This document discusses concussions and contusions, providing information on their causes, symptoms, diagnosis, and treatment. It then discusses how repeated head injuries may be linked to the neurodegenerative disease Parkinson's. The document outlines the symptoms and progression of Parkinson's as well as current treatment options, which aim to manage symptoms as there is no cure. It suggests alternative therapies may provide relief for some Parkinson's patients and notes the disease results from loss of dopamine-producing neurons in the brain.
This document discusses geriatric rehabilitation and provides information on:
- The components of geriatric rehabilitation including accommodation, prevention of disability/restoration of function, and medical treatment of impairments.
- Physiological changes that occur with normal aging like changes in body composition, posture, gait, neurological and skin functions, and cardiopulmonary and urological systems.
- Principles of geriatric rehabilitation including ascertaining the level of function, differentiating between delirium, dementia and depression, determining patient goals and motivation, and emphasizing function over diagnosis.
- Common impairments seen in geriatrics like fractures, arthritis, Parkinson's disease, and peripheral nerve impairments.
-Detailed Introduction, Patho-physiology, Evaluation & Physiotherapy Management of Parkinsonism.
-Clinical classification is discussed.
-Various measures of evaluation and physical therapy is discussed in this.
Parkinson's disease is a neurodegenerative disorder caused by the loss of dopamine-producing neurons in the substantia nigra. The main symptoms are motor symptoms like tremors and rigidity, as well as non-motor symptoms like depression and sleep disorders. Diagnosis is based on the presence of cardinal motor features and there are no definitive medical tests. Current treatments aim to replace dopamine or stimulate dopamine receptors through drugs. Emerging treatments include gene therapy, stem cell therapy, deep brain stimulation surgery, and alternative therapies like acupuncture. Researchers are developing new drug formulations and therapies to better treat Parkinson's symptoms like bradykinesia and tremors that remain problematic.
Intraoperative Monitoring for Brain and Spinal Cord TumorsDhaval Shukla
Intraoperative monitoring (IOM) during brain and spinal surgeries aims to prevent new or worsened neurological deficits. While IOM is not based on class I evidence, controlled studies would be unethical given its effectiveness in predicting injuries. Studies show IOM reduces postoperative deficits compared to no monitoring. For glioma resections, IOM-guided resection allows safer maximal removal in eloquent areas, improving survival and quality of life. Awake craniotomy with IOM results in fewer deficits than general anesthesia. While false negatives and cost are challenges, IOM avoidance risks greater deficits and rehabilitation costs. IOM should be used for brain and spinal tumor resections when near critical structures.
Our errors in diagnosing dizziness slidesBest Doctors
This document summarizes a webinar on diagnosing dizziness presented by Best Doctors. It includes:
1) Four case studies on misdiagnoses of dizziness presented by Drs. Samuels, Calkins, Megerian, and Derebery focusing on conditions like pheochromocytoma, postural orthostatic tachycardia syndrome, endolymphatic sac tumor, and migraine-associated vertigo.
2) A discussion by Dr. Derebery of the differential diagnosis of dizziness and approaches to diagnosis based on temporal patterns and urgency.
3) Details on ACCME accreditation and speaker disclosures for continuing education credits.
Tardive dyskinesia is a delayed onset movement disorder caused by dopamine receptor-blocking agents. It affects 20-50% of patients treated with neuroleptics long-term and is characterized by involuntary movements, especially of the face. Diagnosis involves ruling out other causes and observing symptoms for at least a month after discontinuing the offending drug. Management focuses on withdrawing the causal medication, though symptoms often persist long-term.
Parkinson's disease is a brain disorder that occurs when certain nerve cells in the substantia nigra die or become impaired, reducing dopamine production. The key signs are tremor, slowness of movement, rigidity, and difficulty with balance. While symptoms usually develop after age 65, 15% of cases are younger patients. Current treatments include medications and deep brain stimulation surgery, but there is no known cure. Support groups and maintaining a healthy lifestyle can help patients manage their condition. Further research through clinical trials continues in hopes of finding a cure.
This document discusses concussions and contusions, providing information on their causes, symptoms, diagnosis, and treatment. It then discusses how repeated head injuries may be linked to the neurodegenerative disease Parkinson's. The document outlines the symptoms and progression of Parkinson's as well as current treatment options, which aim to manage symptoms as there is no cure. It suggests alternative therapies may provide relief for some Parkinson's patients and notes the disease results from loss of dopamine-producing neurons in the brain.
This document discusses geriatric rehabilitation and provides information on:
- The components of geriatric rehabilitation including accommodation, prevention of disability/restoration of function, and medical treatment of impairments.
- Physiological changes that occur with normal aging like changes in body composition, posture, gait, neurological and skin functions, and cardiopulmonary and urological systems.
- Principles of geriatric rehabilitation including ascertaining the level of function, differentiating between delirium, dementia and depression, determining patient goals and motivation, and emphasizing function over diagnosis.
- Common impairments seen in geriatrics like fractures, arthritis, Parkinson's disease, and peripheral nerve impairments.
-Detailed Introduction, Patho-physiology, Evaluation & Physiotherapy Management of Parkinsonism.
