This chapter describes the neurological and neurosynaptic pathways for both acute and chronic pain. It also delineates the psychological differences between acute and chronic pain. Finally, it introduces the concept of the specific type of pain associated with a specific tissue type, which is useful in the diagnosis of pain problems. This chapter is the foundation for understanding all subsequent chapters on pain.
Physiology of Pain (PPT) Nervous System PhysiologyShaista Jabeen
https://www.youtube.com/channel/UCrrAABI7QDRCJ1yMrQCip_w/videos
https://www.facebook.com/ShaistaJabeeen/
https://www.facebook.com/Human-Physiology-Lectures-100702741804409/
Physiology of Pain (PPT)
Nervous System Physiology
INTRODUCTION
BENEFITS OF PAIN SENSATION
COMPONENTS OF PAIN SENSATION
PATHWAYS OF PAIN SENSATION
FROM SKIN AND DEEPER STRUCTURES
FROM FACE
FROM VISCERA
FROM PELVIC REGION
VISCERAL PAIN
CAUSES OF VISCERAL PAIN
REFERRED PAIN
DEFINITION
EXAMPLES OF REFERRED PAIN
MECHANISM OF REFERRED PAIN
NEUROTRANSMITTERS INVOLVED IN PAIN SENSATION
ANALGESIA SYSTEM
ANALGESIC PATHWAY
GATE CONTROL THEORY
APPLIED PHYSIOLOGY
Short Notes
pdf ppt
Conclusions:
74% of patients discharge home with moderate to severe pain --> with or without treatment before
ED patients should receive proper pain management, avoiding delays such as those related to diagnostic testing or consultation
In order to further improve patient care we must now apply our knowledge regarding acute and chronic pain treatment base on pharmacology of the drugs
Ongoing research in the area of ED patient pain management conducted and an algorythm or clinical guidelines in this area should be developed
Effective physician and patient educational strategies should be developed regarding pain management, including the use of pain therapy adjuncts and how to minimize pain after disposition from the ED
Physiology of Pain (PPT) Nervous System PhysiologyShaista Jabeen
https://www.youtube.com/channel/UCrrAABI7QDRCJ1yMrQCip_w/videos
https://www.facebook.com/ShaistaJabeeen/
https://www.facebook.com/Human-Physiology-Lectures-100702741804409/
Physiology of Pain (PPT)
Nervous System Physiology
INTRODUCTION
BENEFITS OF PAIN SENSATION
COMPONENTS OF PAIN SENSATION
PATHWAYS OF PAIN SENSATION
FROM SKIN AND DEEPER STRUCTURES
FROM FACE
FROM VISCERA
FROM PELVIC REGION
VISCERAL PAIN
CAUSES OF VISCERAL PAIN
REFERRED PAIN
DEFINITION
EXAMPLES OF REFERRED PAIN
MECHANISM OF REFERRED PAIN
NEUROTRANSMITTERS INVOLVED IN PAIN SENSATION
ANALGESIA SYSTEM
ANALGESIC PATHWAY
GATE CONTROL THEORY
APPLIED PHYSIOLOGY
Short Notes
pdf ppt
Conclusions:
74% of patients discharge home with moderate to severe pain --> with or without treatment before
ED patients should receive proper pain management, avoiding delays such as those related to diagnostic testing or consultation
In order to further improve patient care we must now apply our knowledge regarding acute and chronic pain treatment base on pharmacology of the drugs
Ongoing research in the area of ED patient pain management conducted and an algorythm or clinical guidelines in this area should be developed
Effective physician and patient educational strategies should be developed regarding pain management, including the use of pain therapy adjuncts and how to minimize pain after disposition from the ED
Pain is a common yet complex biopsychosocial phenomenon that affects every aspect of a patient’s life
Optimal management often requires good assessment, formulation of the problem in the patient, and combining pharmacological and non-pharmacological (psychological and social) interventions
Lecture given to the West of Scotland Pain Group on Wednesday 28th November 2012 by Emma Mair, Specialist Physiotherapist in Pain Management about Complex Regional Pain Syndrome (CRPS) and its treatment with Graded Motor Imagery (GMI).
