Seminar presentation by 4th year medical student of Lincoln University College, supervised by HRPZ Orthopedic's specialist.
Reference were from reliable medical websites and also from texttbook; Apley and Solomon's Concise System of Orthopaedics and Trauma, 4th Ed.
This is a lecture presentation on applying external fixator on open fracture specially on tibia. This method is a classical method. Various new and dynamic fixators are there but the basics are the same.
This is a lecture presentation on applying external fixator on open fracture specially on tibia. This method is a classical method. Various new and dynamic fixators are there but the basics are the same.
Colles fracture is the fracture at the distal end of radius, at its
cortico cancellous junction(about 2cm from the distal articular
surface).
It is not just the fracture of distal radius but the fracture
dislocation of the inferior radio-ulnar joint.
Colles fracture is the fracture at the distal end of radius, at its
cortico cancellous junction(about 2cm from the distal articular
surface).
It is not just the fracture of distal radius but the fracture
dislocation of the inferior radio-ulnar joint.
Seminar presentation by 5th-year medical students under the supervision of in house lecturer. He was previously working as a consultant surgeon in Syria. Reference as mentioned in the slides.
Seminar presentation by 5th year Medical Student under the supervision of a pediatric surgery specialist from HRPZ II. Reference as mentioned in the slide.
Seminar presentation by group C 5th year medical student under supervision Dato Imi, endocrine specialist in HRPZ II.
Reference as mentioned at the end of the slide presentation
4th year medical student's seminar presentation under supervision of orthopedic lecturer. Reference is from Dr. Sameh Doss Textbook of upper and lower limb, and also other multiple websites.
Seminar presentation by student under supervision of endocrinology specialist from HRPZ. References as mentioned in the slides. Mostly from Malaysia CPG.
- 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
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
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!
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.
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ASA GUIDELINE
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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
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
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
1. a u d i a f f a n h i d a y u l i y a n a h u s n a s a t i s h
COMPARTMENT
SYNDROME
2. An elevation of interstitial pressure in a closed osteo-fascial compartment that result in microvascular
compromise
It is a TRUE orthopedics emergency.
WHAT IS COMPARTMENT ?
A c l o s e d a r e a o f m u s c l e g r o u p , n e r v e s a n d b l o o d v e s s e l s s u r r o u n d e d
b y f a s c i a
Muscle are arranged in different compartments and
surrounded by one fascia, this arrangement is called
osteofascial compartment.
Normal compartment pressure: 5 – 15 mmHg
Intacompartmental pressure rises to 35 – 40 mmHg
DEFINITION
5. ANATOMY
COMPARTMENT OF THE HAND
There are 10 compartments in the hands, which include
1. Hypothenar
2. Thenar
3. Adductor pollicis
4. Dorsal interosseous – 4
5. Volar(palmar) interosseous – 3
7. ANATOMY
COMPARTMENT OF THE THIGHS
Anterior Posterior Adductor
1. Quadriceps
a) Rectus femoris
b) Vastus lateralis
c) Vastus intermedius
d) Vastus medialis
2. Sartorius
1. Hamstrings
a) Semitendinosus
b) Semimembranous
c) Biceps femoris (long and
short)
1. Adductors
a) Adductor longus
b) Adductor brevis
c) Adductor magnus
d) Gracilis
Femoral nerve Sciatic nerve Obturator nerve
9. ANATOMY
COMPARTMENT OF THE LEGS
Anterior Lateral Deep posterior Superficial
posterior
Function
Dorsiflexion of foot
and ankle
Plantarflexion and
eversion of foot
Plantarflexion and
inversion of foot
Mainly
plantarflexion of
foot and ankle
Muscles
1.Tibialis anterior
2.Ext hallucis longus
3.Ext digitorum
longus
4.Peroneus tertius
1.Peroneus
longus
2.Peroneus brevis
Only
affect superficial
peroneal nerve
1.Tibialis posterior
2.Flx digitorum
longus
3.Flx hallucis longus
1. Gastrocnemius
2. Soleus
3. Plantaris
10. Any condition that reduces the volume of a compartment or increases the
fluid content of the compartment can lead to an acute compartment
syndrome.
Increased Fluid Content Decreased Compartment Size
1. Fracture of the bones (mainly
tibia and femur fracture)
2. Trauma
3. Burns
4. Hemorrhage
5. Vascular disruption/puncture
6. Snake venom
1. Burns
2. Cast
3. Bandage
AETIOLOGY
12. Acute Compartment Syndrome Chronic Compartment Syndrome
Medical emergency
Caused by severe injury
The classic sign of acute compartment
syndrome is pain, especially when the
muscle within the compartment is
stretched.
The pain is more intense than what
would be expected from the injury
itself.
Using or stretching the involved muscles
increases the pain.
There may also be tingling or burning
sensations (paresthesias) in the skin.
The muscle may feel tight or full.
Numbness or paralysis are late signs of
compartment syndrome. They usually
indicate permanent tissue injury.
Known as exertional compartment
syndrome
Not a medical emergency
Most often caused by athletic exertion
Chronic compartment syndrome causes
pain or cramping during exercise.
This pain subsides when activity stops. It
most often occurs in the leg.
