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Osteoarthritis is a chronic degenerative disorder of synovial joints in which there is progressive softening and erosion/disintegration of the articular cartilage. In the presentation, I will deal in detail about the condition in every dimension with the most recent evidence.
Osteoarthritis is a chronic degenerative disorder of synovial joints in which there is progressive softening and erosion/disintegration of the articular cartilage. In the presentation, I will deal in detail about the condition in every dimension with the most recent evidence.
A Power Point Presentation on the Disease Rheumatoid Arthritis covering everything from explanation and history to causes, effects, treatments, diagnosis, and prognosis.
Idiopathic scoliosis is a condition that causes the spine to curve to the side. While the cause of scoliosis is unknown, it usually runs in families and typically affects girls and young women more often and severely than boys and young men. Mild cases that do not cause pain or discomfort require no treatment. However, cases that are moderate to severe and with or without pain or discomfort require treatment which is determined on a case by case basis.
http://www.davidsfeldmanmd.com/specialties/scoliosis
Scoliosis 101 describes the condition of scoliosis, how it is evaluated, traditional treatment recommendations,andt he most recent developments in non-invasive
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Devyani Pandya’s ppt on Rheumatoid Arthritisdevyaniforreal
A presentation on Rheumatoid Arthritis which contains the mechanism, treatment, prophylaxis and much more like Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease, which means that your immune system attacks healthy cells in your body by mistake, causing inflammation (painful swelling) in the affected parts of the body. RA mainly attacks the joints, usually many joints at once.
Rhematoid arthritis is systemic autoimmune inflammatory disorder of unknown etiology affecting multiple organ systems. These ppt includes comprehensive management of it.
Arthritis (Rheumatoid Arthritis, Osteoarthritis, Gout)
PPT contains content for UG healthcare students.
Elaborated topics referred from Nursing books, Orthopedics books, and some live cases from the department.
rheumatoid arthritis is chronic inflammatory disease having symmetrical pattern , can affect the small and large joints. cause is unknown but there is + RH factor and there is pannus formation including the cartilage and joint destruction, reduction in synovial fluid,clinical feature includes morning stiffness fatigue, fever. pharmacology treatment and physiotherapy management.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
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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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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
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This document describes the acute management of AV block.
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
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.
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.
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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
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Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Rhumatoid arthritis
1.
2. What is:-
Chronic symmetrical polyarthritis.
Characterized by:-
1- chronic pain,stiffness,swelling around joint and
tendon.
2- associate with extra- articular feature.
3- chronic inflammatory synovitis of peripheral
joint.
4- course of disease is prolong with exacerbation
and remission.
3. Incidence:-
- Female to male ratio 3:1
- peak age between 20-40 years.
Cause:-
1- genetic factor associate with HLA-DR4
2- autoimmunity for the following reasons:
a-present auto antibodies IgG,IgM.
b-immune complex in synovial fluid and circulation.
3- female gender.
4. Pathology:-
Stage I:- preclinical characterized by..
immune pathology is beginning
increased ESR, C-reactive protein and rheumatoid factor.
Stage II:- synovitis characterized by..
thickening and cell rich synovial membrane.
painful and swelling.
joint and tendon still intact.
this disorder reversible.
Stage III:- destruction characterized by..
due to persist inflammation.
articular cartilage is eroded by proteolyses enzymes.
bone is eroded by granulation tissue invasion and osteoclast resorpation.
tenosynovitis lead to partially or complete rupture of tendons.
synovial effusion due to fibrinoid material also lead to swelling.
5. Stage IV:- deformity characterized by..
combination of articular destruction, capsular stretching and
tendon rupture lead to progressive instability and deformity.
6. Deformity of hands and wrist:-
1- spindling of fingers:- early stage, swelling of MCP joint.
2-swan neck:- hyperextension at proximal interphalangeal joints
and fixed flexion at distal interphalangeal joints.
3-boutonniere :-fixed flexion of proximal interphalangeal joint and
extension of distal interphalangeal joints.
4- Z deformity of thumb:- hyperextension of 1st interphalangeal joint and
flexion of 1st MCP joint with consequent loss of thumb mobility.
5- carpal tunnel syndrome:- tenosynovitis at wrist entrap median nerve.
6-mallet finger:- flexion DIP joint due to rupture of extensor tendon.
7.
8.
9. Deformity of feet and ankle:-
1- Lateral deviation of toes and subluxation of
MTP joints.
2- Heads of MT become palpable in sole of feet.
3- Ankle develops valgus deformity.
4- Hammer toe.
5- Clow toe.
6- mallet toe.
7- hallux valgus.
10. 1- Hammer toe deformity:-
flexion of PIP joint
Extension of DIP joint.
(similar to boutonnière deformity in fingers)
13. 4-Bunion deformity "hallux valgus" or "hallux abducto-valgus":-
Term "hallux" refers to the great toe
"valgus" refers to the abnormal angulation of the great toe
"abductus/-o" refers to the abnormal drifting or inward leaning of
the great toe towards the second toe.
refers to the motion the great toe moves away from the body's
midline.
14.