-Clinical classification is discussed.
-Various measures of evaluation and physical therapy is discussed in this.
Parkinson's disease is a neurodegenerative disorder caused by the loss of dopamine-producing neurons in the substantia nigra. The main symptoms are motor symptoms like tremors and rigidity, as well as non-motor symptoms like depression and sleep disorders. Diagnosis is based on the presence of cardinal motor features and there are no definitive medical tests. Current treatments aim to replace dopamine or stimulate dopamine receptors through drugs. Emerging treatments include gene therapy, stem cell therapy, deep brain stimulation surgery, and alternative therapies like acupuncture. Researchers are developing new drug formulations and therapies to better treat Parkinson's symptoms like bradykinesia and tremors that remain problematic.
Intraoperative Monitoring for Brain and Spinal Cord TumorsDhaval Shukla
Intraoperative monitoring (IOM) during brain and spinal surgeries aims to prevent new or worsened neurological deficits. While IOM is not based on class I evidence, controlled studies would be unethical given its effectiveness in predicting injuries. Studies show IOM reduces postoperative deficits compared to no monitoring. For glioma resections, IOM-guided resection allows safer maximal removal in eloquent areas, improving survival and quality of life. Awake craniotomy with IOM results in fewer deficits than general anesthesia. While false negatives and cost are challenges, IOM avoidance risks greater deficits and rehabilitation costs. IOM should be used for brain and spinal tumor resections when near critical structures.
Our errors in diagnosing dizziness slidesBest Doctors
This document summarizes a webinar on diagnosing dizziness presented by Best Doctors. It includes:
1) Four case studies on misdiagnoses of dizziness presented by Drs. Samuels, Calkins, Megerian, and Derebery focusing on conditions like pheochromocytoma, postural orthostatic tachycardia syndrome, endolymphatic sac tumor, and migraine-associated vertigo.
2) A discussion by Dr. Derebery of the differential diagnosis of dizziness and approaches to diagnosis based on temporal patterns and urgency.
3) Details on ACCME accreditation and speaker disclosures for continuing education credits.
Tardive dyskinesia is a delayed onset movement disorder caused by dopamine receptor-blocking agents. It affects 20-50% of patients treated with neuroleptics long-term and is characterized by involuntary movements, especially of the face. Diagnosis involves ruling out other causes and observing symptoms for at least a month after discontinuing the offending drug. Management focuses on withdrawing the causal medication, though symptoms often persist long-term.
Parkinson's disease is a brain disorder that occurs when certain nerve cells in the substantia nigra die or become impaired, reducing dopamine production. The key signs are tremor, slowness of movement, rigidity, and difficulty with balance. While symptoms usually develop after age 65, 15% of cases are younger patients. Current treatments include medications and deep brain stimulation surgery, but there is no known cure. Support groups and maintaining a healthy lifestyle can help patients manage their condition. Further research through clinical trials continues in hopes of finding a cure.
A 15-month-old baby was brought in with a history of inability to sit without support, inability to speak, and convulsions, which may indicate cerebral palsy. Cerebral palsy is a non-progressive brain disorder causing impaired movement and posture, and is the most common motor disability in childhood. It has a variety of causes including prenatal and perinatal brain injuries. Treatment is multidisciplinary and aims to improve mobility, communication, learning, and independence through therapies and management of symptoms.
This document summarizes the biological treatments for obsessive compulsive disorder (OCD) according to the DSM-5 criteria. It discusses the neurobiology of OCD including structural changes in the brain, functional studies showing increased activity in certain areas, and neurotransmitter imbalances. FDA approved medications for OCD like SSRIs and clomipramine are outlined. Augmentation strategies and treatments for resistant cases are provided. Other somatic therapies explored include repetitive transcranial magnetic stimulation, deep brain stimulation, electroconvulsive therapy, and vagus nerve stimulation. Neurosurgical procedures are discussed as last line treatments for severe, long-standing OCD.
This document discusses young-onset dementia (YOD), which is defined as cognitive and functional impairment in individuals under 65 years of age. It provides epidemiological data on YOD, noting that the most common causes are Alzheimer's disease, frontotemporal lobar degeneration, and Creutzfeldt-Jakob disease. Unique challenges of YOD include difficulties with diagnosis due to atypical presentations, as well as social, family, financial and caregiver challenges. Five case studies are presented to illustrate different causes and presentations of YOD.
This document provides an overview and updates on Parkinson's disease from 2016. It discusses imaging techniques used to diagnose Parkinson's as well as drug treatments and surgical options like deep brain stimulation. It also addresses questions on the potential roles of dietary supplements, exercise, supportive therapies, criteria for deep brain stimulation, current search for a cure, and typical disease prognosis. The overall document aims to inform about Parkinson's disease management and research progress.
Challenges in rehabilitation of the elderly patientMarc Evans Abat
This document discusses rehabilitation in the elderly. It covers the prevalence of disability in the elderly, benefits of rehabilitation such as improved function and reduced risk of nursing home admission. Goals of rehabilitation include improving function and preventing further disability. Challenges include physiological changes like decreased muscle mass and strength, and geriatric syndromes like dementia, falls, and incontinence. Proper communication and addressing sensory issues are important in the rehabilitation of elderly patients. Tests like the timed up and go and functional reach can assess function.
