Negative pressure wound therapy (NPWT) is a non-invasive technique that employs negative pressure within a sealed suction system, applied to acute or chronic wounds, and promotes wound healing process through the elimination of exudate, mechanical contraction of wound edges, and stimulation of angiogenesis.
Journal club on Connective tissue graft associated or not with low laser ther...Shilpa Shiv
Connective tissue graft associated or not with low laser therapy to treat gingival recession: randomized clinical trial, Fernandes-Dias SB, de Marco AC, Santamaria Junior M et al.
JCP 2015.
Journal club on Connective tissue graft associated or not with low laser ther...Shilpa Shiv
Connective tissue graft associated or not with low laser therapy to treat gingival recession: randomized clinical trial, Fernandes-Dias SB, de Marco AC, Santamaria Junior M et al.
JCP 2015.
The Utility of the CADISS® System in the Dissection of Epidural Fibrosis in ...Michel Triffaux
Spine surgery and spinal fusion surgery are rising. Revision rates following initial surgery are between 8
and 45%. Epidural fibrosis is a common response to spine surgery for most patients and increases
complications in revision surgery. Previous research suggests using MESNA (Sodium 2-mercaptoethane
sulfonate) in combination with mechanical blunt dissection safely reduces surgical complications. MESNA is
a mucolytic agent which selectively cleaves disulphide bonds involved in the adherence and strength of
fibrosis, meaning cutting instruments are not needed. The Chemically Assisted DISSection (CADISS®)
System is an optimised non-cutting surgical device, consisting of a reconstitution cartridge for MESNA
preparation, irrigated surgical instruments, and a footswitch to control MESNA release. This is the first study
to investigate the use of the CADISS® System in revision spine surgery.
Francis Derk1, Troy Wilde2,
Tim Pham2, Mike Griffiths3
1South Texas VA Medical Center (San Antonio, United States)
2UTHSC (San Antonio, United States)
3AOTI (Oceanside, United States)
EWMA 2013 - Ep543 - Evidence Based Wound Conversion Algorithm for University ...EWMAConference
Francis Derk1, Troy Wilde2,
Tim Pham2, Mike Griffiths3
1South Texas VA Medical Center (San Antonio, United States)
2UTHSC (San Antonio, United States)
3AOTI (Oceanside, United States)
Evaluate and Compare the Effectiveness of Back Care with Traditional Method v...ijtsrd
A pressure ulcers is a localized area of tissue necrosis that tends to develop when soft tissue is compressed for a prolonged period of time between a bony prominence and an external surface. The frequency of pressure ulcers ranges from3 14 globally. The incidence of pressure ulcer in hospital has been reported to be 23 to 27.5 Prevention of pressure ulcers is a significant nursing concern. Nurses' ability to identify the patient at risk for the formation of the pressure ulcer would help to reduce the costs of treatment. Pressure ulcers not only cause suffering to the patients but also increases the economical burden. Mrs. Kanagavalli K | Dr. Harinderjeet Goel | Mrs. Madumitha Dey | Dr. Tankeshwar Boruah "Evaluate and Compare the Effectiveness of Back Care with Traditional Method versus Cavilon Spray in Term of Prevention of Decubitus Ulcer in Bedridden Patients" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47501.pdf Paper URL : https://www.ijtsrd.com/medicine/nursing/47501/evaluate-and-compare-the-effectiveness-of-back-care-with-traditional-method-versus-cavilon-spray-in-term-of-prevention-of-decubitus-ulcer-in-bedridden-patients/mrs-kanagavalli-k
Title: Efficacy of Injectable Collagenase in the treatment of Dupuytren’s contracture in comparison to Partial Fasciectomy
Authors: Mohamed A. El Rouby, MD, Ahmed Abd El Salam, MD, Ahmed Gad, MD Khaled Rizq, MD
Plastic and Reconstructive Surgery Department, Ain Shams University, Cairo, EGYPT.
