Compartment syndrome is a complication that patients experience following fractures (most common cause), soft tissue trauma, or reperfusion injuries, which leads to arterial obstruction and muscle swelling. This presentation was given to the physicans at Banner Health in Feburary 2014 by David Carfagno, DO, of Scottsdale Sports Medicine
Severe pain syndromes may be recorded during all phases of hematopoietic stem cell transplantation (HSCT) for hematological malignancies: from stem cell mobilization to the long-term post transplant period.
Although the major cause of pain in the setting of HSCT is injury to mucosal tissues induced by the conditioning regimen, pain from several other causes has been reported.
This was a presentation done at Kanungo Institute of diabetic Specialitis Bhubaneswar . the audience included the students from Karolinkska Institute Sweden
Musculoskeletal manifestations of diabetes mellitusfathi neana
The complications of diabetes mellitus are numerous and multisystemic including the musculoskeletal system. The long term metabolic consequences of diabetes mellitus stay behind Several rheumatic conditions. Higher levels of diabetic complications is due to poor glycemic control. The incidence and prevalence of diabetes mellitus is rising. About 50% of people with diabetes mellitus are unaware of their condition.
Approximately 25% of all patients with diabetes undergoing surgery are undiagnosed on admission to hospital. Patients with diabetes have a higher risk of cardiovascular insult and a higher perioperative risk. Surgeons and anaesthetists should be familiar with the risks of the diabetes, surgery and anesthesia.
In emergency situations or non-elective cases insulin, glucose and potassium infusions (blood glucose control + rehydration) before surgery
Prone to post operative complications, infection, wound care and bone healing.
Pharmacotherapy, diet, regular exercises and sensible physiotherapy programmes should be the cornerstone of diabetes management.
Severe pain syndromes may be recorded during all phases of hematopoietic stem cell transplantation (HSCT) for hematological malignancies: from stem cell mobilization to the long-term post transplant period.
Although the major cause of pain in the setting of HSCT is injury to mucosal tissues induced by the conditioning regimen, pain from several other causes has been reported.
This was a presentation done at Kanungo Institute of diabetic Specialitis Bhubaneswar . the audience included the students from Karolinkska Institute Sweden
Musculoskeletal manifestations of diabetes mellitusfathi neana
The complications of diabetes mellitus are numerous and multisystemic including the musculoskeletal system. The long term metabolic consequences of diabetes mellitus stay behind Several rheumatic conditions. Higher levels of diabetic complications is due to poor glycemic control. The incidence and prevalence of diabetes mellitus is rising. About 50% of people with diabetes mellitus are unaware of their condition.
Approximately 25% of all patients with diabetes undergoing surgery are undiagnosed on admission to hospital. Patients with diabetes have a higher risk of cardiovascular insult and a higher perioperative risk. Surgeons and anaesthetists should be familiar with the risks of the diabetes, surgery and anesthesia.
In emergency situations or non-elective cases insulin, glucose and potassium infusions (blood glucose control + rehydration) before surgery
Prone to post operative complications, infection, wound care and bone healing.
Pharmacotherapy, diet, regular exercises and sensible physiotherapy programmes should be the cornerstone of diabetes management.
Outcomes of Venous Interventions in C5-6 DiseaseVein Global
By: Mark H. Meissner, MD
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Limb Complex Multi system Injury (Mangled Extremity) is one of the most challenging problems in Orthopaedic surgery. Mangled Extremity is a limb with an injury to at least three out of four systems (soft tissue, bone, nerves, and vessels). Decision have to be made either amputation + Prosthesis or limb salvage procedure. The decision of Primary Amputation in the acute setting is difficult for the patient, family, & the treating surgical team. The majority of mangled extremities are potentially salvageable for which, in the acute setting, a treatment plan needs to be made.
Presentation by Dr Adnan Saithna, Professor of Orthopedic Surgery, Kansas City University, delivered at American Academy of Orthopedic Surgeons Annual Meeting 2020. This presentation reports that professional athletes are at higher risk of septic arthritis after ACL reconstruction than recreational athletes
Resuscitation after Injury Attenuates Plasma-Mediated Endothelial Barrier Dys...Arthur Stem
Severely injured patients are prone to developing coagulopathy, organ failure, and infection. All these sequelae of injury are partly attributed to the loss of vascular endothelial barrier integrity. Prior work from our group has demonstrated that plasma from trauma patients induces endothelial barrier breakdown in vitro. However, the temporal changes in vascular permeability after injury, especially with resuscitation, remain unknown.
Technology and Spinal Cord Injury (SCI): How could technology further help th...Hillary Green
Dr. Josh Geering, PT, DPT, from the Dallas VA Medical Center's Spinal Cord Injury & Disorders Center presents at the UT Arlington Research Institute's Symposium on Biomedical Technologies.
In the presentation, I discussed new concepts in OA pathogenesis and identified possible targets of treatment. This was followed by a review of new treatment options for osteoarthritis. Presented during the Joint RA OA SIG Symposium at the F1 Hotel last 28 November 2014.