Knowledge of pain physiology is very important in understanding of electrotherapy prescription. So, this slide may be useful in understanding the background of the pain processes.
Option of interventional pain therapy in multimodal treatment of chronic cancer and non-cancer pain
Established role when pharmacotherapy or surgery not suitable
Indications well accepted
Evidence for efficacy moderate to strong
Interventional pain management by dr rajeev harsheRajeev Harshe
This is a brief presentation on how pain can be managed in a better way. Dr Rajeev Harshe is senior pain management consultant in western India. He is attached to Apollo Hospitals and has his private consulting room as well.Email: dr.harshe@gmail.com. If you are anaesthesiologist and if you wish to learn pain management,contact him.
Pain is a common yet complex biopsychosocial phenomenon that affects every aspect of a patient’s life
Optimal management often requires good assessment, formulation of the problem in the patient, and combining pharmacological and non-pharmacological (psychological and social) interventions
Lecture given to the West of Scotland Pain Group on Wednesday 28th November 2012 by Emma Mair, Specialist Physiotherapist in Pain Management about Complex Regional Pain Syndrome (CRPS) and its treatment with Graded Motor Imagery (GMI).
Knowledge of pain physiology is very important in understanding of electrotherapy prescription. So, this slide may be useful in understanding the background of the pain processes.
Option of interventional pain therapy in multimodal treatment of chronic cancer and non-cancer pain
Established role when pharmacotherapy or surgery not suitable
Indications well accepted
Evidence for efficacy moderate to strong
Interventional pain management by dr rajeev harsheRajeev Harshe
This is a brief presentation on how pain can be managed in a better way. Dr Rajeev Harshe is senior pain management consultant in western India. He is attached to Apollo Hospitals and has his private consulting room as well.Email: dr.harshe@gmail.com. If you are anaesthesiologist and if you wish to learn pain management,contact him.
New directions in the psychology of chronic pain managementepicyclops
Lecture followed audience discussion on contextual cognitive behaviour therapy and acceptance and commitment therapy in the management of chronic pain from the West of Scotland Pain Group on Wednesday 5th December 2007. The speaker is Lance M. McCracken PhD, of the Pain Management Unit at the Royal National Hospital for Rheumatic Diseases & University of Bath, Bath UK.
www.wspg.org.uk
Further reading:
DAHL, J., & LUNDGREN, T. (2006). Living beyond your pain using acceptance and commitment therapy to ease chronic pain. Oakland, CA, New Harbinger Publications.
http://www.worldcat.org/oclc/63472470
HAYES, S. C., STROSAHL, K., & WILSON, K. G. (1999). Acceptance and commitment therapy an experiential approach to behavior change. New York, Guilford Press.
http://www.worldcat.org/oclc/41712470
MCCRACKEN, L. M. (2005). Contextual cognitive-behavioral therapy for chronic pain. Progress in pain research and management, v. 33. Seattle, IASP Press.
http://www.worldcat.org/oclc/57564664
this topic explains the nature of pain, signs and symptoms of pain, different types of pain, factors influencing pain, assessment of pain and pharmacological and non pharmacological management of pain.
In this ppt I mentioned all the imp point related to pain pathway and pain pathophysiology. refrence: essentials of interventional techniques in managing chronic pain (laxmaiah manchikanti)
Pain Physiology Presented At St Thomases Hospital 2.3.07London Pain Clinic
Pain Physiology.
Presented At St Thomases Hospital for trainee Anaesthetists as part of their FRCA (Fellow of the Royal College of Anaesthetists) examination preparations.
2nd March 2007
Pain pathway gate control theory
Pain management
An unpleasant emotional experience usually initiated by noxious stimulus and transmitted over a specialized neural network to CNS where it is interpreted as such.
