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Five pearls and pitfalls in using head CT for diagnosis of traumatic brain injury. This was presented at the 51st Annual Scientific Meeting of the Royal College of Radiologists of Thailand (6 Aug 2014)
Utility of balloon assisted technique in trans catheter closure of
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Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...drashraf369
femoral head fractures are very complex fractures that need immediate and prompt surgical intervention.conventional surgical appproaches to hip may lead to short and long term complications.dr mohamed ashraf ,dr rahul thampi et al are presenting their experience with gantz safe surgical dislocation approach to surgical management of femoral head fractures
Safe surgical dislocation[ssd] for avascular necrosis hip[ avn]drashraf369
presenting a novel technic to treat avascular necrosis of hip.AVN hip is a challenge for any orthopaedic surgeon especially in precollapse stage. here dr mohamed ashraf and dr jyothis george from govt TD medical college alleppey kerala india demonstrate a novel and effective method to arrest the progression of disease to collapse.instead of performing a conventional core decompression they do multiple micro core decompression through safe surgical dislocation of GANTZ .in addition they are supplementing the procedure with intralesional infiltration of zolidronic acid to prevent structural collapse.
Utility of balloon assisted technique in trans catheter closure of
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Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...drashraf369
femoral head fractures are very complex fractures that need immediate and prompt surgical intervention.conventional surgical appproaches to hip may lead to short and long term complications.dr mohamed ashraf ,dr rahul thampi et al are presenting their experience with gantz safe surgical dislocation approach to surgical management of femoral head fractures
Safe surgical dislocation[ssd] for avascular necrosis hip[ avn]drashraf369
presenting a novel technic to treat avascular necrosis of hip.AVN hip is a challenge for any orthopaedic surgeon especially in precollapse stage. here dr mohamed ashraf and dr jyothis george from govt TD medical college alleppey kerala india demonstrate a novel and effective method to arrest the progression of disease to collapse.instead of performing a conventional core decompression they do multiple micro core decompression through safe surgical dislocation of GANTZ .in addition they are supplementing the procedure with intralesional infiltration of zolidronic acid to prevent structural collapse.
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Spine care program at Wockhardt Hospitals makes it a centre for excellence in neurology care with highly skilled clinical expertise
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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).
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- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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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.
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- 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
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C-Spine Collar Clearance In The Obtunded Adult Blunt Trauma Patient
1. J Trauma Acute Care Surg
2015;78: 430-441.
Cervical Spine Collar Clearance
In The Obtunded Adult Blunt
Trauma Patient
A systematic review and
practice management guideline
from the Eastern Association
for the Surgery of Trauma
3. C-spine collar clearance or removal is well
established for the alert patient with or
without symptoms; however, for the
obtunded adult blunt trauma patient, it is
unclear whether primary screening with
CT is sufficient or whether a second
diagnostic adjunct is required.
4. Continued use of the cervical collar carries
the risk of pressure ulcers, decreased
cerebral venous return, IICP, secondary
brain injury, and difficulties with airway and
central line management.
5. With the use of the framework advocated by
the Grading of Recommendations
Assessment, Development and Evaluation
(GRADE) Working Group, our aims were
to perform a systematic review and to
develop evidence-based
recommendations that might be used to
direct decision making in the removal of a
cervical collar from the adult obtunded
blunt trauma patient.
6. PICO
Population
In the obtunded adult blunt trauma patient
Intervention
Should cervical collar removal be performed after a negative
high-quality C-spine CT result combined with adjunct
imaging?
Comparator
Should cervical collar removal be performed after a negative
high-quality C-spine CT result alone?
Outcome
To reduce peri-clearance events, such as new neurologic
change (paraplegia, quadriplegia), unstable C-spine injury
(subcategories, treated with operation or treated with
orthotic), stable C-spine injury (subcategories treated with
operation or treated with orthotic), post-clearance imaging,
false-negative CT imaging result on re-review, pressure
ulcers, and time to cervical collar clearance.
7. PICO Question
In the obtunded adult blunt trauma patient,
should cervical collar removal be performed
after a negative high-quality C-spine CT
result alone or after a negative high-quality
C-spine CT result combined with adjunct
imaging, to reduce peri-clearance events,
such as new neurologic change, unstable C-
spine injury, stable C-spine injury, need for
post-clearance imaging, false-negative CT
imaging result on re-review, pressure ulcers,
and time to cervical collar clearance?
9. Our protocol was registered with the
PROSPERO international prospective
register of systematic reviews on August
23, 2013.
10. Inclusion criteria consisted of adult blunt
trauma patients 16 years or older, who
underwent C-spine CT with axial thickness
of less than 3 mm and who were obtunded
with any author-specified definition of this
term GCS score < 15, unconscious,
intubated, altered mental status, unreliable
examination, distracting injury, intoxication,
or not meeting NEXUS guidelines.
11. Exclusion criteria consisted of those studies
that did not specify axial CT slice thickness
and those with axial slice thickness of 3 mm
or greater, so as to eliminate outdated CT
technique and/or equipment. We also
excluded case reports, newspaper articles,
letters, comments, practice guidelines,
news, editorials, legal cases, reviews, or
congresses that contained no original data.
12. Hierarchy of outcomes for assessing C-spine collar removal in the obtunded adult blunt
trauma patient after a negative C-spine CT result.
18. RECOMMENDATION
In obtunded adult blunt
trauma patients, we
conditionally
recommend cervical
collar removal after a
negative high-quality
C-spine CT scan
result alone.
19. This conditional recommendation is based
on very low-quality evidence but places a
strong emphasis on the high negative
predictive value of high quality CT imaging
in excluding the critically important
unstable C-spine injury.
This recommendation is further supported
by the high costs of MRI or other
additional imaging.
20. Adjunctive imaging after a high-quality CT
scan increases the number of low-value
diagnoses, places patients at risk for
unnecessary treatment plans, puts
patients with multiple injuries at risk by
moving them out of the ICU to the
resource limited MRI suite, and at best,
results in the same clinical action of collar
removal.