An intertrochanteric fracture occurs between the greater and lesser trochanters of the femur. It commonly affects elderly osteoporotic patients, usually women in their 80s, following a simple fall. X-rays are used to diagnose this extracapsular hip fracture. Treatment involves early internal fixation with devices like the sliding hip screw or intramedullary hip screw to allow early ambulation and prevent complications of non-operative management. Complications can include failure of fixation, malunion, or nonunion if reduction or implant positioning is inadequate.
An Introduction, History, Diagnosis, Current Guidelines on Treatment of trochanteric fractures of femur. Presentation also contain an introduction of Dynamic Hip Screw and Surgical Techniques.
it comprises of the anatomy, epidemiology, mechanism of injury and management options.
there is also the fracture classifications
management was grouped into operative and conservative
there is also a section for children.
An Introduction, History, Diagnosis, Current Guidelines on Treatment of trochanteric fractures of femur. Presentation also contain an introduction of Dynamic Hip Screw and Surgical Techniques.
it comprises of the anatomy, epidemiology, mechanism of injury and management options.
there is also the fracture classifications
management was grouped into operative and conservative
there is also a section for children.
Complement system and its synthesis + activationVaisHali822687
Proteins normally found in serum in inactive form, but when activated they augment the immune responses.
Complements constitute about 5% of normal serum proteins.
Their level does not increase following either infection or vaccination.
There are four main stages in the activation of any of the complement pathways.
Initiation of the pathway
Formation of C3 convertase
Formation of C5 convertase
Formation of membrane attack complex (MAC)
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
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
2. DEFINITION
• An InterTrochanteric fracture occurs between the greater
trochanter, where the Gluteus Medius and Minimus muscles (hip
extensors and abductors) attach, and the lesser trochanter, where
the Iliopsoas muscle (hip flexor) attaches.
3.
4. GENERAL FEATURES
• Completely ExtraCapsular fracture with variable comminution
• Common in elderly osteoporotic patient, usually women in their
80’s
• More common than IntraCapsular # - Neck of Femur
• Unites easily
• Rarely causes avascular necrosis
5. MECHANISM OF INJURY
• Intertrochanteric fractures in younger individuals are usually the
result of a high-energy injury, such as a motor vehicle accident
(MVA) or fall from a height
• In the elderly, it results from a simple fall (trivial trauma).
6. SIGNS AND SYMPTOMS
• Pain
• Marked shortening of lower limb
• Patient cannot lift their leg
• Complete External Rotation Deformity
• Swelling, ecchymosis and tenderness over the Greater Trochanter
• Displaced fractures are clearly symptomatic, such patients usually
cannot stand, much less ambulate
• Non-displaced fractures may be ambulatory and experience minimal
pain, and there are yet others who complain of thigh or groin pain
but have no history of antecedent trauma
• The amount of clinical deformity in patients with an intertrochanteric
fracture reflects the degree of fracture displacement
7. ASSOCIATED INJURIES
• Older individuals who sustain an intertrochanteric fracture
as a result of a low-energy fall occasionally have an
associated osteoporosis related fracture, such as a distal
radius or proximal humerus fracture.
• Intertrochanteric fractures in younger individuals are usually
the result of a high-energy injury, such as a motor vehicle
accident or fall from a height. In these instances,
assessment must be made of possible associated head,
neck, chest, and abdominal injuries.
8. DIAGNOSTIC IMAGING
• X-ray is the standard diagnostic tool.
• When a hip fracture is suspected but not apparent on standard x-
rays, a technetium bone scan or a MRI scan should be obtained.
• MRI has been shown to be at least as accurate as bone scanning in
identification of occult fractures of the hip, and it will reveal a
fracture within 24 hours of injury.
9.
10. BOYD & GRIFFIN’S CLASSIFICATION
1. Linear IT line #
2. Linear IT line # with comminution
3. Subtrochanteric #
4. Inter-/Subtrochanteric # with extension into proximal
femoral shaft
16. • In elderly patients, this approach was associated with high
complication rates; typical problems included
• Decubiti
• Urinary tract infection
• Joint contractures
• Hypostatic Pneumonia
• Thromboembolic complications
• Fracture healing was generally accompanied by varus deformity and
shortening because of the inability of traction to effectively
counteract the deforming muscular forces = MALUNION!
17. OPERATIVE TREATMENT
Intertrochanteric fractures are almost always treated
by early internal fixation – not because they fail to
unite with conservative treatment (they unite quite
readily), but
• Obtain the best possible position
• Early ambulation to reduce the complications associated with
prolonged recumbency.
18. SLIDING HIP COMPRESSION SCREW
Indications
• stable intertrochanteric fractures
Outcomes
• equal outcomes when compared to
intramedullary hip screws for stable
fracture patterns
19. • The sliding hip screw is the most widely used implant for stabilization
of both stable and unstable intertrochanteric fractures.
• Sliding hip screw side plate angles are available in 5 degree
increments from 130 to 150 degrees.
• The 135 degree plate is most commonly utilized; this angle is easier
to insert in the desired central position of the femoral head and neck
than higher angle devices and creates less of stress
20.
21. TROCHANTERIC STABILIZING PLATES
• The trochanteric stabilizing plate and the
lateral buttress plate are modular
components that reinforces the greater
trochanter
• These plates are placed over a four-hole
sideplate and are used to prevent
excessive slide (and resulting deformity)
in unstable fracture patterns
• These devices prevent telescoping of the
lag screw within the plate barrel when
the proximal head and neck fragment
abuts the lateral buttress plate
22.
23. INTRAMEDULLARY HIP SCREW
Also known as the Proximal Femoral Nail (PFN).
Indications
• stable fracture patterns
• unstable fracture patterns
• reverse obliquity fractures (56% failure when treated with sliding
hip screw)
• subtrochanteric extension
• lack of integrity of femoral wall
Outcome
• equivalent to sliding hip screw for stable fracture patterns
• use has significantly increased in last decade
24.
25. COMPLICATIONS
EARLY
• The same as with femoral neck fractures, reflecting the fact
that most of these patients are in poor health.
LATE
• Failed fixation Screws may cut out of the osteoporotic bone if
reduction is poor or if the fixation device is incorrectly
positioned. If union is delayed, the implant itself may break. In
either event, reduction and fixation may have to be re-done.
• Malunion
• Coxa Vara and external rotation deformities are common
• Non-union (uncommon, unlike # NoF)
• Traumatic Osteoarthritis
• Avascular Necrosis (rare)
26. PATHOLOGICAL FRACTURE
• Due to metastatic disease or myeloma.
• Unless patients are terminally ill, fracture fixation is essential in
order to ensure an acceptable quality of life for their remaining
years.
• In addition to internal fixation, methylmethacrylate cement may
be packed in the defect to improve stability.