1. Exteroceptors: arising from receptors from skin & mucosa. sensed at conscious level
E.g. Merkel corpuscles : Tactile receptors.
Free Nerve ending :Perceive superficial pain.
2. Proprioceptors : From musculoskeletal structures.
The presence , positions & movement of body. below conscious levels.
E.g. 1) Muscle spindles : Skeletal muscle fibers. Mechanoreceptors.
2) Free nerve ending : Perceive deep somatic pain & other sensations.
3. Interoceptors : From viscera of body below conscious level.
E.g. Pacinian corpuscles : perception of touch-pressure.
Free nerve ending : Perceive visceral pain & other sensations.
Third Party Reporting of Patient Improvement.docxNelson Hendler
Reproting of outcome studies is often subjective. This collection of real leterrs, emails, and Facebook posting provides third party documentation and validation of the efficacy of treatment, without the subjective bias of the party doing the treatment.
Johns Hopkins Hospital doctors report that 40%-80% of chronic pain patient are misdiagnosed, and that MRIs and CTs miss pathology 56%-78% of the time, Therefore, during extensive chart reviews of current medical data will produce a classic case of GIGO-garbage in giving garbage out. The need for accurate diagnoses and testing is critical for AI to work.
Top_Down_or_The_Bottom_Up to Save Money.pdfNelson Hendler
The article describes the need for a more "granular:" assessment of workers' compensation claims, rather than the typical approach of insurance carriers which average large numbers, which causes the loss of valuable data.
The former head of HR for Burger King, British Petroleum, and Walmart, and former Assist. Prof. of Neurosurgery from Johns Hopkins Hospital describe methods to save 54% on workers' compensation using on-line "expert system" questionnaire from Johns Hopkins Hospital doctors
40%-80% of auto accident claimants have overlooked diagnoses. The most commonly overlooked are thoracic outlet syndrome, cervical disc damage mistakenly called sprain or whiplash, post-concussion syndrome, slipping rib syndrome, Tietze syndrome and Tempro-mandibular joint syndrome. This article tells readers the clinical sign and symptoms of each and the correct medical tests to use, which are employed by doctors at Johns Hopkins Hospital. It also described an on-line questionnaire at www.DiagnoseThePains.com which gives diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors.
This paper shows how thermography can be used to disprove the misdiagnosis and over used diagnosis of "psychogenic pain." in a group of chronic pain patients.
This article outlines the differences between the anatomical and pharmacological differences between acute and chronic pain. This has significant implications for treatment, since they really are separate disorders.
This study compares the effect of benzodiazepines to narcotics on EEG, memory quotient, and WAIS testing. Valium, Librium, Dalmane and other benzodiazepines produced EEG and cognitive abnormalities in 70% of the patients, while only 30% of patients on narcotics had cognitive impairment.and EEG abnormalities.
Bi-polar patients who were having side-effects from lithium were given spironolactone to control mood swings. Five the 6 had good control for 1 year. The mechanism of membrane stabilization compared to lithium are discussed.
Emg vs. thermography to diagnose crps and radiculopthyNelson Hendler
This large clinical trial (803) patients compares the accuracy of thermography to EMG studies to see which one was a better diagnostic tool for each disorder and the degree of overlap between testing.
Valuable info for orthopedic and neurosurgeons specializing in spinal injuriesNelson Hendler
Reports from Johns Hopkins Hospital doctors document that 40%-80% of patients labeled as soft tissue injury, whiplash, sprain or strain are misdiagnosed. Use of an Internet expert system provides diagnoses with a 96% correlation with diagnoses of former Johns Hopkins Hospital doctors, resulting in a 192% increase in interventional testing, and a 50%-63% increase in surgery in previously misdiagnosed patients, 93% of whom report good to excellent improvement after surgery. .
Headache diagnostc paradigm from former Johns Hopkins Hospital staffNelson Hendler
The medical literature reports that 35%-70% of patients diagnosed with migraine headache do not have this order. The Internet based "expert system" developed by former Johns Hopkins Hospital staff, including the past president of the American Headache Society and American Academy of Pain Management provides an Internet based "expert system" which gives diagnoses with a 94% correlation with diagnosed of these doctors.
