This document summarizes a case conference about a 15-year-old male patient presenting with right knee pain for one month. Physical examination revealed swelling and pus drainage from the right knee. Investigation showed elevated inflammatory markers and imaging found chronic osteomyelitis of the right femur from a previous open fracture injury. The patient was diagnosed with chronic osteomyelitis and treated with intravenous antibiotics, pain medications, and debridement surgery. Osteomyelitis is a bone infection that can be acute or chronic, requiring prolonged antibiotic treatment and sometimes surgical intervention.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
From The Guardian to Cisco, big business to small, it seems that everybody is talking about the Internet of Things — but what exactly is IoT and why does it matter?
Taking a deep dive, we explore the many faces of IoT in Healthcare. Technology research and advisory company, Gartner, currently place the Internet of Things at the peak of inflated expectations and there are certainly challenges. But IoT also holds real promise for healthcare and it is already making an impact today.
We demonstrate why the Internet of Things has a far reaching impact across all determinants of health and how it could lead to a broader model of healthcare. We look at some of the technologies that are available to buy or that are already in development today, whilst also exploring some of the very real challenges that integrating such technologies into healthcare presents. Finally, we offer some ideas about how you can get involved, whether you are a healthcare professional or not.
This ppt presentation discusses about the various models of mental illness. I found it useful to download as it gives a fair idea about various models which are generally not found in books.
This presentation gives a brief idea of Acute osteomyelitis, its cause, predisposing factors, pathogenesis, signs and symptoms, investigation and its management. It also explain Nades principle.
Slides for 3rd and 4th year medical students in Obstetrics and Gynecology- to not overlook the possibility as a diagnosis- still present. Slides highlighting diagnostic and management challenges
From The Guardian to Cisco, big business to small, it seems that everybody is talking about the Internet of Things — but what exactly is IoT and why does it matter?
Taking a deep dive, we explore the many faces of IoT in Healthcare. Technology research and advisory company, Gartner, currently place the Internet of Things at the peak of inflated expectations and there are certainly challenges. But IoT also holds real promise for healthcare and it is already making an impact today.
We demonstrate why the Internet of Things has a far reaching impact across all determinants of health and how it could lead to a broader model of healthcare. We look at some of the technologies that are available to buy or that are already in development today, whilst also exploring some of the very real challenges that integrating such technologies into healthcare presents. Finally, we offer some ideas about how you can get involved, whether you are a healthcare professional or not.
This ppt presentation discusses about the various models of mental illness. I found it useful to download as it gives a fair idea about various models which are generally not found in books.
This presentation gives a brief idea of Acute osteomyelitis, its cause, predisposing factors, pathogenesis, signs and symptoms, investigation and its management. It also explain Nades principle.
Slides for 3rd and 4th year medical students in Obstetrics and Gynecology- to not overlook the possibility as a diagnosis- still present. Slides highlighting diagnostic and management challenges
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
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This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
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3. • Past history : 1 ปีก่อนมาโรงพยาบาลเคยได้รับอุบัติเหตุมีกระดูก
ต้นขาขวาหักร่วมกับกระดูกหน้าแข้ง ได้รับการใส่เหล็ก6 เดือน
(DX:Open fracture right distal femur and right
proximal tibia)
• Last admit 13-19 /10/2016 remove plate and
screw
• Medication
– None
– No use herb or steroid, no drug allergy
• Personal history
– No smoking ,no alcohol drinking
4. Physical examination
• GA : A Thai man, good conscious ,well co-
operate
• V/S BP 120/80 PR 128 RR 20 BT 37.5
• HEENT: not pale conjunctivae, anicteric sclerae
• HEART: normal s1,s2 no murmur
• Lung : clear both lung ,no adventitious sound
• Abdomen : soft ,not tenderness
5. • Neurology : alert ,well co-operative ,motor
grade 5 all extremity ,sensory intact , reflex 2+
all extremity
• Musculoskeletal :
– surgical wound along right anterior of femur to
anterior of tibia, there are pus from sinus tract at
right lower part of femur ,right knee swelling ,no
redness , no warm,
– tender around sinus tract ,limit ROM due to pain,
not tenderness along joint line, ballottement test
negative
16. Osteomyelitis
• Osteomyelitis is an infectious process that
involves bone and its medullary cavity.
Bacteria are the usual causes of osteomyelitis
• Infecting organisms may enter bones or joints
in the following ways
– hematogenous spread
– external inoculation
– extension from an adjacent structure that is
infected
19. pathophysiology
• Hematogenous
– brushing our teeth ,impetigo, otitis media,
pharyngitis, or pneumonia. Reticulo-endothelial
defense mechanisms fail, however, bacteria may
gain access to bone. In experimental studies,
previous trauma
– In children, the growth plate (transient
bacteremia)
20. Osteoblast
cell death
Phagocytosis cell and
endothelial cell secrete
osteoclast activating
factor>>sinus day3
Purulent exudate extend to cortex,
periosteum ( sub periosteal abscess)
and subcutaneous tissue
Involucum and sequestrum
Joint capsule
(hip,ankle,elbow
,shoulder)
21.
22.
23.
24. Acute osteomyelitis
• osteomyelitis is an infection that is diagnosed
within 2 weeks of the onset of symptoms.
• It is more common in males (2:1 ratio), is most
often monostotic (>90%), and usually
• involves the lower extremity (90%). Parents of
children with this condition commonly
• report that their children walk with a limp, or
that they refuse to walk.
26. investigation
• CBC
• ESR(48-72hr,3-5day) ,CRP(6hr,1week)
• Film antero-posterior and lateral radiographs
of the affected area
• blood culture(30%)
• aspiration of the affected area.(30-50%)
• Urine analysis
• Other : CT ,MRI, bone scan
31. Age group pathogen antibiotics
Neonate-6 month Group B streptococci,
Gram-negative organisms
flucloxacillin plus a third-
generation cephalosporin like
cefotaxime +- gentamycin
6month-6 years Haemophilus influenzae flucloxacillin and cefotaxime or
cefuroxime.
Older children and previously fit
adult
Staphylococcal infections intravenous flucloxacillin
and fusidic acid.
Elderly and previously unfit
patients
Gram-negative
infections
flucloxacillin and
a second- or third-generation
cephalosporin
Patients with sickle-cell disease salmonella and/or other Gram-
negative organisms
third-generation cephalosporin
or a fluoroquinolone
like ciprofloxacin.
Heroin addicts and
immunocompromised patients
Pseudomonas aeruginosa,
Proteus mirabilis or anaerobic
Bacteroides
species)
third-generation cephalosporins
or a fluoroquinolone
32. Management
• ATB3-6 week or ESR<25mm/hr 3 week
• IV ATB until the patient’s condition begins to
improve and the CRP values return to normal
levels which usually takes 2–4 weeks
