1. Dr. Gazielly has over 33 years of experience specializing in shoulder surgery. He has examined over 26,000 shoulders and operated on over 7,600 shoulders, with 70% done arthroscopically to repair rotator cuffs.
2. Common shoulder issues Dr. Gazielly treats include rotator cuff tears that cause night pain, painful aging of the rotator cuff tendons, and "the trials and tribulations" of determining the underlying cause of a painful shoulder.
3. Arthroscopic surgery has revolutionized shoulder surgery by allowing for less pain, lower risks of infection, and faster recovery compared to open surgery. Dr. Gazielly has 25 years of experience
This is short presentation of most common fracture in hip joint. Femoral neck fractures are the most common type of fractures around the hip joint- more common in elderly in weak osteoporotic bone. This presentation gives a brief idea about these fractures, investigations, methods of management in different age groups.
Fracture Neck of the femur with a case presentation and theory background
reference:
Apley's System of Orthopaedics and Fractures
Oxford Handbook of Orthopaedics and Trauma
This is short presentation of most common fracture in hip joint. Femoral neck fractures are the most common type of fractures around the hip joint- more common in elderly in weak osteoporotic bone. This presentation gives a brief idea about these fractures, investigations, methods of management in different age groups.
Fracture Neck of the femur with a case presentation and theory background
reference:
Apley's System of Orthopaedics and Fractures
Oxford Handbook of Orthopaedics and Trauma
Recent Advances in Arthroscopic Hip Treatmentcoreinstitute
One of the most exciting and potentially beneficial recent advances in orthopedic surgery has been the use of arthroscopy to repair injuries of the hip joint. View this presentation to learn more about this advance in hip treatment.
Recent Advances in Arthroscopic Hip Treatmentcoreinstitute
One of the most exciting and potentially beneficial recent advances in orthopedic surgery has been the use of arthroscopy to repair injuries of the hip joint. View this presentation to learn more about this advance in hip treatment.
Best Shoulder replacement surgery or shoulder arthroplasty is a surgical technique to replace the damaged ends of the bones of the shoulder joint that are causing pain and discomfort.
Best Shoulder replacement surgery or shoulder arthroplasty is a surgical technique to replace the damaged ends of the bones of the shoulder joint that are causing pain and discomfort.
Shoulder injuries, particularly rotator cuff injuries, can significantly
impact daily activities and hinder the quality of life. Understanding
the causes, symptoms, and treatment options for these injuries is
crucial for effective recovery. In this ebook, "Healing the
Shoulder: A Comprehensive Guide to Rotator Cuff Injuries,"
Arthroscopy, or Minimally Invasive “keyhole” surgery, allows the surgeon to look into the knee joint, make an exact diagnosis, and treat the condition with an operation that requires very small skin cuts. We use specially made instruments that fit through the small skin incisions and we visualize the knee using a camera. Because this technique disturbs the knee joint less than open surgery, the hospital stay is shorter and the recovery smoother than with “open surgery”.
La hernie du sportif : diagnostic et traitement, technique mini-ainvasive -Dr...VitamineB
La hernie du sportif : diagnostic et traitement, technique mini-invasive
Par le Docteur Ulrike MUSCHAWECK
Lors de la 1ère Journée Européenne de la pubalgie
Clinique du Sport Bordeaux Mérignac
Les douleurs de l'épaule sont très fréquentes et invalidantes, surtout la nuit.
Leur traitement, pour être efficace, passe par un diagnostic précis, clinique et radiologique. Une physiothérapie spécialisée est incontournable. Quand l'opération est nécessaire, une fois sur quatre, elle bénéficie le plus souvent des avantages de la chirurgie arthroscopique non invasive. Enfin, la fiabilité à long terme des prothèses d'épaule est liée à l'expérience de l'équipe chirurgien physiothérapeute qui prend en charge le patient...
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
- 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
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
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Conference 33 ans d'épaule (English)
1. Key takeaways
of 33 years in
shoulder specialization
Dr Dominique-François Gazielly
FMH Orthopaedic Surgeon
www.drgazielly.com
2. 33 years devoted to treat
shoulders exclusively
New-York (1985) Saint-Etienne (1986)
Paris (1999) Genolier (2012)
3. 26,000 shoulders examined
7,600 shoulders operated
70% by arthroscopy (Rotator cuff)
30% by open surgery
15% Athletes’ recurrent dislocation
15% Shoulder replacement
4. I would like to ask you two questions…
1- Who, amongst you, has
or has previously had a
shoulder problem?
2- Do you have joint
hyperlaxilty, are you too
flexible?