Missed Diagnoses association in Rear end collisions Nelson Hendler
There are a number of overlooked diagnoses which occur after a rear-end accident. This paper shows an attorney how to convert a misdiagnosed 'soft tissue injury case" into damaged cervical disc,TMJ, thoracic outlet syndrome,and post concussion syndrome using a diagnostic paradigm to get diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors. This improves patient care and increases recovery.
The paper lists the correct method of diagnosing chronic pain, and matching the proper medication to tissue damage without the use of narcotics or opioids.
This list is all of the researchers who have published articles on the Pain Validity Test and Diagnostic Paradigm from www.MarylandClinicalDiagnostics.com
This is a simplified instruction manual, with screen shots, which will teach staff members how to administer the on-line questionnaires from www.MarylandClinicalDiagnostics.com. It will take any staff member only 15 minutes to review the handbook. Once they have reviewed the handbook, it will take only 5 minutes of staff time to set up a patient to take the tests from www.MarylandClinicalDiagnostics.com
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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.
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
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
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.
Follow us on: Pinterest
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
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.
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.
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.
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.
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.
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Course 1 acute versus chronic pain
1. Acute versus Chronic Pain
Nelson Hendler, MD, MS
Former Assistant Professor of Neurosurgery
Johns Hopkins University School of Medicine
Past president-American Academy of Pain Management
www.MarylandClinicalDiagnostics.com
Lecture 1
2. Anatomy of a Nerve- I
• Everything in the body works due to nerve input
• Nerves are the signal system of the body
• Think of a nerve as an electrical telephone wire
which transmits information from one place to
another, via electrical impulses
• Just like an electrical wire, nerves have insulation,
called myelin, which can be very thick, or thin.
• The myelin is made by a special cell called a
Schwann cell.
• The myelin wraps around the nerve in layers
3. Anatomy of a Nerve - II
• A nerve has a cell body, which provides the
metabolic energy for the nerve, and receives
information from other nerves.
• The fiber extending from the cell body is an axon
• The axon ends in a “button termineaux” or
terminal button or swelling, where the chemicals
called neurosynaptic transmitters are made
• These neurosynaptic transmitters are what
create the specificity of nerve transmission
• Nerve activity can be modified at the cell
membrane electrically & the synapse chemically
4. Anatomy of a Nerve III
• The center of a axon is called axoplasm, which
transports nutrients to the entire nerve
• The cell wall of the nerve is a lipo-protein
membrane with channels through it, modified by
sodium (Na+), potasium (K+) calcium (Ca++),
magnesium (Mg++) and other cations
• When a nerve discharges, due to stimulation of
the cell body, the channels change, and allow
Na+ into the axon, and K+ goes out
• Then a pump in the axon (Na+/K+ ATPase) moves
the cations back to original position
5. Anatomy of a Nerve IV
• The transient flow of Na+ into the axon, and K+ out
of the axon creates a electron flow along the axon
• This flow moves a signal electrically along the nerve
• This electrical signal reach the end of the nerve and
causes the release of the chemicals- the
neurosynaptic transmitters
• So a sensory nerve receives stimulation, either
mechanical or chemical, and transmits this
information electrically, along the axon, until it
reaches the end where it then converts it to a
chemical message again.
