Phantom limb syndrome (PLS) involves feeling that an amputated limb is still present, while phantom limb pain (PLP) describes painful sensations like throbbing or electric shocks in the missing limb. Around 78% of amputees experience PLP. Theories for its causes include cortical remapping in the brain, enlarged representations in the thalamus, and aberrant signaling from injured nerves. While the exact mechanisms are unclear, a better understanding may lead to new treatments to reduce amputees' suffering from PLP.
Phantom pain is pain caused by elimination or interruption of sensory nerve impulses by destroying or injuring the sensory nerve fibers after amputation or deafferentation
Phantom pain is pain caused by elimination or interruption of sensory nerve impulses by destroying or injuring the sensory nerve fibers after amputation or deafferentation
Sebastian Lattuga M.D. provides patient education materials on Lumbar Spinal Stenosis.
*What is lumbar spinal stenosis?
*What are the symptoms of lumbar spinal stenosis?
*Non-surgical treatment
*Surgical treatment
*Living with lumbar spinal stenosis
Ponencia invitada en la V Jornada de Fisioterapia en Geriatría, Barcelona 2015.
"Pain management in the elderly". Invited speaker at V Jornada de Fisioterapia en Geriatría, Barcelona 2015.
Sebastian Lattuga M.D. provides patient education materials on Lumbar Spinal Stenosis.
*What is lumbar spinal stenosis?
*What are the symptoms of lumbar spinal stenosis?
*Non-surgical treatment
*Surgical treatment
*Living with lumbar spinal stenosis
Ponencia invitada en la V Jornada de Fisioterapia en Geriatría, Barcelona 2015.
"Pain management in the elderly". Invited speaker at V Jornada de Fisioterapia en Geriatría, Barcelona 2015.
In this presentation the author, David Lopez Chiropractor DC and Kinesiologyst (PT) from Chile expose about the different principles under the scope of the osteopathic manipulation of the spine. Dr. Lopez is director of the progran in Chiropractic for healh professional of the "Universidad Central de Chile" and director of the Diplomats in Manual Therapy of the "Universidad Santo Tomas de Chile. The interest is to review the fundamentals to understand the approach of the Osteopathy to the practice of the manual therapy and healthcare. This vision was exposed in Poland in the framework of an international symposium of Physiotherapy.
Assessment Of Complex Regional Pain Syndrome Dr Candy Mccabeepicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Dr Candy McCabe. In this talk, Dr McCabe discusses the mechanisms and assessment of patients with complex regional pain syndrome.
What/Where is the true source of PFP?
What theories do we use for diagnosing PFP and how does literature support the theories?
How can we better treat “PFPS” patients through a more thorough evaluation and the developing classifications of PF disorders?
Lecture References and online resources: Tendons: Mechanisms of pathogenicity...Mark Sexton
This lecture reviews and connects developments different areas of the published research: in the areas of Anatomy, Cellular Mechanotransduction, Connective Tissue (Histology, Innervation, differentiation, plasticity), Tendinopathy, Tendon Repair, Neural plasticity and Bioplasticity.
These developments have implications for clinical practice, research, education and health promotion.
This research was discussed as it informs common Treatment and Rehabilitation techniques (Exercise Therapy, Acupuncture, Manual Therapy, Low Level Laser, Biomechanics). Future directions in research were discussed.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
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.
2. Phantom Limb Syndrome (PLS):
Feeling that the amputated limb is still present
Phantom Limb Pain (PLP):
Throbbing, stabbing, electric shock sensations, and even
cramped and painfully immobile limb sensations
Weinstein SM. Phantom limb pain and related disorders. Neurol Clin. 1998;16(4):919–936.
Carlen PL, Wall PD, Nadvorna H, Steinbach T. Phantom limbs and related phenomena in recent traumatic amputations. Neurology. 1978;28(3):211–217.
Giummarra MJ, Gibson SJ, Georgiou-Karistianis N, Bradshaw JL. Central mechanisms in phantom limb perception: the past, present and future. Brain Res Rev. 2007;54(1):219–232.
3. 78% of amputee; reported experiencing PLP
Impair quality of life
A better understanding of its pathophysiology and etiology
could lead to new modalities to alleviate the suffering it
causes
Sherman RA, Sherman CJ, Parker L. Chronic phantom and stump pain among American veterans: results of a survey. Pain. 1984;18(1):83–95.
4. A French surgeon, Ambroise Paré, was likely the first to
document an instance of PLP, in the 16th century
The term did not arise until the American Civil War, when it
was described by military battlefield surgeon (and later,
neurologist) Silas Weir Mitchell
Finger S, Hustwit MP. Five early accounts of phantom limb in context: Paré, Descartes, Lemos, Bell, and Mitchell. Neurosurgery. 2003;52(3):675–686; discussion 685.
