Supracondylar fractures of the humerus are the most common elbow injuries in children, accounting for about 60% of cases, and involve the area just above the elbow. These fractures are classified into 3 types - Type I is nondisplaced, Type II is displaced with an intact posterior cortex, and Type III is completely displaced with no cortical contact. Treatment involves closed or open reduction and pin fixation or casting depending on the fracture type and stability.
Posterolateral corner injuries of knee joint Samir Dwidmuthe
Missed posterolateral corner injuries of knee joint is a common cause for failure of ACL and PCL reconstruction only next to malpositioned tunnels.
Isolated PLC injuries are uncommon, making up <2% of all acute knee ligamentous injuries. Covey JBJS 2001
Incidence of PLC injuries associated with concomitant ACL and PCL disruptions are much more common (43% to 80%). Ranawat JAAOS 2008
A recent (MRI) analysis of surgical tibialplateau fractures demonstrated an incidence of PLC injuries in 68% of cases. Gardner JOT 2005
Take home message
PLC injuries to be ruled out in every case of ACL& PCL rupture.
Neurovascular integrity to be checked in every case.
Grade I & II can be managed conservatively.
Grade III Acute- Repair.
Grade III Chronic- Anatomic PLC recon.
Beware of varus knee alignment.
Posterolateral corner injuries of knee joint Samir Dwidmuthe
Missed posterolateral corner injuries of knee joint is a common cause for failure of ACL and PCL reconstruction only next to malpositioned tunnels.
Isolated PLC injuries are uncommon, making up <2% of all acute knee ligamentous injuries. Covey JBJS 2001
Incidence of PLC injuries associated with concomitant ACL and PCL disruptions are much more common (43% to 80%). Ranawat JAAOS 2008
A recent (MRI) analysis of surgical tibialplateau fractures demonstrated an incidence of PLC injuries in 68% of cases. Gardner JOT 2005
Take home message
PLC injuries to be ruled out in every case of ACL& PCL rupture.
Neurovascular integrity to be checked in every case.
Grade I & II can be managed conservatively.
Grade III Acute- Repair.
Grade III Chronic- Anatomic PLC recon.
Beware of varus knee alignment.
paediatric injuries around the elbow
supracondylar elbow injuries
pulled elbow in paediatric age r
radiological signs around elbow in supracondylar fracture humerus
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
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
- 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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
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.
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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
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- 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
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.
2. Distal Humerus Anatomy
Medial epicondyle
proximal to trochlea –
Lateral epicondyle
proximal to capitellum
–
Radial fossa –
accommodates margin of
radial head during flexion
Coronoid fossa –
accepts coronoid process of
ulna during flexion
3. Supracondylar Fractures of Humerus
It is # which involves the lower end of the humerus usually
involving the thin portion of the humerus through
Olecranon fossa or
Just above the fossa or
Metaphysis
Most common elbow injuries in children.
Makes up approximately 60% of elbow injuries.
Becomes uncommon as the age increases.
4. General considerations
Incidence of supracondylar #:
a) Age : peak age : 5-7 yrs
Average age : 6.7 yrs
b) Sex : Boys > Girls (Earlier)
Boys = Girls (Latest Trends)
c) Side : Left > Right
( Non dominant > dominant )
d) Nerve injuries : 7% - Median> Radial > Ulnar
e) Vascular injuries : 1%
f) Open injuries : < 1%
5. g) Cause of #
Fall from height 70% ----- children > 3 yrs
Fall from bed children < 3 yrs
Non accidental injury ( Child abuse) children < 15 months
h) Associated #s
Distal radius > Scaphoid > Proximal humerus >
Monteggia
i) Clinical types
Extension type: 98%
Flexion type : 2%
6. Mechanism of injury
For Extension type of
SC # humerus
Fall on outstretched hand
Elbow hyper extended
Fore arm – pronated or
supinated
7. Mechanism of injury
For Flexion type
of SC # humerus
Fall directly on the
elbow rather than
out stretched hand
8. Radiographic anatomy of distal
Humerus
What are the radiographic views:
Antero posterior
Lateral
Oblique
Axial ( jones view )
9. What to look for in
AP View----- Baumann`s angle
Humero ulnar angle
Metaphysio diaphyseal angle
10. Radiographic Anatomy
Baumann’s angle is formed by a line
perpendicular to the axis of the humerus, and a
line that goes through the superior part of
physis of the capitellum.