The document discusses Parkinson's disease, including its causes, symptoms, stages, diagnosis, treatment, and prevention. Some key points:
- Parkinson's is a progressive nervous system disorder caused by loss of dopamine-producing brain cells. Symptoms include tremors, rigidity, and impaired movement.
- It is staged from 1 to 5 based on severity, from mild symptoms on one side of the body to requiring 24/7 care. Diagnosis is based on symptoms and medical history.
- Treatment focuses on managing symptoms through medications like levodopa and carbidopa that aim to replace dopamine. Surgery like deep brain stimulation may also help in severe cases.
- Risk can be reduced through diet high in omega
John, age 45, presented with declining memory and concentration along with involuntary movements in his fingers, toes and face. After extensive evaluation, he was diagnosed with Huntington's disease, which was confirmed by a DNA analysis showing 43 CAG repeats. Huntington's disease is an inherited, degenerative disorder that affects movement, cognition and psychiatric functions. It is caused by a dominant genetic mutation and results in the death of brain cells in the basal ganglia. There is currently no cure for Huntington's disease.
1. Cerebral palsy is a motor dysfunction caused by damage to the brain's motor areas, resulting in problems with muscle control and movement.
2. The most common type is spastic cerebral palsy, which causes muscle stiffness. Other types include dyskinetic, ataxic, and mixed forms.
3. Risk factors include prematurity, low birth weight, genetic disorders, infections, and complications during birth. Treatment involves a multidisciplinary approach including physical therapy, medications, surgery, and rehabilitation.
This slide is prepared by medical student for educatonal purpose. Please comment if anything to add on this slide.Please share if youlike the slide in your educational group.
Research on Young-Onset Dementia and Its Implications for Criminal and Civil ...guest7053e1d
This document summarizes a presentation on young-onset dementias and their forensic implications. It discusses the differential diagnosis of young-onset dementias, common neuropsychiatric complications, and management challenges. Specific conditions covered include Alzheimer's disease, frontotemporal lobar degeneration, traumatic brain injury, Creutzfeldt-Jakob disease, and Huntington's disease. Case examples are also provided to illustrate real-world management issues.
This document discusses various types of metabolic headaches according to the International Classification of Headache Disorders. It summarizes the diagnostic criteria and proposed pathophysiology for headaches attributed to conditions like high altitude, airplane travel, diving, sleep apnea, dialysis, hypertension, and pheochromocytoma. Specific details are provided on symptoms, triggers, evaluations and treatments for these secondary headache disorders related to disruptions in homeostasis.
This document discusses Parkinson's disease and summarizes key points from a lecture on the topic. It defines clinical and pathological criteria for Parkinson's disease and other Parkinsonian disorders. It outlines current understanding of genetic factors and proteins involved like alpha-synuclein. Environmental risks and protective factors are also mentioned. The document examines the pathology of Lewy bodies and their spreading pattern in the brain.
Cerebral palsy is a disorder of movement and posture caused by an injury to the developing brain. It has a variety of presentations ranging from mild motor impairment to severe involvement of the entire body. Risk factors include preterm birth, infections, genetic factors, and complications during delivery. The main types are spastic, athetoid, ataxic, and hypotonic cerebral palsy. Treatment is multidisciplinary and focuses on rehabilitation, physical therapy, medications, and surgery to improve symptoms and quality of life. Hydrocephalus is an excess of cerebrospinal fluid in the brain which can occur as a complication of cerebral palsy.
The document discusses several neuromuscular disabilities and brain injuries including epilepsy, cerebral palsy, traumatic brain injury, and muscular dystrophy. It provides information on the causes, symptoms, diagnosis, and treatment/interventions for each condition. Epilepsy is caused by brief electrical disturbances in the brain and can be generalized or partial. Cerebral palsy is caused by damage to the developing brain and presents with motor impairments. Traumatic brain injury results from external forces to the head and requires acute, subacute, and chronic treatment. Muscular dystrophy involves inherited muscle weakness and wasting that worsens over time.
This document discusses neonatal seizures, including their causes, types, diagnosis, treatment, and nursing management. Neonatal seizures are a medical emergency that can cause irreversible brain damage. They are most commonly caused by perinatal complications, developmental neurological problems, perinatal infections, or metabolic problems. The main types of neonatal seizures are subtle, tonic, clonic, and myoclonic. Diagnosis involves history, physical exam, laboratory tests, imaging, and EEG. Treatment focuses on controlling seizures, stabilizing vital functions, treating the underlying cause, and providing supportive care. This includes anticonvulsant medication, treating hypoglycemia, hypocalcemia, or other metabolic abnormalities, and ensuring proper nursing observation
This document provides information on cerebral palsy (CP), including what it is, its main types and causes, related conditions, classifications, its discovery by William John Little, and various treatment options. CP is a form of paralysis caused by brain damage, characterized by difficulty controlling voluntary muscles. The three main types are hemiplegia affecting one side of the body, diplegia affecting both legs more than arms, and quadriplegia affecting all four limbs. Causes include prenatal brain defects, birth injuries, infections, and accidents. Treatments include physical therapy, orthotics, surgery, Botox injections, hyperbaric oxygen therapy, massage, yoga, cord blood therapy and more.
