian et al.,2010).The presence of all these signs
simultaneously is not typically required for diagnosis(Cook et
al.,2007). The clinical history and the neurological examination pave
to the need for diagnostic confirmation through complementary
exams such as computed tomography (CT) and the gold standard,
magnetic resonance imaging (MRI)
3. • Among the causes of compression, the following are
majorly noteworthy: extruded disc herniation, tumor
lesions, vertebral fractures, canal stenosis, infections,
surgical manipulation, spinal anesthesia, anky losing
spondylitis, and gunfire wounds (Downie et al., 2013).
Some reports also indicated its onset after chiropractic
manipulation (Bell et al., 2007).This is an orthopedic
emergency and its treatment of choice continues to be
surgical decompression, which, if performed as early as
possible, decreases neurological damage and improves
the prognosis (Domen et al., 2009).
4.
5. • Clinical Characteristics of CES
• Cauda Equina Syndrome (CES) is a challenging phase to diagnose and
manage. It may present at any time or in any setting and it is imperative
that clinicians are able to quickly reason through their findings to manage
the patient effectively (Fraser et al., 2009). There are many causes of CES,
but the most common cause is that typically of a lumbar spine disc
herniation and it occurs most frequently between the ages of 31–
50(Kebaish et al., 2005). Cauda equina compression usually occurs as a
result of a disc prolapse, often at the L4/5 level (Harrop et al., 2004). Any
space-occupying lesion, such as spinal stenosis, tumour, cysts, infection or
bony ingress can narrow the spinal canal and cause compression of the
cauda equine (Thongtrangan et al., 2004). In 1995, The Clinical Standards
Advisory Group suggested that serious pathology comprised just 1% of all
back pain, with CES being just one of the many serious conditions that can
lead to back pain (Kostuik et al., 20004).
6. • Despite CES being estimated to have a very low prevalence, it is considered to be a
main problem internationally and multiple National Guidelines for the
management of low back pain refer to the importance of screening for CES
(Cohen, 2004). It is key to note that whilst the published evidence is that in the
general population CES is rare, in an eighteen-month period in a Primary Care
Interface service in the UK, 29 positive CES patients were managed as emergency
cases and referred to a specialist spinal service, representing 3.6% of the service's
patient population(Jensen,2004). In 1996 the Office of National Statistics
estimated that in the UK one CES patient will present annually for every 50,000
patients seen in primary care, the equivalent of 0.003 %( Morandi et al., 2004)
these varying statistics appear to be contradictory; however, they can be explained
by understanding the clinical context in which these patients were seen. The
incidence of CES patients attending a particular medical setting mainly depends on
the type of the medical service provided (Bartleson et al., 2013). Spinal surgeons
will always see more CES patients than a GP, and physiotherapists will probably see
a number in between depending where on the patient pathway they sit (Ozgen et
al., 2004). Physiotherapists working at an advanced practice level are likely to see
and assess more patients with CES as their patient population is likely to be more
complex.
7. • Regardless of the healthcare setting or clinician, it is still
pivotal to have a framework, which supports the early
identification and management of patients with suspected
CES (Flores et al., 1999). Timely diagnosis is predominant to
avoid life-changing outcomes for patients; it is estimated
that one fifth of patients will have a poor outcome, with
on-going treatment for bladder, bowel and sexual
dysfunction, along with key psychosocial consequences
(Solheim et al., 2007).
• The best and most widely availed model that currently
exists to aid in the identification of CES is the system of Red
Flags, although these previously considered cornerstones of
safe practice have been called into question (Gleave et al.,
2002).
8. • These systematic reviews and investigations have focused on the diagnostic accuracy of specific Red
Flags. Due to the combined challenges of the relatively rare prevalence of serious pathology in the
total back pain population, and the major difficulty in designing high quality studies in this area, the
findings that most Red Flags are not good predictors of serious pathology, is quiet
unsurprising(Theys et al.,2014). In light of this, it would be fair to question the utility of current red
flags for CES and to ask what we can do as treating physiotherapists to manage these patients
(Sonntag, 2014). To answer this queries, it is useful to go back to basics and consider the clinical
interaction between a physiotherapist and a patient arriving for their first appointment with a
complaint of low back pain, whether it is 4pm on a Friday or first thing Monday morning(Chau
etal.,2014). The physiotherapist needs to decide in a limited timeframe whether the patient's
problem is typically suitable for physiotherapy management (keep), or whether the patient needs
to be referred to other medical personnel or sent for further investigation (refer) and if so, in what
time frame (emergency/soon/routine)(O’Laoire et al.,1981).
• These are vital decisions to make, as CES can have permanent and chronic life changing
consequences if not acted upon in a timely manner; in the UK the current guidance is that patients
should be sent for an emergency MRI and surgical opinion on the same day (Bydon et al., 2014).
9. REFERNCE
• Journal of Pathology, Communicable diseases
and Preventive Medicines, Cauda Equina
Syndrome Bowel Dysfunction, S.
Sreeremya,2018.Vol(1):1,1-8.