There is a wide range of normal for this value,
and it can vary with rotation of the radiograph.
The Baumann angle is good measurement of
any deviation of distal humerus`s angulation
In this case, the medial impaction and varus
position alters the Bauman’s angle.
11. Radiograph Anatomy/Landmarks
Anterior Humeral
Line:
This is drawn along
the anterior humeral
cortex.
It should pass
through the junction
of anterior &
middle 3rd of the
capitellum.
12. Radiograph Anatomy/Landmarks
The capitellum is
angulated anteriorly
about 30 degrees.
The appearance of the
distal humerus is similar
to a hockey stick.
30
13. Radiograph Anatomy/Landmarks
The physis of the
capitellum is usually
wider posteriorly,
compared to the
anterior portion of
the physis
Wider
15. Radiographic Classification of SC #s
Based on X- Ray appreance # displacement Gartland
described 3 types:
Type – I : Undisplaced
Type – II : Displaced (posterior cortex intact)
Type –III : Displaced ( no cortical contact)
Posteromedial
Posterolateral
16. Type 1: Non-displaced
Note the non-
displaced fracture
(Red Arrow)
Note the posterior fat
pad (Yellow Arrows)
18. Type 3: Complete Displacement, with
No Contact between Fragments
19. Clinical signs & Symptoms
In most cases, children will not move the elbow if a fracture is present,
although this may not be the case for non-displaced fractures.
Swelling about elbow is a constant feature, develop within first few hrs.
S shaped deformity
Distal humeral tenderness
Anterior plucker sign +ve
21. Physical Examination
Neurologic exam is essential, as nerve injuries are common. In most
cases, full recovery can be expected
Neuro-motor exam may be limited by the childs ability to
cooperate because of age, pain, or fear.
Thumb extension– EPL (radial – PIN branch)
Thumb flexion – FPL (median – AIN branch)
Cross fingers - Adductors (ulnar)
22. Physical Examination
Nerve injury incidence is high, between 7 and 16 %
(median, radial and ulnar nerve)
Anterior interosseous nerve is most commonly injured nerve
In many cases, assessment of nerve integrity is limited , because children
can not always cooperate with the exam
Carefully document pre manipulation exam, as post manipulation
neurologic deficits can alter decision making
23. Physical Examination
Vascular injuries are rare, but pulses should always be
assessed before and after reduction
In the absence of a radial and/or ulnar pulse,
the fingers may still be well-perfused, because of the
excellent collateral circulation about the elbow
Doppler device can be used for assessment
24. Physical Examination
Thorough documentation of all findings is important. A
simple record of “neurovascular status is intact” is
unacceptable.
Individual assessment and recording of motor, sensory, and
vascular function is essential
Always palpate the arm and forearm for signs of compartment
syndrome.
25. Treatment
General principles:
Splinting elbow in comfortable position
20-30degrees of flexion of elbow, pending
Careful physical examination & X-ray evaluation.
Tight bandaging/ excessive flexion or excessive
extension should be avoided
Associated life threatening complications ( if any)
to be attended first.
26. Treatment of type – I #
Simple posterior long arm splint for 3-7days.
Elbow 60-90o flexion & Forearm neutral position.
Check X-ray after 3-7 days to document any displacement
or lack of it.
Splint converted to long arm cast if no displacement.
If displacement noticed # reduction done & cast applied or
pinning done.
27.
28. Duration of immobilisation 3-4wks.
No need for any physiotheraphy ( Generally )
Outcome: Predictablly excellent if alignment is
maintained during early healing.
Hence type – I #s requires careful
treatment &
follow up.
29. Treatment of type – II #
Good stability obtained after closed reduction.
