scoliosis is a lateral bending of curve with associated rotation, it is a three dimensional deformity. the finite element analysis is the effective method of treatment where the axial rotation and lateral bending is considered because of coupling movements, The facet orientation also plays the major diagnosis factor of treatment.
Shoulder subluxation and Wilmer carrying OrthosisSmita Nayak
The patients having the problem of shoulder subluxation due to brachial plexus injury, hemiplegia or muscle weakness need a biomechanically efficient orthosis to treat the problem as well as maintain the functional position of the limb, in that case, the Wilmer carrying orthosis plays the major role by shifting the center of gravity nearer to the elbow joint that able to place the femoral head inside the acetabulum without displacing the head laterally. This orthosis is better in comparison to the conventional orthosis used for the subluxation like bobathcuff, shoulder cuff, slings, and hemislings.the design of the elbow Wilmer orthosis also varies as per the age of the patients. The design for the child case also available without a locking elbow joint but with a spring that helps the child to do different activities of daily living which enhances the growth of the child. The major problem in Erb's palsy in addition to shoulder subluxation is the associated fail elbow and wrist drop, these problems can be solved by this orthosis by modifying the design on the standard version. The lightweight feature for children which starts from 35 grams to 80 gram makes this design more comfortable and cosmetically appealing.
Posture - a perquisite for functional abilities in daily life. Posture is a combination of anatomy and physiology with inherent application of bio-mechanics and kinematics. Sitting, standing, walking are all functional activities depending on the ability of the body to support that posture to carry out each activity. Injuries and pathologies either postural or structural can massively change the bio-mechanics of posture and thus affect functional abilities.
scoliosis is a lateral bending of curve with associated rotation, it is a three dimensional deformity. the finite element analysis is the effective method of treatment where the axial rotation and lateral bending is considered because of coupling movements, The facet orientation also plays the major diagnosis factor of treatment.
Shoulder subluxation and Wilmer carrying OrthosisSmita Nayak
The patients having the problem of shoulder subluxation due to brachial plexus injury, hemiplegia or muscle weakness need a biomechanically efficient orthosis to treat the problem as well as maintain the functional position of the limb, in that case, the Wilmer carrying orthosis plays the major role by shifting the center of gravity nearer to the elbow joint that able to place the femoral head inside the acetabulum without displacing the head laterally. This orthosis is better in comparison to the conventional orthosis used for the subluxation like bobathcuff, shoulder cuff, slings, and hemislings.the design of the elbow Wilmer orthosis also varies as per the age of the patients. The design for the child case also available without a locking elbow joint but with a spring that helps the child to do different activities of daily living which enhances the growth of the child. The major problem in Erb's palsy in addition to shoulder subluxation is the associated fail elbow and wrist drop, these problems can be solved by this orthosis by modifying the design on the standard version. The lightweight feature for children which starts from 35 grams to 80 gram makes this design more comfortable and cosmetically appealing.
Posture - a perquisite for functional abilities in daily life. Posture is a combination of anatomy and physiology with inherent application of bio-mechanics and kinematics. Sitting, standing, walking are all functional activities depending on the ability of the body to support that posture to carry out each activity. Injuries and pathologies either postural or structural can massively change the bio-mechanics of posture and thus affect functional abilities.
Effects of various types of lifting like stoop lifting, squat lifting, semi-squat lifting on the body and also when to use which type of lift to help prevent or minimize the risk of musculoskeletal injury.
Effects of various types of lifting like stoop lifting, squat lifting, semi-squat lifting on the body and also when to use which type of lift to help prevent or minimize the risk of musculoskeletal injury.
Traction is a physical force which brings about separation of the joint through the bone along its long axis. This can be done manually or mechanically and provides several beneficial effects.
