This document provides information on spinal infections. It discusses two main types of spinal infections - pyogenic and non-pyogenic infections like tuberculosis. Pyogenic infections usually involve the lumbar spine and are caused by bacteria like Staph aureus. Tuberculosis is the most common non-pyogenic infection and usually affects the lower thoracic spine. Clinical features, investigations, management and various surgical approaches for treating spinal infections are described in detail.
Vertebral osteomyelitis( spondylodiskitis )
usually seen in adults (median age is 50 to 60 years)
Location
50-60% of cases occur in lumbar spine
30-40% in thoracic spine
~10% in cervical spine
Vertebral osteomyelitis( spondylodiskitis )
usually seen in adults (median age is 50 to 60 years)
Location
50-60% of cases occur in lumbar spine
30-40% in thoracic spine
~10% in cervical spine
dr. Rajasekaran dr. Rajasekaran dr. Rajasekaran s
Management of Spinal TB
Chemotherapy
Multidrug antitubercular treatment (ATT) is the mainstay of
treatment in both complicated and uncomplicated TB.65-68
Multidrug ATT is essential, as varying categories of bacilli
exist in a lesion. They may exist as intracellular, extracellular,
dormant, or rapidly multiplying forms and each has different
growth and metabolic properties.69 In addition, multidrug ATT
reduces instances of drug resistance.70 The duration of chemotherapy for spinal TB has been long debated, and the WHO
recommends 9 months of treatment where 4 drugs—isoniazid,
nature in underprivileged sections of developing countries,
TB is now an international concern, as it has its footprints
spread all over the world due to the global migration Epidemiology
The incidence of extrapulmonary TB (EPTB) is low at 3%, but
there has been no significant reduction in incidence of EPTB
when compared to pulmonary TB (PTB).7 Skeletal TB (STB)
contributes to around 10% of EPTB, and spinal TB has been the Clinical Presentation of Spinal TB
The clinical picture of spinal TB is extremely variegated.
Spinal TB usually is insidious in onset and the disease progresses at a slow pace.22 The diagnostic period, since onset
of symptoms, may vary from 2 weeks to several years. The
manifestation of spinal TB depends on the severity and duration of the disease, site of the disease, and the presence of
complications such as abscess, sinuses, deformity, and neurological deficit.23 Spinal TB can either be complicated or
uncomplicated. In complicated TB, patients present with deformity, instability, and neurological deficit. Uncomplicated
spinal TB is one in which diagnosis is made prior to development of such complication Pathophysiology of Spinal TB
TB is caused by Mycobacterium tuberculosis complex, which
has around 60 species. Among them only Mycobacterium
tuberculosis (the most common), Mycobacterium bovis, Mycobacterium microti, and Mycobacterium africanum are known to
affect humans.16 It is a slow-growing fastidious, aerobic bacillus. The primary site of infections can be in the lungs, lymph
nodes of the mediastinum, mesentery, gastrointestinal tract,
genitourinary system, or any other viscera. The bacilli tend to
remain dormant for prolonged periods and multiplies every 15
to 20 hours in aerobic conditions whenever favorable. Spinal
infection is always secondary and is caused by hematogenous
dissemination of the bacillus from a primary focus.17,Cold Abscess
Cold abscess lacks inflammatory features and initially forms in
the infective focus. Later, it takes the path of least resistance
along the natural fascial and neurovascular planes as depic
Back pain
Etiology
Anatomical & pathophysiological concepts
Diagnostic approach
Clinical approach
Red flags & yellow flags
Investigations
Back pain in children & elderly
dr. Rajasekaran dr. Rajasekaran dr. Rajasekaran s
Management of Spinal TB
Chemotherapy
Multidrug antitubercular treatment (ATT) is the mainstay of
treatment in both complicated and uncomplicated TB.65-68
Multidrug ATT is essential, as varying categories of bacilli
exist in a lesion. They may exist as intracellular, extracellular,
dormant, or rapidly multiplying forms and each has different
growth and metabolic properties.69 In addition, multidrug ATT
reduces instances of drug resistance.70 The duration of chemotherapy for spinal TB has been long debated, and the WHO
recommends 9 months of treatment where 4 drugs—isoniazid,
nature in underprivileged sections of developing countries,
TB is now an international concern, as it has its footprints
spread all over the world due to the global migration Epidemiology
The incidence of extrapulmonary TB (EPTB) is low at 3%, but
there has been no significant reduction in incidence of EPTB
when compared to pulmonary TB (PTB).7 Skeletal TB (STB)
contributes to around 10% of EPTB, and spinal TB has been the Clinical Presentation of Spinal TB
The clinical picture of spinal TB is extremely variegated.
