1. Hematogenous osteomyelitis is a bacterial infection of the bone that most commonly affects the metaphysis of long bones in children. Staphylococcus aureus is the primary cause in 70-90% of cases.
2. Infection typically begins in the vascular metaphyseal region of bones and can spread to the joint space in young children. Symptoms include fever, bone pain, and local swelling. Diagnosis involves blood tests, imaging, and bone aspiration to confirm bacteria.
3. Treatment involves IV antibiotics targeting S. aureus for 2-4 weeks, followed by oral antibiotics if the child improves. Surgery to drain abscesses may be needed
Seminar presentation by 4th year medical student of Lincoln University College, supervised by HRPZ Orthopedic's specialist.
Reference were from reliable medical websites and also from texttbook; Apley and Solomon's Concise System of Orthopaedics and Trauma, 4th Ed.
Seminar presentation by 4th year medical student of Lincoln University College, supervised by HRPZ Orthopedic's specialist.
Reference were from reliable medical websites and also from texttbook; Apley and Solomon's Concise System of Orthopaedics and Trauma, 4th Ed.
•Recognize patients at risk for diabetic foot infections
•Design a diagnostic work-up for diabetic foot osteomyelitis
•State the principles of management of diabetic foot infections
Acute and Chronic Osteomyelitis - Infection of BoneRahul Singh
Acute and Chronic Osteomyelitis - Infection of Bone
http://essentialinspiration4u.blogspot.com
Osteomyelitis is defined as an acute or chronic inflammatory process of bone, bone marrow and its structure secondary to infection with micro organisms.
Duration , Mechanism & Host response.
Duration - Acute / Subacute / Chronic
Mechanism - Heamatogenous (tonsil , lungs , ear/ GIT) - Exogenous (injection , open fractures)
Host response - Pyogenic / Granulomatous
Introduction of bacteria from :
Outside through a wound or continuity from a neighboring soft tissue infection
Hematogenous spread from a pre existing focus (most common route of infection)
To learn more about diabetic foot wounds visit my website
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Bone infections
OSTEOMYELITIS
(Acute, subacute and chronic)
Etiology
Pathophysiology
Presentation
Diagnosis
Management and complications
Osteomyelitis has long been one of the most difficult and challenging problems confronted by orthopaedic surgeons.
Currently, morbidity and mortality from osteomyelitis are relatively low because of modern treatment methods, including the use of antibiotics and aggressive surgical treatment.
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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
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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
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
4. DEFINITION
• Osteomyelitis is inflammation of the bone and bone
marrow generally caused by a bacterial infection.
The most common form in childhood is acute
hematogenous osteomyelitis (AHO), which is
infection of the bone of less than two weeks
duration spread hematogenously.
5. EPIDEMIOLOGY
• Frequency
United States
• The exact frequency is unknown as osteomyelitis is not a reportable disease.
International
• Chronic osteomyelitis is frequently reported in developing countries where medical and surgical
treatment modalities are not commonly accessible.
Mortality/Morbidity
• As noted in recent studies, patients may develop deep vein thrombosis and fractures. [1, 2, 3, 4]
Race
• Few studies have commented on race differences.
Sex
• A preponderance in males is observed in all age groups. Factors related to increased incidence in males
may include increased trauma due to risk-taking behavior or other physical activities that predispose to
bone injury.
Age
• One half of cases occur in preschool-aged children.
6. ETIOLOGY
• Acute hematogenous osteomyelitis typically arises in the metaphysis of long
tubular bones, with approximately twothirds of all cases involving the femur,
tibia or humerus. While a variety of bacterial pathogens may be involved,
Staphylococcus aureus is the pre-eminent pathogen and is responsible for 70–
90% of acute hematogenous osteomyelitis infections in children. Other
etiological agents, in no particular order, include Streptococcus pyogenes,
Streptococcus pneumoniae, Group B streptococci, coagulasenegative
staphylococci, Kingella kingae, enteric Gram-negative bacilli and anaerobic
bacteria.
7. PATHOPHYSIOLOGY
• Young children primarily experience acute hematogenous osteomyelitis due
to the rich vascular supply in their growing bones. Circulating organisms tend
to start the infection in the metaphyseal ends of the long bones because of
the sluggish circulation in the metaphyseal capillary loops. The presence of
vascular connections between the metaphysis and the epiphysis make infants
particularly prone to arthritis of the adjacent joint. Involvement of the
shoulder joint or hip joint is also noted when the intracapsular metaphyseal
end of the humerus or femoral is infected. If untreated, infection can also
spread to the subperiosteal space after traversing the cortex.