Outcomes of Venous Interventions in C5-6 DiseaseVein Global
By: Mark H. Meissner, MD
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Limb Complex Multi system Injury (Mangled Extremity) is one of the most challenging problems in Orthopaedic surgery. Mangled Extremity is a limb with an injury to at least three out of four systems (soft tissue, bone, nerves, and vessels). Decision have to be made either amputation + Prosthesis or limb salvage procedure. The decision of Primary Amputation in the acute setting is difficult for the patient, family, & the treating surgical team. The majority of mangled extremities are potentially salvageable for which, in the acute setting, a treatment plan needs to be made.
Presentation by Dr Adnan Saithna, Professor of Orthopedic Surgery, Kansas City University, delivered at American Academy of Orthopedic Surgeons Annual Meeting 2020. This presentation reports that professional athletes are at higher risk of septic arthritis after ACL reconstruction than recreational athletes
Resuscitation after Injury Attenuates Plasma-Mediated Endothelial Barrier Dys...Arthur Stem
Severely injured patients are prone to developing coagulopathy, organ failure, and infection. All these sequelae of injury are partly attributed to the loss of vascular endothelial barrier integrity. Prior work from our group has demonstrated that plasma from trauma patients induces endothelial barrier breakdown in vitro. However, the temporal changes in vascular permeability after injury, especially with resuscitation, remain unknown.
Technology and Spinal Cord Injury (SCI): How could technology further help th...Hillary Green
Dr. Josh Geering, PT, DPT, from the Dallas VA Medical Center's Spinal Cord Injury & Disorders Center presents at the UT Arlington Research Institute's Symposium on Biomedical Technologies.
In the presentation, I discussed new concepts in OA pathogenesis and identified possible targets of treatment. This was followed by a review of new treatment options for osteoarthritis. Presented during the Joint RA OA SIG Symposium at the F1 Hotel last 28 November 2014.
A case of unprovoked venous thromboembolism in a marathon athlete presenting atypical sequelae: What are the chances?
C. M. Hull1, C. L. Hopkins2, N. J. Purdy 1, R. C. Lloyd2, J. A. Harris2
1Institute of Life Science 1, College of Medicine, Swansea University, Swansea, UK, 2Penmaen Residence, University Health Centre, Swansea, UK Corresponding author: Claire M. Hull, PhD, Swansea University, Institute of Life Science, College of Medicine, Singleton Park, Swansea, Swansea SA2 8PP, UK. Tel: +44 1792 295417, Fax: +44 1792 602147, E-mail: c.m.hull@swansea.ac.uk Accepted for publication 1 May 2014
Scandinavian Journal of Medicine and Science in Sports
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Top Effective Soaps for Fungal Skin Infections in India
Compartment Sydrome: A Sports Medicine Physician's Perspective
1. A SPORTS MEDICINE PHYSICIAN’S
PERSPECTIVE
DAVID CARFAGNO, D.O., CAQSM
SCOTTSDALE SPORTS MEDICINE
2.
23 year professional football player left the
game in the 2nd quarter due to lower leg pain
He doesn’t recall a specific injury
Upon inspection, Team Physician felt that there
were no broken bones, muscle weakness,
sprains or strains and declared his discomfort
was due to cramping and had the player
benched
3.
Following the game, player returned home
Noticed an increase in pain as the night
progressed
Tried to sleep, but awoke with severe lower leg
pain which lead him to call the Team Physician
for help
4.
Moore was transported to the University of
Colorado Hospital where he was diagnosed
with lateral compartment syndrome
He underwent emergency surgery to have his
fascia opened to relieve increasing pressure
5.
6.
7.
8. Q. Fractures are the cause in less than
25% of cases of compartment
syndrome.
A. True
B. False
9.
10.
Acute Compartment Syndrome (ACS) is a
complication following fractures, soft tissue
trauma, and reperfusion injury after acute
arterial obstruction.
Common in participants of sports with high
incidence of falls, fractures, contusions, etc.
Difficult to diagnose without clinical testing
Most often associated with fractures of long
bones (e.g., tib-fib)
Poor outcomes assoc. with delayed diagnosis
11. ACS is defined as a compartment pressure of >30
mmHg or within 30 mmHg of diastolic
pressure.
J Bone Joint Surg Br 1996;78:99–104.
12.
1/3 of all cases involve tibial shaft fractures
Young age: Patients <35 years old more likely
than older patients to develop ACS following
same type of injury
10x more common in males
Most cases associated with fractures of long
bones, although 23.2% of cases associated with
soft tissue injury only
No difference in incidence of ACS in open
compared to closed fractures
J Bone Joint Surg Br. 2000;82:200–203.
13.
14.
15.
16.
17.
Following an injury
(e.g., fracture), muscl
e swelling
compresses VAN in
compartment
Intracompartmental
pressure rises
Ischemia, followed
by necrosis
18.