Accepted: Egyptian Journal of Plastic and Reconstructive Surgery
Abstract:
Background: Dupuytren's disease as a benign fibroproliferative disease with an abnormal slowly progressive thickening and shorting of the palmar aponeurosis leads to severe functional limitations in the finger movements particularly of the metacarpophalangeal (MCP) joints and/or the proximal interphalangeal (PIP) joints. The authors aimed to evaluate the role of injectable collagenase (CCH) in the treatment of Dupuytren’s contracture in comparison to surgical treatment.
Material and method: This study included 15 patients (33 rays), They were divided into two groups, Group A: 26 rays underwent open fasciectomy. (10 patients) and Group B: 7 rays were treated by collagenase injection. (5 patients). Exclusion criteria for group B were contraindications of injection of CCH. The primary efficacy variable was clinical success, contracture correction to within 5° of normal (normal = 0°) by using goniometry. Additional efficacy variables included the time and number of injections required to achieve success in the primary joint. Recurrence rate and adverse effects were recorded.
Results: Initial clinical experience was recorded of 5 patients (7rays) (mean age 57 years) and compared to previously surgically managed 10 patients (26 rays) (mean age 59 years). Of all population, 51% for little, 47% for ring, 1% for middle and 1% for index fingers. The mean of the pre-intervention fixed flexion contracture in the MCP joint was 39° and improved to one-year postintervention 14°, and in the PIP joint 47° to 19°. In group B one ray with no improvement at all and recurrence in one ray. Partial stretching was achieved in one ray. No serious complications were observed after injections. In cases of group A (26 rays) that was treated by partial fasciectomy, recurrence occurred in 6 rays and nerve injuries as nerve division and neuropraxia occurred in 2 rays.
Conclusion: The treatment of Dupuytren's disease with injectable collagenase is safe and effective. However, the financial aspects should be considered especially in developing countries.
”DVT Prevention What Works BestSHINE BELL, .docxodiliagilby
“
”
DVT Prevention:
What Works Best?
SHINE BELL, RN, LACEY KEITH, LPN, AMBER MCGRAW, RN, REGAN WENTZ, RN.
FACULTY CONSULT: JAMIE MORRIS, MS RN
OU College of Nursing: Degree Completion
Evidence-Based Practice Symposium
Friday, April 26. 2019
Objective
To analyze and critique current research
regarding the most effective means of
DVT prophylaxis.
PICO Question
For Deep Vein Thrombosis (DVT) prophylaxis, which intervention,
mechanical, pharmacological or combination, best decreases
DVT occurrence in the acute care setting?
Population: Patients in the Acute Care Setting
Intervention: DVT Prophylaxis
Comparison: Mechanical vs Pharmacological vs Combination
Outcome: Decrease of DVT occurrence
What is the Problem?
No current standardized practice guideline for DVT
prevention.
DVT prophylaxis is not implemented correctly in all patients
for whom it is ordered.
There is currently no consensus regarding the preferred
pharmacological therapeutic agent.
Why is this a Problem?
As many as 70% of healthcare-associated blood clots are preventable, yet
fewer than half of hospitalized patients receive appropriate preventive
treatment (CDC, 2018).
Almost all patients admitted to the hospital are at risk for developing a DVT
(Sachdeva, 2018).
DVT is the single most important preventable cause of morbidity and
mortality in many surgical specialties (Chibbaro, 2018).
Without prophylaxis, DVT occurs in 40–60 percent of postoperative cases in
the 7–14 days following surgery (AHRQ, 2012).
Literature Review
Database Search: PubMed, CINAHL, Ovid, Joanna
Briggs
Key terms included: Deep Vein Thrombosis, prophylaxis,
mechanical, pharmacological, DVT best practice, DVT
acute care setting.
Articles used are between the years 2012-2018
Literature Review & Conclusions
Bala et al (2017)
A large database analysis asking (1) What are the differences in VTE incidence in primary
TKA after administration of aspirin, warfarin, enoxaparin, or factor Xa inhibitors? (2) What
are the differences in bleeding risk among these four agents? (3) How has use of these
agents changed with time? Concluded that utilization trends for these agents are not
well-studied.
Beitland et al (2015)
A systematic review with meta-analysis and trial sequential analysis of randomized
controlled trials (RCTs) comparing pharmacological thromboprophylaxis with low
molecular weight heparin (LMWH) versus unfractionated heparin (UFH) in ICU patients.