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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
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
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Without intervention, a curve is likely to progress
between the time of detection and the time of
skeletal maturity
3. The risk of progression
• increases as the degree of
curvature increases
• increases with the magnitude of
the curve at the time of
detection
• decreases with increased age
at the time of detection
Nachemson et al, 1982
Younger girls (ten, eleven, or twelve years old) who had a curve of at least
30o at the time of detection had the highest likelihood of progression,
ranging from 90% to 100%.
4. Curves that are 20o
or less before the time
of skeletal maturity
are considered mild
and generally are
re-evaluated
every six months.
5. Curves that
• progress 5o to 10o in
6 months
• that are more than
30o at the time of
diagnosis
usually are treated
with a brace, as
early and intensive
bracing is believed
to preclude the need
for an operation in
most instances.
6. Ideally, braces
should be prescribed
to patients with
idiopathic scoliosis
with curves between
30o and 40o, or with
curves less than 30o
who have a history
of curve progression
with a high risk for
continued
progression
Edgar et al, JBJS, 1985
Kehl et al , Clin Orth, 1988
Lonstien et al. JBJS(Am), 1994
chemson et all, JBKS(Am), 1995
14. Combination of
pressures applied to
the torso
over a prolonged
period, brace
treatment attempts to
modify mechanically
the scoliotic spine
morphology
and to control
progression of spinal
curvature
Peterson et al, JBJS, 1995
15. The degree of spinal
correction is related to
many parameters such
as
• The flexibility of the spinal
curves
• The shape and stiffness
of the brace shell
• The location, size and
thickness of brace parts
• The strap tension
adjustment
• The biomechanical
properties of truncal
tissues to transmit the
brace forces to the spine
• The duration of brace
forces applied on the torso
17. A flexible tissue matrix
was developed,
composed of thin
circular sensors that
measure the
pressures generated
at the entire skin-brace
interface.
It was suggested that Boston brace action is limited mainly to specific
regions of pressure
18. Measuring mean brace
forces exerted locally
by the brace found
that correction of
curves was not solely
depended on the level
of force applied by
the brace
The patients with the
greatest curves
achieved little
correction despite
significant levels of
applied force
Chase et al, Spine 1989
19. Measurement of
• magnitude,
• location
• and direction of pressures
generated by the brace
and the forces present in the
straps while the pts assumed
different positions,
proved that :
posterior thoracic pads
provided scoliotic correction
and derotation and that brace
interface pressure were
present in all positions.
20. Low strap forces had
scoliotic curves that
progressed while in the
brace, whereas those
with high strap forces
had a reduction in
curvature.
It was concluded that
although high strap forces
are necessary to ensure
lateral and derotational
forces on the spine they
also cause undesirable
forces that induce
lordosis.
21. An increase in
strap tension
by 50%
resulted in an
increase of 20%
in the mean
force exerted
through the
compression
pads
22. Therefore it would seem that
the effectiveness of the
brace depends to a certain
extend on how tightly it is
adjusted and fastened
Currently, there is no
standardized strap
tension at which the brace
should be fastened to obtain
optimal results
23. A great deal of
variability in the
strap tension also
was found the
patients were
taking different
positions
regardless of how
tightly the straps
were originally
fastened
24. Even when the
patients returned in
the standing position
after having
performed other tasks
these were also
significant decreases
in strap tension
25. Several authors
believe that the
Heuter-Volkmann
principle contributes
to the development
of adolescent
idiopathic scoliosis
(A.I.S.)
Machida et al, Spione, 1999
Dickson et al, JBJS, 1984
Stokes et al, Spine, 1996
27. Bracing a scoliotic
curve should, in
theory, unload the
growth plates on the
concave side of the
vertebral bodies
near the curve’s
apex
28. Growth stimulation
leading to structural
remodeling
of the vertebral bodies,
on the curve’s concave
side may explain the
improvement
or lack of curve
progression,
as measured by Cobb
angles, reported with
successful brace
management of A.I.S.
