This document discusses peripheral nerve injury, including classifications, diagnosis, and treatment. It describes the anatomy of nerves and the cellular components. There are two main types of peripheral nerve injuries - primary injuries resulting from trauma and secondary injuries from complications like infections. Two classifications of nerve injuries are described: Seddon classification divides injuries into neurapraxia, axonotmesis, and neurotmesis. Sunderland classification further divides injuries into 5 degrees based on severity. Diagnosis involves clinical exams, imaging like ultrasound and MRI, and electrodiagnostic tests like nerve conduction studies and electromyography.
PNI with Relevant Anatomy, Etiology, Mechanism of Degenration and Regenration, Saddon's and Sunderland Classifications, Clinical symptoms and Examination (Tests) of Brachial Plexus, Radial & Median Nerve.
PNI with Relevant Anatomy, Etiology, Mechanism of Degenration and Regenration, Saddon's and Sunderland Classifications, Clinical symptoms and Examination (Tests) of Brachial Plexus, Radial & Median Nerve.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Nerve injury is an injury to nervous tissue. There is no single classification system that can describe all the many variations of nerve injuries. In 1941, Seddon introduced a classification of nerve injuries based on three main types of nerve fiber injury and whether there is continuity of the nerve.
Seddon2 classified nerve injuries into three broad categories; neurapraxia, axonotmesis, and neurotmesis.
With the pandemic overclouding the whole world it has effected every strato of people including the Orthopaedic groups. This is to highlight the impact of COVID 19 on the orthopaedic in general.
Conservative management in 3 and 4 part proximal humerus fractureBipulBorthakur
Proximal humerus fracture is common in both young as well as elderly people with most of the elderly patients unable to undergo operative management. This study is to see the aspect of conservative management in proximal humerus fracture.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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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
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
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
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3. Anatomy of nerve (contd.)
Connective tissue-
a. Epineurium- surrounds the nerve.
b. Perineurium- surrounds the fasicle
c. Endoneurium- around the axon.
4. Etiology of peripheral nerve injury.
Trauma.
Ischaemia.
Metabolic or collagen diseases.
Malignancy.
Infections.
Radiation.
Thermal.
Chemical
Mechanical.
5. Primary injury- Results from trauma that injures bone or joint.
Secondary injury – Results from involvement of nerve by infections, scars, vascular
complications, ischaemia, AV fistula or aneurysms.
7. SEDDON CLASSIFICATION
This classifications was described by Sedon in 1943.
He divided nerve inury into 3 groups
1. Neurapraxia.
2.Neurotmesis.
3.Axonotmesis.
8. Neurapraxia
Physiological inury to the nerve.
No anatomical damage is present.
Paralysis is transient.
Sensory loss is light.
Temporary loss of motor conduction.
No conduction occurs across the area of injury.
Prognosis is good.
9. Axonotmesis
It is interruption of nerve fibers within their sheath.
Loss of conduction but the nerve is in continuity.
Neural tubes are intact.
Wallerian degeneration distal to lesion and few millimeter retrograde.
10. Neurotmesis
Division of nerve trunk.
Rapid wallerian degeneration.
Destruction of endoneural tubes seen.
Scarring prevents regeneration of axons.
11.
12. Sunderland classification.
Classification based on the severity of nerve injury.
Divided into
First – degree injury.
Second- degree injury.
Third- degree injury.
Fourth – degree injury.
Fifth- degree injury.
13. Classification
First – degree injury -
1. Similar to neuropraxia.
2.Physiological block at the site of injury.
3. Axon is not disrupted.
4. Best prognosis.
5. Complete recovery within a few weeks.
14. Classification (contd.)
Second degree injury –
1.Disruption of axon.
2. Integrity of endoneural tube is maintained here.
3.Wallerian and retrograde degeneration from the point of injury.
4. Corresponds to axonotmesis.
5. Good chances of recovery.
15. Classification (contd.)
Third- degree injury –
1.Axonal disruption with endoneurium disruption.
2.Scar tissue formations prevent further regeneration of nerves.
3. Chances of motor and sensory recovery but with deficit.
Fourth – degree injury –
1. Disruption of perineurium and some part of epineurium .
2. Poor chances of recovery.
3. Surgical intervention essential for some recovery.
16. Fifth – degree injury –
1. Complete transection of nerve.
2. Seen mainly with open wounds.
3. No possibility of neural recovery without surgery.
17.
18.
19. Diagnosis of peripheral nerve injury.
Clinical diagnosis
1. In the upper extremities :-
a. Loss of pain perception at the tip of little finger indicates ulnar nerve injury.
b. Loss of pain perception at the tip of index finger indicates median nerve injury.
c. Inability to extend the thumb in hitchhiker sign indicates radial nerve injury.
2.In the lower extremities :-
a. Loss of pain perception in sole of foot indicates sciatic or tibial nerve inury.
b. Inability to extend the great toe or foot indicates peroneal or sciatic nerve injury.
20. Diagnostic tests
IMAGING:-
1. High resolution ultrasound and MRI can accurately assess the physical
integrity of the nerve immediate after injury.
2. Provide valuable information regarding surgery decision making.
2. Both intraneural and perineural Injuries can be identified by these
techniques.
21. Diagnostic test (contd.)
Electrodiagnostic studies :-
1.The best and most accessible correlative electrophysiologic confirmations of a
peripheral nerve injury are nerve conduction and electromyographic mapping.
2.The presence, location, severity and possibly prognosis of the neural insult can be
determined from these studies.
3.Information regarding recovery pattern can be identified if the test are done
sequentially over time.
22. Diagnostic test(contd.)
Nerve conduction velocity test:-
1. Orthodromic motor and antidromic-orthodromic sensory studies and retrograde
studies (e.g F wave studies).
2. F wave study are especially used for investigating peripheral nerves that are
more proximal and less accessible through other techniques.
23. Diagnostic test(contd.)
Electromyography(EMG)
In an EMG a thin needle electrode inserted into muscle and its activity at rest and
in motion are recorded. Reduced muscle activity indicate nerve injury.
24. Diagnostic studies(contd.)
Tinel sign:-
1. Gentle percussion by a finger or by percussion hammer along the course
of an injured nerve. A transient tingling sensation should be felt by the patient in the
area of an injured nerve rather than the area percussed and the sensation should be
present for several seconds after stimulation.
2. Positive tinel sign is presumptive evidence that regenerating axonal sprouts
that have not attained complete myelinization are progressing along the endoneural
tube.
25. Diagnostic test(contd.)
Sweat test :-
The degree of sweating within the autonomous zone of nerve injury suggest
that complete interruption of nerve has not occurred.
Ninhydrin print test is another method of assessing sweat patterns in hand.
26. Diagnostic method (contd.)
Skin resistance test :-
1.Richter dermometer is used here
2. Autonomous zone of absence of sweating shows an increase resistance to
passage of
electric current.
Electric stimulation test:-
1. Give early evidence of denervation after injury and are useful for following
reinnervation of nerve injury, which is less easily assessed by other methods.
27. THANK YOU
“na jāyate mriyate vā kadācin
nāyaṃ bhūtvā bhavitā vā na bhūyaḥ
ajo nityaḥ śāśvato’yaṃ purāṇo
na hanyate hanyamāne śarīre”
“The soul is never born, it never dies having come into being once, it never
ceases to be.
Unborn, eternal, abiding and primeval, it is not slain when the body is slain.”