Neuromuscular weakness or paralysis in children 2021Imran Iqbal
This document provides an overview of neuromuscular weakness or paralysis in children, including:
- Types of neuromuscular weakness can be caused by upper motor neuron (UMN) or lower motor neuron (LMN) lesions in the brain, spinal cord, peripheral nerves, neuromuscular junction, or muscles.
- Common UMN conditions include hemiplegia from brain lesions, paraplegia/quadriplegia from spinal cord lesions, and corticospinal diseases like cerebral palsy.
- Common LMN conditions include Guillain-Barré syndrome, poliomyelitis, myasthenia gravis, and muscular dystrophies.
- A
Cognitive reserve is the brain's ability to cope with brain damage or pathology. It allows some individuals to maintain cognitive function despite significant Alzheimer's disease pathology. The document discusses theories of cognitive reserve including brain reserve capacity and cognitive reserve models. It describes measures of reserve like education and occupation. Epidemiological evidence shows factors like higher education are associated with lower dementia risk. Imaging studies provide further support, finding relationships between cognitive reserve proxies and brain activation patterns. Maintaining cognitive stimulation through activities across life may help increase cognitive reserve and resilience against cognitive decline.
Neonatal seizures are the most common neurological manifestation in newborns and can be difficult to recognize. They are often caused by hypoxic-ischemic encephalopathy, hypoglycemia, hypocalcemia or infections. When a neonatal seizure is observed, the newborn must be stabilized, underlying causes should be investigated through bloodwork and imaging, and seizures treated aggressively with anticonvulsants like phenobarbital. Identifying and correcting the underlying etiology is important for management and prognosis.
This document provides an overview of movement disorders in paediatrics. It discusses the major categories of hyperkinetic and hypokinetic movement disorders and some specific disorders including tics, chorea, dystonia, stereotypies, and tremor. For each disorder, it covers typical presentation, age of onset, differential diagnosis, evaluation, and treatment approaches. The document emphasizes that movement disorders in children often require a thorough history and examination to determine if the pattern is abnormal, changed over time, can be suppressed, and if there are other neurological findings or family history of similar conditions.
A 15-month-old baby was brought in with a history of inability to sit without support, inability to speak, and convulsions, which may indicate cerebral palsy. Cerebral palsy is a non-progressive brain disorder causing impaired movement and posture, and is the most common motor disability in childhood. It has a variety of causes including prenatal and perinatal brain injuries. Treatment is multidisciplinary and aims to improve mobility, communication, learning, and independence through therapies and management of symptoms.
This document summarizes the biological treatments for obsessive compulsive disorder (OCD) according to the DSM-5 criteria. It discusses the neurobiology of OCD including structural changes in the brain, functional studies showing increased activity in certain areas, and neurotransmitter imbalances. FDA approved medications for OCD like SSRIs and clomipramine are outlined. Augmentation strategies and treatments for resistant cases are provided. Other somatic therapies explored include repetitive transcranial magnetic stimulation, deep brain stimulation, electroconvulsive therapy, and vagus nerve stimulation. Neurosurgical procedures are discussed as last line treatments for severe, long-standing OCD.
This document discusses young-onset dementia (YOD), which is defined as cognitive and functional impairment in individuals under 65 years of age. It provides epidemiological data on YOD, noting that the most common causes are Alzheimer's disease, frontotemporal lobar degeneration, and Creutzfeldt-Jakob disease. Unique challenges of YOD include difficulties with diagnosis due to atypical presentations, as well as social, family, financial and caregiver challenges. Five case studies are presented to illustrate different causes and presentations of YOD.
This document provides an overview and updates on Parkinson's disease from 2016. It discusses imaging techniques used to diagnose Parkinson's as well as drug treatments and surgical options like deep brain stimulation. It also addresses questions on the potential roles of dietary supplements, exercise, supportive therapies, criteria for deep brain stimulation, current search for a cure, and typical disease prognosis. The overall document aims to inform about Parkinson's disease management and research progress.
Challenges in rehabilitation of the elderly patientMarc Evans Abat
This document discusses rehabilitation in the elderly. It covers the prevalence of disability in the elderly, benefits of rehabilitation such as improved function and reduced risk of nursing home admission. Goals of rehabilitation include improving function and preventing further disability. Challenges include physiological changes like decreased muscle mass and strength, and geriatric syndromes like dementia, falls, and incontinence. Proper communication and addressing sensory issues are important in the rehabilitation of elderly patients. Tests like the timed up and go and functional reach can assess function.
The document discusses Parkinson's disease, including its causes, symptoms, stages, diagnosis, treatment, and prevention. Some key points:
- Parkinson's is a progressive nervous system disorder caused by loss of dopamine-producing brain cells. Symptoms include tremors, rigidity, and impaired movement.
- It is staged from 1 to 5 based on severity, from mild symptoms on one side of the body to requiring 24/7 care. Diagnosis is based on symptoms and medical history.