Spinal TB usually is insidious in onset and the disease progresses at a slow pace.22 The diagnostic period, since onset
of symptoms, may vary from 2 weeks to several years. The
manifestation of spinal TB depends on the severity and duration of the disease, site of the disease, and the presence of
complications such as abscess, sinuses, deformity, and neurological deficit.23 Spinal TB can either be complicated or
uncomplicated. In complicated TB, patients present with deformity, instability, and neurological deficit. Uncomplicated
spinal TB is one in which diagnosis is made prior to development of such complication Pathophysiology of Spinal TB
TB is caused by Mycobacterium tuberculosis complex, which
has around 60 species. Among them only Mycobacterium
tuberculosis (the most common), Mycobacterium bovis, Mycobacterium microti, and Mycobacterium africanum are known to
affect humans.16 It is a slow-growing fastidious, aerobic bacillus. The primary site of infections can be in the lungs, lymph
nodes of the mediastinum, mesentery, gastrointestinal tract,
genitourinary system, or any other viscera. The bacilli tend to
remain dormant for prolonged periods and multiplies every 15
to 20 hours in aerobic conditions whenever favorable. Spinal
infection is always secondary and is caused by hematogenous
dissemination of the bacillus from a primary focus.17,Cold Abscess
Cold abscess lacks inflammatory features and initially forms in
the infective focus. Later, it takes the path of least resistance
along the natural fascial and neurovascular planes as depic
Back pain
Etiology
Anatomical & pathophysiological concepts
Diagnostic approach
Clinical approach
Red flags & yellow flags
Investigations
Back pain in children & elderly
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
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.
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
- 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
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
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
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
2. Spondylodiscitis
• infection of the
intervertebral disc
Vertebral osteomyelitis
• If infection invades the
endplates or the vertebral
body.
INTRODUCTION
Spinal infections are basically divided into
two types:
a)Pyogenic
b)Non pyogenic(granulomatous)
3. PYOGENIC INFECTION
Represents 2-7% of all pyogenic
osteomyelitis
Bimodal distribution: First peak in children
and other around 50.
Site of involvement: >Lumbar spine- 50-
60% >Thoracic 30-40%
5. Etiology
Predisposing factors:
Septic focus(skin, Genitourinary tract, etc.)
Invasive procedures
Immunocompromised
Diabetes
Steroid use
Old age
Spine surgery
Most common organism – Staph. Aureus(50%)>
Gram negative(E.coli)> Anaerobes
6. CLINICAL PRESENTATION
Nonspecific local pain – first presenting feature
Pain more during night.
Constitutional symptoms like night sweats, anorexia,
low grade fever are less common but more
commonly seen in TB spine.
Most common SIGN is Tenderness at local site.
Sustained paraspinal muscle spasm is noted
Abscess formation – rare presentation
Complication: Neurological deficit - suggestive of
abscess compressing over the cord
8. LABORATORY INVESTIGATIONS
ESR
Elevated in 71-97% of patients
Generally > 50mm/hr
Elevated after surgery peak at 5 days and
elevated for 4 weeks.
Persistent elevation after surgery suggestive of
infection
Remains high even after treatment for prolonged
period of time
CRP
More sensitive marker
Peaks within 2 days of surgery and has rapid fall
Elevation even after a week of surgery suggest of
infection
Rapidly decline following treatment.