Once satisfactory reduction achieved further management is
same as type – I.
If medial column collapse present then skeletal stabilisation
with 2 lateral pins is advocated.
Recent trends led to SELECTIVE PINNING for type – II #s
30. SELECTIVE PINNING
Closed reduction is done
Splinting in flexion
Non movable cuff & collar sling
Early careful X-ray follow up
If # displacement /angulation noticed
pin stabilisation is done .
31. Treatment of type – III #
Treatment involves management of skeletal
injuries & associated soft tissue injuries (if any).
Treatment of skeletal injury:
Reduction either closed or open
Stabilisation either with pins or cast
32. Technique of reduction (closed)
Traction – to restore length & alignment.
Milking maneuver -- if length & alignment
not restored by traction
Correction of medial/ lateral displacements.
Correction of rotational deformities.
Correction of posterior displacement by --
flexion reduction maneuver
Elbow held in hyper flexion.
Fore arm held in pronation – if distal fragment is
postero medially displaced,
Fore arm held in supination -- if distal fragment is
postero laterally displaced.
33.
34. Indications for open reduction
Open reduction is indicated to obtain alignment if
closed reduction is unsuccessful as with the following,
Button holing of the proximal fragment through
the anterior soft tissues ,
Interposition of the biceps ,
Interposition of the neurovascular structures .
An open reduction is also indicated if there is an open
fracture ,that requires irrigation and debridement .
35. ANATOMIC OR NEAR ANATOMIC
REDUCTION IS A PREREQUISITE FOR
SKELETAL STABILISATION
36. Skeletal stabilization after reduction
Skeletal stabilization after reduction is done either
with pins or cast
Now a days skeletal stabilization by casing is not done
as reduction maintenance is not achieved .
Generally skeletal stabilization is achieved by means of
passing pins across the fracture site .
37. Pin Fixation
Many children have anterior subluxation of the ulnar nerve
with hyperflexion of the elbow .
The medial pin can injury the ulnar nerve.
Some advocate 2 lateral pins to avoid injuring the median
nerve.
Some advocate usage of a small incission of size 1.5 cm
over the medial epicondyle and dissection is performed up
to the level of the medial epicondyle and the ulnar nerve
identified and protected and the medial pin applied
38. Medial pin placement :
this pin is placed directly through
the medial epicondyle , using the
opposite thumb to pull the soft
tissues posteriorly, thus
protecting the ULNAR
NERVE .
The pin is directed from
posteromedial to anterolateral
(10o posterior & 40o with shaft)
under c arm imaging with the
upper extremity fully
EXTERNALLLY ROTATED
39. If 2 lateral pins are used, they should be widely spaced at the
fracture site.
If the lateral pins are placed close together at the fracture site,
the pins may not provide much resistance to rotation and
further displacement.
BIOMECHANICAL STUDIES HAVE PROVED :
DIVERGENT PIN CONFIGURATION IS FAR
SUPERIOR CONSTRUCT WHEN COMPARED TO
THE PARALLEL PIN CONFIGURATION.
40. If pin fixation is used, the pins are
usually bent and cut outside the skin.
The skin is protected from the pins
by placing felt pad around the pins.
The arm is immobilized.
Pins can easily be removed
3 - 4 weeks later.
If adequate callus formation is
present, gentle range of motion
exercises are initiated.
In most cases, full recovery of
motion can be expected.
42. OR Setup
The monitor
should be
positioned across
from the OR table,
to allow easy
visualization of the
monitor during the
reduction and
pinning
43. The C-Arm
fluoroscopy unit can be
inverted, using the base
as a table for the elbow
joint.
The child should be
positioned close to the
edge of the table, to
allow the elbow to be
visualized by the c-arm.
Mobilize the image
intensifier but not
elbow
44. Complications
Immediate :
a) neurological
b) vascular
Early :
a) compartment syndrome
b) volkmann`s ischemia
Late :
a) mal union : cubitus varus / cubitus valgus
b) volkmann`s ischemic contracture
c) myositis ossificans
d) elbow stiffness