Concluded a need for future trials.
Chibbaro et al (2018)
A prospective comparative study analyzing results from two separate prophylaxis
protocols implemented in a European neurosurgical center to assess the safety and
efficacy of prevention. Concluded that mechanical devices are non-negligible support
in the prophylaxis of clinically symptomatic DVT.
Literature Review & Conclusions
O'Brien et al (2018)
A two-stage sequential multi ...
Nursing Evidence Based Practice PPT for BSN Nurses.
This ppt assess effectiveness of using NPWT for DFUs with providing highest level of evidence. DFUs are a prevalent issue in many countries and is treated via dressings which take a long time to heal but utilizing this method will certainly make the recovery faster.
Postoperative recovery after mandibular third molar surgery. By Dr. Akhila Damodar { dr.akhila.n@gmail.com }
This study sought to evaluate postoperative recovery after mandibular third molar surgery, with and without the use of sutures.
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.
More Related Content
Similar to Negative Pressure Wound Therapy in Diabetic Foot Ulcer.pptx
The Utility of the CADISS® System in the Dissection of Epidural Fibrosis in ...Michel Triffaux
Spine surgery and spinal fusion surgery are rising. Revision rates following initial surgery are between 8
and 45%. Epidural fibrosis is a common response to spine surgery for most patients and increases
complications in revision surgery. Previous research suggests using MESNA (Sodium 2-mercaptoethane
sulfonate) in combination with mechanical blunt dissection safely reduces surgical complications. MESNA is
a mucolytic agent which selectively cleaves disulphide bonds involved in the adherence and strength of
fibrosis, meaning cutting instruments are not needed. The Chemically Assisted DISSection (CADISS®)
System is an optimised non-cutting surgical device, consisting of a reconstitution cartridge for MESNA
preparation, irrigated surgical instruments, and a footswitch to control MESNA release. This is the first study
to investigate the use of the CADISS® System in revision spine surgery.
Francis Derk1, Troy Wilde2,
Tim Pham2, Mike Griffiths3
1South Texas VA Medical Center (San Antonio, United States)
2UTHSC (San Antonio, United States)
3AOTI (Oceanside, United States)
EWMA 2013 - Ep543 - Evidence Based Wound Conversion Algorithm for University ...EWMAConference
Francis Derk1, Troy Wilde2,
Tim Pham2, Mike Griffiths3
1South Texas VA Medical Center (San Antonio, United States)
2UTHSC (San Antonio, United States)
3AOTI (Oceanside, United States)
Evaluate and Compare the Effectiveness of Back Care with Traditional Method v...ijtsrd
A pressure ulcers is a localized area of tissue necrosis that tends to develop when soft tissue is compressed for a prolonged period of time between a bony prominence and an external surface. The frequency of pressure ulcers ranges from3 14 globally. The incidence of pressure ulcer in hospital has been reported to be 23 to 27.5 Prevention of pressure ulcers is a significant nursing concern. Nurses' ability to identify the patient at risk for the formation of the pressure ulcer would help to reduce the costs of treatment. Pressure ulcers not only cause suffering to the patients but also increases the economical burden. Mrs. Kanagavalli K | Dr. Harinderjeet Goel | Mrs. Madumitha Dey | Dr. Tankeshwar Boruah "Evaluate and Compare the Effectiveness of Back Care with Traditional Method versus Cavilon Spray in Term of Prevention of Decubitus Ulcer in Bedridden Patients" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47501.pdf Paper URL : https://www.ijtsrd.com/medicine/nursing/47501/evaluate-and-compare-the-effectiveness-of-back-care-with-traditional-method-versus-cavilon-spray-in-term-of-prevention-of-decubitus-ulcer-in-bedridden-patients/mrs-kanagavalli-k
Title: Efficacy of Injectable Collagenase in the treatment of Dupuytren’s contracture in comparison to Partial Fasciectomy
Authors: Mohamed A. El Rouby, MD, Ahmed Abd El Salam, MD, Ahmed Gad, MD Khaled Rizq, MD
Plastic and Reconstructive Surgery Department, Ain Shams University, Cairo, EGYPT.
