This document provides an overview of rotator cuff injuries, including anatomy, causes, symptoms, diagnosis, and treatment. It describes how the rotator cuff is composed of four tendons that stabilize the shoulder joint. Rotator cuff tears occur when one or more of these tendons becomes damaged and can range from partial to full thickness. Symptoms may include shoulder pain that is worsened with movement. Diagnosis involves physical examination along with imaging tests like x-rays, MRI, or ultrasound. Treatment options include non-operative measures like medication and physical therapy or surgical repair if conservative treatment fails.
Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle).
Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle).
Lumbar spinal canal stenosis is one of the difficult topic of spine. All the information are taken from Campbell's operative orthopedics Thirteen edition and from internet. I also took help from the lectures of renowned orthopedics professors of Bangladesh.
Complete descripition of the shoulder impingement syndrome and its management (both clinical and physical therapy intervention ) is explained in this slideshare,
Lumbar spinal canal stenosis is one of the difficult topic of spine. All the information are taken from Campbell's operative orthopedics Thirteen edition and from internet. I also took help from the lectures of renowned orthopedics professors of Bangladesh.
Complete descripition of the shoulder impingement syndrome and its management (both clinical and physical therapy intervention ) is explained in this slideshare,
The shoulder joint is a ball and socket joint. It is the major joint connecting the upper limb to the trunk. The shoulder is located where the humerus, clavicle, and scapula meet. The shoulder actually has four joints:
The sternoclavicular joint is located where the clavicle meets the sternum at the top of the chest.
The acromioclavicular joint is located where the clavicle glides along the scapula’s acromion. The acromioclavicular joint facilitates raising the arm over the head.
The glenohumeral joint is what most people think of as the shoulder joint. It’s the major joint in the shoulder, where the head of the humerus nestles into a rounded socket of the scapula called the glenoid.
The scapulothoracic joint is sometimes considered a joint. It is located where the scapula glides against the thoracic rib cage at the back of the body. No ligaments connect the bones at this joint.
Seminar clinical anatomy of upper limb joints and musclesQuan Fu Gan
This is not all, there are many more clinical anatomy in terms of condition such as Popeye Deformity with are not included here and Special Test such as Neer's Impingement and Hawkins Kennedy etc... with touches on the upper limb muscles and joints. Also not forgotten Long tendon test and so forth. In general, this is just a simplified slides. Tq
Supraspinatus tear - medial information martinshaji
A supraspinatus tear is a tear or rupture of the tendon of the supraspinatus muscle. The supraspinatus is part of the rotator cuff of the shoulder.
please comment
thank you ....
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
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.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
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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
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
3. Rotator cuff tears are tears of one or more of the four
tendons of the rotator cuff muscles.
A rotator cuff injury can include any type of irritation or
damage to the rotator cuff muscles or tendons.
Rotator cuff tears are among the most common conditions
affecting the shoulder.
4. Of the four tendons, the supraspinatus is most
frequently torn as it passes below the acromion;
the tear usually occurs at its point of insertion
onto the humeral head at the greater tuberosity.
7. The shoulder joint is made up of three bones:
The shoulder blade (Scapula),
The collarbone (Clavicle) and
The upper arm bone (Humerus).
The shoulder is a complex mechanism of intertwining
bones, ligaments, joints, muscles, and tendons:
9. Bone is living tissue that makes up the body's skeleton
providing shape and support.
The bones that form the shoulder are the
Clavicle
Humerus,scapula
Glenoid fossa
Acromion
Coracoid processe
10. These 2 bones create a ball-and-socket joint.
Also known as the glenohumeral joint. that give
the shoulder its wide range of motion
In order for this joint to be operational ligaments,
muscles, and tendons help support the bone;
keeping it in place.
11.
12. Ligaments and joints are formed from
the connection between two bones that
are adjacent.
Examples of both ligaments and joints
are represented by the glenohumeral,
acromiclavicular, and sternoclavicular
regions.
15. The major muscle groups of the rotator cuff are
the:-
Supraspinatus
Subscapularis
Infraspinatus
Teres minor
16. The cuff plays two main roles: it stabilizes the
glenohumeral joint and rotates the humerus outward.
The cuff centers the humeral head in the glenoid cavity via
passive effects and, more importantly, via active
multidirectional effects.
In other words, the cuff prevents upward migration of the
humeral head caused by the pull of the deltoid muscle at the
beginning of arm elevation.
Furthermore, two cuff muscles, the infraspinatus and the
teres minor, are the only muscles that ensure external
rotation of the arm.
20. Tears of the rotator cuff tendon are described as
partial thickness tears,
full thickness tears and
full thickness tears with complete detachment of the
tendons from bone.
•Partial thickness tears often appear as fraying of an
intact tendon.
21.
22. •Full thickness tears are through-and-through tears.
