This document is a case study presentation on a patient with impaired right upper limb function as a post-surgical complication of multiple myeloma. It begins with an introduction to multiple myeloma and its epidemiology. It then describes the patient's history, examination findings, and physiotherapy management over 12 sessions. The physiotherapy led to improvements in the patient's right upper limb strength and function, including increased independence with activities of daily living. The presentation concludes with recommendations for promoting awareness of pathological fractures and low-intensity exercise programs for multiple myeloma patients.
the presentation gives a detail information about the seronegative spondyloarthropathy. this ppt also provide recent evidences to frame the rehab protocol.
this presentation is about the spondylosis of the cervical region.
there is information about cervical spondylosis, its etiology, epidemiology, sign symptoms and its treatment options.
the presentation gives a detail information about the seronegative spondyloarthropathy. this ppt also provide recent evidences to frame the rehab protocol.
this presentation is about the spondylosis of the cervical region.
there is information about cervical spondylosis, its etiology, epidemiology, sign symptoms and its treatment options.
Avascular necrosis (AVN) or Aseptic Necrosis of the hip is caused by a disruption to the hip’s blood supply which results in the deterioration and often collapse of the ball of the thigh bone (femoral head). Early identification and treatment of the condition increases the likelihood that a patient’s hip will recover. Surgery may be required in severe cases to repair or revascularize (restore circulation) the hip or to replace the hip in neglected/end stage cases.
http://www.davidsfeldmanmd.com/specialties/avascular-necrosis-hip
Common Musculoskeletal (orthopedic) disorders in elderlyBhaskarBorgohain4
elderly and geriatric old age people tend to suffer many orthopedic disability due to common functional limitations and mobility issues as a result of pain from osteoarthritis, osteoporotic fractures, low back pain and degenerative spinal disorders like lumbar spondylosis and vitamin D and nutritional deficiencies. early diagnosis , prevention, timely surgical interventions and optimum rehabilitation are paramount to bring elderly to pre-injury state of functional independence.
Avascular necrosis (AVN) or Aseptic Necrosis of the hip is caused by a disruption to the hip’s blood supply which results in the deterioration and often collapse of the ball of the thigh bone (femoral head). Early identification and treatment of the condition increases the likelihood that a patient’s hip will recover. Surgery may be required in severe cases to repair or revascularize (restore circulation) the hip or to replace the hip in neglected/end stage cases.
http://www.davidsfeldmanmd.com/specialties/avascular-necrosis-hip
Common Musculoskeletal (orthopedic) disorders in elderlyBhaskarBorgohain4
elderly and geriatric old age people tend to suffer many orthopedic disability due to common functional limitations and mobility issues as a result of pain from osteoarthritis, osteoporotic fractures, low back pain and degenerative spinal disorders like lumbar spondylosis and vitamin D and nutritional deficiencies. early diagnosis , prevention, timely surgical interventions and optimum rehabilitation are paramount to bring elderly to pre-injury state of functional independence.
A protocol for the management of breast cancer developed by the multidisciplinary oncology team at University of Nigeria Teaching Hospital, fully adapted to our environment
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.
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.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Drug Discovery and Development .....NEHA GUPTA
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.
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Impaired function of right upperlimb as a post surgical complication in a patient with multiple myeloma; a physiotherapy case study
1. Impaired function of Rt UL as a
post surgical complication in a
patient with multiple myeloma;
A case study
Enwelunta Obed Onyedikachi
Dept. of Physiotherapy, AKTH
An End of Orthopaedic/ Surgery posting presentation
11/8/2019 1
3. Introduction
• Multiple Myeloma is a type of cancer formed by cancerous plasma
cells.
• It affects the bones and bone marrow of the vertebrae, ribs, skull,
pelvis, as well as the long bones.
• It progresses to cause kidney damage, recurrent infections and may
affect the nervous system.
• Multiple myeloma is an incurable condition with a poor prognosis.
(Int M myeloma Foundation, 2017)
11/8/2019 3
4. Epidemiology
• Globally, More than 20,000 new cases of multiple myeloma every year with
more than half of that number ending in mortality.
• It has a slight male preponderance with primary affectation of folks over 65
years.
• It affects blacks more than Caucasians.
(Alexander et al., 2007)
• A multicenter study carried out in 2014 among eight tertiary health
institutions across six geopolitical zones in Nigeria found 135 cases of MM
from 2005 to 2014 with peak incidence at age >60 years and M:F ratio of
1.4:1.
(Odunukwe et al., 2015)
11/8/2019 4
5. Etiology & Risk factors
• Exact cause unknown but Risk factors include;
• Age > 60yrs
• Gender
• Race
• Familial hx of MM
• Exposure to ionizing radiation
• Occupational hazards (i.e. petroleum, leather, lumber and agricultural
industries)
(Landgren et al., 2006)
11/8/2019 5
8. Clinical features
• Skeletal pain at the site of tumor which is sharp with moderate or
severe intensity, and intermittent or constant duration.
• Hypercalcemia leading to dehydration, polyuria, loss of appetite,
constipation, etc.
• Bone destruction with spontaneous bone fracture
• Neurologic signs like back pain with radicular symptoms, spinal cord
compression, etc.