Accepted: Egyptian Journal of Plastic and Reconstructive Surgery
Abstract:
Background: Dupuytren's disease as a benign fibroproliferative disease with an abnormal slowly progressive thickening and shorting of the palmar aponeurosis leads to severe functional limitations in the finger movements particularly of the metacarpophalangeal (MCP) joints and/or the proximal interphalangeal (PIP) joints. The authors aimed to evaluate the role of injectable collagenase (CCH) in the treatment of Dupuytren’s contracture in comparison to surgical treatment.
Material and method: This study included 15 patients (33 rays), They were divided into two groups, Group A: 26 rays underwent open fasciectomy. (10 patients) and Group B: 7 rays were treated by collagenase injection. (5 patients). Exclusion criteria for group B were contraindications of injection of CCH. The primary efficacy variable was clinical success, contracture correction to within 5° of normal (normal = 0°) by using goniometry. Additional efficacy variables included the time and number of injections required to achieve success in the primary joint. Recurrence rate and adverse effects were recorded.
Results: Initial clinical experience was recorded of 5 patients (7rays) (mean age 57 years) and compared to previously surgically managed 10 patients (26 rays) (mean age 59 years). Of all population, 51% for little, 47% for ring, 1% for middle and 1% for index fingers. The mean of the pre-intervention fixed flexion contracture in the MCP joint was 39° and improved to one-year postintervention 14°, and in the PIP joint 47° to 19°. In group B one ray with no improvement at all and recurrence in one ray. Partial stretching was achieved in one ray. No serious complications were observed after injections. In cases of group A (26 rays) that was treated by partial fasciectomy, recurrence occurred in 6 rays and nerve injuries as nerve division and neuropraxia occurred in 2 rays.
Conclusion: The treatment of Dupuytren's disease with injectable collagenase is safe and effective. However, the financial aspects should be considered especially in developing countries.
”DVT Prevention What Works BestSHINE BELL, .docxodiliagilby
“
”
DVT Prevention:
What Works Best?
SHINE BELL, RN, LACEY KEITH, LPN, AMBER MCGRAW, RN, REGAN WENTZ, RN.
FACULTY CONSULT: JAMIE MORRIS, MS RN
OU College of Nursing: Degree Completion
Evidence-Based Practice Symposium
Friday, April 26. 2019
Objective
To analyze and critique current research
regarding the most effective means of
DVT prophylaxis.
PICO Question
For Deep Vein Thrombosis (DVT) prophylaxis, which intervention,
mechanical, pharmacological or combination, best decreases
DVT occurrence in the acute care setting?
Population: Patients in the Acute Care Setting
Intervention: DVT Prophylaxis
Comparison: Mechanical vs Pharmacological vs Combination
Outcome: Decrease of DVT occurrence
What is the Problem?
No current standardized practice guideline for DVT
prevention.
DVT prophylaxis is not implemented correctly in all patients
for whom it is ordered.
There is currently no consensus regarding the preferred
pharmacological therapeutic agent.
Why is this a Problem?
As many as 70% of healthcare-associated blood clots are preventable, yet
fewer than half of hospitalized patients receive appropriate preventive
treatment (CDC, 2018).
Almost all patients admitted to the hospital are at risk for developing a DVT
(Sachdeva, 2018).
DVT is the single most important preventable cause of morbidity and
mortality in many surgical specialties (Chibbaro, 2018).
Without prophylaxis, DVT occurs in 40–60 percent of postoperative cases in
the 7–14 days following surgery (AHRQ, 2012).
Literature Review
Database Search: PubMed, CINAHL, Ovid, Joanna
Briggs
Key terms included: Deep Vein Thrombosis, prophylaxis,
mechanical, pharmacological, DVT best practice, DVT
acute care setting.
Articles used are between the years 2012-2018
Literature Review & Conclusions
Bala et al (2017)
A large database analysis asking (1) What are the differences in VTE incidence in primary
TKA after administration of aspirin, warfarin, enoxaparin, or factor Xa inhibitors? (2) What
are the differences in bleeding risk among these four agents? (3) How has use of these
agents changed with time? Concluded that utilization trends for these agents are not
well-studied.