These can be small pin-point tears or larger button
hole tears or tears involving the majority of the
tendon where the tendon still remains substantially
attached to the humeral head and thus maintains
function.
23. Shoulder pain is variable and does not always
correspond to the size of the tear.
For surgical purposes classifying the tendon
further is needed in order to determine the
correct repair strategy.
Neer generalized the concept of rotator cuff
disease in 3 stages.
24. Stage I occurs in those younger than 25 years and involves
edema and hemorrhage of the tendon and bursa.
Stage II involves tendinitis and fibrosis of the rotator cuff in 25-
to 40-year-olds.
Stage III involves tearing of the rotator cuff (partial or full-
thickness) and occurs in those older than 40 years. Before surgery
every aspect of the shoulder needs to be taken into account.
25. Therefore, it has further been described depending on the
tear location (articular, bursal, complete),
size or area (in mm2),
depth (grade 1, <3 mm deep; grade 2, 3–6 mm deep; grade
3, >6 mm deep).
And still further measurements are taken to classify the
acromiohumeral distance, acromial shape, fatty infiltration or
degeneration of muscles, muscle atrophy, tendon retraction,
vascular proliferation, chondroid metaplasia, and calcification.
26. Age-related degeneration of thinning and
disorientation of the collagen fibers,
myxoid degeneration
hyaline degeneration also need to be taken into
consideration before a surgery plan is implemented.
27. Tears are also sometimes classified as
acute,
subacute, and
chronic based on the trauma that caused the injury:
•Acute tends to happen as a result of a sudden, powerful
movement. This might include falling over onto an
outstretched hand at speed, making a sudden thrust
with the paddle in kayaking, or following a powerful
pitch/throw.
28. •Subacute arises in similar situations to acute
•Chronic develops over a period of time, usual occurs at or
near the tendon (as a result of the tendon rubbing against the
overlying bone), and is usually associated with an
impingement syndrome.
29. WHEN TO CALL THE DOCTOR
If shoulder pain lasts more than 2 days
If shoulder problems (pain) do not allow you to work
If you are unable to reach overhead to get an item in a
cabinet above shoulder level, for example
If you are unable to play a certain sport such as baseball or
engage in an activity such as swimming
30. WHEN TO GO TO THE HOSPITAL
For any acute injury in which you are unable
to move the injured shoulder as well as the
uninjured shoulder, seek emergency medical
care.
31. MODE OF INJURY
A fall on the shoulder
An attempt at lifting a heavy object
Throwing heavy objects with over head
action
36. Diagnosis is based upon
a physical assessment and a detailed history of the
patient
including descriptions of previously participated
activities
acute or chronic symptoms experienced.
The physical examination of a shoulder deals with a
systematic approach constituting inspection, palpation,
range of motion, strength testing, and neurological
testing.
37. Common medical studies used in diagnosing a
rotator cuff tear include
X-ray
MRI
ultrasound techniques.
39. These Acute symptoms include severe pain that
radiates through the arm
tenderness at the site of injury
and limited range of motion, specifically during abduction
motions of the shoulder.
40. Symptoms that persist as a result of a chronic
rotator cuff tears are
Sporadic worsening of pain
Debilitation and atrophy of the muscles
Noticeable pain during rest
Crackling sensations when moving the shoulder,
and inability to move or lift the arm sufficiently,
especially during abduction and flexion motions.
41. Pain in the anterolateral aspect of the shoulder can be
due to many causes, symptoms may reflect pathology
outside of the shoulder which cause referred pain to
the shoulder from sites such as the neck, heart or gut.
42. Symptoms of a rotator cuff tear may advance instantly
after a trauma (acute) or develop gradually, yet
persistently over time (chronic).
Acute injuries are not as frequent as chronic rotator cuff
disease. Acute tears occur following bouts of forcefully
raising the arm against resistance, which are evident
during weight lifting.
In addition, falling forcefully on the shoulder can elicit
acute symptoms.
43. Patient history will often include
pain or ache over the front and outer aspect of the
shoulder,
pain aggravated by leaning on the elbow and pushing
upwards on the shoulder (such as leaning on the armrest of
a reclining chair),
intolerance to overhead activity,
pain at night when lying directly on the affected shoulder,
pain when reaching forward (e.g. unable to lift a gallon of
milk from the refrigerator).
44. Weakness may be reported.
With longer standing pain, the shoulder is favored and
gradually loss of motion and weakness may develop which,
due to pain and guarding are often missed by the patient
and are only brought out during the examination.
45. Primary shoulder problems may cause pain over the deltoid
muscle that is made worse by abduction against resistance,
called the impingement sign.
Impingement reflects pain arising from the rotator cuff but
cannot distinguish between inflammation, strain, or tear.
