crush syndrome comprises of compartment syndrome and crush injury. its effects , pathophysiology and management is discussed. it will be helpful for post graduate orthopaedic theory exam
Seminar presentation by 4th year medical student of Lincoln University College, supervised by HRPZ Orthopedic's specialist.
Reference were from reliable medical websites and also from texttbook; Apley and Solomon's Concise System of Orthopaedics and Trauma, 4th Ed.
polytrauma lecture prepare by three medical student in Kerbala university / college of medicine department of surgery to presented as seminar
for download as ppt
https://drive.google.com/open?id=1bc3HMEeJyhrOwag-AvTFMmPVKi12O1PU
Dr. Ch VT- The topic describe about the general as well the the dental aspect too. The classification, clinical features and management. The dental conditions associated with haemorrhage and shock has been highlighted with their management
Seminar presentation by 4th year medical student of Lincoln University College, supervised by HRPZ Orthopedic's specialist.
Reference were from reliable medical websites and also from texttbook; Apley and Solomon's Concise System of Orthopaedics and Trauma, 4th Ed.
polytrauma lecture prepare by three medical student in Kerbala university / college of medicine department of surgery to presented as seminar
for download as ppt
https://drive.google.com/open?id=1bc3HMEeJyhrOwag-AvTFMmPVKi12O1PU
Dr. Ch VT- The topic describe about the general as well the the dental aspect too. The classification, clinical features and management. The dental conditions associated with haemorrhage and shock has been highlighted with their management
Haemorrhage and Shock: Relevance in Periodontal SurgeryNavneet Randhawa
Haemorrhage types and definition, shock types and definition, relevance of shock and haemorrhage in Periodontics, Methods to cope with haemorrhage and shock in Periodontal Surgery
Tumor lysis occurs when cancer cells release their contents into the blood stream, either spontaneously or following antineoplastic therapy leading to an influx of electrolytes and nucleic acids into the circulation.
The sudden development of hyperkalemia, hyperuricemia and hyperphosphatemia can have life-threatening end-organ effects on the myocardium, kidneys and CNS.
Hypocalcemia is a consequence of hyperphosphatemia in TLS.
Symptoms are variable from the metabolic derangements of TLS.
Shock is defined as a state of circulatory inadequacy with poor tissue perfusion resulting in generalized cellular hypoxia.
Circulatory inadequacy is due to a disparity between the circulating blood volume and the capacity of the circulatory bed.
The net effect of this disparity is inadequate exchange of oxygen and carbon dioxide between
the intra and extravascular compartments.
Similar to Crush syndrome/crush injury/its management (20)
CPR is a life saving technique useful in many emergencies in which someone breathing or heart beat has stopped.
Immediate CPR can double or triple chances of survival after cardiac arrest.
Elbow is the most common joint to dislocate in children. Posterior dislocation is most common.
Simple dislocations are those without fracture.
Complex dislocations are those that occur with an associated fracture
Distraction osteogenesis is a method of producing unlimited quantities of living bone directly from a special osteotomy by controlled mechanical distraction. The new bone spontaneously bridges the gap and rapidly remodels to a normal macrostructure for the local bone.
Madelung deformity is an abnormality of the palmar ulnar part of the distal radial physis in which progressive ulnar and volar tilt develops at the distal radial articular surface, with dorsal subluxation of the distal ulna.
cold abscess is seen in tuberculosis spine and it is a favorite question of post graduate examiners. all the sites and the tracking of cold abscess explained in detail
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- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
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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
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ASA GUIDELINE
NYSORA Guideline
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- 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
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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
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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
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Crush syndrome/crush injury/its management
1. CRUSH INJURY
DEFINITION
Crush syndrome is the systemic manifestation of rhabdomyolysis caused by prolonged
continuous pressure on muscle tissue. Crush syndrome includes crush injury and
compartment syndrome.
The diagnostic criteria for crush syndrome are:
• Crushing injury to a large mass of skeletal muscle.
• The sensory and motor disturbances in the compressed limbs, which subsequently
become tense and swollen.
• Myoglobinuria and/or hematuria.
• Peak creatine kinase (CK) > 1000 U/L.
Patients with nephrological problems are defined as crush injury and one of the following
characteristic:
- oliguria (urine output <400 ml/24 h),
- elevated levels of blood urea nitrogen (BUN) (>40 mg/dl),
- serum creatinine (2 mg/dl),
- uric acid (8 mg/dl),
- potassium (>6 mg/dl),
- phosphorus (> 8 mg/dl),
- decreased serum calcium (< 8 mg/dl)12
.