8. PATHOGENESIS
• In the metaphysis, nutrient arteries branch into non-anastomosing
capillaries under the physis make a sharp loop before entering
venous sinusoids draining into the marrow ( Hair-pin Ends)
• Blood flow, sluggish and provides an ideal environment for bacterial
seeding
• Relative paucity of phagocytic cells in this area
9. PATHOGENESIS- IN NEONATES AND YOUNG INFANTS
Transphyseal blood vessels connect the metaphysis and epiphysis
commonly pus from the metaphysis enters the joint space
Result in abnormal growth and bone or joint deformity
Joint involvement takes place when the metaphysis is intra- articular as
in hip, ankle, shoulder, and elbow joint or when sub-periosteal pus
ruptures into the joint space
10. PATHOGENESIS- IN CHILD >18 MONTHS AGE
• Spread through the cortex.
• Porous metaphyseal cortex provides easy assess for the exit of exuate or pus
• Elevates the periosteum (thick periosteum loosly adherent to the cortex)
• Subperiosteal pus collection(further impairing blood supply to the cortex and metaphysis)
• Enough periosteal destruction → soft tissue abcess.
11. PATHOGENESIS…IN LATER CHILDHOOD AND
ADOLESCENCE
The growth plate closes, hematogenous osteomyelitis more often begins in the diaphysis and can spread to
the entire intramedullary canal.
Closed plate is relatively resistant to spread of infection.
• The periosteum becomes more adherent, favoring pus to decompress through the periosteum
• The fluid formed seeks the path of least resistance from the metaphysis
12. CLINICAL FEATURES…
Signs and symptoms
Older infants and children are more likely to have fever, pain, and localizing signs such as edema, erythema,
and warmth
With involvement of the lower extremities, limp or refusal to walk
Careful Physical examination may reveal focal bony tenderness.
13. DIAGNOSIS
Children with acute bone pain and systemic signs of sepsis should be
considered to have acute hematogenous Osteomyelitis until proved
otherwise.
Diagnosis may be established if a patient fulfills two of the following criteria:
1. Bone aspiration yield pus
2. Bacterial culture of bone or blood positive
3. Presence of the classical s/s of acute osteomyelitis
4. Radiographic changes typical for osteomyelitis.
14. LABORATORY FINDINGS
• No specific laboratory tests.
• Elevations in peripheral WBC, ESR, and CRP –
• ESR-Nonspecific acute phase reactant
• Increased 48-72 hrs
• Increased in 90% of cases
• Not affected by antibiotic tx
• CRP- Increased in 98% of cases
• Blood culture-
• Positive in 30-50%
• Decreased with antibiotic
• 48 hours to get most organisms
15. RADIOLOGY
• Plain x-ray
• Sensitivity 43-75%
• Specificity 75-83%
• Soft tissue swelling 48hrs
• Periosteal reaction 5-7days
• Osteolysis 7-14 days of infection(need 30-50% bone loss)
• Magnetic Resonance Imaging (MRI)
• Computed Tomography (CT)
• Radionuclide Study
16. BONE ASPIRATION
A bacteriologic diagnosis is made by culturing the involved bone or pus, once a clinical diagnosis of
acute osteomyelitis is established.
Useful to determine whether an abscess is present.
The organism detection rate is increased to 75% to 80% by aspiration of the affected bone
K. kingae may need to be identified by polymerase chain reaction
Also useful in determining the future course of therapy of the child
17. TREATMENT
• Antibiotics
• In NEONATES -I.V antibiotics
• Oxacillin or nafcillin (150 – 200 mg/kg/24 hrs in q6h IV) + BSA like Cephotaxime (150-225 mg/kg/24 hr
divided q8h IV)
• provide coverage for the S. aureus, group B streptococcus, and gram-negative bacilli.
• If MRSA suspected vancomycin is substituted for nafcillin
In Neonate with Central Line , the possibility of nosocomial bacteria (Pseudomonas)
or fungi (Candida)
In older infants and children, the principal pathogens - S. aureus and streptococcus.
• Adjust according to culture reports.
18. IV TO ORAL
• Changing antibiotics from the IV route to oral administration when a patient's condition clearly has
improved and the child is afebrile for ≥48-72 hr, may be considered.
• β-lactam drugs for susceptible staphylococcal or streptococcal infection cephalexin
• Oral clindamycin in clindamycin-susceptible CA-MRSA or for patients who are seriously allergic or
cannot tolerate β-lactam antibiotics.
19. INDICATION OF SURGICAL TREATMENT
Abscess collection (Sub-periosteal , soft tissue, or intramedullary)
Patient is not responding to appropriate antibiotic therapy after a negative bone aspiration
(If a child with acute hematogenous osteomyelitis does not show symptomatic
improvement with decrease in swelling and tenderness after 36-48 hrs of
appropriate antibiotic treatment, the bone should be aspirated again and
consideration given to surgical drainage)
In subacute Osteomyelitis when debridement is necessary (granulation tissue within the cavity even
though no pus)
Radiographic lesion, sequestrum
20. PROGNOSIS
• Improvement in signs and symptoms is rapid when timely intervened.
• Failure to improve or worsening by 72 hr requires review of antibiotic therapy, the need for surgical
intervention, or the correctness of the diagnosis.
• Recurrence of disease and development of chronic infection after treatment occur in <10% of patients.