Patients may report their experience with the impingement
sign when they report that they are unable to reach upwards
to brush their hair or to reach in front to lift a can of beans up
from an overhead shelf.
56. X-rays cannot directly reveal tears of the rotator cuff as the
tendon is made of soft tissue and not bone.
Normal x-rays cannot rule out a torn or damaged rotator
cuff.
Large tears of the rotator cuff may allow the humeral head
to migrate upwards ( high riding humeral head) and this can
be seen on x-ray.
57. Prolonged contact between a high riding humeral
head and the acromion above it, may lead to x-
rays findings of wear on the humeral head and
the acromion and secondary degenerative
arthritis of the glenohumeral joint(the ball and
socket joint of the shoulder) may ensuecalled
cuff arthropathy.
58. MRI
Magnetic resonance imaging (MRI) or ultrasound are
comparable to examine the rotator cuff.
The MRI can reliably detect most full thickness tears,
although very small pin point tears can be missed.
If a small pin point tear is suspected, an MRI combined with
an injection of contrast material, called an MR-arthrogram
may help to confirm the diagnosis.
59. MRI of normal shoulder
intratendinous signal
60. The MRI is sensitive in identifying tendon degeneration
(tendinopathy), however, the MRI may not be able to
reliably distinguish between a degenerative tendon and a
partially torn tendon.
Magnetic resonance arthrography can improve the
differentiation of rotator cuff degeneration from partial
or complete rotator cuff tears.
61. The MRI provides more
information about
adjacent structures in
the shoulder such as the
capsule, glenoid labrum
muscles and bone. These
are factors to be
considered in each case
when selecting the
appropriate study.
62. Ultrasound
Ultrasound studies have also been reported as a means of
identifying rotator cuff tears.
Unlike x-rays which require exposure to radiation and MRI
studies which are costly, ultrasound studies have been
advocated as an alternative, when read by experienced
clinicians.
63. Ultrasound can also reveal the presence of other conditions
that may mimic rotator cuff tear at clinical examination,
including tendinosis
calcific tendinitis
subacromial subdeltoid bursitis
greater tuberosity fracture
and adhesive capsulitis
65. Patients suspected of having a rotator cuff tear are divided
into two treatment groups
non-operative treatment
operative
66. Non-operative treatment
Patients with pain and maintenance of reasonable function
are generally treated for pain relief at first.
Non-operative treatment of shoulder pain thought to be
related to the rotator cuff, or a tear of the rotator cuff,
includes:
oral medications that provide pain relief such as anti-
inflammatory medications
topical pain relievers such as cold packs
subacromial cortisone/local anesthetic injection
67. Iontophoresis
A sling may be offered for comfort for a day or two, with the
awareness that the shoulder can become stiff with prolonged
immobilization, which is to be avoided.
Early physical therapy may afford pain relief with modalities
(ex. iontophoresis) and help to maintain motion.
Ultrasound treatment
As pain decreases, strength deficiencies and biomechanical
errors can be corrected.
Home exercises may be obtained
68. Each patient is given a home therapy kit, which includes
elastic bands of six different colors and strength.
The program is customized to each individual patient, fitting
the needs of the patient and altering when necessary.
Patients are asked to do all their home exercise program on
their own whether that be at home, at work, or when
traveling.
69. INVASIVE TREATMENT
Rotator cuff tear surgical procedure
If conservative treatments have yielded poor results, surgery
is considered to repair the torn tendons.
70. There are several surgical options for treatment of a rotator
cuff tear.
The exact type of surgery may depend on factors including
the degree of tendon disruption,
location of the tear,
patients preferred activities, and
presence or absence of bone spurs that may be contributing
to the tear.
71. The three general approaches of
surgical repairs are
arthroscopic repair,
mini-open repair, and
open surgical repair.
In the recent past small tears were treated
arthroscopically, while larger tears would usually
require an open procedure.
72. Arthroscopic surgery allows for a shorter recovery time and
predictably less pain in the first few days following the
procedure than does open surgery.
arthroscopic repair, open repair (6–10 cm incision), or mini-
open repair (3–5 cm incision) will often include an
acromioplasty, a subacromial decompression, as part of the
procedures. Subacromial decompression consists of removal
of a small portion of the bone (acromion) that overlies the
rotator cuff, hoping to relieve pressure on the rotator cuff in
certain conditions and promote healing and recovery.
73. Although subacromial decompression may be beneficial to
partial and full thickness tears, this procedure does not
consists of physically repairing the tears. The repair can be
performed through an open incision, again requiring
detachment of a portion of the deltoid.
The mini-open technique approaches the tear through
a deltoid splitting approach.
This seemingly causes less damage to the deltoid
muscle and may produce better results.
74. Modern techniques now use an all arthroscopic
approach.
Surgical recovery can take as long as
3–6 months, with a sling being worn for the first 1–6
weeks.