1) Infected nonunions occur when a fracture healing process halts due to mechanical or biological failure, with a gap filled with fibrous tissue, and infection is present.
2) Common causes include open fractures that become infected, or infections developing after surgery to repair closed fractures. The infection can lead to bone and tissue loss.
3) Treatment requires aggressive debridement of all infected and dead tissue, stabilization of the fracture, soft tissue coverage to prevent reinfection, and bone grafting to fill defects and promote healing.
Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...drashraf369
femoral head fractures are very complex fractures that need immediate and prompt surgical intervention.conventional surgical appproaches to hip may lead to short and long term complications.dr mohamed ashraf ,dr rahul thampi et al are presenting their experience with gantz safe surgical dislocation approach to surgical management of femoral head fractures
Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...drashraf369
femoral head fractures are very complex fractures that need immediate and prompt surgical intervention.conventional surgical appproaches to hip may lead to short and long term complications.dr mohamed ashraf ,dr rahul thampi et al are presenting their experience with gantz safe surgical dislocation approach to surgical management of femoral head fractures
conventional plates including different functions of screws, modes of plate application, Compression Mode.
Neutralization Mode.
Buttress plate.
Antiglide plate.
Bridge plating or span plating.
Tension band.
prebending precountouring
working length
lag screw
AO principles
biological fixation
MIPO
Newer implants for geriatric hip fracturesArjun Viegas
PFNA2 from AO Synthes, Intertan Nail from Smith and Nephew, Gamma3 nail from Stryker, Natural Nail from Zimmer are all newer implants which have changed the way we treat comminuted and osteoporotic hip fractures. This presentation focuses on these newer implants with literature review.
The Ilizarov apparatus is a type of external fixation used in orthopedic surgery to lengthen or reshape limb bones; as a limb-sparing technique to treat complex and/or open bone fractures; and in cases of infected nonunions of bones that are not amenable with other techniques. It is named after the orthopedic surgeon Gavriil Abramovich Ilizarov from the Soviet Union, who pioneered the technique.
conventional plates including different functions of screws, modes of plate application, Compression Mode.
Neutralization Mode.
Buttress plate.
Antiglide plate.
Bridge plating or span plating.
Tension band.
prebending precountouring
working length
lag screw
AO principles
biological fixation
MIPO
Newer implants for geriatric hip fracturesArjun Viegas
PFNA2 from AO Synthes, Intertan Nail from Smith and Nephew, Gamma3 nail from Stryker, Natural Nail from Zimmer are all newer implants which have changed the way we treat comminuted and osteoporotic hip fractures. This presentation focuses on these newer implants with literature review.
The Ilizarov apparatus is a type of external fixation used in orthopedic surgery to lengthen or reshape limb bones; as a limb-sparing technique to treat complex and/or open bone fractures; and in cases of infected nonunions of bones that are not amenable with other techniques. It is named after the orthopedic surgeon Gavriil Abramovich Ilizarov from the Soviet Union, who pioneered the technique.
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)
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
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
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. NON UNION
A state in which healing process comes to a halt as judged by
clinical & x-ray evidence, beyond the stipulated period of
healing for a particular bone due to mechanical or biological
failure , with a gap being filled with fibrous or dense fibro
cartilaginous tissue requiring a change in treatment.
3. INFECTED NONUNION
That state existing after considerable time [6-8 months] has
elapsed, when there is no evidence that fracture will unite
and infection still persists. Therefore other method of
treatment to be done to achieve union and eradicate
infection.
7. Infection perse doesn’t cause nonunion
OM thrombosis of blood vessel of haversian canals
bone sclerosis and dead bone.
Butterfly fragments become sequestrii, isolated & devitalized
by pus & infection granulation tissue.
8. Infection granulation tissue Osteolysis gaps
nonunion.
Osteolysis occurs around the implants loosening
instability of fixation nonunion.
Infection causes nonunion earlier than non-infected pts.
9. BIOFILM
Key for the development & persistence of inf.
Aggregation of microbes enclosed with in an extracelluar
polysaccharide matrix [glycocalyx] that adheres to the surface
of the implants or devitalized bone.
