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. The patient was diagnosed with chronic osteomyelitis based on his history of open femur and tibia fractures treated with plating one year prior. He underwent debridement surgery and was started on IV antibiotics. Key points discussed included types and management of acute versus chronic osteomyelitis.
A PowerPoint review of photomicrographs depicting the various histological features of compact bone. By Timothy Ballard, UNC Wilmington. Licensed under a Creative Commons License: Attribution Non-Commercial-NoDerivs. From http://www.lifescitrc.org/resource.cfm?submissionID=8987.
A PowerPoint review of photomicrographs depicting the various histological features of compact bone. By Timothy Ballard, UNC Wilmington. Licensed under a Creative Commons License: Attribution Non-Commercial-NoDerivs. From http://www.lifescitrc.org/resource.cfm?submissionID=8987.
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.
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Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
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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.
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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.
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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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http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
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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