- Treatment focuses on managing symptoms through medications like levodopa and carbidopa that aim to replace dopamine. Surgery like deep brain stimulation may also help in severe cases.
- Risk can be reduced through diet high in omega
John, age 45, presented with declining memory and concentration along with involuntary movements in his fingers, toes and face. After extensive evaluation, he was diagnosed with Huntington's disease, which was confirmed by a DNA analysis showing 43 CAG repeats. Huntington's disease is an inherited, degenerative disorder that affects movement, cognition and psychiatric functions. It is caused by a dominant genetic mutation and results in the death of brain cells in the basal ganglia. There is currently no cure for Huntington's disease.
1. Cerebral palsy is a motor dysfunction caused by damage to the brain's motor areas, resulting in problems with muscle control and movement.
2. The most common type is spastic cerebral palsy, which causes muscle stiffness. Other types include dyskinetic, ataxic, and mixed forms.
3. Risk factors include prematurity, low birth weight, genetic disorders, infections, and complications during birth. Treatment involves a multidisciplinary approach including physical therapy, medications, surgery, and rehabilitation.
This slide is prepared by medical student for educatonal purpose. Please comment if anything to add on this slide.Please share if youlike the slide in your educational group.
Research on Young-Onset Dementia and Its Implications for Criminal and Civil ...guest7053e1d
This document summarizes a presentation on young-onset dementias and their forensic implications. It discusses the differential diagnosis of young-onset dementias, common neuropsychiatric complications, and management challenges. Specific conditions covered include Alzheimer's disease, frontotemporal lobar degeneration, traumatic brain injury, Creutzfeldt-Jakob disease, and Huntington's disease. Case examples are also provided to illustrate real-world management issues.
This document discusses various types of metabolic headaches according to the International Classification of Headache Disorders. It summarizes the diagnostic criteria and proposed pathophysiology for headaches attributed to conditions like high altitude, airplane travel, diving, sleep apnea, dialysis, hypertension, and pheochromocytoma. Specific details are provided on symptoms, triggers, evaluations and treatments for these secondary headache disorders related to disruptions in homeostasis.
This document discusses Parkinson's disease and summarizes key points from a lecture on the topic. It defines clinical and pathological criteria for Parkinson's disease and other Parkinsonian disorders. It outlines current understanding of genetic factors and proteins involved like alpha-synuclein. Environmental risks and protective factors are also mentioned. The document examines the pathology of Lewy bodies and their spreading pattern in the brain.
Cerebral palsy is a disorder of movement and posture caused by an injury to the developing brain. It has a variety of presentations ranging from mild motor impairment to severe involvement of the entire body. Risk factors include preterm birth, infections, genetic factors, and complications during delivery. The main types are spastic, athetoid, ataxic, and hypotonic cerebral palsy. Treatment is multidisciplinary and focuses on rehabilitation, physical therapy, medications, and surgery to improve symptoms and quality of life. Hydrocephalus is an excess of cerebrospinal fluid in the brain which can occur as a complication of cerebral palsy.
The document discusses several neuromuscular disabilities and brain injuries including epilepsy, cerebral palsy, traumatic brain injury, and muscular dystrophy. It provides information on the causes, symptoms, diagnosis, and treatment/interventions for each condition. Epilepsy is caused by brief electrical disturbances in the brain and can be generalized or partial. Cerebral palsy is caused by damage to the developing brain and presents with motor impairments. Traumatic brain injury results from external forces to the head and requires acute, subacute, and chronic treatment. Muscular dystrophy involves inherited muscle weakness and wasting that worsens over time.
This document discusses neonatal seizures, including their causes, types, diagnosis, treatment, and nursing management. Neonatal seizures are a medical emergency that can cause irreversible brain damage. They are most commonly caused by perinatal complications, developmental neurological problems, perinatal infections, or metabolic problems. The main types of neonatal seizures are subtle, tonic, clonic, and myoclonic. Diagnosis involves history, physical exam, laboratory tests, imaging, and EEG. Treatment focuses on controlling seizures, stabilizing vital functions, treating the underlying cause, and providing supportive care. This includes anticonvulsant medication, treating hypoglycemia, hypocalcemia, or other metabolic abnormalities, and ensuring proper nursing observation
This document provides information on cerebral palsy (CP), including what it is, its main types and causes, related conditions, classifications, its discovery by William John Little, and various treatment options. CP is a form of paralysis caused by brain damage, characterized by difficulty controlling voluntary muscles. The three main types are hemiplegia affecting one side of the body, diplegia affecting both legs more than arms, and quadriplegia affecting all four limbs. Causes include prenatal brain defects, birth injuries, infections, and accidents. Treatments include physical therapy, orthotics, surgery, Botox injections, hyperbaric oxygen therapy, massage, yoga, cord blood therapy and more.
Neuromuscular weakness or paralysis in children 2021Imran Iqbal
This document provides an overview of neuromuscular weakness or paralysis in children, including:
- Types of neuromuscular weakness can be caused by upper motor neuron (UMN) or lower motor neuron (LMN) lesions in the brain, spinal cord, peripheral nerves, neuromuscular junction, or muscles.
