This document discusses nevral mechanosensitivity and neurodynamic testing. It provides definitions for concepts like hyperalgesia, secondary hyperalgesia, allodynia, and wind-up. It also discusses how to perform nerve palpation and quantitative sensory testing in clinical practice. The importance of communicating findings to patients through narratives, metaphors, addressing their beliefs, and creating meaning is emphasized.
Entrapment Neuropathies in Upper Limb.pptxNeurologyKota
This presentation is about the entrapment syndrome of upper limb giving an insight regarding diagnosis clinically as well as electrophysiologically and
its management.
Take home message
Acute pain is a symptom, tell us that there is something wrong in our body.
Chronic pain is a disease entity and that must be treated differently to acute pain.
Since chronic pain is biopsychosocial phenomenon it must be treated by multidisciplinary team with multidisiplinary approach.
Definition n classification •Pathophysiologyof pain. •Physiological Effects of pain. •Pharmacological & non-pharmacological methods of analgesia. •Principles of pain management.METHODS OF CONTROLLING METHODS OF CONTROLLING
Non-pharmacological Preoperative counseling TENS Acupuncture
Pharmacological Opioids •Im •IV infusion •IV PCA Local anaesthetics: •Local Infiltration •Nerve Blocks •Epidural Blocks NSAIDS •IM •IV infusion •IV PCA
NON-PHARMACOLOGICAL METHODS PRE-OP COUNSELLING: Well informed patients about: •Nature of operation •Nature of post operative pain •Methods of analgesia available
Cope better with Post –op Pain
NON-PHARMACOLOGICAL METHODS TENS (Trans Cutaneous electric nerve stimulation)
Stimulates afferent myelinated (A-beta) nerve fibers at 70hz
Inhibitory circuits within sp cord activated
Nerve impulse transmission reduced
Maximum benefit in neurogenic pain
PHARMACOLOGICAL METHODS OPIODS •Activate opiodreceptors within the CNS •Reduce transmission of nerve impulses by modulation in the dorsal horn
PHARMACOLOGICAL METHODS
LOCAL ANAESTHETICS –Blocks the conduction of nerve impulses –Can be given with adrenaline because •Decreases absorption of L.A allowing larger doses •Also acts on alpha 2 receptors which potentiates analgesic effect
PHARMACOLOGICAL METHODS
NASIDS –Blocks synthesis of PG’s –Only suitable for miledto moderate pain
PRINCIPLE OF MANAGEMENT OF PAIN •Pre-emptive analgesia •Balanced or combination analgesia •Analgesia ladder
PHARMACOLOGICAL METHODS
Balanced Analgesia –NASID are used in conjunction with opioids. –Reduces amount of opioids –Reduces side affect of opioids,ASSESMENT OF PAIN •Observe the behaviour of the patient •Monitor analgesic requirement of the patient –Visual Analogue Score( VAS )
–Verbal Rating Score ( VRS ) •None •Mild •Moderate •severe
Entrapment Neuropathies in Upper Limb.pptxNeurologyKota
This presentation is about the entrapment syndrome of upper limb giving an insight regarding diagnosis clinically as well as electrophysiologically and
its management.
Take home message
Acute pain is a symptom, tell us that there is something wrong in our body.
Chronic pain is a disease entity and that must be treated differently to acute pain.
Since chronic pain is biopsychosocial phenomenon it must be treated by multidisciplinary team with multidisiplinary approach.