Beitland et al (2015)
A systematic review with meta-analysis and trial sequential analysis of randomized
controlled trials (RCTs) comparing pharmacological thromboprophylaxis with low
molecular weight heparin (LMWH) versus unfractionated heparin (UFH) in ICU patients.
Concluded a need for future trials.
Chibbaro et al (2018)
A prospective comparative study analyzing results from two separate prophylaxis
protocols implemented in a European neurosurgical center to assess the safety and
efficacy of prevention. Concluded that mechanical devices are non-negligible support
in the prophylaxis of clinically symptomatic DVT.
Literature Review & Conclusions
O'Brien et al (2018)
A two-stage sequential multi ...
Nursing Evidence Based Practice PPT for BSN Nurses.
This ppt assess effectiveness of using NPWT for DFUs with providing highest level of evidence. DFUs are a prevalent issue in many countries and is treated via dressings which take a long time to heal but utilizing this method will certainly make the recovery faster.
Postoperative recovery after mandibular third molar surgery. By Dr. Akhila Damodar { dr.akhila.n@gmail.com }
This study sought to evaluate postoperative recovery after mandibular third molar surgery, with and without the use of sutures.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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).
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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
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
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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
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
2. Introduction
• Global diabetes prevalence exceeds 400 million
individuals, with approximately 15% of this population
expected to develop Diabetic Foot Ulcer (DFU) during
their lifetime (Cho et al., 2018).
• DFU encompass ulcers, infections and tissue damage
of the foot below the medial malleolus (Maranna et al.,
2021).
• Major impact on morbidity, mortality and quality of life
of patients as well as economic burden on society
(Maranna et al., 2021).
• Negative pressure wound therapy (NPWT) is a non-invasive technique that employs negative pressure
within a sealed suction system, applied to acute or chronic wounds, and promotes wound healing process
through the elimination of exudate, mechanical contraction of wound edges, and stimulation of
angiogenesis (Ari et al., 2023).
3. Pathogenesis of DFU
Main factors involved:
• Persistent hyperglycaemia
• Diabetic neuropathy
• Peripheral artery disease
• Local infection
(Ari et al., 2023).
Figure 1: The mechanisms of diabetic non-healing wound
development (Deng & Chen, 2022)
4. Mechanism of NPWT
Negative Pressure Wound Therapy (NPWT) is a biophysical tool with a mechanical apparatus linked to a
dressing via a plastic tube and, when connected to a suction device, this setup facilitates the generation of
sub-atmospheric pressure at the location of a wound (Nain et al., 2011).
• Wound perfusion → stimulates angiogenesis
• Increase growth factor expression – transforming
growth factor – β, pro-healing growth factors
Figure 2: NPWT diagram (Gilero, 2023) Figure 3: Mechanism of NPWT (Triage Meditech, 2020).
5. Components of Vacuum Assisted Closure therapy
A. Showing the polyurethane foam applied over the diabetic foot
ulcer.
B. Showing the canister into which the effluents from the wound
are collected.
C. VAC therapy unit from which a continuous negative pressure of
125 mm Hg was applied (Maranna et al., 2021)
6. Current Research on NPWT in DFU
DiaFu study (Seidel et al., 2020) Wu et al. (2023) Maranna et al. (2021)
To evaluate effectiveness and safety of
NPWT compared to standard moist
wound care in DFU in clinical practice.
To compare the efficacy of NPWT
and alginate dressings on wound
bed preparation prior to split
thickness skin graft (STSG) surgery
in chronic DFUs
To compare NPWT and conventional
saline dressings
in DFU healing
Adult patients (age >18 years);
chronic DFUs (≥ 4 weeks);
Wagner grade 2–4
Adult patients (age >18 years);
chronic DFU wounds (≥2 weeks),
ankle brachial index (ABI) 0.5~0.9,
wound area 8~20 cm2, Wagner
grade 2-3
Adult patients (age >18 years);
chronic DFU wounds (≥3 months),
Wagner 1-2; ulcer size 5-20cm
7. Methods
DiaFu study (Seidel et al., 2020) Wu et al. (2023) Maranna et al. (2021)
Patients underwent amputation,
debridement, or thorough wound
cleansing up to 6 hours before
randomization.
