Trauma Society of India is a pioneering initiative to promote knowledge in the fields of orthopedics and traumatology. The society has taken a giant leap in its endeavors by launching the first ever standard guidelines for orthopedic clinicians. These guidelines would go a long way in establishing treatment protocols and providing a roadmap to clinicians that guides them in the assessment, decision-making and management of complex fracture situations.
The guidelines will be published in a series of books titled Guidelines in Fracture Management, compiled by eminent Indian and international clinicians. They illustrate all possible treatment options and latest management techniques that can be used, with special emphasis on the health scenario in the Asia-Pacific region.
Guidelines in Fracture Management--Proximal Tibia discusses the classification, assessment of personality, and planning and treatment protocols for the much-debated proximal tibia fractures.
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
Trauma Society of India is a pioneering initiative to promote knowledge in the fields of orthopedics and traumatology. The society has taken a giant leap in its endeavors by launching the first ever standard guidelines for orthopedic clinicians. These guidelines would go a long way in establishing treatment protocols and providing a roadmap to clinicians that guides them in the assessment, decision-making and management of complex fracture situations.
The guidelines will be published in a series of books titled Guidelines in Fracture Management, compiled by eminent Indian and international clinicians. They illustrate all possible treatment options and latest management techniques that can be used, with special emphasis on the health scenario in the Asia-Pacific region.
Guidelines in Fracture Management--Proximal Tibia discusses the classification, assessment of personality, and planning and treatment protocols for the much-debated proximal tibia fractures.
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
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 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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
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4. MECHANISMS
In middle-aged or elderly patients, simple falls lead most commonly
to lateral-side fracture patterns.
Split depression fractures of the lateral plateau are most common
Higher speed injuries in younger patients from sports or similar
mechanism can cause split fractures or rim avulsion fractures
5. A combination of valgus and axial compression
produces lateralside depression, split depression, or
less commonly, lateral split or total lateral condyle
fractures (the classic “bumper fracture”). Younger
patients with good bone tend to have split fractures with
less depression and elderly patients with osteopenic
bone have a greater component of compression with a
less prominent split fragmen
he intact medial collateral ligament (MCL) acts like a
hinge for the lateral femoral
A posteromedial shearing fracture The mechanism has
been described as knee flexion, varus, and internal
rotation of the medial
femoral condyle.13
7. INJURIES ASSOCIATED WITH TIBIAL PLATEAU
FRACTURES
Knee dislocation : Schatzker type IV patterns
Compartment syndrome .acl injury. Poor prognose
Ligament injury : Schatzker type IV, V, and VI
High-energy : small risk of vascular injury and a high risk for
compartment syndrome
pathognomonic of cruciate ligament injury :
Segond fracture
reverse Segond fracture,
anteromedial tibial margin fractures,
semimembranosus tendon insertion site fractures
8. IMAGING
Standard examinations :
Anteroposterior (AP), lateral, and an AP view in the plane of the plateau (10-
to 15-degree caudal view)
The caudal view :
Better view of the articular surface
Assess displacement and depression better than the standard AP view
Overestimate anterior displacement and depression
oblique views are obtained to assess the location of fracture lines or degree
of displacemen When there is substantial fracture displacement, particularly
in bicondylar or fracture-dislocation patterns, radiographs in traction will better
assesst hefracture anatomy
CT scan typically demonstrates more articular displacement and
comminution
MRI is more sensitive at detecting ligamentous and meniscal injuries
14. TYPE1
involves the medial plateau
Nonoperative treatment in undisplaced and
stable fractures is a reasonable option with a cast in