Definition n classification •Pathophysiologyof pain. •Physiological Effects of pain. •Pharmacological & non-pharmacological methods of analgesia. •Principles of pain management.METHODS OF CONTROLLING METHODS OF CONTROLLING
Non-pharmacological Preoperative counseling TENS Acupuncture
Pharmacological Opioids •Im •IV infusion •IV PCA Local anaesthetics: •Local Infiltration •Nerve Blocks •Epidural Blocks NSAIDS •IM •IV infusion •IV PCA
NON-PHARMACOLOGICAL METHODS PRE-OP COUNSELLING: Well informed patients about: •Nature of operation •Nature of post operative pain •Methods of analgesia available
Cope better with Post –op Pain
NON-PHARMACOLOGICAL METHODS TENS (Trans Cutaneous electric nerve stimulation)
Stimulates afferent myelinated (A-beta) nerve fibers at 70hz
Inhibitory circuits within sp cord activated
Nerve impulse transmission reduced
Maximum benefit in neurogenic pain
PHARMACOLOGICAL METHODS OPIODS •Activate opiodreceptors within the CNS •Reduce transmission of nerve impulses by modulation in the dorsal horn
PHARMACOLOGICAL METHODS
LOCAL ANAESTHETICS –Blocks the conduction of nerve impulses –Can be given with adrenaline because •Decreases absorption of L.A allowing larger doses •Also acts on alpha 2 receptors which potentiates analgesic effect
PHARMACOLOGICAL METHODS
NASIDS –Blocks synthesis of PG’s –Only suitable for miledto moderate pain
PRINCIPLE OF MANAGEMENT OF PAIN •Pre-emptive analgesia •Balanced or combination analgesia •Analgesia ladder
PHARMACOLOGICAL METHODS
Balanced Analgesia –NASID are used in conjunction with opioids. –Reduces amount of opioids –Reduces side affect of opioids,ASSESMENT OF PAIN •Observe the behaviour of the patient •Monitor analgesic requirement of the patient –Visual Analogue Score( VAS )
–Verbal Rating Score ( VRS ) •None •Mild •Moderate •severe
- 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
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.
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.
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
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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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.
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Evaluation of antidepressant activity of clitoris ternatea in animals
Det perifere Nervesystmet 2019 B
1. 03.02.2019
1
Mekanosensitivitet Hva er egentlig nevral mekanosensitivitet?
Mecahnosensitivity is thought to be a normal
protective mechanism that allows the nerves to
respond to the mechanical stresses imposed
upon them during movement
Bread & Butter - Neurodynamics
Nevrodynamiske tester
Er det i det hele tatt biologisk plausibelt ?
Mekanosensitivitet Nervepatologi BPS Modell
Nervepatologi
BPS Modell
Mekanosensitivitet Validitet av de nevrodynamiske testene
NTPT Overeks Medianus Radialis Ulnaris
Nee 2012 Cx radikulopati (svak evidens) Cx radikulopati (ingen evidens) Case study på cubital syndrom
Ingen hjelp ved CTS
Appelby – Albrecht 2016 Cx radikulopati (sterk evidens)
både for +ve og -ve
Cx radikulopati (svak evidens)
både for +ve og -ve
Cx radikulopati (sterk evidens)
både for +ve og -ve
Koulidis 2019 Systematic
Review
Validitet Testen
Gull
Standard
- Reproduksjon av symptomer
- Strukturell differensiering
- Falske positive hos normale
2. 03.02.2019
2
Nevrodynamikk i praksis
• NTPT
• Utgangsstilling ?
• Nakkeposisjon ?
• Hva er en positiv test ?
• Hva tester man egentlig?
- tensjon? strekk? lengde? smerte? CNS?
Butler DS (2001) The Sensitive Nervous System, Melbourne, Aus
Grunnleggende prinsipper
• Fortell pasienten akkurat hva du skal gjøre og hva de skal gjøre
• Du må ha resonnert deg frem til at du ønsker å gjøre testen før du
tester – ingen kliniske tester må gjøres på autopilot
• Når du kan, test aktivt først (anamesen?)
• Føl for motstand, smerte eller spenning
• Start posisjon må være konstant
• Smerterespons må defineres
• Do it well and properly, if not, dont fucking bother, do something else
(Helen Slater, personlig kommunikasjon 2006)
Quick test – screening – aktive prøver
Medial biasRadial bias
NTPT 1 - brachial plexus / medianus
Test for hele plexus C5- T1, med bias for medianus
NTPT 3 ulnaris NTPT 2 radialis
3. 03.02.2019
3
Straight Leg Raise L3-S2 SLUMP Test..L4-S2
Alternativ SLUMP Femoralis nerven L2-L4
Nerve palpasjon et forglemt verktøy for vurdering av
mekanosensitivitet i nervesystemet
This study provides support for
the use of nerve palpation in
clinical examination, with
evidence of excellent reliability
and diagnostic accuracy as well
as validity of manual palpation
for three lower limb nerve sites.