59% of orthopaedic biomaterial related infections +ve
findings.
10. Protects the organism from antibiotics and host defense
mechanism.
Allows the infection to exist in sub clinical state and recur.
Implants promotes biofilm, infection would persist.
11. MICROBIOLOGY
Staphylococcus aureas most common, [alone or in
combination in 65-70%].
Pseudomonas aeroginosa [20-37%]
Commonly polymicrobial [32-70%].
Atypical mycobacterium & fungi in immunocompromised
pts.
13. ROSEN et al [AO manual]
Infected non-draining nonunion
Infected draining nonunion.
14. Infected nondraining nonunion
Quiescent ( dry, nondraining for at least 3 months)
Needs one stage treatment.
Active ( non draining but abscess & fever).
Needs two stage treatment.
15. Infected draining nonunion
I STAGE: By pass bone grafting [fibular protibia,
posteromedial femur or humerus grafting.
II STAGE: By pass has become solid radical debridement
& open/closed irrigation & antibiotics.
III STAGE: cancellous B.G, muscle or skin pedicle flap,
17. TYPE I: fragments in apposition with mild infection and
with or with out implant, stable implant insitu with
mild infection.
TYPE II: Fragments in apposition with severe infection
with large or small wound.
TYPE III: Severe infection with a gap or deformity or
shortening.
3A defect with loss of full circumference
3B defect in > 1/3 of cortex
3C infected nonunion with deformity.
18. CLINICAL EVALUATION
Pain, erythema, swelling, draining sinuses, abnormal
mobility.
No Fever
Infection is clinically silent.
High index of suspicion esp in atrophic nonunion.
0.2-1.6% chronic draining sinuses S.C.C
Suspect when change in pain / discharge.
19. INVESTIGATION
Elevated ESR & CRP,Normal WBC.
X RAY:
1] Quality of bone
2] Type of implant
3] Fracture healing status
4] Angular alignment.
20. Areas suspicious of infection
Bone resorption
Sequestrum & involucrum
Periosteal & endosteal new bone formation
Cortical irregularities.
21. Disadvantages
Due to distorted anatomy due to trauma
Physiological reaction of bone to injury.
Presence of implants.
Can't reliably differentiate between septic and aseptic
changes
Serial x rays, sensitivity-14%, specificity- 70% in diagnosing
active infection.
22. C.T SCAN
Better cortical bone details
Sequestrum
Subtle cortical erosion
Best detail of bone structure for planning.
No artifact with implants.
23. MRI
Highly sensitive modality. 98% sensitivity, 75% specificity.
Gadolinium enhanced MRI: allows discrimination of active
infection from artifacts and fibro-vascular scar.
Demonstrate sinus tracts, differentiate bone & soft tissue inf,
extent of bone involvement.
26. CULTURE
Gold standard
Prior antibiotic treatment and improper handling of
specimens preclude the growth.
Multiple intra-op specimens: sinus tract, purulent fluid, soft
tissue, curetted bone, bed of the involved bone.
Different micro enviroments.
27. PRINCIPLES
Prompt diagnosis and aggressive Rx
Infection control with surgical debridement and specific
antibiotics.
# stabilisation
Soft tissue coverage
Restoration of bone defects.
28. GOALS
(1) the infected tissues must be resected to live margins;
(2) the methods must address previous fixation failures
and structural deficiencies;
(3) the patient must have the potential to heal, survive
treatment, and benefit from treatment; and
(4) the prognosis for success must be reasonable and the
methods within the capabilities of the medical team
30. CONVENTIONAL METHOD
To convert an infected and draining nonunion in to one
that has not drained for several months and then to
promote bone healing by bone grafting.
More time consuming.
Stiffness of adjacent joints.
Reconstructive procedures should be delayed until at
least 6 months after all signs of infections have
disappeared.
31. POSTEROLATERAL GRAFTING
To avoid the active draining sinuses and poor skin in the
anterior aspect.
Posterior aspect of the tibia is roughened superior and
inferior to nonunion.
