1. The document discusses skin grafts, defining grafts as tissue detached from its blood supply and placed in a new area, while flaps retain some original blood supply.
2. It classifies grafts as autografts, allografts, or xenografts based on donor species, and as thin, thick, or full thickness based on depth.
3. The ideal donor site provides skin identical to the recipient area, but skin varies in color, thickness, hair, and texture between body sites. Common donor sites include the post auricular area, upper eyelid, and thigh.
A brief description of human skin structures and barriers. Its include elaborate description of skin structure and basics of skin barriers which prevent or control the trans dermal drug delivery.
A brief description of human skin structures and barriers. Its include elaborate description of skin structure and basics of skin barriers which prevent or control the trans dermal drug delivery.
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
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.
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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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.
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
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
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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!
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.
4. EPIDERMIS
No blood vessels.
Relies on diffusion from
underlying tissues.
Stratified squamous
epithelium composed
primarily of keratinocytes.
Separated from the dermis
by a basement membrane.
protective barrier
(against mechanical
damage, microbe
invasion, & water loss)
high regenerative
capacity
Producer of skin
5. DERMIS
Composed of two “sub-
layers”: superficial
papillary & deep reticular.
The dermis contains
collagen, capillaries, elastic
fibers, fibroblasts, nerve
endings, etc.
mechanical strength
(collagen & elastin)
Barrier to microbe invasion
Sensation (point, temp,
pressure, proprioception)
Thermoregulation
(vasomotor activity of blood
6. Immunological surveillance
Most skin is thin, hair-bearing, has sebaceous
glands
Skin of palms/soles/flexor surface of digits is
thick, not hair-bearing, no sebaceous glands
Vascular supply confined to dermis
7.
8.
9. Graft
A skin graft is a tissue of epidermis and
varying amounts of dermis that is detached
from its own blood supply and placed in a new
area with a new blood supply.
Flap
Any tissue used for reconstruction or wound
closure that retains all or part of its original
blood supply after the tissue has been moved
to the recipient location.
11. 1. Autografts – A tissue transferred from one part
of the body to another.
2. Homografts/Allograft – tissue transferred from a
genetically different individual of the same
species.
3. Xenografts – a graft transferred from an
individual of one species to an individual of
another species.
12. Classification :
According to their donor sites & •
thickness:
Thin intermediate. Thick
Xenograft Allograft
Allograft
13. Grafts are typically described in terms of thickness or
depth.
Split Thickness(Partial): Contains 100% of the
epidermis and a portion of the dermis. Split
thickness grafts are further classified as thin or
thick.
Full Thickness: Contains 100% of the epidermis
and dermis.
14.
15.
16. Type of Graft
Thin Split
Thickness
Advantages
-Best Survival
-Heals Rapidly
Disadvantages
-Least resembles original skin.
-Least resistance to trauma.
-Poor Sensation
-Maximal Secondary
Contraction
Thick Split
Thickness
-Lower graft survival
-Slower healing.
Full
Thickness
-More qualities of normal
skin.
-Less Contraction
-Looks better
-Fair Sensation
-Most resembles normal
skin.
-Minimal Secondary
contraction
-Resistant to trauma
-Good Sensation
-Aesthetically pleasing
-Poorest survival.
-Donor site must be closed
surgically.
-Donor sites are limited.
18. Plasmatic Imbibition:
Initially graft ischaemic (24 – 48 hrs)
Fibrin adhesion
Imbibition allows the graft to survive this period
? Important for nutrition of graft
? Stops drying out
19. Inosculation & capillary ingrowth:
At 48 hrs
Through fibrin layer
Capillary buds from recipient bed contact graft
vessels
Open channels (neo-vascularization)
pink graft
20. Revascularization & fibrous attachment:
Connection of graft & host vessels via anastomoses
(inosculation)
Formation of new vascular channels by invasion of
graft (neovascularisation)
Combination of old & new vessels
(revascularisation)
Fibroblast proliferation: conversion of fibrin
adhesion fibrous tissue attachment (anchorage
within 4 days)
21.
22. Appendages:
-sweating dependent on no. of transplanted
sweat glands & degree of sympathetic
reinnervation; will sweat like recipient site in
FTSG only
-sebaceous gland activity mostly in thicker
grafts: SSG usually dry & shiny
-hair grows from FTSG if well taken with no
complications
23. Initially white then pinkens with new blood
supply
Lymphatic drainage by day 6
Collagen replacement from day 7 to week 6
Vascular remodelling for months
24. Contraction:
- shrinks immediately due to elastic
recoil: – FTSG 40%; medium SSG 20%;
thin SSG 10%.
- secondary contracture as heals:
- FTSG remains same size after above
shrinkage;
- SSG will contract as much as possible;
- more dermis = less contraction
- ? Due to myofibroblasts
25. Reinnervation:
from margins to bed;
Depends on graft thickness and bed;
Uneventful healing leads to near normal 2PD;
Cold sensitivity can be a problem
26. Based on principle that wounds
reepithelialized from the periphery
Expansion provides larger areas from which
epithelium can grow
Larger areas can be covered with less skin
27. Meshing
- covers large area
- easier to contour
- fluid can drain through holes
- cosmetic results less than ideal
- various mesh ratio
28. Meshed graft or sheet graft :
Advantages
Lager area
Contours irregular surface
Drain blood & exudates
Increase edges _reepithilialization
Disadvantages
Much of wound heal with contracture
Cobble stone appearance
Sheet Graft
Joint
Hands
face
31. INDICATIONS OF SKIN GRAFT:
1 Skin loss:
- Post –traumatic
- Post surgical
- pathological process e.g venous ulcer
- Extensive burn
2 Mucosal loss:
- After excision of leukopakic patch in oral
cavity
- vaginal a genesis
32. Contraindications:
1 Avascular recipient areas :
- Cortical bone without periosteum
- Cartilage without perichondrim
- Tendon without paratenon
2- Infection :
a.heavily infected wound with copious
discharge(100 000 bact./ gram of tissue).
b. Infection by Beta haemolytic streptococcus
33. The ideal donor site would provide skin that is
identical to the skin surrounding the recipient
area.
Unfortunately, skin varies dramatically from one
anatomic site to another in terms of:
- Colour
- Thickness
- Hair
- Texture
34.
35.
Post auricular skin
Upper eyelid skin
Supraclavicular skin
Flexural skin
Thigh and abdominal skin
FTG should be clear of fat
FTG sutured edge to edge while STG overlaps
the defect.
Use quilting / tie over
36.
Razor Blades
Grafting Knives (Blair, Ferris, Smith, Humbly,
Goulian)
Manual Drum Dermatomes (Padgett, Reese)
**Electric/Air Powered Dermatomes (Brown,
Padgett, Hall)
Electric & Air Powered tools are most commonly used.