- Common UMN conditions include hemiplegia from brain lesions, paraplegia/quadriplegia from spinal cord lesions, and corticospinal diseases like cerebral palsy.
- Common LMN conditions include Guillain-Barré syndrome, poliomyelitis, myasthenia gravis, and muscular dystrophies.
- A
Cognitive reserve is the brain's ability to cope with brain damage or pathology. It allows some individuals to maintain cognitive function despite significant Alzheimer's disease pathology. The document discusses theories of cognitive reserve including brain reserve capacity and cognitive reserve models. It describes measures of reserve like education and occupation. Epidemiological evidence shows factors like higher education are associated with lower dementia risk. Imaging studies provide further support, finding relationships between cognitive reserve proxies and brain activation patterns. Maintaining cognitive stimulation through activities across life may help increase cognitive reserve and resilience against cognitive decline.
Neonatal seizures are the most common neurological manifestation in newborns and can be difficult to recognize. They are often caused by hypoxic-ischemic encephalopathy, hypoglycemia, hypocalcemia or infections. When a neonatal seizure is observed, the newborn must be stabilized, underlying causes should be investigated through bloodwork and imaging, and seizures treated aggressively with anticonvulsants like phenobarbital. Identifying and correcting the underlying etiology is important for management and prognosis.
This document provides an overview of movement disorders in paediatrics. It discusses the major categories of hyperkinetic and hypokinetic movement disorders and some specific disorders including tics, chorea, dystonia, stereotypies, and tremor. For each disorder, it covers typical presentation, age of onset, differential diagnosis, evaluation, and treatment approaches. The document emphasizes that movement disorders in children often require a thorough history and examination to determine if the pattern is abnormal, changed over time, can be suppressed, and if there are other neurological findings or family history of similar conditions.
This document provides an overview of geriatrics and aging. It defines geriatrics as the care of aged people and notes it is a subspecialty of internal medicine focused on prevention and treatment of age-related disabilities. Key points include:
- Geriatrics aims to address common problems in old age like immobility, instability, intellectual impairment, incontinence, and multiple medical issues.
- Comprehensive Geriatric Assessment is a multidisciplinary approach to evaluate older patients' medical, psychological and functional status to maximize health and quality of life.
- Research seeks to understand aging processes to develop interventions that may slow or stop aging through approaches like modifying gene expression, repairing telomeres, or
Parkinson's disease is a progressive neurodegenerative disorder that affects movement. It is caused by the loss of dopamine-producing neurons in the brain. The main symptoms are tremors, rigidity, bradykinesia, and impaired balance and coordination. There is no cure for Parkinson's, but treatment aims to manage symptoms through medication and sometimes surgery. Nursing management focuses on maintaining mobility and self-care abilities, addressing complications, ensuring adequate nutrition, and supporting coping.
This document provides information about Parkinson's disease including causes, pathophysiology, clinical manifestations, assessment, diagnosis, and nursing management. Parkinson's disease results from loss of dopamine-producing neurons in the brain. Key symptoms include tremors, rigidity, bradykinesia, and postural instability. Nursing focuses on managing mobility, self-care, communication, and coping through exercise, adaptive devices, swallowing techniques, and emotional support.
Neurodegenerative diseases such as Alzheimer's, Huntington's, and Parkinson's cause the progressive loss of structure and function of neurons in the brain and spinal cord. Neurons cannot be replaced when damaged or died. Common symptoms include memory loss, movement difficulties, and behavioral changes. While there are currently no cures for these diseases, medications can help manage symptoms. Caregiving requires adapting to the patient's changing abilities from early to late stages of the disease.
Parkinson's disease is a progressive neurological disorder that results from the loss of dopamine-producing neurons in the brain. The main symptoms include tremors, rigidity, slow movement, and impaired balance and coordination. There is no cure for Parkinson's, but treatments can help manage the motor symptoms by replacing dopamine or mimicking its effects in the brain. Diet and nutrition also play an important role, as the disease can affect swallowing, digestion and weight. Maintaining a healthy diet with small, frequent meals and modifying protein intake is recommended. Exercise is also encouraged to help with symptoms and overall well-being. While Parkinson's is not fatal, complications from the disease are a leading cause of death.
Parkinson's disease is a neurological disorder that occurs when certain neurons in the brain die or become damaged. These neurons produce dopamine, which is important for muscle movement throughout the body. The main symptoms include tremors, slow movement, stiffness, and balance and walking problems. Currently there is no cure, but medications can help treat symptoms by replacing dopamine. Researchers are working on developing treatments using stem cells to create new dopamine neurons.
SSPE, dr. amit vatkar, pediatric neurologistDr Amit Vatkar
Subacute sclerosing pan encephalitis (SSPE) also known as Dawson Disease, Dawson encephalitis, and measles encephalitis is a rare and chronic form of progressive brain inflammation caused by a persistent infection with measles virus.