Other tests: CBC: may show leucocytosis
Blood culture- positive in around 60%
9. XRAY
Findings lag 2-4 weeks behind onset of symptoms
May show: Narrowing of disc space
Vertebral plate irregularity
Late findings include- Destruction of vertebral body, bony
ankylosis
10. CT SCAN
Beneficial over radiograph –
more sensitive to earlier changes
Identifies soft tissue and
paraspinal mass easily
Findings- > lytic defects in
subchondral bone
> Multiple holes seen in cross
sectional views
11. MRI
T1 IMAGES: Low density changes in bone and disc
T2 IMAGES: High density changes in bone and disc. Abscess are areas with very high uptake.
• Using serial MRI helps in showing response to treatment.
• Following treatment soft tissue findings tend to improve while the bony findings like marrow edema remains.
T1 T2
12. RADIONUCLEIDE SCANNING
Radionuclide scans with
technetium-99m become
positive long before plain
film changes are evident
Gadolinium is a good
adjunct. Combination of
Tc99m and Ga67 is used-
shows increased uptake
at the site of infection
13. CT guided
• Minimal invasive
Open biopsy
• If blood cultures and percutaneous
biopsy fail to identify the infecting
organism.
Biopsy
Best method of determining the infection.
18. INDICATIONS FOR SURGERY
• Open biopsy
• Neurological deficit
• Vertebral collapse
• Abscess
• Failure of medical treatment
MANAGEMENT CONTD..
NON OPERATIVE
Antibiotics chosen according to culture and
sensitivity
Response to treatment evaluated with serial ESR
and CRP.
Duration: INTRAVENOUS – FOR 4-6 WEEKS followed
by oral antibiotics based on individual response.
19. BRUCELLOSIS
Brucella melitensis - organism
Consumption of unpasteurized milk
and soft cheeses made from the
milk of infected animals
Symptoms: polyarthralgia, night
sweats, anorexia, headache.
Psoas abscess is found in 12% of
patients
Lumbar spine most commonly
involved
20. Radiography:
Confirm diagnosis: Titre of brucella >1:80
Treatment: Antibiotics (rifampicin and
doxycycline) for 4 months
BRUCELLOSIS(contd.)
21. FUNGAL INFECTIONS
Opportunistic infection, common in
immunodeficient
Symptoms develop very slowly. Pain is less
prominent
Most common: Aspergillus> Cryptococcal
Most common involvement is of lumbar
ESR and CRP elevated but WBCs are not
raised
Diagnosis by biopsy
22. How to differentiate?
MRI: serrated margins of vertebral endplates without
severe VB destruction
Disc space: Typically spared; lack of T2 hyperintensity
Treatment: conservative by antifungal chemotherapy.
FUNGAL INFECTIONS (contd.)
26. WHY MOST COMMONLY
OCCURS AT DL JUNCTION???
Greater extent of movement
Degree of weight bearing and
microfracture
Large spongy cancellous bone
Proximity to kidney and cistern
chili
29. Constitutional
symptoms(40%)
• Malaise
• Loss of appetite/weight
• Night sweats.
• Evening rise of temperature.
CLINICAL PRESENTATION
Presentation depends on the site and stage of disease:
Patient gives h/o of back ache
- Slight pain and stiffness are earliest complaints
- Pain is initially localized, dull aching brought down by jarring or movement of
spine
REFERRED PAIN : depending on the nerve root involvement
CERVICAL LESION - pain over occiput, ear, jaw, upper limb
UPPER THORACIC - intercostal neuralgia
THORACO-LUMBAR - girdle pain or epigastric pain
LUMBAR - Hips and legs
30. GAIT
Patient is very cautious and avoids jarring of
spine and walks with HEAD AND CHEST THROWN
BACKWARD AND legs apart and waddles - so
called “ALDERMAN’S GAIT”
SEEN IN TB OF LOWER DORSAL AND UPPER
LUMBAR
31. OTHER FEATURES
KYPHOTIC DEFORMITY
ENLARGED LYMPH NODE
NEURAL DEFICIT-20%
SPASTICITY
CLONUS
EXAGGERATED REFLEXES
32.
33.
34.
35. INVESTIGATIONS
1)CBC:
Decreased Hb, Lymphocytosis
2) ESR & CRP-
>Raised in active stage of the disease.
>Used as an aid for diagnosis and monitoring of treatment
response.
