The document discusses congenital talipes equino varus (clubfoot). It is a birth deformity where the foot is twisted inward and downward. It involves muscle, tendon and bone abnormalities. Causes may be genetic or due to in-utero factors. Treatment involves manipulation, serial casting and sometimes surgery to correct the deformity. The goal is to fully correct the clubfoot early in life through non-surgical or surgical methods and maintain the correction through bracing and exercises.
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.
As part of a class presentation, we attempted to make this to briefly explain what Torticollis meas, the Types of presentation of Torticollis, and Management strategies for a Physiotherapist for Congenital Torticollis especially.
I hope this helps. :)
The pictures and information had been taken from internet, complied to make a brief presentation for the purpose of class presentation.
I do not own any content.
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.
As part of a class presentation, we attempted to make this to briefly explain what Torticollis meas, the Types of presentation of Torticollis, and Management strategies for a Physiotherapist for Congenital Torticollis especially.
I hope this helps. :)
The pictures and information had been taken from internet, complied to make a brief presentation for the purpose of class presentation.
I do not own any content.
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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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.
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
2. INTRODUCTION
• Also known as clubfoot.
• Congenital talipes equino varus describes a deformity noted at the birth and
includes idiopathic as well as non-idiopathic talipes equino varus.
• In non idiopathic group it is a manifestation of a systemic skeletal syndrome; the
associated skeletal anomalies are due to the same etiological factor that caused
failure of the normal development as in:
i. From muscle imbalance e.g. neuromuscular disorders.
ii. From fibrosis of soft tissue as in Arthrogryphosis
iii. From bone and joint anomalies.
3. • Talipes Equinovarus comes from the following:
1. “Tali” means Ankle,
2. “Pes” means Foot
3. “Equinus” means foot pointing down (like a horse’s foot)
4. “Varus” means deviated towards midline
4. THEORIES
Theories to explain
1. IDIOPATHIC CTEV -
i. Mechanical pressure in utero e.g.: Oligohydraminos
ii. Neuromuscular defect — Spina bifida, Weak peroneal muscles
iii. Germ cell defect
iv. Intrauterine arrest of the growth.
v. Hereditary.
vi. Multifactorial.
5. 2. NON-IDIOPATHIC CAUSES:
i. Arthrogryphosis
ii. Nail patella syndrome
iii. Streeter syndrome
iv. Muscular dystrophy
v. Myelomeningocele, Spina bifida, Spinal cord defects
6. EPIDEMOLOGY
• DEMOGRAPHICS -
• Most common musculoskeletal birth defect
• Overall incidence 1:1,000, though some populations 1:250
• Male: Female ratio approximately 2:1
• ANATOMIC LOCATION -
• half of cases are bilateral
• in 80%, clubfoot is an isolated deformity
7. ETIOLOGY
• PATHOPHYSIOLOGY –
1. Muscle contractures contribute to the characteristic deformity that includes (CAVE):
i. Cavus - (tight intrinsic, FHL, FDL)
ii. Adductus of forefoot - (tight tibialis posterior)
iii. Varus - (tight tendoachilles, tibialis posterior, tibialis anterior)
iv. Equinus - (tight tendoachilles)
2. Bony deformity consists of medial spin of the midfoot and forefoot relative to the
hindfoot:
i. Talar neck is medially and plantarly deviated
ii. Calcaneus is in varus and rotated medially around talus
iii. Navicular and Cuboid are displaced medially
8. • GENETICS –
1. Genetic component is strongly suggested
2. Unaffected parents with affected child have 2.5% - 6.5% chance of having another
child with a clubfoot
3. Familial occurrence in 25%
4. Recent link to PITX1, transcription factor critical for limb development
9. PATHOLOGICAL ANATOMY
• The clubfoot deformity is due to the abnormal relationship of the tarsal bones: the
navicular and calcaneus are displaced around the tarsus.
