This document discusses septic arthritis, which is a joint infection caused by bacteria, viruses, or other microorganisms invading the joint space. Common causes include bloodstream dissemination from a distant infection, adjacent soft tissue infection, or trauma. Symptoms include intense joint pain, swelling, and inability to move the joint. Diagnosis involves joint fluid analysis showing inflammatory cells. Treatment requires appropriate antibiotics based on culture results as well as surgical drainage of the joint in some cases. Risk factors include diabetes, rheumatoid arthritis, or immunosuppression. Prompt diagnosis and treatment are important to prevent joint destruction and systemic infection.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
2. Septic Arthritis
Septic arthritis, also known as infectious arthritis,
represents a direct invasion of joint space by various
microorganisms, most commonly caused by a variety
of bacteria, viruses, mycobacteria and fungi
3.
4. Dissemination of pathogens via the blood, from distant site….
(Most common)
Dissemination from an acute osteomylitic focus
Dissemination from adjacent soft tissue infection,
Entry via penetrating trauma
Entry via iatrogenic means
5.
6. On entering the joint space, the bacteria initially deposit
in the synovial membrane and produce an inflammatory
reaction.
Synovial membrane hyperplasia develops in 5 to 7 days,
and the release of cytokines leads to hydrolysis of
proteoglycans and collagen, cartilage destruction, and
eventually bone loss.
Direct pressure necrosis due to large synovial effusion
results in further cartilage damage
8. Usually related with underlying abnormality
Bacteremia (IVDA, Endocarditis, Infections at other sites )
Damaged or prosthetic joints
Compromised immunity (DM, CKD, Alcoholism, Cirrhosis,
Immunosuppressive Rx )
Loss of skin integrity
9. Staphylococcus Aureus—50%
Streptococcal species, such as Streptococcus viridans,
S Pneumoniae & group B streptococci
Gram-negative bacilli -- 10% --
E.coli & Psudomonas -More common
11. Symptoms and Signs :
Acute Onset
• Intense joint pain .
• Joint swelling .
• Joint redness .
• Unable to move the limb with the infected joint .
• Low-grade fever.
• Chills
12. Investigations :
Non specific features of acute inflammation-
leucocytosis, ESR,CRP-are suggestive but not
diagnostic
Joint fluid analysis
(Cell Type, Count, Gram stain, Culture +ve in 70-90 %)
Blood Culture--- 50% Positive
13.
14. Imaging –
Xray, CT, MRI --------less helpful in diagnosis
Can demonstrate
• Joint effusion
• Synovial thickening
• Perisynovial edema
• Cartilage destruction
• Bone destruction
• Bursitis, tenosynovitis
15. Treatment:
General Measures:
The first priority is to aspirate the joint and examine the
fluid, treatment is then started without further delay.
• Analgesics and splinting of the involved joint in the
position of maximal comfort to alleviate pain.
• Fluid replacement and nutritional support may be
required.
• Other foci of infection and any coexisting medical
conditions must be identified and treated appropriately
16. Treatment:
Appropriate Antibiotics & Drainage of affected joint
Empiric Abx:
Oxacillin + 3rd Gen Cephalosporin
Replace Oxacillin with Vancomycin if MRSA suspected
Alter Abx based on culture results
Duration of Rx: 6 weeks
17. Drainage of Joint :
Consider Ortho Consult
Arthroscopic Lavage , Debridement & Drain placement
Open surgical Drainage
18. Drainage:
Indication of Surgical Drainage:
1-Joints that do not respond to antimicrobial therapy and
daily arthrocentesis
2-. Any joint with limited accessibility, including the
sternoclavicular or the hip joint
3-Patients with underlying disease, including diabetes,
rheumatoid arthritis, immunosuppression, or other systemic
symptoms, should be treated more aggressively with earlier
surgical intervention
19. Factor include
•Health of Patient
•Organism
•How quickly Rx is started
Mortality rate – 30% in Polyarticular type of Septic
arthritis
21. Usually in otherwise healthy individuals
Sexually active
More common in Women than Men
Congenital Complement component deficiency
22. Migratory Polyarthralgias– Wrist, Knee, Ankle or Elbow
Tenosynovitis –Wrist, fingers, Ankles, or toes (60%)
Tenosynovitis is inflammation of the synovium (protective sheath that covers tendons)
Purulent Monarthritis –Knee, Wrist, Ankle , Elbow –(40%)
Charcteristic skin lesion – 2 to 10 small nacrotic pustules on palms and
soles
Fever
23.
24. Investigations :
Non specific features of acute inflammation-
leucocytosis, ESR,CRP-are suggestive but not
diagnostic
Joint fluid analysis
Cell Type Count, Gram stain, Culture +ve in <50%)
Blood Culture--- 40% Positive
Urethral, Throat & Rectal cultures
25. Imaging –
X-ray, CT, MRI less helpful in diagnosis—Normal
Can demonstrate joint effusion Soft tissue swelling
29. Acute monoarthritis should be evaluated emergently to
rule out the possibility of septic arthritis.
Untreated septic arthritis can lead to rapid joint space
destruction and systemic sepsis, so early diagnosis is
imperative.
Consider septic arthritis in patients with underlying
inflammatory arthritis if one joint is more acutely inflamed
than others.
30. Aspiration of the involved joint is critical to identifying the
organism.
Therapy with empirical antibiotics should immediately
follow aspiration, with subsequent narrower coverage only
after culture results are obtained.
Risk factors including old age, trauma, limb ulceration,
and prior hospitalization can predict the likely organism
infecting the joint.
31. Patients receiving immunosuppressive medications,
steroids, and chemotherapy are at greater risk for
developing septic arthritis.
Treatment includes appropriate joint drainage and
surgical options depending on the joint involved.
32. Case:
A 55-year-old man is hospitalized for a 2-day history of left knee pain. He has a history
of type 2 diabetes mellitus and hyperlipidemia. Medications are glipizide, simvastatin,
and low-dose aspirin.
On physical examination, temperature is 38.3 ° C (100.9 ° F), pulse rate is 98/min,
respiration rate is 18/min, and blood pressure is 145/92 mm Hg. The left knee is
erythematous, warm, swollen, and tender to touch. The patient resists movement of the
left knee. The remainder of the musculoskeletal examination is unremarkable.
The leukocyte count is 12,000/μL (12 × 109/L). The hemoglobin level, serum metabolic
panel, uric acid level, and urinalysis are normal.
Arthrocentesis of the left knee joint yields cloudy yellow synovial fluid with a leukocyte
count of 105,000/μL (105 × 109/L) (97% polymorphonuclear cells). Gram's stain of the
fluid reveals gram-positive cocci in chains. Polarized light microscopy shows no
crystals.
In addition to daily aspiration of the knee, which of the following is the
most appropriate next step in this patient's treatment?
A Naproxen
B Intravenous imipenem
C Oral dicloxacillin
D Intravenous ceftriaxone
E Intra-articular cefazolin
33. Correct Answer: D ------- Intravenous ceftriaxone
Gram-positive cocci in chains