In this presentaion i will a case a sspe and give u some information regarding daignosis and treatment
Progeria is an extremely rare genetic condition where children age rapidly, experiencing many signs of aging at a very early age. It affects about 1 in 4-8 million births. The main symptoms include baldness, wrinkled skin, joint stiffness, loss of body fat and muscle, and cardiovascular problems. Average life expectancy is 13 years. While there is no cure, treatments can help manage symptoms and slow progression, such as low-dose aspirin, physical therapy, and lifestyle modifications. Progeria is caused by a genetic mutation and provides insight into normal human aging processes.
This document presents a case study of 16-year-old Soumya who was brought to the hospital with fever, shortness of breath, and vomiting. After examination, she was diagnosed with progeria. Progeria is an extremely rare genetic condition where children exhibit rapid aging symptoms. It is caused by a genetic mutation that prevents prelamin A from being properly processed. Children with progeria have short stature, loss of hair and body fat, stiff joints, heart disease, and typically die in their early teens. While currently incurable, research is ongoing to develop treatments to target the underlying genetic cause.
This document provides an overview of geriatrics and common issues in caring for elderly patients. It discusses how biological age is more important than chronological age in clinical decision making. Frailty and disability are also addressed. Common geriatric problems like falls, delirium, incontinence and adverse drug reactions are examined in terms of presentation, evaluation, and management strategies. The importance of a comprehensive assessment, considering multiple comorbidities and functional status, is emphasized in developing treatment plans for elderly patients.
Cerebral palsy is a motor function disorder caused by a permanent, non-progressive brain lesion present at birth or shortly thereafter. It is a non-curable, lifelong condition that affects muscle strength, movement, balance and coordination. Common causes include prematurity, low birth weight, infections, and lack of oxygen during birth. Treatment focuses on managing symptoms through physical, occupational and speech therapy as well as bracing, medication and sometimes surgery. The goals are to improve functional abilities and quality of life.
This document discusses neurocognitive disorders including delirium, major neurocognitive disorders such as dementia and amnestic syndrome, mild neurocognitive disorder, epilepsy, and traumatic brain injury. It provides details on the diagnostic criteria, clinical features, epidemiology, treatment, and prognosis of these conditions. Case studies are also presented to illustrate delirium and complex partial seizures.
Erectile dysfunction is the inability to get or maintain an erection firm enough for sex. It can be caused by physical or psychological factors such as vascular disease, diabetes, depression, or performance anxiety. Treatments include oral medications like Viagra, vacuum devices, injections, implants, or counseling. Premature ejaculation involves ejaculating sooner than desired during sex and can be treated with behavioral techniques or medications. Proper diagnosis involves taking a medical and sexual history to determine the underlying cause.
Similar to STEM CELL THERAPY HAS A PROMISE IN PARKINSON’S DISEASE, Dr. Sharda jain (20)
Medical Facts of STEM CELL THERAPY in DIABETES Type I & II , Dr. Sharda Jain StemcellGP21
Stem cell therapy shows promise for improving outcomes for people with diabetes. It can help decrease insulin needs by 50% or more, prevent common complications like blindness and kidney failure, and improve overall health and well-being. Stem cell therapy works best when combined with standard medical treatment for diabetes. While results vary, many patients report significantly improved control of their diabetes symptoms after undergoing stem cell therapy.
Smart Anti Ageing with Stem Cell Therapy Global stemgenn, Dr. Sharda Jain StemcellGP21
1) Stem cell therapy is revolutionizing anti-aging by using stem cells to reactivate healing cells and boost the body's natural rejuvenation abilities.
2) Top doctors in Delhi are scared of losing mental faculty in old age, but stem cell therapy plus lifestyle changes can prevent, halt, or delay aging effects.
3) Predictions indicate that by 2050, people living productive lives to 100 years and beyond will be common due to advances in anti-aging including stem cell therapy and lifestyle modifications.
Stem cell therpay a hope to no hope disodersStemcellGP21
This document discusses stem cell therapy and its potential to treat various incurable or "no hope" disorders. It provides an overview of stem cells, their sources and types. Mesenchymal stem cells from sources like bone marrow, umbilical cord blood and adipose tissue are highlighted as having advantages for therapy due to their ability to differentiate, lack of ethical issues, and potential to be used across HLA barriers. A number of incurable conditions are identified where stem cell therapy may be effective or very effective, including diabetes, neurological disorders, anti-aging, and orthopedic issues. The success of stem cell therapy depends on isolating and culturing the appropriate stem cell types for differentiation. Questions about the therapy are also addressed
A. B. C. of STEM CELL therapy Dr. Sharda jain Lifecare Centre StemcellGP21
This document provides information about LifeCare-ReeCure Centre, a stem cell therapy organization. It introduces the board of directors and discusses the sources of stem cells they use, such as bone marrow, menstrual blood, and hair follicles. It also outlines several diseases that can be treated with stem cell therapy according to the organization, including cardiovascular, neurological, liver, bone, and blood disorders. The document promotes the organization's proprietary technology and focus on treating "no hope" diseases. It shares case studies and testimonials of successful stem cell therapy treatments.