6. Anatomy-Peripheral Receptors
• Meissner's corpuscles are mechanoreceptor, in
the skin, which senses vibration, and light touch
• Pacinian corpuscles in the skin sense pressure
• Free Nerve endings have no myelin-so sensitive
• Afferent Nervous System-carries sensory
messages to the brain- pain is one of these
• There are three major types of pain nerves
• A beta fibers have a moderate amount of myelin
• A delta fibers have some myelin
• C fibers – have no myelin or very little myelin
7. Electrical vs chemical transmission
• Once a peripheral pain receptor is stimulated,
this starts a series of events which allow the
message of pain to reach the cortex of the brain
• This transmission is electrical along the axon and
chemical at the end of the nerve with the
neurosynaptic transmitters
• Without pain information reaching the cortex of
the brain, there is no perception of pain
• Pain relief is directed to preventing the message
of pain from reaching the cortex of the brain
8. Blocking the Pain Message
• Modify the electrical transmission in the axon
using anti-convulsants to stabilize the membrane,
by hyper-polarizing the membrane, or put in
cations, like lithium (Li+), which interfere with
normal cation activity of Na+, K+, Mg++ and Ca++
• Modify the release of neurosynaptic transmitters,
by enhancing those which produce pain relief,
and blocking those which transmit the message
of pain
• Stop cortical reception by electrical stimulation of
the sensory cortex or cutting out the cortex
9. Electrical & Chemical Transmission
• Acute pain is a fast transmission process, i.e. the
time from stimulation ‘til the message reaches
the brain is short
• Chemical transmission of a message at the
synapse is much slower than the electrical
transmission along the axon
• Acute pain is a fast pain pathway, with only 2
synapses. You want fast transmission when your
hand is In a fire. Pain tells you something is wrong
• Chronic pain is a slow pain pathway with many
synapses. It tells you something is still wrong
10. The Value of Spinal Synapses
• Pain information from sensory nerves enters
lamina III and V of the posterior horn of the
spinal cord, and synapse there.
• Wide dynamic range neurons modify this
information, regulating intensity
• Neuronal plasticity allow pain to continue to
exist at a spinal level, even after the source of
the original source of the pain is removed
• Crossing pain fibers in the spinal cord help
localize the location of the pain
11. Neurochemical and Anatomical Pathway For
Acute Pain-Fast Transmission
(2 synapses)
• Neo-Spino-Thalamic Tract (Acute Pain)
BRAIN
Spinal Cord sends message to the brain
Peripheral Sensory Nerve
(A beta, A delta, C fibers)
carries the message to the
spinal cord
Mechano or
pressure receptor
(Meisner or
Pachinian
corpusule) or
chemoreceptor (C
fiber) in a finger
Synapses (Chemically mediated)
Thalamus
Somato-
Sensory
Cortex
(Pain)
Chemical synapses lends specificity, and a site to manipulate pain perception
12. Neurochemical and Anatomical Pathway For Chronic Pain
(Many areas of the brain are involved and multiple
synapses- so this is slower transmission)
• Palleo-Spino-Thalamic Tract (Chronic Pain)-Slow
BRAIN
Spinal Cord sends message to the brain
Peripheral Sensory Nerve
(A beta, A delta, C fibers)
carries the message to the
spinal cord
Mechano or
pressure receptor
(Meisner or
Pachinian
corpusule) or
chemoreceptor (C
fiber)
Synapses (Chemically mediated)
Reticular
Activating
System
Thalamus
Hypothalamus
Limbic
System
Somato-
Sensory
Cortex (Pain)
Chemical transmission is slower than electrical transmission
13. Other Neurosynaptic transmitters in
the Brain
• Biogenic Amines: dopa, dopamine, nor-
epinephrine, epinephrine, serotonin.
• 35% of neurosynaptic transmitters-GABA
• 10% of neurosynaptic transmitters-Ach
• 2%-5% of all neurosynaptic transmitters in the
brain use biogenic amines
• 95% of biogenic amines transmitters are in the
hypothalamus and limbic system.
• 90% of encephalins are in limbic system
14. Neurochemical and Anatomical
Pathway For Chronic Pain
• Palleo-Spino-Thalamic Tract (Chronic Pain)-slow
BRAIN
Spinal Cord
Peripheral Sensory Nerve
(A beta, A delta, C fibers)
Mechano or
pressure receptor
(Meisner or
Pachinian
corpusule) or
chemoreceptor (C
fiber)
Sleep caused by serotonin
Reticular
Activating
System
Thalamus
Hypothalamus
Limbic
System
Somato-
Sensory
Cortex (Pain)
Encephalin, and 95% of biogenic amines exist in the
same area
15. The Synapse and Neuro-Synaptic
Transmitters (NST)
• Pre-synaptic Synapse Post-synaptic
• MAO and COMT break down NST
• 1)Transmitters are released from nerve A, 2) bind to the receptors, on nerve B, causing nerve
B to fire, and 3) then reuptake occurs to stop the action of the NST.