Entire area is covered with graft.
Nonunion site is not exposed.
32.
33. ACTIVE METHOD
To obtain bony union early and thus shorten the period of
convalescence.
To preserve the motion in adjacent jts.
Restoration of bony continuity- I step.
Bone union takes priority over infection.
Nonunion exposed through old scars and sinuses.
34. The ends of the fragments are decorticated subperiosteally
osteoperiosteal flaps.
All devitalized and infected bone and soft tissue were
removed.
Fragments aligned and stabilised ext.fix.
If necessary a second decortication with or with out B.G
carried out.
35.
36. ILIZAROV METHOD
To eliminate infection and to achieve union vascularity must
be increased.
By corticotomy and circular ext. fix.
To remove necrotic and infected segments before
osteosynthesis.
For hypertrophic nonunion with minimal infection & no
sequestrated bone compression.
39. Segmental bone transport
Eliminates need for B.G.
Simultaneous restoration of bony defect
Elimination of limb shortness
Correction of deformity
Improvement in local soft tissue.
Increase in local blood circulation
Elimination of infection.
40. TYPES OF BONE TRANSPORT
3 TYPES.
Differs in the way that the bone fragments are transfixed to
the frame and in how they are transported to the intended
site
41. EXTERNAL TRANSPORT
For combined bone loss replacement with correction of
deformity and lengthening of the limb
INTERNAL TRANSPORT:
For bone loss replacement without deformity correction
or limb lengthening.
42. B.T OVER A NAIL
Herzenberg et.al
At the end of the bone transport interlocking was done.
Ilizarov fixator can be removed at an early stage .
Avoid complications of the ring fixator.
43. HARMONS GRAFTING
Bone grafting on the interosseous membrane to obtain a long
synostosis with fibula, spanning the tibial defect.
C.I in proximal defects.
45. Free vascularised bone transfer
Rib, fibula, iliac crest.
Isolation of a segment of contra lateral fibula with attached
nutrient artery and vein.
Length of graft should be 4 cm longer than defect to allow 2
cm overlap at the proximal and distal ends.
49. DEFORMITY CORRECTION
Complex deformity consists of : shortening, rotation,
angulation & translation.
Generally length must be reestabilised before other
deformities being corrected.
51. Polymethyl methacrylate powder is mixed with antibiotic
powder beads.
Aminoglycosides common choice.
broad spectrum
heat stability
low allergenicity.
52. BEAD POUCH TECHNIQUE
Occupy dead space and prevents haematoma or scar tissue.
Free flap placed over the beads contour much better.
High local conc. Antibiotic.
Minimizes systemic toxicity.
Seals the wound from external environment with semi
permeable barrier prevents secondary inf.
54. CLOSED SUCTION IRRIGATION
Used when there is a large potential space or cavity after closure.
Abandoned due to risk of secondary contamination.
55. PRIMARY CLOSURE
When all the infected tissue has been removed, wound is
alive, dead space has been addressed and the antibiotic is
pathogen specific.
57. Gap tissues progressively calcify and are invaded
by vessels from the flanking bone margins,
producing a picture very similar to that of normal
endochondral ossification.
The electrical fields do not stimulate osteogenesis
directly, but rather appear to modify
fibrochondrocyte function so that any soft-tissue
impediment to bridging by bone is eliminated.
58.
59. PAPINEAU PROCEDURE
Open bone grafting tech, done to control infection.
Infected nonunion with large cavity or bone defect &
inadequate soft tissue coverage & inability to close skin
directly.
60. PAPINEAU TECH
1) granulation tissue markedly resists infection,
2) Autogenous cancellous bone grafts are rapidly
revascularized and are resistant to infection,
3) the infected area is completely excised,
4) adequate drainage is provided,
5) adequate immobilization is provided,
6) antibiotics are used for prolonged periods.
63. Amputation
Any one or all of the following
1) Extensive bone defect
2) Poor soft tissue cover
3) Neurovascular compromise
4) Anticipated poor outcome after treatment.
5) Severe Pt co morbidities.