Hip dysplasia describes a condition where the hip becomes partially or fully dislocated and/or the hip’s ball (femoral head) and socket (acetabulum) are misaligned. The condition primarily affects children but is also commonly diagnosed in adulthood. Treatment options range from simple bracing to extensive surgery and should be determined based on the patient’s age and the severity of their condition.
http://www.davidsfeldmanmd.com/specialties/hip-dysplasia
Hip dysplasia describes a condition where the hip becomes partially or fully dislocated and/or the hip’s ball (femoral head) and socket (acetabulum) are misaligned. The condition primarily affects children but is also commonly diagnosed in adulthood. Treatment options range from simple bracing to extensive surgery and should be determined based on the patient’s age and the severity of their condition.
http://www.davidsfeldmanmd.com/specialties/hip-dysplasia
Planning and performance of a total hip replacement for a case of neglected acetabular fracture. Surgery performed by Dr.A.K.Venkatachalam of www.hipsurgery.in.
Planning and performance of a total hip replacement for a case of neglected acetabular fracture. Surgery performed by Dr.A.K.Venkatachalam of www.hipsurgery.in.
A course Review from James Moore's Sporting Hip and Groin Course - February 2016 (Highly Recommend!). Following my attendance of the course, i performed my own research on 'The Sporting Hip and Groin' and incorporated this into the course review which I presented to the Sports Science and Medicine staff at Wigan Athletic FC. Further references available upon request.
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
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
pharmacotherapies for AUD.
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.
NVBDCP.pptx Nation vector borne disease control program
Developmental Dysplasia of Hip
1. By: Dr. Daniel Joseph Augustine
MOSC Medical College, Kolenchery
2. ANATOMY OF HIP JOINT
It is a multiaxial ball and socket joint designed for stability
and weight bearing.
Movements at the joint include flexion, extension,
abduction, adduction, medial and lateral rotation, and
circumduction.
ARTICULAR SURFACES:
Head of femur articulates with acetabulum of hip bone to
form hip joint
Head of femur- more than ½ a sphere, covered with
hyaline cartilage
Acetabulum- lunate shape –notch & fossa
3. Except for
the fovea,
the head of
the femur is
also
covered by
hyaline
cartilage
4.
5. LIGAMENTS OF HIP JOINT
1. Fibrous Capsule
2. Acetabular labrum
3. Ligaments:
Iliofemoral
Pubofemoral
Ischiofemoral
Ligament of the head of the femur
Transverse ligament of the acetabulum
6.
7. BLOOD SUPPLY
Obturator .A, two circumflex femoral .A, two gluteal.A
Retinacular br.
NERVE SUPPLY
Femoral .N
A/D of obturator .N, Accessory obturator .N
Nerve to Quadratus femoris
Superior gluteal .N
8.
9. STABILITY OF HIP JOINT
Depth of acetabulum
Tension and strength of ligaments & surrounding
muscles
Length & obliquity of the neck of femur
High degree of stability & mobility
10. DDH
DDH is defined as partial or complete
displacement of the femoral head from the
acetabular cavity since birth
It comprises a spectrum of disorders including
acetabular dysplasia without displacement,
subluxation and dislocation
Incidence: Females affected 7 times more
The left hip is more often affected than the right, B/L
involvement in 1 in 5 cases
11. Theories of Etiology
GENETIC- hereditary predisposition- generalized joint
laxity and shallow acetabula
HORMONAL – common in females, maternal relaxin,
high E & P levels – aggravate laxity
INTRAUTERINE MALPOSITION: extended breech -
favour D/L- “packaging d/o”
POST NATAL FACTORS: uncommon in Asia and India
12. PATHOLOGY
Dislocated at birth (classic DDH) or dislocatable after
birth (underlying laxity)
Following changes seen:
Femoral head is d/l upwards & laterally, epiphysis is small
& ossifies late
Femoral neck- excessively anteverted
Acetabulum shallow, ligamentum teres HP
Labrum may be folded into the cavity
Capsule is stretched, Hip muscles undergo adaptive
shortening
13. CLINICAL FEATURES
Detected at birth or soon after when child starts
walking
Birth –Routine screening for suggestive signs in every
newborns especially those at high risk
Early childhood- Asymmetry of groin fold, click,
limitation of movement
Older child- peculiar gait, no pain
14. CLINICAL TESTS
For infants :
Look for asymmerty of groin crease, limitation of movt
or audible click
Special tests include Barlow’s and Ortolani’s
15. Barlow’s Test
To assess DDH in neonate.
The Barlow maneuver identifes the unstable hip that is
in a reduced position that the clinician can passively
dislocate
Here the hip is started reduced and the test will
dislocate the hip
16.
17. Ortolani Test
Ortolani maneuver is performed following Barlow's
test to determine if the hip is actually dislocated
Here the hip is started dislocated and the test will
reduce the hip
18.
