Spinal Tuberculosis by Dr. Monsif IqbalMonsif Iqbal
This is the case presentation of a middle aged lady who presented with severe backache for the last one month with topic review after the case presentation
Tuberculosis was popularly known as consumption for a long time. Scientists know it as an infection caused by M. tuberculosis. In 1882, the microbiologist Robert Koch discovered the tubercle bacillus, at a time when one of every seven deaths in Europe was caused by TB
Spinal Tuberculosis by Dr. Monsif IqbalMonsif Iqbal
This is the case presentation of a middle aged lady who presented with severe backache for the last one month with topic review after the case presentation
Tuberculosis was popularly known as consumption for a long time. Scientists know it as an infection caused by M. tuberculosis. In 1882, the microbiologist Robert Koch discovered the tubercle bacillus, at a time when one of every seven deaths in Europe was caused by TB
Tuberculosis of Spine for Medical students, Neurosurgeons, Orthopedic Surgeons and Nursing students. Covers history, presentation, clinical features, pathoanatomy, treatment and surgical options. Data taken from textbook by S M Tuli.
General and simple presentation of tuberculosis of spine on incidence, pathology, complications, management. This presentation is suitable for PGs, Ugs.
spinal tuberculosis, potts spine, tb spine, caries spine,
spine infection, kyphosis
Dysphagia is an important problem in surgical patients. I have discussed Introduction, Zenker's diverticulum, GERD, Achalasia Cardia and Carcinoma Esophagus. If you watch all these videos together, i assure you that you will become confident in managing a case of dysphagia.
Tuberculosis of Spine for Medical students, Neurosurgeons, Orthopedic Surgeons and Nursing students. Covers history, presentation, clinical features, pathoanatomy, treatment and surgical options. Data taken from textbook by S M Tuli.
General and simple presentation of tuberculosis of spine on incidence, pathology, complications, management. This presentation is suitable for PGs, Ugs.
spinal tuberculosis, potts spine, tb spine, caries spine,
spine infection, kyphosis
Dysphagia is an important problem in surgical patients. I have discussed Introduction, Zenker's diverticulum, GERD, Achalasia Cardia and Carcinoma Esophagus. If you watch all these videos together, i assure you that you will become confident in managing a case of dysphagia.
Intra Partum Cardiotocography - dr vivek patkardrvivekpatkar
Cardiotocography ( CTG )
is a procedure of graphically ( graph) recording fetal heart activity and uterine contractions ( Toco ) – both recorded in the same time scale simultaneously and continuously through uterine quiscience and contractions
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Dr Golwala - Tuberculosis of Spine -Past President Lecture
1. Tuberculosis of spine
DR.PARESH P.GOLWALA
PROFESSOR AND HEAD, DEPT. OF
ORTHOPAEDICS
S.B.K.S.M.I.R.C.,
PIPARIYA
Dr. Paresh Golwala
1
2. HISTORY
RIGVEDA AND ATHARVA VEDAS:
3500 – 1800 BC
CHARAKA AND SUSHRUTA:
1000 – 600 BC
HIPPOCRATES: 400 – 300 BC
DESCRIBED AS YAKSHMA
Dr. Paresh Golwala
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3. HISTORY
PERCIVAL POTT – (1779)
DESCRIBED TB SPINE AS A KIND OF
LOWER LIMB PALSY WHICH IS
FREQUENTLY FOUND TO ACCOMPANY
A CURVATURE OF THE SPINE
LAENAEC – (1781- 1826)
IDENTIFIED AND DESCRIBED
TUBERCLE BACILLI IN 1817
BCG VACCINE IN 1945
SPECIFIC AKT IN 1948-1951
Dr. Paresh Golwala
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4. TB SPINE
Disease of developing world
Affects young wage earners
Dr. Paresh Golwala
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6. STAGE OF ONSET
Lasts 1 month to 1 year
Localised disease --- warm, tender
swelling --- Localised osteoporosis
with minimised destruction
Dr. Paresh Golwala
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7. STAGE OF
DESTRUCTION
Lasts 1 to 3 years
Gross destruction of bones and joints
with deformity, subluxation,
contractures and abscess formation
abscess ruptured
Sinuses develop and secondary
pyogenic infections occur
LOWERED Defence mechanism
Severe cachexia
Dr. Paresh Golwala
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9. STAGE OF REPAIR AND
ANKYLOSIS
Occures 3 years after onset
Improved general condition
Resorpton of abscesses
Healed sinuses
Destroyed bones remineralised
Fusion in deformed position(kyphosis)
Unsound ankylosis-unsatisfactory
(pain on movement and weight bearing)
Dr. Paresh Golwala
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13. TWO TYPES OF
AFFECTION
In children the blood supply is central to
the vertebrae. That is why the affection is
central .
In adults the blood supply is paradiscal
that is why the affection is paradiscal .
Dr. Paresh Golwala
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16. PATHOLOGY CONTD… …
No blood supply to disc that is Nucleus pulposus
intervertebral disc
Nutrition to disc is from paradiscal region.
90% of disc content is water.
With the affection in paradiscal region the disc gets
dehydrated and looses height --- reduction in disc
space.