Wound Bed Preparation :
NPWT group: commercially available
CE-marked NPWT devices;
intermittent & continuous NPWT with
negative pressure adapted to dressing
type and wound needs.
Control Arm: any local wound
treatment standard except NPWT.
Follow-up – 6 months
Radical surgical debridement
→ antibiotics for infections / insulin
pumps for glycemic control →
offloading therapies.
Wound Bed Preparation :
NPWT group: Utilized Vacuum-
Assisted Closure (VAC) system with
specific protocols negative pressure
of -125 mmHg (continuous mode).
The VAC foams were changed once
every 72 hours (h)
Control group: Used alginate
dressings with fabric dressings
STSG surgery
Initial assessments/surgical
debridement
NPWT Group: VAC therapy -
Polyurethane foam applied, secured
airtight by the TRAC system,
continuous negative pressure of -125
mm Hg to the wound.
Dressings changed after 72 hours
with aseptic precautions.
Control group: normal saline-soaked
gauze dressing, changed daily with
aseptic precautions.
Follow-up – 3 months
TRAC- therapeutic regulated accurate care
8. Result | DiaFu study (Seidel et al., 2020)
Primary outcome:
• Wound closure within 16 weeks – no significant difference
(difference: n=4 (2.5% (95% CI−4.7% – 9.7%); p=0.53))
• NPWT group completed treatment in a shorter duration
compared to SMWC (33.3±25.0 days vs. 40.0±25.5 days).
Secondary Outcomes:
• Recurrence rate after complete wound closure was slightly
higher for NPWT (4.0%) compared to SMWC (0%), but the
difference was not significant.
• After 6 months, the number of participants with closed wounds
was higher in the SMWC arm (20.7% vs. 14.0%),
but the difference was not significant.
Safety:
• Incidence of Adverse Events (AEs) in the NPWT arm compared to
SMWC - 56.1% vs. 41.4%. No significant difference in Serious
Adverse Events (SAEs) between
the treatment arms.
Figure 4: Time until complete, sustained and verified
wound closure in the ITT population. NPWT, negative
pressure wound therapy; SMWC, standard moist wound
care.
9. Result | Wu et al. (2023)
• NPWT group had a shorter time to STSG surgery compared to the
control group (mean days: 7.2 vs. 13.6, p=2.2×10^-24).
• NPWT group had significantly reduced hospital days compared to
the control group (mean days: 15.0 vs. 24.1, p=1.2×10^-53).
• Skin graft survival rate was 100% in the NPWT group and 76% in
the control group (mean difference: 24%, p=3.1×10^-19).
• NPWT group showed a significantly reduced number of
Neutrophil Extracellular Traps (NETs) compared to the control
group.
• NPWT group exhibited a shift from M1 to M2 macrophage
phenotypes.
Safety:
• Incidence of Adverse Events (AEs) in the NPWT arm compared to
SMWC - 56.1% vs. 41.4%. No significant difference in Serious
Adverse Events (SAEs) between
the treatment arms.
Figure 5: Kaplan‒Meier plot demonstrated that
patients in the NPWT group had less time to STSG
surgery. X axis: time to STSG surgery (day), Y axis:
cumulative event.
10. Result | Maranna et al. (2021)
Figure 6. Graph showing the change in ulcer size
(cm2) between the two groups on day 1 and day 14.
X-axis depicting size of the ulcer (cm2) and Y-axis
showing time period (days). The mean size of ulcers
after NPWT was 29 cm2 and after conventional
dressings was 37.57 cm2 and was statistically
significant (p = 0.037).