(Mayo Clinic, 2019)
11/8/2019 8
12. Physiotherapy management
Aims;
• Improve overall quality of life
• Help in Pain control
• Prevent further complications associated with decreased activity and
exercise.
• Manage disease and treatment related symptoms.
11/8/2019 12
15. Case study
• Informant: patient Gender: Male Age: 50yrs
• C/C: inability to functionally use the right upper limb X 4/52
• Hx: Pt was apparently well until around 2016 in Benin Republic when he had
unexpected fracture at his Rt collarbone while trying to carry a heavy load. He
was taken to TBS where he was treated and the fracture healed.
• Some months later, he started experiencing pain at the region of the Rt
sternoclavicular joint with swelling and the pt was advised by his sister, a staff
here, to come to Kano, Nigeria for more investigation. He came to this facility via
orthopaedic clinic where he did some radiological investigations and was
diagnosed with multiple myeloma and started chemotherapy. After a year and
some months on chemo, he started having pains at the ULs and did an x-ray of
bilateral upper limbs where they discovered there was severe demineralization
and impending fracture of the Rt humerus. He had a prophylactic ORIF with IM
nail to help support the humerus. A consult was sent to physiotherapy to partake
in the management.
11/8/2019 15
16. Case study
• PMHx: HTN⁺, DM⁺,MM⁺, Surgery⁺, PUD⁻, Asthma⁻
• FSHx: A 50 years old business man married with 4 children all alive, No hx
of similar condition in the family but his mom has DM. Non smoker, does
not take kolanut, took alcohol but stopped two yrs ago.
• DrugHx: currently on Chemotherapy.
• O/E: Pt walked into the assessment cubicle with normal gait, with Rt UL
dangling in a monoparetic pattern, afebrile to touch, acyanosed, anicteric
and no ORD.
• CNS- conscious & alert, oriented in TPP
• CVS- BP: 140/80 mmHg PR: 92 bpm
• H/N: presence of cervical kyphosis
11/8/2019 16
17. Case study
• T&A: chest clinically clear, no organomegaly on palpation of the abdomen.
• Back: presence of scoliosis
• UL; Lt - NAD
• Rt – mzl power- 3/5(shoulder), 2/5(elbow), 0/5(wrist)
• Superficial Sensation diminished @ the thumb, hypotonic
• LL; pitting Edema at both feet
• Rt UL grip strength – 0kg (hand dynamometer)
• UEFI score- 0/80
• DASH score- 116
• Investigation; x-ray shows features of Rt humeral mid shaft fracture with IM nail
in situ.
11/8/2019 17
19. Case study
• Fxnal Limitations:
• Can’t eat with Rt hand
• Can’t put on clothes independently
• Can’t put on shoe
• Impression: Impaired fxn of the Rt UL 2” to post surgical complication
of MM
11/8/2019 19
20. Case study
Rx;
• Mobilization of the Rt Ul X 15 reps X 3 sets daily
• Self assisted exs to Rt ul X 15 reps X 3 sets daily
• WBExs X 15 mins twice daily
• Shoulder exs X 15 reps X 3 sets daily
• Effleurage massage to the LL
• Patient advice and education
11/8/2019 20
21. Case study
Across 12 sessions, we modified the Rx plan by adding;
• Active ROM exs X 15 reps X 3 sets daily
• Supination & Pronation exs X 15 reps X 3 sets daily
• FA exs & RA exs to the Rt ul X 10 reps X 3 sets daily
• ES to the extensors of the wrist and fingers X 15 mins twice a week
• Neurodynamics to radial nerve
• Task Oriented training exs
• Grip strength training (manual)
• Cryotherapy to the shoulder and wrist X 15 mins
• Wrist deviation exs X 15 reps X 3 sets daily
• Finger abduction & adduction exs X 15 reps X 3 sets daily
11/8/2019 21
25. Case study
• UEFI score increased from 0/80 to 30/80
• DASH score decreased from 116 to 88
• Pt. is more independent in ADLs
• Pt. can eat, dress up, groom himself and even carry a little grocery
bag with his Rt UL.
• Pt. hand grip strength increased from 0 kgforce to 8kgforce
11/8/2019 25
26. Conclusion
Early and intensive rehabilitation improves functional outcomes in
patients with upper extremity disabilities.
11/8/2019 26
27. Recommendation
• Routine medical check up after age 50
• Promote awareness of pathological fractures and ways to avoid them
• Benefits of low intensity fitness programs for MM pts.
11/8/2019 27
28. References
Landgren O, et al. Familial characteristics of autoimmune and hematological
disorders in 8,406 multiple myeloma patients: A population-based case-control
study. Int. J. Cancer. 2006. Volume 118, 3095-3098.
Dosunmu A, et al. A review of epidemiology and management of multiple myeloma
in a resource poor country. Ann Trop Pathol 2018;9:99-105.
Odunukwe N, et al. Multiple myeloma in Nigeria: a multi-center epidemiological
and biomedical study. The Pan African Medical Journal. 2015;22:292.
Alexander D, et al. Multiple myeloma: A review of the epidemiologic literature. Int.
J. Cancer. 2007. Volume 120; 12.
International Myeloma Foundation website. Reviewed July 2019.
Multiple Myeloma. Physiopedia website. Reviewed July 2019.
Multiple Myeloma. Mayo Clinic website. Reviewed July 2019.
11/8/2019 28
