Most states in the US require separation distances between livestock production/ manure storage facilities and water resources
Iowa, for example, for liquid manure from animal buildings and manure storages requires 150 -300 meters separation
Ageing is a syndrome consisting of good number of diseases.
If one makes an attempt ageing male who is suffering from different diseases can be investigated, the deficiency can be found out and accordingly the deficiency may be replaced so as to help the ageing male. There is no authentication in this regard however this is hypotheticated as a concept
Most states in the US require separation distances between livestock production/ manure storage facilities and water resources
Iowa, for example, for liquid manure from animal buildings and manure storages requires 150 -300 meters separation
Ageing is a syndrome consisting of good number of diseases.
If one makes an attempt ageing male who is suffering from different diseases can be investigated, the deficiency can be found out and accordingly the deficiency may be replaced so as to help the ageing male. There is no authentication in this regard however this is hypotheticated as a concept
The right of children to free and compulsory education act, 2009mahesh lone
children's right for free and compulsory education. it is right of children from six years to fourteen years for free education in their neighborhood school. The Act laids down responsibility on Government, School and parents.
Tulane Medical School - med/peds resident presentation medical malpractice av...Conrad Meyer JD MHA FACHE
Tulane Medical School - Presentation to Med/Peds Residents on Medical Malpractice Avoidance, documentation, communication with patients and staff. Discussion included series on "distracted physicians" and use of smart devices that distract from patient care.
The focus on communication with patients along with proper history from patients and family was a key factor in decreasing medical malpractice suits. In addition, the expression of compassion or empathy when adverse outcomes arise plays a key role in decreasing medical malpractice suits. This followed a review of the Louisiana "I'm Sorry" law and its application
The right of children to free and compulsory education act, 2009mahesh lone
children's right for free and compulsory education. it is right of children from six years to fourteen years for free education in their neighborhood school. The Act laids down responsibility on Government, School and parents.
Tulane Medical School - med/peds resident presentation medical malpractice av...Conrad Meyer JD MHA FACHE
Tulane Medical School - Presentation to Med/Peds Residents on Medical Malpractice Avoidance, documentation, communication with patients and staff. Discussion included series on "distracted physicians" and use of smart devices that distract from patient care.
The focus on communication with patients along with proper history from patients and family was a key factor in decreasing medical malpractice suits. In addition, the expression of compassion or empathy when adverse outcomes arise plays a key role in decreasing medical malpractice suits. This followed a review of the Louisiana "I'm Sorry" law and its application
Θωρακική κύφωση
Επιδημιολογία
1-8% του γενικού πληθυσμού
Άνδρες - Γυναίκες
Φυσική εξέλιξη κυφώσεως τύπου Scheuermann
Δεν υπάρχουν αρκετές καλά προγραμματισμένες, μελέτες με μακρύ χρόνο παρακολούθησης
Κριτικό όριο ως προς το σχήμα της θεραπευτικής αγωγής της κυφώσεως είναι οι 70ο – 90ο
5% -10% of unconscious patients who present to the Emergency Dept. as the result of a M.V.A. or fall, have a major injury to the Cervical Spine
Spinal cord injury occurs in more than 11.000/USA pts per year/USA or in 40- 50 persons per million
Injuries of the Cervical Spine produce neurological damage in approximately 40% of patients
Indicators to Monitor the Effect of Nutrients within the Black Sea Iwl Pcu
The Black Sea is an endangered sea shared by Bulgaria, Georgia, Romania, Russia, Turkey & Ukraine. A large basin inhabited by 160 million people from 17 countries. The new GEF assistance is designed to address the three highest priority transboundary problems of the Black Sea (namely eutrophication, discharge of toxic substances including oil, loss of critical benthic habitats and wetlands) and to highlight emerging ones.
171. SACRUM FRACTURES –– DDEENNIISS CCLLAASSSSIIFFIICCAATTIIOONN
ZONE I
Across sacral
Neurological injuries
•due to superior migration of fragments
•6% of the whole
•lumbrosacral plexus L5,S1 (24%)
•Femoral nerve
172. SACRUM FRACTURES – DENIS CLASSIFICATION
ZONE II
• Through the neuroforamina
• Neurological injuries ® L5, S1 (50%)
• Unilateral sacral anesthesia
• Incontinence
• Flaccid bowel and bladder
• impotence
• Evaluation
• Achilles reflex
• Bulbocaverosus reflex
• Rectal tone
173. SACRUM FRACTURES – DENIS CLASSIFICATION
ZONE III
• through the body of the sacrum
• Neurological injuries
• 56% of the whole
• Cauda equina
• Neurogenic bladder
• Saddle anesthesia
• Loss of sphincter tone
• Bowel, bladder dysfunction 70%
184. MRI
• The most sensitive
in detection of fractures
- soft tissue edema
- marrow changes
185. TREATMENT
ZONE I
• Without neurologic deficits and stable
• Symptom relief
• Bed rest (7-10 days)
• Log-rolled
186. TREATMENT
ZONE II and III
• Without neurologic deficits
• Bed rest for 4-8 weeks
• Weight bearing at 4-8 weeks on the fractured side
187. TREATMENT
ZONE III
• Without neurologic deficits
• Observation: neuropraxia that will resolve
• Symptoms beyond 6-8 weeks: foraminal decompression
188. TREATMENT
ZONE III
• With neurologic injury
• Aggressive radiologic examination
• Early posterior
decompression
for
Return of – bowel, bladder
control
Reserval of foot drop
189. COMPLICATIONS OF CONSERVATIVE
TREATMENT
• chronic pain
• sacroiliac joint arthritis
• changes in the alignment on the sacrum
• bowel, bladder disability
190. DETERMINATION OF FRACTURE STABILITY
• Stable fractures
• Impacted vertical fracture
• Nondisplaced fracture of posterior
sacroiliac complex
• Fracture of the upper sacrum
191. DETERMINATION OF FRACTURE STABILITY
• Unstable
• Fracture diastasis
of
more than 0,5 – 1cm along
with an anterior unstable
injury
192. SURGICAL INDICATION
• posterior or vertical displacement or both
(>1cm)
• Rotationally unstable pelvic ring injuries
• Sacral fractures with unstable pelvic ring
that requires mobilization
• Neurological injury
194. PERCUTANEOUS ILIOSACRAL SCREW FIXATION
• For unilateral sacral fractures zone I or zone II
• Under fluoroscopic control the reduction is obtained and
held by iliac screws (cannulated)