With surrounding cavity and destruction the disc is
resorbed.
This leads to pus formation and the surrounding
ligaments are swollen --- soft tissue shadow.
Dr. Paresh Golwala
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18. COLD ABSCESS
2 or more vertebra affected.
Pus spread due to pressure
If spread anteriorly
– Cervical --- posterior to esophagus /
oropharynx / nasopharynx
– Dorsal --- along the ribs
– DL / Lumbar --- along psoas sheath --psoas abscess
Dr. Paresh Golwala
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19.
If spread posteriorly
– Pressure over the cord
– Causes Paraplegia or Quadruplegia
depending on the level
Dr. Paresh Golwala
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20. POTT’S PARAPLEGIA
Pus under pressure
Collapse of vertebrae --- Sequestrum
Meningitis --- Pachy Meningitis
Thrombosis of artery supplying spinal
cord (Artery of Adam & Kiewz) (At D9-10
level)
Dr. Paresh Golwala
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25. AIM OF TREATMENT
Eradication of infection
correction / prevention of angular
deformity
recovery of neurological deficit
Dr. Paresh Golwala
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26. TREATMENT
CONSERVATIVE :
– Bed rest --- 3 months --- Wedging /
compression is more than 50%
– AKT --- DOTS Category 1
– Rifampicin, Isoniazide, Ethambutol,
Pyrizinamide along with Inj. Streptomycin
--- preferably for two months
– Rifampicin, Isoniazide, Ethambutol for
another 7 to 8 months depending on
healing --- ESR / X-RAY / Clinical
Dr. Paresh Golwala
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27.
OPERATIVE :
–
–
–
Backache Alone --- Conservatively
Backache With Cold Abscess
Backache With Neurological Deficit
Historically in India mid path regime was followed with
the advent of MRI and after study from Rajshekharan
more emphasis has been put on to prevent post
Tuberculous Kyphosis --- internal Gibbus
Hongkong school believes in anterior curettage and
stabilization of vertebrae --- gold standard treatment
Dr. Paresh Golwala
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28. NEWER INDICATIONS OF
SURGERY
Global disease: instability
Long segment disease > 3 vertebrae
with severe kyphosis
Spinal cord compression:
Pus
Granulation tissue
Caseous tissue
Discs
Bony sequestra
Dr. Paresh Golwala
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29.
Cord compression on MRI does not
correlate with neural deficit (76%
encroachment of canal may also have
intact neural state)
Dr. Paresh Golwala
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30. INTRINSIC CAUSES OF
CORD COMPRESSION
Cord oedema
Myelomalacia
Direct affection of meninges and cord
Infective thrombosis and endarteritis
Poor prognosis
Dr. Paresh Golwala
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31.
PARAPLEGIC PATIENT:
– Not responding to drugs after 1 month of
AKT
– Sudden bladder bowel involvement
RELATIVE INDICATIONS:
– Kyphosis --- severe
– Children costo transversectomy
Dr. Paresh Golwala
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33. ANTERIOR SURGERY
Gold standard treatment
Radical surgery
Deals with the precise pathology
Stabilizes vertebrae
Decompresses thoroughly
Done in our institute
Dr. Paresh Golwala
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36. BONE GRAFTING
Tricortical iliac crest : good ,
preferred
Rib graft : good osteo-induction
likely to fracture or
collapse
Fibular
good strength
femoral :
and
tibial
poor osteo induction
Dr. Paresh Golwala
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37. HARDWARE
Anterior plating or screw and rod
fixation
OR
Post segmental pedicle screw fixation
Dr. Paresh Golwala
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49. MALE PATIENT – 60
YEARS WITH HUGE COLD
ABSCESS – PREOP - MRI
Dr. Paresh Golwala
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50. MALE PATIENT – 60 YEARS WITH HUGE COLD ABSCESS – PREOP – CT SCAN
Dr. Paresh Golwala
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51. MALE PATIENT – 60
YEARS WITH HUGE
COLD ABSCESS POSTOP
Dr. Paresh Golwala
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52. MALE PATIENT – 60
YEARS WITH HUGE
COLD ABSCESS POSTOP
Dr. Paresh Golwala
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53. COMPLICATIONS
Paraplegia
– Difficult to rehabilitate
– Bed sores
– UTI
Unyielding
TB infection associated with
HIV may lead to death.
Dr. Paresh Golwala
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54. AUTONOMIC
DYSFUNCTION
SPINAL CORD LESION WITH
NEUROLOGICAL DEFICIT IS
ASSOCIATED WITH SIGNIFICANT
DYSFUNCTION OF SYMPATHETIC
NERVOUS SYSTEM
LOSS OF SUPRA-SPINAL CONTROL
OF SYMPATHETIC NERVOUS
SYSTEM
ASSOCIATED WITH CERVICAL AND
Dr. Paresh Golwala
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55. AUTONOMIC
DYSFUNCTION CONT…
COMPLICATED BY 3
PHENOMENON BELOW THE LEVEL
OF LESION:
1) REDUCED SYMPATHETIC
ACTIVITY
LEADS TO ORTHOSTATIC
HYPOTENSION
2) LOW RESTING BLOOD
PRESSURE
Dr. Paresh Golwala
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