PATHOGENESIS AND CLINICAL FEATURES
The mechanism behind the crush syndrome is the leakiness of the sarcolemmal
membrane caused by pressure or stretching. A crush insult opens stretch-activated
channels in the muscle cell membrane and disrupts the Na/K transporter, allowing
calcium to move freely into the cell. As the sarcolemmal membrane is stretched, sodium,
calcium and water leak into the sarcoplasm, trapping extracellular fluid inside the
muscle cells (Table 1). In addition to the influx of these elements into the cell, the cell
releases potassium and other toxic substances such as myoglobin, phosphate and
urate into the circulation. The post-ischemic tissues have high concentrations of
neutrophil chemoattractants, leading to activation of neutrophils with release of
proteolytic enzymes and generation of free radical superoxide anions once perfusion is
restored.
2. The result
- hypovolemic shock,
- hyperkalaemia,
- metabolic acidosis,
- compartment syndrome, and
- acute renal failure.
Following systems are compromised
1.CVS: due to hyperkalemia. Hypocalcemia and hypovolemic shock
2.Respiratory: ARDS from inflammatory mediators and pulmonary edema which occurs
during treatment of ARF with excessive crystalloids
3.Hematolical: DIC due to systemic inflammation
4.Infection: due to fasciotomies
5.Renal: The ARF is caused by
- hypovolemia with subsequent renal vasoconstriction,
- metabolic acidosis
- nephrotoxic substances such as myoglobin, urate and phosphate.
6.Compartment syndrome
Compartment syndrome occurs after crush because of the uptake of fluid into muscle
cells contained within a tight compartment. Once compartment pressure exceeds capillary
perfusion pressure at about 30 mmHg, the tissue inside the compartment becomes
ischemic, and compartment syndrome develops.
3. Table 1: Flow of solutes and water across the sarcolemma in
rhabdomyolysis.
Consequences
Influx from extracellular compartment into muscle cells
Water, sodium
chloride, and
calcium
Hypovolemia and hemodynamic shock, prerenal
and acute renal failure; hypocalcemia, aggravated
hyperkalemic cardiotoxicity; increased cytosolic
calcium, activation of cytotoxic proteases
Efflux from damaged muscle cell
Potassium
Hyperkaliemia and cardiotoxicity aggravated by
hypocalcemia and hypotension
Purines from
disintegrating cell
nuclei
Hyperuricemia, nephrotoxicity
Phosphate
Hyperphsphatemia, aggravation of hypercalcemia,
and metastatic calcification, including the kidney
Lactic acid and
other organic acids
Metabolic acidosis and aciduria
Myoglobin
Nephrotoxicity, particularly with coexisting
oliguria, aciduria, and uricosuria
Thromboplastin Disseminated intravascular coagulation
Creatine kinase Extreme elevation of serum creatine kinase level
Creatinine Increased serum creatinine
APPROACH TO TREATMENT
• The treatment of crushed casualties should begin as soon as they are discovered.
Administer 2 amps of Sodium Bicarb just prior to extrication
• After airway, breathing, and circulation are assessed, if possible, the oxygen and
any obvious hemorrhage should be controlled.
4. • Intravenous access should be obtained, and the patient should receive fluid. The
most critical therapy in crush syndrome is early and aggressive fluid resuscitation
with 0.9% saline to restore circulating blood volume.
• Patient should be urine catheterized.
• Once in hospital, ECG, electrolytes, arterial blood gases, and muscle enzymes
should be measured.
• Administer 1 amp of Calcium Chloride if dysrhythmias continue
Fluid-resuscitation :
In the adult, a saline infusion of 1000-1500 ml/h should be initiated during extrication.
When a urine flow has been established, a forced mannitol-alkaline diuresis up to 8 L/d
should be maintained (urine pH greater than 6.5). Mannitol for three purposes, as an
osmotic diuretic, as a free-radical scavenger, and as an osmotic agent, to reduce the
swelling of the affected limb and decrease the risk of compartment syndrome.
Once the patient reaches hospital, 5% dextrose should be alternated with normal saline to
reduce the potential sodium load.
Alkalinization increases the urine solubility of acid hematin and aids in its excretion. This
may protect against renal failure and should be continued until myoglobin is no longer
detectable in the urine. In addition to its protective effect as an osmotic diuretic, mannitol
also is an effective scavenger of oxygen free radicals and may help reduce the reperfusion
component of this injury by this mechanism
The treatment of compartment syndrome is still the subject of debate, although evidence
would point to a trial of conservative management before fasciotomy.