15. 1-valgus deformity (bent outward), varus deformity
(bent inward) appear with joint instability.
2-synovial effusion (demonstrated with patellar tap).
3- Baker cyst:- extension of inflamed synovium into
popliteal space, causing pain and swelling. high pressure
generated by flexion of knee can cause rupture of cyst into
calf, manifested as calf swelling, tenderness and pitting
edema.
Deformity of knee:-
16.
17.
18. Clinical feature:-
I- early stage:-swelling, stiffness, increased warmth,
tenderness proximal finger joint and wrist.
II-moderate stage:- restricted joint movement.
subcutaneous nodule.
isolated tendon rupture.
III-late stage: -constant ache of joint destruction.
-rheumatoid deformity.. Ulnar deviation of finger, valgus
knee, valgus feet, clowed toes.
-extra articular feature as muscle wasting,
lymphadenopathy, neuropathy….
19.
20. Extra- articular feature:-
1- MSS: subcutaneous nodules, muscle wasting.
2-ocular: sjogren’s syndrome, scleritis.
3-neurologic: carpal tunnel syndrome,
polyneuropathy.
4-hematology:anemia, thrombocytosis, esinophilia.
5- pulmonary: pleural effusion, rheumatoid nodules
in lung.
6-lymphadenopathy.
7-felty’s syndrome:- RA associate with
splenomegaly and neutropenia, in <1%.
21. Investigation:-
Note:- no test is specific for Dx of RA. Following
investigation may be helpful.
1-rhumatoid factor:- auto antibodies present in about 70% of
cases. not established Dx it for prognostic significance. Also
RA factor is positive in 10% of normal population.
2-ANA (Antinuclear antibodies):- is positive in 30% of
cases.
3- Blood:- anemia, thrombocytosis, ESR and C-reactive
protein are raised (inflammatory markers).
22. 4- X-ray:-
- during first 6 months are read normal.
- early changes occur in the wrist or feet.
- 4 stages of x-ray progression in RA:-
I- periarticular osteoporosis (osteopenia).
II- loss of articular cartilage (joint space).
III- bony erosions on margins.
IV- subluxation and ankylosis.
5- MRI and bone scan detect early inflammatory
changes.
23.
24. 6- Synovial fluid aspiration:-
- fluid is usually turbid.
- reduced viscosity.
- increased protein content.
- decreased or normal glucose concentration.
- C3 and C4 markedly low.
- WBC count varies 5-50.000.
25. Criteria for the Dx of rheumatoid arthritis:-
(American Rheumatism Association 1987 Revised criteria)
1- morning stiffness (>1 hour).
2- arthritis of 3 or more joint areas.
3- arthritis of hand joints.
4- symmetrical arthritis,
5- rheumatoid nodules.
6- rheumatoid factor.
7-radiological changes.
When 4 or more of the above criteria are met, diagnosis of RA is made.
26.
27. DDx:-
1- osteoarthritis.
2- gouty arthritis.
3-septic arthritis.
Management:-
1- non-pharmacology:-
- rest:- in mild inflammation.
-exercise:- to maintain joint mobility and muscle power.
-heat and cold :- for muscle relax.
-splint:- to provide rest joint, decreased pain,
-weight loss:- to reduce symptoms of weight bearing joint.
28. 2-pharmacological treatment:-
I- NSAIDs:- select COX2 as anti-inflammatory effect.
II- corticosteroid:- Perdnisolone is the oral steroid of choice
III- disease modifying anti-rhumatoid drugs (DMARD):-
used in persist sing of inflammation with progressive damage.
a- methotrexate:-is ttt of choice.
b- antimalaria (hydroxychloroquine sulfate) use in mild cases.
c- pencillamine:- used combination with methotrexate in severe
RA active disease.
d-gold:-who fail improve.
e-immunosuppression therapy (as cyclophosphamide):-
Use in pt who failed therapy with DMARD.
IV-newer drugs as TNF inhibitors:-reduce inflammation during short
term, disadvantage:-local irritation and expensive.
V-IL1 and IL6 receptors blocker:- rapid anti-inflammatory effect.
29. 3-surgical procedure:-
Indicated in patient with RA:-
1- severe joint destruction.
2- fixed deformity.
3- loss of function.
4- If a 6 months trail of medical treatment has been failed.
5- To reduce pain.
Types of surgical intervention:-
a-tendon repair.
b- synovectomy.
c- arthroplasty.
d- arthrodesis special for interphalangeal joint.
30. Follow up:-
1- Ask pt for severity of joint pain, morning stiffness, fever,
fatigue.
2- Look for joint swelling, deformity, wasting muscle around
joint.
3- Feel warmth, tenderness.
4- assess passive movement, muscle power.
Prognosis:- After 10 years, disease pattern is:-
1-complete remission 25%.
2-moderate impairment 40%.
3-severe disability 25%.
4-severly crippled 10%.
31. Poor prognosis:-
1-high titer of rheumatoid factor.
2-more >1year active disease without remission.
3-early develop nodules and erosion.
4-extra auricular manifested.
5- severe functional impairment of joint.