29. Evidence
demonstrating
the biomechanical
effects of the Hueter-
Volkmann on the
vertebral body growth in
spinal deformities
is lacking
The threshold and limit
of the force magnitudes
necessary for the
Hueter-Volkmann
principle to apply in
A.I.S. have not been
delineated
30. Frank et al Spine Journal, 2003
The purpose of this
investigation was to
determine whether
long-term brace
treatment stimulated
asymmetric
chondrogenesis in the
apical three vertebrae
32. Brace application
was a successful
treatment when
the initial
vertebral body
derotations were
maintained until
skeletal maturity
33. The efficacy of
brace treatment
in patients with
rigid curves was
strongly
questioned
34. The Prevalence and
Natural History
Committee of the
Scoliosis Research
Society decided to
compare, with use of
meta-analysis, the
results of non-
operative treatment of
idiopathic scoliosis
35. The type of brace
had a significant
effect on the
outcome
although this effect
was small compared
with the effects of
other variables
36. The daily duration for
which the brace was
worn also had a
significant effect on the
outcome
39. The goal of brace treatment is to
prevent progression of the
scoliosis by:
1. Correcting the lateral curve
2. Correcting the malrotation
3. Returning the torso to a balanced
position over the sacrum
4. Properly aligning the spine in the sagittal
plane
40.
41.
42.
43.
44.
45. Trochanter PadLumbar Pad
•The length and position of the lumbar pressure pad is determined by applying
•pressure to the paraspinal muscle at the level of the lumbar apex of the curve and
every vertebral body with a segmental vertrebral tilt towards the curve.
•Added length must be estimated for patients with increased lumbar lordosis as this
results in an apparently shorter lumbar spine.
•If L4 and L5 are to be included in the lumbar pad, the pad thickness should be
tapered in this area so that a bridging effect between the gluteus and the upper
lumbar region do not occur
•A trochanter pad is
used to correct a stiff
lumbo-sacral curve and
to act as a lever arm for
the lumbar pad and/or
the axilla extension.
•It is usually placed on
the same side that L5
tilts toward.
46.
47. •The length and position of the thoracic
pressure pad is determined from the
ribs which project downward from the
thoracic curve.
•The pad is positioned from the mid-illiac
crest roll level and extends superiorly to
include the rib of the apex vertebra.
•The pad should not extend above the
•rib of the apex vertebra.
•The thickness of the pad should not
extend to the posterior vertical
•trim line to avoid worsening thoracic
hypokyphosis.
•The thickness of the thoracic pressure
pad is determined by the severity of the
thoracic curve and the extent to which the
thorax is displaced from the center line.
•The pad should provide superior medial lift
to the ribs under the apex, thus the pad is
thicker at the bottom than at the top (a
triangle in cross section).
Thoracic Pad
48.
49. Derotation Pad
Axial rotation is most efficiently corrected by using force
couples, that is using a pair of forces directed in opposite
directions working on opposite sides of the axis
majority of derotational corrective forces are built-in to
the brace.
Just as the lateral forces require a relief area
opposite the correcting force, rotational
forces require an area of relief so that the
spine can migrate axially to derotate.
These relief areas can be created by an
adjacent pad which draws the brace away
from the body as seen anteriorly or by
bending the brace away from the body as
seen posteriorly on the right
Anterior Lumbar
Derotation Pad
50. ASIS Derotation Pad
Because the ribs slope downward from back to
front, the anterior thoracic derotation pad will be
inferior to the posterior derotation pad on the
thorax to give the appropriate force.
Thoracic posterior derotational pads are not
recommended in patients who present with a
hypo-kyphotic or lordotic
thoracic spine.
Anterior Thoracic Derotation Pad
In order to keep the brace from twisting on the
pelvis, pads may be needed, in a force-couple
arrangement,opposite to the ones used for
derotation of the lumbar spine.
This can be accomplished by a pad anterior to the
ASIS on one side and by bending inward the
lower margin of the module posteriorly