Post-Synaptic
Receptor Sites
Nerve transmission
of information
Nerve transmission
of information
Neuro-synaptic
transmitter (NST)
1
2
3
1
COMT
MAO
BA
16. How medications works on the synapse
• Pre-synaptic Synapse Post-synaptic
• Increase activity by
1)Cause Release 2) Stop Reuptake 3)Mimic NST
Post-Synaptic
Receptor Sites
Nerve transmission
of information
Nerve transmission
of information
Neuro-synaptic
transmitter
2
3
1
I
17. How medications works on the synapse
• Pre-synaptic Synapse Post-synaptic
• Decrease activity by
1) Stop Release 2) Increase Breakdown 3)Block NST
Post-Synaptic
Receptor Sites
Nerve transmission
of information
Nerve transmission
of information
Neuro-synaptic
transmitter
3
1
COMT
2
2
18. The Axon and Cell Body
• Transmission along a nerve, causing Na+ influx
K+
Na+
Axoplasm
Extracellular fluid
Na+/K+ channelK+ comes out,
Na+ goes in
Pumps Na+ out,
and K+ back in
This entire process generates a current (90uV) across cell membrane
19. Mechanism of Action of Various Drugs
• Medication can work at the synapse, which is very
specific (as an example, there are 20 subtypes of
serotonin receptors)
• Medication can work on the nerve membrane
(more non-specific).
• Medication can inhibit natural transmitters by
blocking release of transmitters or blocking
receptor sites,
• Medication can release transmitters, or block
reuptake pre-synaptically, so the transmitter
remains on a receptor longer
20. Psychological Factors
Acute Pain- impacted by psychological states
Acute Pain –is reduced by enkephlins, ACTH, and
endorphins released at time of stress.
Chronic Pain- less influenced by psychological
states, but causes depression and anxiety
Chronic Pain goes through 4 stages
No psychological change-expecting to get well
Somatic concern and anxiety when not getting well
Depression when realizing that pain is chronic
Adjustment to the deficit
21. Other Factors Influencing Acute Pain
• Pain tells a person “something is wrong with your
body”
• If the cause of pain is obvious, like your finger in a
fire, you know to withdraw your finger from a fire
• But when a blister forms, this can not only
produce pain, but also fear of the unknown
• Will the skin fall off? How long will the pain last?
• Will the pain spread to my hand? Will this get
infected? Will I lose sensation in the finger?
• Fear of the unknown produces anxiety
22. Psychological Issues of Acute Pain
• The “psychological state” of anxiety worsens the
perception of pain
• When someone is in an accident, with a serious
injury, the anxiety over the loss of the use of an
arm or leg is overwhelming.
• Education about the body, and reducing the
“anxiety about the unknown” can be reduced by
education of the injured person
• Convert “anxiety” into a realistic “fear” by
education about the body,
• Tell the truth. Avoid phony reassurances
23. Modification of Acute Pain
• Assess the type of pain which is present
• See the next slide for an overview method
• The next slide has only suggestions. It is not a
substitute for clinical judgment on the scene
• Tell the patient what you are finding, and what
you think the source of the pain might be
• Educate the patient, with drawings of the body
• Give the patient odds about outcome—”The
medical literature says about 90% of patients
have no residual problems” etc.