Bleeding: after vascular injuries or from cancellous
bone following fractures
Edema: from increased capillary permeability & fluid
extravasation due to oxygen deprivation caused by
bleeding
Increases perfusion barrier resulting in hypoxia + acidosis
Hypoxia + acidosis further increase capillary permeability &
fluid extravasation
Increases intracompartmental pressure
Restricted intracompartmental space: inelastic
compartment cannot accommodate expansion due to
finite borders defined by surrounding fascia and bone
Arterial compression, ischemia, then cellular death
19.
20.
Delayed diagnosis often has limb- and lifethreatening consequences.
Despite the relative frequency with which ACS
is seen by orthopedic surgeons, the diagnosis is
difficult.
Clinical signs mimic other conditions
Gold standard: assess intracompartmental
pressure with tonometry; fasciotomy
Refer to orthopedic specialist
Curr Rev Musculoskelet Med. 2012 September; 5(3): 206–213.
21.
Pain out of proportion to initial injury
Pain on passive stretch of muscles within affected
compartment
Palpably tense compartment
Weakness and paresthesia of areas supplied by nerves
crossing the compartment
Late signs: loss of pulses (due to arterial
occlusion), paralysis
High index of suspicion for compartment syndrome
must be maintained, even if all diagnostic criteria are
not met
Clin Orthop Relat Res. 2010 April; 468(4): 940–950.
25.
Measure intracompartmental pressures with tonometer
Doppler (rule out DVT)
Serum chemistry studies (rule out rhabdomyolysis)
Imaging (determine nature and severity of fractures)
26.
Perform
FASCIOTOMY when
difference between
compartment pressure
and diastolic blood
pressure is <30 mm
Hg or when clinical
symptoms are
obvious.
Fasciotomy of all
compartments is
required.
Clin Orthop Relat Res. 2010; 468(4): 940–950.
27.
28.
29.
30.
May be significant
-Skin grafts over incisions often needed
-Muscle weekness in affected limb can persist
Overall complication rate is 10x higher if
fasciotomy is delayed 12 hours from onset
- amputation rate increased to over 50%
- 8% of pts (untreated) vs 68% (treated) had limb
function return to normal
J Bone Joint Surg Br. 2000; 82 (2):200
31.
In patients with tibial fractures, McQueen et al.
demonstrated that the time between apparent
onset of compartment syndrome and surgical
release influenced the outcome rather than the
time between trauma and fracture stabilization.
Documentation of clinical findings in ACS is
important since serial examinations are
necessary and the findings over time must be
compared.
35.
PHASE I: Protection and Mobility (Surgery to 2-3 weeks).
Protection, Rest, Ice, Compression, and Elevation.
PHASE II: Light Strengthening (begin after meeting Phase I
criteria, approximately 3-4 weeks following surgery). ROM,
stretching.
PHASE III: Progression of Strengthening (begin after
meeting Phase II criteria, approximately 4-6 weeks following
surgery).
PHASE IV: Impact/Sport Training (Begin after meeting
Phase III criteria, approximately 8-12 weeks following
surgery)
http://www.youtube.com/watch?v=hDHyrhbwq-M
36.
Tibial Fracture: 12-13
weeks average
healing time, followed
by rehabilitation and
gradual increase in
exercise intensity.
Fibular Fracture: 8-12
weeks
Tib-fib: 6 months or
more
High Ankle Sprain:
weeks to months
Int J Sports Phys Ther. 2011 June; 6(2): 126–141.
37.
Study: over a 23-year period, 6% of all
malpractice claims against orthopedic surgeons
were related to ACS and greater than 50% were
ruled in favor of the patient.
Linear relationship between the number of
cardinal signs and the time from presentation
to fasciotomy and payment size.
Shadgan et al suggest that poor communication
between physician, other members of the
healthcare team, and the patient is associated
with unfavorable outcomes.
Bhattacharyya ‘04
Shadgan et al, ‘10
38.
ACS in children most common in leg
Classic signs and symptoms often present later
or are completely absent
Nearly 1/3 of pediatric patients present only
with pain
Average normal resting intracompartmental
pressure is slightly higher in children (13 to 16
mmHg) than in adults (8 mmHg)
J Bone Joint Surg Br. 1996;78:95–98.
Curr Rev Musculoskelet Med. 2012 September; 5(3): 206–213
39.
Compartment syndrome is a serious syndrome
that needs to be diagnosed early
Palpable pulses don’t exclude compartment
syndrome
If diagnosis and fasciotomy are done early,
prognosis is good
If delayed, complications will develop
40. David Carfagno, D.O., C.A.Q.S.M.
Board Certifications: Internal Medicine, Sports
Medicine (CAQ), Ringside Medicine (ABRM)
Medical Director, Ironman Arizona & Rock and Roll
Marathon Arizona.
Team physician, USA Boxing
10133 N. 92nd Street, Suite 102
Scottsdale, AZ 85258
Office – 480.664.4615
Email – david.carfagno@gmail.com
Editor's Notes
Common/Frequently seen?Periods for sentences onlyFont problemsMore recent studies!Blame it on your crappy help
Doppler
Arterial and venous
Outcome depends on underlying condition or causation of injury, whether there vascular disease, and time interval between onset and treatment