>Normal ESR for 3 months suggest patient is in recovery phase.
3) MONTOUX/TUBERCULIN SKIN TEST
Positive test can be observed 1 to 3 months after infection.
4)Other tests: HIV
IFN –Gamma release assays
36. 5) Z-N STAINING : Detects acid fast bacilli
- Positive only 50% cases.
6) ELISA- antibody detection
7) PCR- TB Gene expert (from sample)
- result within 4-6 hr
- Ripampicin resistance detected.
8) Culture- Growth often can be detected
within 2 weeks. Typical hold periods are for
4–6 weeks- allows drug succeptibility
assessment.
TESTS FROM OBTAINED
SAMPLE
48. TUBERCULAR
Chronic back pain -Long standing
History of months to years.
Presence of active
pulmonary TB – 60 %
Most common location thoracic
spine
>3 contiguous vertebral body segment
involvement common
Skip lesions- common
Vertebral collapse - 67%
Posterior elements involvement
possible
PYOGENIC
Acute onset : History of days to
months
Not present
Lumbar spine
Mostly involves single level
Rare
Rare –
21%
Rare
Vs.
49. DD- NEOPLASTIC LESIONS
In early stages of central type of
tuberculosis of spine, there is no
involvement of intervertebral disc thereby
mimicking neoplastic lesion.
However, in chronic tubercular lesion
intervertebral disc is involved making it
easy to differentiate from neoplastic
lesion
Hence the term : “Good disc, bad news;
Bad disc, good news”)
50. POTT’S PARAPLEGIA
Incidence : 10 - 30 %
Dorsal spine most common
Motor functions affected before /
greater than sensory.
Sense of position & vibration last
to disappear
54. BASIC PRINCIPLES OF
MANAGEMENT
Early diagnosis
• Medical Treatment – AKT and
bracing
• Surgery to drain abscess,
debridement and fusion
• Stabilization to Prevent kyphotic
deformity
55. TREATMENT OF TB SPINE
CONSERVATIVE
AKT[18 MONTHS] REST AND BRACE
SURGERY
(DEBRIDEMENT+FIXATION
+FUSION)
ANTERIOR
APPROACH
POSTERIOR
APPROACH
COMBINED
APPROACH
56. AKT GUIDELINES
ENTIRE DUARTION OF CHEMOTHERAPY LASTS FOR
16-18 MONTHS- 2 months intensive phase
+
10-16 months maintenance phase- 2HRZE+10HRE)
•10 MG PYRIDOXINE FOR PREVENTION OF PERIPERAL
NEUROPATHY
57. INDICATIONS FOR SURGERY IN TB SPINE
WITHOUT NEUROLOGICAL DEFICIT
Diagnosis is uncertain and open biopsy is
indicated
Mechanical instability – panvertebral disease
Suspected drug resistance –inadequate clinical
improvement or deterioration on ATT
Spinal deformity – severe kyphotic deformity at
presentation, or in
Children at high risk of progression of
kyphosis-”SPINE AT RISK SIGNS” with growth
after healing of disease.
58. INDICATIONS FOR SURGERY IN TB SPINE
WITH NEUROLOGICAL DEFICIT
Neural complications developing or getting worse
or remaining stationary during the course of non-
operative treatment (3–4 weeks)
Paraplegia of rapid onset
Spinal tumour syndrome
Severe paraplegia – flaccid paraplegia, paraplegia
in flexion, complete sensory loss and complete
loss of motor power for more than 6 months
Painful paraplegia in elderly patients.
61. • This figure shows
temporary fixation
with one side rod and
resection of the
spinous process, facet
joint on one side and
the lower
costotransverse joint
with a small fragment
of rib.
•This figure shows
implantation of
specially constructed
titanium mesh cages
into the interbody via
posterior approach
only.
ALL POSTERIOR
62. ☺ Effective to remove disease process
☺ Safe
☺ Excellent in correcting and maintaining
kyphosis
☺ Beneficial for patient in terms of less
blood loss, less operative time and short
duration of hospitalization compared to
combined approach.
ADVANTAGES OF ALL POSTERIOR
APPROACH