Nathanson M. Phantom limbs as reported by S. Weir Mitchell. Neurology. 1988;38(3):504–505.
6. Neuromatrix representation
Cortical Remapping Theory (CRT)
Subcortical Theory
Proprioceptive memory
Dissociation of vision and proprioception
7. The concept of a representation of the self within the brain
that is modified by life experiences, termed the neuromatrix
After limb amputation, an individual’s cortical and peripheral
body representations remain intact, but no longer correspond,
and this mismatch is enhanced by a lack of visual feedback
from the missing limb, thus generating excessive pain, in spite
of the lack of a sensory stimulus
Flor H. Phantom-limb pain: characteristics, causes, and treatment. Lancet Neurol. 2002;1(3):182–189.
Melzack R. Pain and the neuromatrix in the brain. J Dent Educ. 2001;65(12):1378–1382.
8. According to the CRT, neurons that received input from an
arm before its amputation subsequently respond to new
inputs from the face that invade the nearby arm-associated
somatosensory region
Consequently, with facial stimulation, an amputee may
experience PLS, including pain
Wartan SW, Hamann W, Wedley JR, McColl I. Phantom pain and sensation among British veteran amputees. Br J Anaesth. 1997;78(6):652–659
Sapunar D, Kostic S, Banozic A, Puljak L. Dorsal root ganglion — a potential new therapeutic target for neuropathic pain. J Pain Res. 2012;5:31–38.
9. Researchers using microstimulation and microelectrode
recordings found that:
- The representation of the residual limb in the thalamus was
enlarged compared with that of corresponding areas of
individuals with intact limbs
- Thalamic stimulation could evoke PLS and even PLP in
amputees
Davis KD, Kiss ZH, Luo L, Tasker RR, Lozano AM, Dostrovsky JO. Phantom sensations generated by thalamic microstimulation. Nature. 1998;391(6665):385–387.
10. Amputees continue to have proprioception of missing limbs
Ramachandran VS, Hirstein W. The perception of phantom limbs. The D. O. Hebb lecture. Brain. 1998;121(pt 9):1603–1630.
Anderson-Barnes VC, McAuliffe C, Swanberg KM, Tsao JW. Phantom limb pain — a phenomenon of proprioceptive memory? Med Hypotheses. 2009;73(4):555–558.
Gentili ME, Verton C, Kinirons B, Bonnet F. Clinical perception of phantom limb sensation in patients with brachial plexus block. Eur J Anaesthesiol. 2002;19(2):105–108.
Katz J, Melzack R. Pain ‘memories’ in phantom limbs: review and clinical observations. Pain. 1990;43(3):319–336.
11. Limb Movement: visual + proprioceptive
The inability to visualize the amputated limb is insufficient to
override the proprioceptive information from the residual limb
PLS
Conflicting signals from the two systems resurrects a phantom limb
Visualization therapies have been relatively successful at reducing
PLP
Tung ML, et al. Observation of limb movements reduces phantom limb pain in bilateral amputees. Ann Clin Transl Neurol. 2014;1(9):633–638.
12. Nerve injury Neurons in the DRG increase their nociceptive
signaling through increases in neuronal excitability and the
creation of ectopic discharges aberrant signaling through
the spinothalamic tract may produce PLP.
Sapunar D, Kostic S, Banozic A, Puljak L. Dorsal root ganglion — a potential new therapeutic target for neuropathic pain. J Pain Res. 2012;5:31–38.
14. Studies have shown that persons who experienced pain prior
to amputation have higher rates of PLP
However, no evidence that preamputation pain plays a role in
persistent PLP, only PLP experienced immediately after surgery
The location and characterization of the pain was only similar
to that experienced before amputation in 10% of patients
Jensen TS, Krebs B, Nielsen J, Rasmussen P. Immediate and long-term phantom limb pain in amputees: incidence, clinical characteristics and relationship to pre-amputation limb pain. Pain. 1985;21(3):267–278.
Bach S, Noreng MF, Tjéllden NU. Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade. Pain. 1988;33(3):297–301.
Nikolajsen L, Ilkjaer S, Krøner K, Christensen JH, Jensen TS. The influence of preamputation pain on postamputation stump and phantom pain. Pain. 1997;72(3):393–405.
15. Gabapentin and pregabalin
Opioids and opiates
Memantine (acute and subacute PLP)
Lidocaine
Visualization therapies (mirror therapy (MT) or virtual reality
(VR) and prosthesis usage) may play a role in diminishing PLP
by enabling the amputee to visualize a limb moving in a
natural manner
16. Following amputation, most amputees still report feeling the
missing limb and often describe these feelings as excruciatingly
painful
Impair quality of life
The condition still perplexes researchers today, with no universally
efficacious treatment available
A better understanding of its pathophysiology and etiology could
lead to new modalities to alleviate the suffering it causes