Symptoms may also include:
Numbness
Difficulty moving the foot
Visible muscle bulging
TYPES
17. PATHOPHYSIOLOGY
In the setting of acute extremity compartment syndrome
regardless of mechanism, the compartment pressure
increases, causing hypoxia of tissues. There is normally an
equilibrium between venous outflow and arterial inflow. When
there is an increase in compartmental pressure, there is a
reduction in venous outflow. This causes a build-up of venous
pressure and an increased venous capillary pressure. If the
intra-compartmental pressure becomes greater than arterial
pressure, a decrease in arterial inflow will also occur. The
decrease of venous outflow and arterial inflow result in
decreased oxygenation of tissues causing ischemia. If the
deficit of oxygenation becomes great enough then, irreversible
necrosis may occur.
20. DIAGNOSIS
EVALUATION
A diagnosis of acute compartment syndrome is not always obvious. Therefore,
serial examinations and frequent assessments are necessary to make such a
diagnosis.
Assess tenderness in the muscle compartment
Evaluate motor and neurologic function
Radiographs should be obtained if a fracture is suspected
In an appropriate setting, measurement of
intra-compartmental pressure using a solid-
state transducer intra-compartmental
catheter (STIC) can aid in a diagnosis. This
device allows monitoring up to 16 hours.
The normal pressure within the compartment is
between 0 mmHg to 8 mmHg (i.e., less than 10
mmHg). An intra-compartmental pressure greater
than 30 mmHg indicates compartment syndrome
22. ACUTE COMPARTMENT SYNDROME (ACS)
Acute compartment syndrome is a surgical emergency, so a prompt diagnosis and
treatment are important for an optimal outcome. Once the diagnosis is confirmed,
immediate emergent surgical fasciotomy is important, since surgical fasciotomy can
potentially reduce intra-compartmental pressure.
MANAGEMENT
15 mmHg to 20 mmHg Serial compartment pressure measurement
20mmHg to 30 mmHg Surgical consultation and admit
Greater than 30 mmHg Surgical fasciotomy
Provide supplemental oxygen.
Remove any restrictive casts, dressings or bandages to relieve pressure.
Keep the extremity at the level of the heart to prevent hypo-perfusion.
Prevent hypotension and provide blood pressure support in patients with
hypotension.
23. ACUTE COMPARTMENT SYNDROME (ACS)
Urgent decompression is necessary to reduce the increased compartment pressure.
The ideal timeframe for fasciotomy is within six hours of injury to ensure full
recovery; it is not recommended after 36 hours following the injury. When tissue
pressure remains elevated for that much time, irreversible damage may occur, and
fasciotomy may not be beneficial in this situation.
After a fasciotomy is performed and swelling dissipates, a skin graft is most
commonly used for closure. Patients must be closely monitored for complications,
such as infection, acute renal failure, and rhabdomyolysis.
If necrosis occurs before fasciotomy is performed, there is a high likelihood of
infection which may require amputation. If infection occurs, debridement is
necessary to prevent the systemic spread or other complications. Renal failure may
also occur.
MANAGEMENT
24. FASCIOTOMY
Fasciotomy or fasciectomy is a surgical procedure where the fascia is cut to
relieve tension or pressure commonly to treat the resulting loss of circulation
to an area of tissue or muscle. Fasciotomy is a limb-saving procedure when
used to treat acute compartment syndrome. It is also sometimes used to treat
chronic compartment stress syndrome.
The procedure has a very high rate of success, with the most common
problem being accidental damage to a nearby nerve. Complications can also
involve the formation of scar tissue after the operation. A thickening of the
surgical scars can result in the loss of mobility of the joint involved. This can be
addressed through occupational or physical therapy.
MANAGEMENT
25. EMERGENCY FASCIOTOMY
1. Dual medial-lateral incision approach
Two 15-18cm vertical incisions separated by 8cm skin bridge
1. Anterolateral incision
2. Posteromedial incision
Post-operative
Dressing changes followed by delayed primary closure or skin grafting at 3-7 days post
decompression
MANAGEMENT
26. EMERGENCY FASCIOTOMY
2. Single lateral incision approach
Single lateral incision from head of fibula to ankle along line of fibula
MANAGEMENT
29. COMPLICATION OF FASCIOTOMIES
MANAGEMENT
1. Altered sensation within margin of wounds
(77%)
2. Dry, scaly skin (40%)
3. Pruritis (33%)
4. Iatrogenic neurovascular injury
5. Swollen limb
6. Tethered scars
7. Recurrent ulceration
8. Pain related to wound
30. CHRONIC COMPARTMENT SYNDROME
Chronic compartment syndrome in the lower leg can be treated
conservatively or surgically. Conservative treatment includes rest, anti-
inflammatories, and physical therapy. Elevation of the affected limb in
patients with compartment syndrome is contraindicated, as this leads to
decreased vascular perfusion of the affected region. Ideally, the affected limb
should be positioned at the level of the heart.
If symptoms persist after conservative treatment or if an individual does not
wish to cease engaging in the physical activities which bring on symptoms,
compartment syndrome can be treated by fasciotomy.
Surgery is the most effective treatment for compartment syndrome. This
decompression will relieve the pressure on the venules and lymphatic vessels,
and will increase blood flow throughout the muscle. Left untreated, chronic
compartment syndrome can develop into the acute syndrome and lead to
permanent muscle and nerve damage.
MANAGEMENT
31. Permanent nerve damage
Permanent muscle damage and reduced function of
affected limb
Rhabdomyolysis which will lead to acute renal failure
Volkmann ischemic contracture (infarcted muscle replaced
by inelastic fibrous tissue)
DIVC
Neurologic deficit
Infection
Amputation
COMPLICATIONS
Editor's Notes
Ddx for chronic compartment syndrome: vascular problems – more common (hard to differentiate)
1. Pain 2. Swelling 3. Measure how tensed is the swelling. ACS is diagnosed clinically.