24. Mechanism of Pain
• Pain occurs when tissue damage occurs, due to
excessive heat, cold, stretching, pressure, cell
disruption from a cut, or chemical irritation
• Different types of pain are caused by damage to
the bone, blood vessels, skin, muscle or nerve
• Cellular damage causes the release of a series of
inflammatory chemicals
• The chemical irritation creates an electrical
discharge from the sensory nerves which then
leads to a series of neuronal transmissions to the
brain
25. Damage to Different Tissue Feels Differently
• NOTE: Damage to different tissue feels differently
• Pain can be constant or intermittent
• Damage to nerves feels like a burning pain, or
pins and needles
• Damage to bone feels like a deep achy pain
• Damage to muscles feels like a cramp or spasm
• Damage to blood vessels feels like a throbbing,
pounding pain
• Damage to skin feels like a burning, sharp pain
• Each type of pain responds to best a different
type of medication
26. Methods to Assess Pain
Burning Throbbing Sharp Dull Aching Spasm
Constant This
suggest
nerve
irritation –
chemical,
metabolic,
or viral
This suggest
vascular
compression
-look for the
source of
the
compression
This
suggests
entrap-
ment of
sensory
nerves in
skin
Suggest a
compres-
sion,
tumor,
deep
bruise, or
infection-
get bone
scan
Deep achy
pain
suggests
bone
bruise or
fracture
get bone
scan
This suggest
nerve
entrapment,
or
compression
look for the
source of
compression
Intermittent This would
be
associated
with spasm
of muscle
or blood
vessel-
treat those
sources
This suggest
vascular
spasm- use
medications
which
reduce
spasm like
Imitrex
Seen in
visceral
spasm,
such as
Crohn’s
disease-
use anti-
spasmotic
Pain only
with use-
sprain or
strain due
to
damage
to tendon
or
ligament
This
suggests
inflama-
tory
process-
use non-
steroidal
anti-
inflama-
tory drugs
This
suggests
muscle
spasm-use
muscle
relaxants
27. Overview of the Nervous System
Organization
Efferent -motor autonomicAfferent –sensory
Brain
Spinal Cord
Sympathetic Parasympathetic
Alpha Beta Muscaric Nicotinic
Alpha 1 Alpha 2 Beta 1 Beta 2
MusclesSkin
28. Systems Associated with Pain
• Motor Nerves leave the brain to the spinal cord
• They emerge from the spinal cord as nerve roots
• The nerve roots then mix in either the brachial or
lumbar plexus, and emerge as mixed motor
sensory nerve, with specific names such as the
ulnar nerve or sciatic nerve
• As an example, the sciatic nerve has contributions
from the L1-L2, L2-L3, L3-L4,L4-L5, and L5-S1 nerve
roots, which mix in the lumbar plexus, and create
the sciatic nerve, a mixed motor-sensory nerve
• These mixed nerves have motor and sensory fibers
29. Mixed Motor-Sensory Nerve in Cross-section
The motor fibers come
from the brain to the
muscle. The sensory
nerves come from the skin,
muscle and bone, and go
to the brain. The sensory
fibers are the A beta, A
delta and C fibers. The
mixed motor-sensory nerve
arises after the lumbar or
brachial plexus, and is a
named nerve, like the ulnar
nerve, sciatic nerve or tibial
nerve. The sensory nerve
fibers carry messages to
the brain, and the motor
nerve carries message
from the brain to the
muscle.
Motor nerves have thick myelin, and sensory nerve have less myelin. Both types of
nerves are wrapped together in a bundle, which is a mixed motor-sensory nerve. .
