This document provides an overview of spinal cord injury (SCI) management. It describes a case of a 47-year-old male who suffered a cervical spine injury in a motor vehicle accident 4 months ago and is now presenting with paraplegia and paraparesis. The document then outlines key topics related to SCI, including anatomy, causes, types, pathophysiology, clinical syndromes, diagnosis, neurological assessment classification, and management. Tables and diagrams are provided to illustrate spinal cord anatomy and tracts, dermatomes, myotomes, and the American Spinal Injury Association classification system.
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury.
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury.
physiotherapy management for chronic obstructive pulmonary disease Sunil kumar
role of physiotherapy in chronic obstructive pulmonary disease, principles of physical therapy management in copd, physiotherapy assessing and treatment for copd
physiotherapy management for chronic obstructive pulmonary disease Sunil kumar
role of physiotherapy in chronic obstructive pulmonary disease, principles of physical therapy management in copd, physiotherapy assessing and treatment for copd
A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of diseases resulting in a change either temporary or permanent, in its normal motor, sensory or autonomic function.
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
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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
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
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
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.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
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.
2. Case scenario
47 y/o male involved in RTA 4/12 ago.
Admitted via A&E in LUTH and
transferred to National Hospital for further
mgt.
Sensation intact on both ULs & LLs.
Muscle power 0/5 below the Umbilicus.
No bladder / bowel control.
Diagnosed of C-spine injury and
presenting now with paraplegia LLs and
paraparesis ULs
4/3/2012 2
4. Overview
SCI is damage to the spinal cord that
results in loss of functions such as mobility
or feeling.
The fourth leading cause of death in the US.
Spinal Cord (SC) is the major bundle of
nerves that carry impulses to/from the brain
to the rest of the body.
Spinal Cord is surrounded by rings of bone-
vertebra and function to protect the spinal
cord.
Most common vertebrae involved are C5,
C6, C7, T12, and L1 because they have the
greatest ROM
4/3/2012 4
5. Key terms used in SCI
SCI is insult to spinal cord resulting in
a change in the normal motor, sensory
or autonomic function. This change is
either temporary or permanent.
Tetraplegia The impairment or loss of
motor and/or sensory function in the
cervical segments of the spinal cord
due to damage of neural elements
within the spinal canal.
Paraplegia The impairment or loss of
motor and/or sensory function in the
thoracic, lumbar, or sacral segments
of the spinal cord due to damage of
neural elements within the spinal
canal.
4/3/2012 5
6. Key terms used in SCI
Dermatome The area of skin
innervated by one sensory nerve root.
Myotome The collection of muscles
innervated by one motor nerve root.
Neurological Level of Injury The most
caudal segment of the spinal cord
with normal motor and sensory
function on both sides.
Skeletal Level The radiographic level
of greatest vertebral damage.
4/3/2012 6
7. Key terms used in SCI
Motor level The most caudal key muscle group
that is graded 3/5 or greater with the segments
cephalad to that level graded normal (5/5)
strength.
Sensory level The most caudal dermatome to
have normal sensation for both pinprick and
light touch on both sides.
Complete injury The absence of sensory and
motor function in the lowest sacral segments.
Incomplete injury Preservation of motor or
sensory function below the neurologic level of
injury that includes the lowest sacral
segments.
4/3/2012 7
8. Key terms used in SCI
Sacral sparing Presence of motor
function (voluntary external anal
sphincter contraction) or sensory
function (light touch, pinprick at S4/5
dermatome, or anal sensation on rectal
examination) in the lowest sacral
segments.
Zone of partial preservation All
segments below the neurologic level of
injury that have preserved motor or
sensory findings; used only in complete
SCI.
4/3/2012 8
9. Anatomy
Spinal cord: foramen magnum 1st/2nd
lumbar vertebrae.
Gray matter: central (cell bodies)
White matter: peripheral (ascending and
descending tracts)
On the surface :
Deep anterior median fissure
Shallower posterior median sulcus
Spinal cord segment :
Section of the cord from which a pair of
spinal nerves are given off
31 pairs of spinal nerves: 8 cervical, 12
thoracic, 5 lumbar, 5 sacral, 1 coccygeal
4/3/2012 9
10. Anatomy
Dorsal root – sensory fibres
Ventral root – motor fibres
Dorsal and ventral roots join at
intervertebral foramen to form the spinal
nerve
4/3/2012 10
16. Type of SCI
Transient concussion - is due to extreme
vibration of the cord and may cause
temporary loss of function lasting 24 to 48
hours. No neuropathologic changes are
present.
Contusion - is a bruising that includes
bleeding, subsequent edema, and possible
necrosis from the edematous
compression. The neurological
involvement depends on the severity of
contusion and necrosis
Laceration
Compression of cord substance
4/3/2012 16
17. Pathophysiology
Hemorrhage: Blood flows into the
extradural, subdural, or subarachnoid
spaces of the spinal cord
Injury to spinal cord vasculature causes
nerve fibers to swell and disintegrate
Blood circulation to the gray matter of
the spinal cord is impaired
Secondary chain of events: Ischemia,
hypoxia, edema, and hemorrhagic
lesions
These secondary events result in
destruction of myelin and axons.