NPWT Group
Conventional saline
dressing group
Reduction in Ulcer Size by
Day 14
40.78 ± 10.12%
(p = 0.008)
21.18 ± 7.11%
Granulation Tissue
Formation on Day 14
91.14 ± 6.53%
(p < 0.001)
52.61 ± 9.64%
Time for 100% Granulation
Tissue Formation
14.82 ± 7.30 days
(p < 0.001)
44.57 ± 9.29 days
Duration of Hospital Stay
15.68 ± 2.02 days
(p < 0.001)
29.00 ± 7.11 days
Complete Healing at
3 Months
90.9% 26.1%
11. Conclusion
• The DiaFu study did not support the use of NPWT in patients with ischemic Diabetic Foot Ulcers
(DFUs) based on the lack of significant differences in primary and secondary outcomes. The
results may not be applicable to non-ischemic DFUs (Seidel et al., 2020).
• According to Wu et al. (2023), for patients with chronic DFUs, NPWT outperforms conventional
moist dressings in wound bed preparation prior to STSG surgery.
• According to Maranna et al. (2021), NPWT led to early reduction in ulcer size, more granulation
tissue formation, shorter hospital stay and complete wound healing. In lower- and middle-
income countries like India with high prevalence of DFUs, early recovery is beneficial to the
patients to resume their daily activities.
• For Wagner 1-2 DFU if appropriate care is given at the right time, progression can be prevented.
• NPWT showed a significant superiority in optimal wound bed preparation compared to
conventional methods.
12. References
Ari, D., Zaenal Muttaqien Sofro, Heny Suseani Pangastuti, & Ishandono Dachlan. (2023). The Efficacy of Negative Pressure Wound Therapy (NPWT) on Healing of Diabetic Foot Ulcers:
A Literature Review. Current Diabetes Reviews, 20. https://doi.org/10.2174/0115733998229877230926073555
Cho, N. H., Shaw, J. E., Karuranga, S., Huang, Y., da Rocha Fernandes, J. D., Ohlrogge, A. W., & Malanda, B. (2018). IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017
and projections for 2045. Diabetes Research and Clinical Practice, 138(1), 271–281. https://doi.org/10.1016/j.diabres.2018.02.023
Deng, H., & Chen, Y. (2022). The role of adipose-derived stem cells-derived extracellular vesicles in the treatment of diabetic foot ulcer: Trends and prospects. Frontiers in Endocrinology,
13. https://doi.org/10.3389/fendo.2022.902130
Gilero. (2023, December 15). Negative Pressure Wound Therapy (NPWT) Device - Gilero. Gilero. https://www.gilero.com/case-study/negative-pressure-wound-therapy-npwt-device/
Maranna, H., Lal, P., Mishra, A., Bains, L., Sawant, G., Bhatia, R., Kumar, P., & Beg, M. Y. (2021). Negative pressure wound therapy in grade 1 and 2 diabetic foot ulcers: A randomized
controlled study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 15(1), 365–371. https://doi.org/10.1016/j.dsx.2021.01.014
Nain, P. S., Uppal, S. K., Garg, R., Bajaj, K., & Garg, S. (2011). Role of Negative Pressure Wound Therapy in Healing of Diabetic Foot Ulcers. Journal of Surgical Technique and Case
Report, 3(1). https://www.ajol.info/index.php/jstcr/article/view/67060
Seidel, D., Storck, M., Lawall, H., Wozniak, G., Mauckner, P., Hochlenert, D., Wetzel-Roth, W., Sondern, K., Hahn, M., Rothenaicher, G., Krönert, T., Zink, K., & Neugebauer, E. (2020).
Negative pressure wound therapy compared with standard moist wound care on diabetic foot ulcers in real-life clinical practice: results of the German DiaFu-RCT. BMJ Open, 10(3),
e026345. https://doi.org/10.1136/bmjopen-2018-026345
Triage Meditech. (2020). Triage Meditech- Advance wound care Technology. Triagemeditech.com. https://www.triagemeditech.com/blogdetails.php?id=4
Wu, Y., Shen, G., & Hao, C. (2023). Negative pressure wound therapy (NPWT) is superior to conventional moist dressings in wound bed preparation for diabetic foot ulcers. Saudi Medical
Journal, 44(10), 1020–1029. https://doi.org/10.15537/smj.2023.44.20230386