19. For Older Child:
Limitation of hip abduction, limb short & ext rotated
Higher buttock fold, asymmetrical thigh fold, lordosis
of the lumbar spine
Galeazzi’s sign: Hips flexed to 70o
,knees flexed-compare
level –lowering on affected side
Ortolani’s may be +ve
Trendelenberg’s Test is +ve
U/L D/L –trendelenberg gait
B/L D/L- waddling gait
20.
21. INVESTIGATIONS
Radiological Imaging
Ultrasonography has replaced radiography for
imaging hips in the newborn. Sequential assessment
allows monitoring of the hip during a period of
splintage.
Plain X-rays: X-ray examination is more useful after
the first 6 months, and assessment is helped by
drawing lines on the x-ray.
22. X-ray findings:
Delayed appearance of ossification center of head of
femur
Retarded development of ossification center
Sloping acetabulum
Lateral and upward displacement of ossification centre
of femoral head
A break in Shenton’s line.
26. Aim is to achieve reduction of the head into the
acetabulum and maintain it until the hip becomes
clinically stable and a “round” acetabulum covers the
head
Most cases closed reduction possible, else open
reduction done
MANAGEMENT OF DDH
27. Birth to 6m:
Where facilities for ultrasound scanning are
available, all newborn infants at risk are examined by
USG.
1. If hip is reduced and has a normal cartilaginous
outline, no treatment is required, observe for 3-6m
2. If acetabular dysplasia or hip instability, the hip is
splinted in a position of flexion and abduction and
USG done at intervals
28. Splintage
Splintage The object of splintage is to hold the hips
somewhat flexed and abducted maintainence of reduction)
Von Rosen’s splint is an H-shaped splint
The Pavlik harness is more difficult to apply but gives the
child more freedom while still maintaining position
3 golden rules of splintage are:
the hip must be properly reduced before it is splinted;
extreme positions must be avoided;
the hips should be able to move.
29.
30. If ultrasound is not available: nurse them in double
napkins or an abduction pillow for the first 6 weeks
and observe for first 6m for devpt of acetabular roof
31. Persistent Dislocation : 6-18m
The hip must be reduced – preferably by closed
methods but if necessary by operation – and held
reduced until acetabular development is satisfactory.
Closed reduction : suitable after 3m and is performed
under G/A with an arthrogram to confirm a concentric
reduction.
Failure to achieve concentric reduction should lead to
abandoning this method in favour of an operative
approach at approximately 1 year of age
32. Splintage
Held in a plaster spica at 60 degrees of flexion, 40
degrees of abduction and 20 degrees of internal
rotation.
After 6 weeks the spica is changed & stability assessed
If satisfactory, spica retained for 6w, then abduction
splint for 6m
If concentric reduction is not achieved, open operation
is done
33. The psoas tendon is divided; obstructing tissues are
removed and the hip is reduced.
It is usually stable in 60 degrees of flexion, 40 degrees
of abduction and 20 degrees of internal rotation. A
spica is applied and the hip is splinted
34. Persistent Dislocation 18m to 4y:
In older children, arthrography and OR preffered over CR
Traction: help to loosen the tissues and bring the femoral
head down opposite the acetabulum.
Arthrography: anatomy of hip, degree of acetabular
dysplasia
Acetabular reconstruction procedures- If there is marked
acetabular dysplasia, either a
Pericapsular reconstruction of the acetabular roof
(Pemberton’s operation)
An innominate (Salter) osteotomy
35. Salter’s osteotomy
Osteotomy of iliac bone, so that
acetabulum becomes more
horizontal and covers the head
Chiari’s Osteotomy: Iliac bone
transversly divided avobe
acetabulum & medially
displaced for additional depth
Pemberton’s osteotomy:
The roof is deflected over the
femoral head.
37. D/L in children >4yr:
U/L D/L in the child over 8 years often leaves the child
with a mobile hip and little pain. This justifies non-
intervention, though the child must accept the fact
that gait is distinctly abnormal.
B/L D/L the deformity –waddling gait – is symmetrical
and therefore not so noticeable;
Operation avoided unless the hip is painful or
deformity unusually severe.
38. COMPLICATIONS
Failed reduction: The acetabulum remains
undeveloped, the femoral head may be deformed, the
neck is usually anteverted and the capsule is thickened
and adherent.
AVN: ischaemia of the immature femoral head. It may
occur at any age and any stage of treatment and is
probably due to vascular injury or obstruction d/t
forceful reduction and hip splintage in abduction.
39. To avoid AVN
Traction should be gentle and in the neutral position;
Soft-tissue release (adductor tenotomy) should
precede closed reduction;
If difficulty is anticipated open reduction is preferable
40. Persistent D/L in Adults:
If disability is severe enough - total joint replacement.
