This document discusses forearm diaphysial fractures in adults. It begins by describing the anatomy and biomechanics of the forearm. It then discusses the epidemiology of forearm fractures, including that they most commonly occur in males ages 15-39 from high-energy trauma. It classifies fractures based on location and describes common fracture patterns like Monteggia and Galeazzi fractures. The document outlines how to assess and manage patients, including indications for operative versus non-operative treatment. Surgical techniques like plate fixation are described. Finally, potential postoperative complications are mentioned.
Elbow is the most common joint to dislocate in children. Posterior dislocation is most common.
Simple dislocations are those without fracture.
Complex dislocations are those that occur with an associated fracture
describing the decision making process in deciding which implant to use for trochanteric fractures and its complications - done for Basic AO course in Bengbu, China
Elbow is the most common joint to dislocate in children. Posterior dislocation is most common.
Simple dislocations are those without fracture.
Complex dislocations are those that occur with an associated fracture
describing the decision making process in deciding which implant to use for trochanteric fractures and its complications - done for Basic AO course in Bengbu, China
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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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.
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?
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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
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
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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.
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
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
3. Introduction
• The forearm plays an important role in positioning of the hand
in space by flexion and extension of the elbow and wrist as
well as pronation and supination through the proximal and
distal radioulnar joints.
4. Introduction
• Ulnar shaft fractures are defined as those
occurring between the distal aspect of the coronoid proximally
and the ulnar neck distally.
• Radial shaft fractures are defined as those occurring between
the radial neck proximally and the junction of the metaphysis
and diaphysis distally, approximately 3 cm proximal to the distal
articular surface.
5. Epidemiology
• Termed frequent a fracture. (Incidence 10 times less than distal radial
#s.)
• Overall incidence – 1.4 / 10,000.
• Male predominance.
• Half of all forearm shaft fractures occur in males within the ages of 15
and 39 years.
• US high school athletes the incidence of forearm fractures is 4 per
10,000 athlete exposures.
• Motor vehicle accidents account for an important fraction of forearm
shaft fractures.
6. Mechanism
• Majority of forearm shaft fractures occur in young males with good
bone stock.
• Frequently occur in the setting of high-energy trauma such as motor
vehicle accidents or sports injuries.
• Direct
• Defense Injuries / Nightstick fractures (isolated Ulnar # commonly)
• Gunshot Injuries
8. Mechanism
• Indirect
• Bending Force.
• Torsional Forces with axial loading.
Both bone # at the same bone
segment due to a bending
force.
9. Mechanism
Monteggia # - bending forces can result
in Monteggia fracture dislocation,
in which the proximal ulna is fractured
and the proximal radioulnar joints
(PRUJs) dislocate in the direction of the
ulnar deformity.
10. Mechanism
Both bone # at different
levels due to torsional
force with axial loading.
12. Classification
• In most instances forearm shaft fractures are classified according to
location (proximal, middle, and distal third) or fracture comminution.
• Open fractures are classified according to Gustilo’s classification.
• Monteggia and Galeazzi fractures have their own subclassifications.
14. Monteggia #
• Proximal radial dislocation and a fracture of the ulna.
They are classified according to Bado based on
the direction of the apex of the ulnar fracture and
the direction of the proximal radial dislocation.
15. Monteggia #
• Understanding the deformity of the ulna and the direction of
dislocation of the radial head is important for fracture
reduction.
• In most instances, reduction of the ulnar fracture
leads to reduction of the radial head.
• type 1 fractures are considered the most frequent type in children.
16. Monteggia # - Subclassification of Type II
• 2A: Very proximal ulna fracture through the coronoid
• 2B: Fracture at the junction of the proximal metaphysis and
diaphysis of the ulna
• 2C: Diaphyseal ulnar fracture
• 2D: Complex fracture involving the ulna from the olecranon
into the diaphysis
17. Galleazzi #
• Fracture of the radial shaft with dislocation of the distal radioulnar
joint.