30. Types of Sensory Nerve Fibers
• The sensory fibers are sparsely myelinated, or
unmyelinated
• The sensory fibers are the A beta, A delta and
C fibers
• C fibers are unmyelinated unlike most
other fibers in the nervous system.[1]
This lack
of myelination is the cause of their
slow conduction velocity, which is on the
order of no more than 2 m/s.[1]
C fibers are on
average 0.2-1.5 μm in diameter.[1]
Purves, Dale; et.al (2004). Neuroscience. Massachusetts: Sinauer Associates, Inc
31. C Fiber Activity
• C fibers are considered polymodal because
they can react to various stimuli. They react to
stimuli that are thermal, or mechanical, or
chemical in nature. C fibers respond to all
kinds of physiological changes in the body. For
example, they can respond to hypoxia,
hypoglycemia, hypo-osmolarity, the presence
of muscle metabolic products, and even light
or sensitive touch. C fiber receptors include
the following functions
Purves, Dale; et.al (2004). Neuroscience. Massachusetts: Sinauer Associates, Inc
32. Functions of C-Fibers
• C fiber nociceptors
– responsible for the second, burning pain
• C fiber warming specific receptors
– responsible for warmth
• ultra-slow histamine-selective C fibers
– responsible for itch
• tactile C fibers
– sensual touch
• C mechano- and metabo- receptors in muscles or joints
– responsible for muscle exercise, burn and cramps
33. A -delta Fiber Activity
• Because of their higher conduction velocity,
Aδ fibers are responsible for the sensation of
a quick shallow pain that is specific on one
area, termed as first pain. They respond to a
weaker intensity of stimulus. C fibers respond
to stimuli which have stronger intensities and
are the ones to account for the slow, but
deeper pain, and spread out over an
unspecific area
Purves, Dale; et.al (2004). Neuroscience. Massachusetts: Sinauer Associates, Inc
34. Spinal Connections
• C fibers synapse to “second-order
projection neurons” in the spinal cord at
the upper laminae of the dorsal horn in
the substantia gelatinosa. The second-
order projection neurons are of the wide
dynamic range (WDR) type, which
receive input from both nociceptive
terminals as well as myelinated A-type
fibers.
• Baron, Ralph (2006). "Mechanisms of Disease: neuropathic pain—a clinical
perspective". Nature Clinical Practice Neurology 2.
35. Spinal Synapses
• After repeated stimulation, WDR (wide
dynamic range) neurons, in the substania
gelatenosa, experience a general increase in
excitability
• C fibers cause central sensitization of the
dorsal horn in the spinal cord in response to
their hyperactivity.
• Sensitized C fibers release glutamate
• Glutamate interacts with the
postsynaptic NMDA receptors, which creates
the sensitization of the dorsal horn.
36. Various lamina of the dorsal horn
I-V are sensory laminae.
Synapses occur here.
Various nuclei, which are a
collection of cell bodies,
which give rise to axons
37. Pain Connections After the Spine
• The second-order neurons ascend to
the brain stem and thalamus in
the ventrolateral, or anterolateral, quadrant
of the contralateral half of the spinal cord,
forming the spinothalamic tract. The
spinothalamic tract is the main pathway
associated with pain and temperature
perception, which immediately crosses the
spinal cord laterally. This crossover feature is
clinically important because it allows for
identification of the location of injury.
• Purves, Dale; et.al (2004). Neuroscience. Massachusetts: Sinauer Associates, Inc
38. Pathway of chronic pain-Spine to Brain
• Central sensitization of the dorsal horn neurons that is
evoked from C fiber activity is responsible for temporal
summation of “second pain” (TSSP). This event is called
‘windup.’Windup is associated with chronic pain and
central sensitization. Functional MRIs show common areas
activated by the TSSP responses which include
contralateral thalamus, anterior and posterior insula, mid-
anterior cingulate cortex, and supplemental motor
areas. TSSP events are also associated with other regions of
the brain that process functions such as somatosensory
processing, pain perception and modulation, cognition, and
pre-motor activity in the cortex.
(1)Staud,Roland;et.al(2007)."BrainactivityrelatedtotemporalsummationofC-fiberevokedpain".Pain(1-2ed.)129(1–2):130–142.
39. Activity in the Brain
• Pain transmission reaches a variety of cells of
the lamina 1 of the cortex of the brain
• There are different cell types in this layer
• These varying neurons are responsible for the
different feelings we perceive in our body
• They can be classified by their responses to
ranges of stimuli
• The brain uses the integration of these signals
to maintain regulation of the body, by positive
or negative feedback, like a thermostat