Editor's Notes
The articular surfaces of the hip joint are: the spherical head of the femur; and
the lunate surface of the acetabulum of the pelvic bone.
The acetabulum almost entirely encompasses the hemispherical head of the femur and contributes substantially to joint stability. The nonarticular acetabular fossa contains loose connective tissue. The lunate surface is covered by hyaline cartilage and is broadest superiorly. Body_ID: P006120 Except for the fovea, the head of the femur is also covered by hyaline cartilage. Body_ID: P006121 The rim of the acetabulum is raised slightly by a fibrocartilaginous collar (the acetabular labrum). Inferiorly, the labrum bridges across the acetabular notch as the transverse acetabular ligament and converts the notch into a foramen. The ligament of the head of the femur is a flat band of delicate connective tissue that attaches at one end to the fovea on the head of the femur and at the other end to the acetabular fossa, transverse acetabular ligament, and margins of the acetabular notch .It carries a small branch of the obturator artery, which contributes to the blood supply of the head of the femur.
Three ligaments reinforce and stabilize the joint, and the iliofemoral, pubofemoral, and ischiofemoral ligaments. The iliofemoral ligament is anterior to the hip joint and is triangular shaped. Its apex is attached to the ilium between the anterior inferior iliac spine and the margin of the acetabulum and its base is attached along the intertrochanteric line of the femur. Parts of the ligament attached above and below the intertrochanteric line are thicker than that attached to the central part of the line. This results in the ligament having a Y appearance.
The pubofemoral ligament is anteroinferior to the hip joint. It is also triangular in shape, with its base attached medially to the iliopubic eminence, adjacent bone, and obturator membrane.
The ischiofemoral ligament is attached medially to the ischium, just posteroinferior to the acetabulum, and laterally to the greater trochanter deep to the iliofemoral ligament.
pages 489 - 492
The iliofemoral ligament is anterior to the hip joint and is triangular shaped. Its apex is attached to the ilium between the anterior inferior iliac spine and the margin of the acetabulum and its base is attached along the intertrochanteric line of the femur. Parts of the ligament attached above and below the intertrochanteric line are thicker than that attached to the central part of the line. This results in the ligament having a Y appearance.
The pubofemoral ligament is anteroinferior to the hip joint. It is also triangular in shape, with its base attached medially to the iliopubic eminence, adjacent bone, and obturator membrane.
The ischiofemoral ligament is attached medially to the ischium, just posteroinferior to the acetabulum, and laterally to the greater trochanter deep to the iliofemoral ligament.
Vascular supply to the hip joint is predominantly through branches of the obturator artery, medial and lateral circumflex femoral arteries, superior and inferior gluteal arteries, and first perforating branch of the deep artery of the thigh. The articular branches of these vessels form a network around the joint The hip joint is innervated by articular branches from the femoral, obturator, and superior gluteal nerves, and the nerve to the quadratus femoris.
Risk factors
such as family history, breech presentation, oligohydramnios
The test is +ve if the hip can be popped out of the socket. The d/l will be palpable
(a,b) Unilateral dislocation of the left
hip.
Trendelenberg test is used to establish the stability of the hip. Hip is stable is the abduction mechanism is intact
Straight line drawn along infr borders of triradiate cartilage -hilginreiner line
2 perpendicular lines at the outer edge of the acetabuli is drawn -Perkins line
Forms 4 quadrants
Nlly femoral head lies in the lower inner quadrant, when head is d/l it moves superolaterally
Line made from the infr aspect of femoral neck thro the infr border of the obturator foramen. broken when femoral shaft moves outward.Shenton
Angle b/w horizontal and outer aspect of acetabuli. Nlly acetabular angle is <20
Straight line drawn along infr borders of triradiate cartilage -hilginreiner line
2 perpendicular lines at the outer edge of the acetabuli is drawn -Perkins line
Forms 4 quadrants
Nlly femoral head lies in the lower inner quadrant, when head is d/l it moves superolaterally
Line made from the infr aspect of femoral neck thro the infr border of the obturator foramen. broken when femoral shaft moves outward.Shenton
Angle b/w horizontal and outer aspect of acetabuli. Nlly acetabular angle is <20
a. The left hip is dislocated, the femoral head is underdeveloped and the acetabular roof slopes upwards much more steeply than on the right side.
In this case the features are very obvious but lesser changes can be gauged by geometrical tests. The epiphysis should
lie medial to a vertical line which defines the outer edge of the acetabulum (Perkins’ line) and below a horizontal line
which passes through the triradiate cartilages (Hilgenreiner’s line). (b) The acetabular roof angle should
not exceed 30°. (c) Von Rosen’s lines: with the hips abducted 45° the femoral shafts should point into the
acetabula. In each case the left side is shown to be abnormal.