• Sub-classified according to the distance of the radial fracture from the
articular surface.
• Type I – # within 7.5cm from distal articulation surface.
• Type II - # > 7.5cm from distal articulation surface.
• Simple – DRUJ reduced after Radial Alignment.
• Complex – DRUJ Irreducible after Radial Alignment.
18. Essex-Lopresti lesion
• An Essex-Lopresti lesion is a proximal radial shaft or radial
head fracture.
• Proximal migration of the radius tears the interosseous membrane
and causes disruption of the DRUJ.
19. Assessment of Patient
• ATLS Approach.
• Assessment of Vascular / Nerve injuries and documentation.
• Radiological Investigations,
• Forearm AP / Lateral – From Elbow to Wrist
• PA view of the forearm is taken with the elbow in 90 degrees of flexion, the
shoulder abducted, and the forearm in neutral rotation.
• Standard lateral radiograph is taken with the elbow flexed to 90 degrees and
the forearm in neutral rotation.
20. Associated Injuries
• One-third of forearm shaft fractures treated surgically occur as isolated
injuries.
• Remaining fractures occur in the presence of at least one additional injury.
• Upper extremity injuries occur in up to 26% of forearm fractures and
include,
• humeral shaft fractures, proximal humerus fractures, elbow dislocation,
wrist injuries, glenoid fractures, and contralateral forearm fractures.
• Distal biceps ruptures have been reported as well as traumatic rotator cuff
tears.
• Radial head fractures may present at the same time as diaphyseal forearm
fractures.
23. Anatomy of forearm - TFCC
• The TFCC serves as the medial continuation of the distal articular
surface of the radius as well as a static stabilizer of the distal
radioulnar joint.
• It consists of an articular disc
• the dorsal radioulnar ligament (DRUL)
• palmar radioulnar ligament (PRUL)
• the meniscus homologue
• the ulnar collateral ligament
• sheath of the
31. Management
• Goals of treatment
• Obtain adequate reduction
• Achieve and maintain fracture reduction
while
• Preserving biology
and allowing
• Early range of motion.
• Anatomical Reduction is important to restore the ROM of forearm
functional joint.
32. Non-Operative Treatment
• Mainly limited to isolated fractures affecting the distal two-thirds
of the ulna
• With less than 50% of displacement.
• Less than 10 degrees of angulation.
• >50% of displacement associated with interosseous membrane damage
leading to instability.
• In the largest study on functional bracing of isolated ulnar shaft fractures,
Sarmiento et al. reported 96.5% of good and excellent results and
a healing rate of 99%.
33. Operative Treatment
• Several approaches may be used to fix shaft fractures of the
forearm:
1. Ulna—entire diaphysis: A straight incision is made along the subcutaneous
border. The plate is placed on the posterolateral (extensor) or anterior
(flexor) aspect of the bone.
2. Radius—entire diaphysis: The anterior approach according to Henry is
used. The plate is placed on the anterior(flexor) aspect of the radius.
3. Radius—middle third of the diaphysis: The posterolateral approach is used
with the plate on the posterior (extensor) aspect of the radius.
36. Operative Treatment
• No significant difference in outcome using DCP
vs LCP
• It is mandatory to fix a simple fracture with
interfragmentary compression providing
absolute stability.
• If the fracture pattern is amenable, a lag screw
can be placed first to hold the shaft fragments
together.
• Clinical experience have proven the plate 3.5 to
be the ideal size for forearm bones.
37. Outcomes / Complications
• Pain
• Infection (Superficial / Deep / OM)
• ROM
• Delayed Union
• Non Union
• Patient-specific outcomes measures using questionnaires,
DASH is a standardized questionnaire that assesses upper extremity function based on pain
symptoms and physical, emotional, and social domains. (DASH - Disability of the Arm, Shoulder and
Hand)