• Correction of this abnormal tarsal relationship is resisted by pathological
contracture of the associated softer parts.
• The severity of the deformity depends on the degree of displacement, whereas the
resistance to the treatment is determined by the rigidity of the soft tissue
structures.
• Two laws used for understanding are:
1. Wolf’s Law
2. Davis Law
10. 1. WOLF’S LAW: every change in the use of the static function of the bone causes a
change in the internal form as well as the architecture and also the external form
and function according to mathematical law.
2. DAVIS LAW: When ligaments and soft tissue in lax state they will shorten.
11. ANATOMICAL REGION WISE INVOLVEMENT
1. POSTERIOR CONTRACTURE: Tend Achilles, Tibiotalar capsule, talo calcaneal
capsule, posterior talo fibular ligament, calcaneo fibulas ligament. These
structures resist equinus correction.
2. MEDIAL: Most important and most resistant structures Tibialis posterior, deltoid,
talonavicular capsule and spring ligament.
3. SUBTALAR: Talo calcaneal interosseousligament, bifurcated Y ligament.
4. PLANTAR CONTRACTURES: Abductor Hallucis, intrinsic flexors,
quadratusplantae, plantar aponeurosis.
12. CLINICAL EXAMINATION
• Smaller stubby feet with shortened first metatarsal ray.
• Equinus deformity with inversion of the heel, adduction and varus of the fore foot.
• Medial border of the foot is concave and elevated, its plantar surface face up ward.
• Lateral border of the foot is convex and depressed down.
• The posterior tuberosity of the heel is upwards, difficult to palpate and less visible.
• Callosity on the dorsal aspect of the fifth metatarsal.
• Boney prominence visible and palpable over the dorsolateral aspect of the foot
represents the head and neck of the talus which are partially uncovered by the
navicular
13.
14. X-RAYS
• A-P view
1. Tibio calcaneal angle normal range 20-40 degrees, abnormal if less than 20
degrees.
• Lateral film in maximum dorsiflexion:
1. Talocalcaneal angle normal range 25-50 degrees, abnormal if less than 25
degrees.
2. Tibio calcaneal angle normal range 5-15 degrees, abnormal if less than 5
degrees or negative.
15. • KITES VIEW: AP view with foot flexed 30 degrees and tube angled 30 degree
anteriorly in sagittal plane. Importance of x-ray on follow-up - Clinically the heel
varus may appear to be corrected because manipulation may have displaced the heel
pad laterally, but x-ray will demonstrate on abnormal tarsal relationship between
talus and calcaneus confirming whether one is dealing with spurious correction.
16. MANAGEMENT OF CTEV
• Aims –
1. To correct the deformity early
2. To correct the deformity fully
3. Hold the correction until growth stops
18. MANIPULATION AND SERIAL CASTING
• Should begin in nursery ideally
• Manipulation before the cast application is most important part of nonoperative
treatment. The objective is to stretch the soft tissue contracture, the plaster of paris
cast serves to maintain the correction obtained by manipulation.
METHOD OF CASTING:
• KITES - Each component of deformity corrected in the sequence. Kite believed that
heel varus would correct simply by everting the heel.
• PONSETTI - All component of the deformity must be corrected simultaneously, not
in the sequence except for equinus, which should be corrected last. The cavus, which
19. arises from the pronation of the forefoot in relation to the hind foot is corrected by
supinating the fore foot in proper alignment with the hind foot. With the arch well
molded, the entire foot can be gently and gradually abducted under the talus,
which is secured against rotation, in the ankle mortise by applying counter
pressure with thumb against the lateral part of the talus. Heel varus will get
corrected when the entire foot is entirely abducted. Finally equinus is corrected by
dorsiflexing the foot, which can be facilitated by simple percutaneous tenotomy of
the tend Achilles. Well molded plaster cast applied after manipulation is complete.
FREQUENCY OF CAST CHANGE –
• Ideally weekly but practically done fortnightly.