4
Joint hyperlaxity: external rotation of
the shoulder beyond 85 degrees
5. Review of 33 years
of shoulder surgery
1. The tendons of the rotator cuff age poorly
2. Night pain that keep awake and lead to consultation
3. The “trials and tribulations” of a painful shoulder
4. Arthroscopic surgery has been a revolution
5. Shoulder prostheses nowadays are highly reliable
6. The shoulder does not like being immobilized
7. It takes 20 years to learn when not to operate a
shoulder
5
7. The 4 tendons of the rotator cuff
are the shoulder’s “motors”
7
8. 1. The tendons of the rotator cuff age poorly
with professional and/or sporting overuse
8
9. The tendons’ ageing process can also be
accelerated by a bone deformity of the anterior
portion of the acromion which “attacks” the
underlying supraspinatus and long head of the
biceps tendons…
9
11. 2. Night pain that keeps awake is the major
symptom of a rotator cuff injury
11
Sleeping on the
affected shoulder
is impossible…
“The shoulder
aspirin” brings
relief…
12. The 5 warning signs of rotator cuff
injury
1. Sleeping on the affected shoulder is impossible
2. Pain when reaching for parking ticket (left shoulder)
3. Sign of the “car belt”, (right shoulder)
4. Pain when reaching for wallet
5. Pain when fastening bra
12
13. Cortisone injection, performed by a radiologist,
efficiently and safely (except when diabetic)
relieves pain, but the effect is temporary
(3 to 4 months).
13
Ultrasound-guided injection into the
subacromial bursa
CT-guided intra-articular injection
for tenosynovitis of the long head
biceps with no full thickness tear
14. Additionally, we have used Mesotherapy for the
past 20 years to treat the inflammation of the
long head of the biceps tendon (LHBT)
- Therapeutic technique using
drugs from the classic
pharmacopeia (never cortisone).
- It consists in injecting a mixture
of drugs under the skin (2 to 4mm
deep).
- It has very few contraindications
and side effects
- Swiss, French, and International
society of Mesotherapy
14
Normal intra-articular LHBT
Inflamed LHBT in the bicipital groove
15. 3. The trials and tribulations of
a painful shoulder
15
1. A painful shoulder cannot be treated efficiently
without establishing a clinical and anatomic
Diagnosis of the underlying lesion
2. The terms “tendinitis”, “capsulitis”, “periarthritis”
must no longer be used…
3. Even these days, patients still waste too much time
and money before finding out what exactly they are
suffering from
4. Do not hesitate to ask for a second advice
16. How to efficiently treat
a painful shoulder?
1. Take time to listen to the patient
2. Take time to examine the patient
3. Establish a clinical diagnosis
4. Prescribe adequate imaging (Arthro-MRI)
5. Establish an anatomic diagnosis of the lesion
Physiotherapy +- Osteopathy Surgery
Hyper-specialized medical network…
16
17. 4. Mini-invasive arthroscopic shoulder surgery
has been a technological revolution in the 1990s
- Less postoperative pain
- Low risk of infection
- Less painful postoperative
mobilization
- Faster functional recovery
- Cosmetic advantages
17
General anaesthesia
18. 1993-2018: 25 years of experience in
arthroscopic repair of rotator cuff tear
18
19. 1993-2018: 25 years of experience in
arthroscopic repair of rotator cuff tear
19
20. Return to sport activities following
arthroscopic repair of a rotator cuff tear
20
22. 5. Shoulder prostheses nowadays are highly
effective in treating osteoarthritis
The distinction must be made between two very
different types of shoulder prostheses:
- “Anatomic” prostheses (1975) are indicated when
the rotator cuff is functional:
“centred” shoulder osteoarthritis
- “Reverse” prostheses (1995) are indicated when
the rotator cuff is no longer functional, or torn and
retracted:
“non-centred” shoulder osteoarthritis
22
23. 23
“Anatomic” prostheses have excellent and
long-term functional results and allow patients
to resume their activities
24. “Anatomic” prostheses have excellent and
long-term functional results and allow patients
to play again an instrument or practice non-
contact sports
24
www.drgazielly.com (Rehabilitation section)
25. “Reverse” prostheses are recommended to
patients who can no longer elevate their arm
due to a major and irreparable rotator cuff tear
25
27. Operated shoulder is, exceptionally,
immobilized between physiotherapy sessions
At night only after shoulder
replacement or opened
stabilization surgery for athletes’
recurrent dislocation.
27
28. 28
50% of the quality of results depends on the
quality of postoperative physiotherapy
1. Quality of the postoperative surgeon’s follow-up
2. Necessity of a physiotherapist who is used to the
surgeon’s rehabilitation protocols:
- No strict immobilization of the operated shoulder
- Respect of the successive sequences: passive,
a assisted active, muscle strengthening exercises
3. Patient motivation is required to perform the
rehabilitation exercises alone at home.
32. 7. “It takes 20 years to learn
when not to operate a shoulder”
- In most of cases, shoulder surgery is the surgical treatment
of pain
- Every patient has his own pain threshold
- If the patient himself requests a surgery and has the
motivation required for postoperative rehabilitation, then
good results are guaranteed...
- However, one must know when not to suggest a surgery to
a patient who lacks the motivation for the postoperative
rehabilitation, or has other related problems (neck pathology
+++, long past medical history, professional issues) that would
lead to random results…
32
33. The Future… What about it?
- Could chondrocyte culture someday avoid using
prostheses?
- Development of information and education of the
patient is necessary to avoid time & money waste.
- Robotic surgery does not, in our opinion, have much of
a future in shoulder surgery, which, despite being
increasingly mini invasive, remains a manual surgery
requiring “craftsmanship”
34. Thank you to our teams who makes it possible
to treat our patients in the safest and most
comfortable environment
34