Palpasjon av nerverøttene ”Door bell”
• Palper anteriore (C4),C5,C6,(C7)
• Landmark: C6 bredest / enklest
• C8 og Th1 ikke mulig å palpere,
men komplett plexus er mulig
5. 03.02.2019
5
Nervepalpasjon
• Fibularis nerven
Nervepalpasjon
• Ischias / Sciatic nerven
Nervepalpasjon
• Femoralis nerven L1 – L3
Perifere Nerver verdt å tenke over #triggerpunkter
Hvor ofte opplever du dette i klinikken?
Hyperalgesi
Sekundær
hyperalgesi
Allodynia Wind up
6. 03.02.2019
6
Og hva betyr det egentlig ?
Hyperalgesi
Hyperalgesia (/ˌhaɪpərælˈdʒiːziə/ or /-siə/;
'hyper' from Greek ὑπέρ (huper, “over”), '-
algesia' from Greek algos, ἄλγος (pain)) is an
increased sensitivity to pain, which may be
caused by damage to nociceptors or peripheral
nerves and can cause hypersensitivity to
stimulus, stimuli which would normally not be
cause for a pain reaction
Og hva betyr det egentlig ?
Sekundær
hyperalgesi
Secondary hyperalgesia is a centrally-mediated
condition that may occur due to injury or disease in
an area of the body. Secondary hyperalgesia is
defined as an increase in pain sensitivity when a
noxious stimulus is delivered to a region
surrounding, but not including, the zone of injury
(increased pain sensitivity outside of the area of
injury or inflammation). Secondary hyperalgesia is
due to central neuron sensitization and requires
continuous nociceptor input from the zone of
primary hyperalgesia for its maintenance.
Og hva betyr det egentlig ?
Allodynia
Allodynia means pain due to a stimulus that does not
normally provoke pain and is mostly used as a synonym
for “Touch evoked hyperalgesia” (e.g., pain evoked by
stroking the skin with a wisp of cotton wool). This kind of
stimulation does not excite nociceptors – even in their
sensitized state. It excites sensitive mechanoreceptor
units belonging to “another sensory modality.” It typically
occurs in an inflamed area, but also in a surrounding
secondary zone, and therefore has been attributed to
altered central synaptic processes.
Og hva betyr det egentlig ?
Wind
up
Abnormal Temporal Summation (“wind-up”):
Repeated stimuli (e.g., touch) delivered in rapid
succession to the skin are normally felt
individually, or as vibration. Patients with
neuropathic pain sometimes report that light
touch stimuli repeated about once per second
cause a sensation that builds up abnormally into
an intensely painful crescendo.
Kvantitativ Sensorisk Testing
SENSORISK PROFILERING
7. 03.02.2019
7
Hvordan kan vi gjøre det i klinikken?
Berøring Vibrasjon Skarp Trykk
Hvorfor bruke tid på dette ?
• Currently pain diagnosis is
primarily based on signs and
symptoms, sometimes in
combination with clinical evi-
dence of structural/tissue damage.
However, this diagnosis provides
limited information regarding the
mechanisms underlying the pain
experience of the individual
patient. It has been suggested that
pain diagnosis and management
should be mechanism-based [49].
Hvordan formidle funn til pasienter?
• Historien – the narrative
• Kommunikasjon – pitching
• Metaforer – linken
• Beliefs – for å kunne utfordre
• Mening – gi mening til plagene
• Refleksjon – gi mening for oss
• Dialog – på samme nivå
• Compliance ??
Nevrodynamiske tester & sensorisk profilering
Diagnostikk
Mening
Beliefs
THIS IS
PHYSIO
Smerte
mekanismer