20. ON REASSESSMENT –
• IF COMPLETELY CORRECTED:
1. Maintain in maximally corrected position for total of 6-8 months.
2. After 6- 8 months Dennis Browne bar with attached tarso pronator shoe for 24
hrs.
3. Checked at routine intervals for recurrence, mother also taught to look for heel
cord shortening.
4. Once walking age attained only tarso pronator shoe with the Dennis Browne
splint at night.
5. Night time splinting continued till 7 years of age. CTEV shoes used in day
time.
• PARTIALLY CORRECTED OR NO CORRECTION:
1. Observed for further 3 months with manipulation and casting.
2. If no correction, static deformity may require surgery at 10 months.
21. DENIS BROWNE SPLINT –
• A dynamic splint in which the kicking movement of each leg exerts a corrective force
on the counter part.
RELAPSED FOOT –
• The deformity recurred after Fair correction.
RESISTANT FOOT –
• Foot is considered resistant when the deformity shows no evidences of further
improvement with manipulation the radiograph and the X rays confirming the
persistence of equinovarus deformity.
22.
23. OPERATIVE MANAGEMENT
• INDICATIONS –
1. When a plateau has been reached in non operative treatment.
2. The child is old enough for the anatomy of foot to be recognized usually by ten
months.
• TREATMENT –
1. Soft tissue release
2. Osteotomy
3. Arthrodesis
25. RESIDUAL DEFORMITY
• Must ensure that there is no neurologic cause. The residual deformity may be –
1. Dynamic - If unable to actively evert the foot. Consider SPLATT (Split ant.
Tibialis transfer).
2. Fixed - Look for the uncorrected component and treat accordingly.
• METATARSUS ADDUCTUS - after 5 year MT osteotomy
• HIND FOOT VARUS –
1. < 2-3 year - complete subtalar release
2. 3-10 year - closed wedge or medial open edge osteotomy of calcaneum;
26. • EQUINUS - TA lengthening with posterior Capsulectomy of ankle, Subtalar joint.
• All three deformities severe, resistant: TRIPLE ARTHRODESIS
27. PHYSIOTHERAPY MANAGEMENT
• CORRECTION PHASE –
1. Daily corrective manipulations of the clubfoot are performed by an experienced
physical therapist and the correction is held with elastic taping and splints until the
next day's session.
2. Family participation is integral to the success of this treatment program as the
family must be able to bring the infant to therapy during the week for 1-3 months.
3. Each session lasts approximately 30 mins per foot and manipulations are
performed in a progressive gentle pattern.
28. 4. Begin with derotation of the calcaneopedal block and correction of forefoot
adduction through massage of the Achilles tendon and gastrocnemius muscle.
5. Medial soft tissues are stretched to allow the navicular to move away from the
medial malleolus and its medial position on the head of the talus. Distraction of the
forefoot and midfoot helps to loosen the tightened structures, and derotation of the
foot facilitates reduction of the talus
6. To maintain the gain achieved in passive range of motion, the toe extensors and
peroneals are recruited by stimulating (tickling) the lateral border of the foot and
leg and the tops of the toes.
7. Once the talonavicular joint has been reduced, attention is directed toward the
correction of varus and equinus. With the valgus maneuver, the calcaneus
gradually moves to a neutral and eventually valgus position. The ankle is
externally rotated at the same time that the calcaneus is being mobilized into
valgus. The knee should be kept at 90° during these maneuvers
29. 8. Equinus is corrected with gradual dorsiflexion of the foot. Correction of equinus
can be augmented with a percutaneous heel cord tenotomy
• MAINTENANCE PHASE –
1. Periodic follow-up is needed to monitor the range of motion of the foot and the
development of the infant and to fabricate new splints.
2. Once the patient is walking, taping is discontinued and a resting ankle-foot orthosis
is used during nighttime and naps until the age of two years.
3. Throughout this treatment program, the patient visits the physician every two to
three months for evaluation of the foot.