extension; generally, early ROM is
encouraged and weight-bearing is begun in 8 to 10
weeks
15. TYPE2
hese injuries are associated with a
high incidence of collateral ligament injury of the
opposite side in about 50% of patients. The
incidence of neurovascular injury with this fracture
pattern is 12%
16. TYPE V: FOUR-PART FRACTURE
These constitute 10% of all fracture-dislocations
17. TREATMENT OPTIONS FOR TIBIAL PLATEAU
FRACTURES
Nonoperative Treatment of Tibial Plateau Fractures
18. Most patients with nonoperatively treated tibial
plateau fractures should be kept nonweightbearing
during the initial weeks after injury. The duration of
nonweight-bearing depends on
the fracture pattern but is typically 4 to 8 weeks
19. TREATMENT OPTIONS FOR TIBIAL PLATEAU
FRACTURES
Operative Treatment of Tibial Plateau Fractures
indicated for displaced unstable tibial plateau fractures
In young healthy patients : almost all bicondylar and shaft
dissociated patterns
Surgical management was indicated if patients had more than 2 mm
articular incongruence, open fracture ,fibular head fracture greater
than 5 mm of condylar widening, over 5 degrees of varus-valgus
instability on physical examination, minimal or no preexisting
osteoarthritis of the knee, and were medically stable
toundergosurgicalintervention
20. PROGNOSE
most studies, the fracture pattern has an effect on
patient outcome. In one study, medial
condylar fractures and bicondylar fractures with a
medial tilt were found to have less
favorable results than lateral-side patterns, and
varus was more poorly tolerated than
fibula fracture was a poor
prognostic sign Another study showed better results
in unicondylar than bicondylar
fractures
21. lateral meniscus (91%) most commonly followed by
ACL (77%), posterolateral corner4267
(68%), and medial meniscus (44%)
Mcl –non operative
22. TREATMENT OPTIONS FOR TIBIAL PLATEAU
FRACTURES
Principles of Plates and Screw Fixation :
The simplest implants : lag screws >> 6.5-mm screws work well for
major plateau fracture lines although smaller screws may work
equally well
rafting screws :
3.5-mm implants are less bulky and easier to fit on the bone and the
smaller 3.5-mm screws allow more screws to be placed closer to the
articular surface to support reduced fragments.
Multiple holes in the head of the plate allow 3.5-mm screws to be
placed parallel and close to the articular surface to support the
reduced articular surface and minimize the chances for postoperative
settling
23. TREATMENT OPTIONS FOR TIBIAL PLATEAU
FRACTURES
Principles of Plates and Screw Fixation :
Lateral plates used for bicondylar and Schatzker type VI fractures
must resist axial, rotational, and bending forces.
Principles of External Fixation :
Definitive external fixation still has a role in complex tibial plateau
fractures based on:
surgeon preference or in cases with severe soft tissue injury,
when despite delay, internal fixation is not felt to be safe
24. TREATMENT OPTIONS FOR TIBIAL PLATEAU
FRACTURES
Principles of External Fixation :
The use of a fine wire external fixator in conjunction with limited-
access internal fixation provides similar stability to ORIF, but with
fewer complications.
patients treated with a fine wire fixator are generally allowed to be
weight-bearing as tolerated very early in the postoperative period
26. TREATMENT OPTIONS FOR TIBIAL PLATEAU
FRACTURES
Most data indicate that external fixation is equally as effective or
more so than plate fixation.
When applying an external fixator for initial stabilization, care is taken
to avoid placement of fixator pins in area of proposed plate
placement as there is theoretical risk of infection associated with pin
sites.
A standard of care for treatment of complex bicondylar fracture
patterns
External fixator application is not recommended for lateral
unicondylar (Schatzker types I, II, and III) fracture patterns, unless
there is significant soft tissue compromise or in case of open
fractures, as these are length stable due to an intact medial column.
27. COMPLICATIONS
Loss of reduction
Wound breakdown and infection
Septic arthritis after external fixation
Knee stiffness
Prominent or painful hardware
Nonunion or delayed union
Posttraumatic arthritis
28. APPROACH
Antrolatral approach
Postromedial approach
Posterior approach+fibular osteotomy
Extensil eapproch dead bone sandwich
29.
30.
31.
32. CASE PRESENTATION
A 34 years old man
CTMA trauma
Lt tibial plateau FX
Sensory & motor normal
Pulse normal
No Compartment syndrome