4/3/2012 17
18. Pathophysiology
These secondary reactions, are believed to
be the principal causes of spinal cord
degeneration .
The damage may be reversible within the
first 4 to 6 hours after the injury.
The consequence of spinal cord injury
depends on
The type of SCI injury
The neurologic level (lowest level at
which sensory and motor functions are
normal)
4/3/2012 18
19. Clinical Syndromes
Central Cord Syndrome: Cervical injury with
sacral sparing and greater weakness in the arms
than the legs.
Brown-Sequard Syndrome: An injury that causes
greater ipsilateral weakness and proprioceptive
loss and contralateral pain and temperature loss.
Anterior Cord Syndrome: Injury to the spinal cord
causing loss of pain and temperature sensation
with preserved proprioception.
Posterior Cord Syndrome: Injury to the spinal
cord causing loss of proprioception with
preserved pain and temperature sensation.
Conus Medullaris Syndrome: Injury of the sacral
conus and lumbar nerve roots
Cauda Equina Syndrome: Injury to the
lumbosacral nerve roots within the neural canal.
21. Diagnosis
X-rays of cervical spine to establish level
and extent of vertebral injury
CT scan and MRI: changes in vertebrae,
spinal cord, tissues around cord
Arterial blood gases to establish baseline
4/3/2012 21
22. Neurological assessment and
classification
The most widely tool for classifying SCI is “the
American Spinal Injury Association (ASIA)
classification,” this assessment requires manual
muscle testing of 10 key muscles bilaterally,
sensory testing for light touch and sharp/dull
discrimination in all dermatomes, and a rectal
exam for sensation and presence of voluntary
anal contraction. These tests are used to
classify injury levels and ASIA Impairment
Scale (AIS) grade
4/3/2012 22
25. ASIA Motor Testing
0 = No movement
1 = Trace contraction
2 = Full AROM gravity eliminated .
3 = Full AROM against gravity
4 = Full AROM against gravity with resistance
5 = Normal power
30. ASIA Impairment Scale
A = Complete: No motor or sensory
function in the lowest sacral segment.
B = Incomplete: Sensory but no motor
function is preserved in the lowest
sacral segment.
C = Incomplete: Less than ½ of the key
muscles below the (single) neurological
level have a grade 3 or better.
D = Incomplete: At least ½ of the key
muscles below the (single) neurological
level have a grade 3 or better.
E = Sensory and motor function are
normal.
31. Management
Immediate
management at the
scene is critical.
Improper handling can
cause further damage
and loss of functioning
Always assume there is
a spinal cord injury
until it is ruled out
Immobilize
Prevent flexion, rotation
or extension of neck
Avoid twisting patient
4/3/2012 31
32. Management
Management consists of
emergency treatment following an
A-B-C-D-E sequence.
Airway
Breathing
Circulation
Disability
Expose
4/3/2012 32
33. Medical management
High dose corticosteroids
(Methylprednisolone) - improves the
prognosis and decreases disability if
initiated within 8 hours of injury.
Patient receives a loading dose and
then a continuous drip.
High dose steroids, Mannitol, Dextran
Neurological/orthopedic management
includes methods a surgeon may use to
treat unstable spinal cord injuries:
Reduction
Fixation
Fusion
4/3/2012 33
34. Reduction
With reduction, the spine is
realigned through the application
of a skeletal traction devise (such
as Gardner-Wells tongs, Minerva
vest, Halo traction) or Soft and
hard collars.
4/3/2012 34
38. Fixation and Fusion
Fixation involves Fusion involves
stabilizing attaching injured
vertebral vertebrae to
fractures with uninjured
wires, plates, and vertebrae with
other types of bone grafts, and
hardware. steel rods to help
maintain
structural
integrity.
39. Physiotherapy Goals
Relieve pain
Maintain optimal level of wellness
Maintain optimal functioning
Minimal or no complications of
immobility
Learn new skills, self care
Return to home
Integrate back into community
42. Mobility
bed mobility (i.e. turning from side
to side, moving from supine to
sitting).
sitting balance.
wheelchair transfers (i.e. from
wheelchair to bed, wheelchair to
car, and wheelchair to floor).
standing balance.
ambulation (wheelchair or
walking).
4/3/2012 42
43. Self care
Along with increasing mobility,
minimizing the need for assistance in
self-care is a major step toward
independence for those with SCI.
Self-care includes feeding, bathing,
dressing, grooming, and toileting.
Those with motor-complete injuries at
the C-7 level or below can usually
achieve independence in all of these
activities.
4/3/2012 43
44. Functional activities
Living skills (e.g. meal
preparation, shopping, cheque
writing, housekeeping, etc) are
necessary tasks of everyday life
and must be relearned and
adapted to a patient’s needs.
These skills are often reacquired
with the help of occupational
therapists.
4/3/2012 44