This document provides information about stem cell therapy from Global Stemgenn Therapy & Research. It discusses how stem cell therapy is a medical revolution that uses a patient's own stem cells to aid recovery from illness or injury. It outlines several indications stem cell therapy can be used for, including orthopedic issues, sports injuries, neurodegenerative diseases, and more. The document also describes the procedures for stem cell therapy and the sources of stem cells that can be used, such as bone marrow, blood, and adipose tissue.
Stem cell therapy shows promise for managing diabetes and preventing its complications. It helps reduce insulin needs by 50% or less in type 1 diabetes and controls blood sugar in type 2 diabetes. Stem cell therapy also prevents common complications that occur in 50% of poorly controlled diabetes cases, such as blindness, kidney failure, and amputation. It has helped diabetics with early kidney failure avoid dialysis and those with chronic renal failure decrease dialysis frequency. The document discusses the benefits of combining stem cell therapy with mainstream diabetes treatment for improved healing and disease control.
This document provides information about Global Stemgenn Therapy & Research, a stem cell therapy and regenerative medicine company. It discusses the types of conditions they treat using stem cell therapy, including arthritis, spinal cord injuries, neurological conditions, diabetes, and lifestyle diseases. It also outlines their anti-aging program. Global Stemgenn is run by medical experts and researchers and provides training on stem cells and regenerative medicine. The document emphasizes that stem cell therapy is a safe, affordable, and effective alternative to certain surgeries and treatments.
Stem Cell Therapy for Anti – Ageing ,DR. SHARDA JAIN, Dr. Prabhu Mishra , Dr...StemcellGP21
This document discusses stem cell therapy as a revolutionary treatment for anti-aging. It notes that stem cell therapy can help regenerate tissues and potentially treat a wide range of diseases. The document outlines the steps involved in stem cell therapy for anti-aging at Global Stemgenn Therapy & Research, including an initial health screening, physician review, and the stem cell transplantation procedure. It claims the therapy can provide benefits like more energy, better mental clarity, and improved skin texture.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
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
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
STEM CELL THERAPY HAS A PROMISE IN PARKINSON’S DISEASE, Dr. Sharda jain
1. STEM CELL THERAPY
HAS A PROMISE IN
PARKINSON’S DISEASE
DR. SHARDA JAIN
Dr. Rashmi Jain
Dr. Indu Tyagi
Dr. Jyoti Agarwal
Dr. Jyoti Bhaskar
Public contact
initiative
www.globalstemgenn.com
Dr. Prabhu Mishra
5. Parkinson’s disease (PD) is a
chronic progressive disease of the
nervous system characterized by
the cardinal features of rigidity,
bradykinesia, tremor and postural
instability.
What is Parkinson’s Disease?
6. In simple terms
• Parkinson’s disease is a disorder
of the brain that leads to shaking
(tremors) and difficulty in walking
movement, and co-ordinaation.
• It is one of the most common
nervous system disorders of the
elderly. Sometimes, Parkinson’s
disease occurs in younger adults,
but is rarely seen in children. It
affects both men and women .
www.globalstemgenn.com
7. Incidence
•In India, the crude age-adjusted
prevalence rate of Parkinson's disease
per 100,000 population is
14 in northern India,
27 in the south and
16 in the east,
363 for Parsis
8. How does it Happen?
Nerve cells use a brain chemical called
DOPAMINE to help control muscle
movement. Parkinson’s disease occurs when
the nerve cells in the brain that make
dopamine are slowly destroyed. Without
dopamine, the nerve cells in that part of the
brain cannot properly send messages. This
leads to the loss of muscle function. The
damage gets worse with time.
www.globalstemgenn.com
9. What are The Symptoms?
Symptoms may be mild at first.
For instance, the patient may have a mild
tremor or a slight feeling that one leg or
foot is stiff and dragging.
10. What are The Symptoms?
General symptoms include gradual
decrease in automatic movements,
constipation, swallowing difficulty,
drooling, impaired balance and
walking, mask-like facial expressions,
muscle aches and pains, rigid muscles,
tremors and stooped posture.
www.globalstemgenn.com
11. Clinical Presentation
• One of the clinical hallmark of parkinson’s
disease is rigidity
• Two types : cogwheel and lead pipe rigidity
• Cogwheel rigidity : jerky, ratchet like resistance
to passive movement and muscles alternative
tense and relax
• Lead pipe rigidity : no fluctuations, more
sustained resistance to passive movements.
• prolonged rigidity results in decreased range of
motion and serious complications of
contractures and postural deformity
12. • Akinnesia : absence of movement.
• Hypokinesia : reduced amplitude of the movement.
• Bradykinesia : slowness and difficult maintaining
movement. Movements are typically reduced in
speed, range and amplitude. Rigidity and
depression can also influence bradykinesia. It is the
most disabling symptom of PD
www.globalstemgenn.com
BRADYKINESIA
13. Tremor
• Parkinsomiam tremor is described as
resting tremor as it is typically present at
rest and disappears with voluntary
movement
• Manifests as pill – rolling tremor of hand
• Resting tremors may also be seen in the
forearm , jaw, or tongue
• Lower limb tremors as apparent when the
patients lies supine
• Postural tremor is seen in head and trunk
when patients tries to maintain upright
position against gravity
• COMPLETELY DIMINISH DURING SLEEPS
14. Increasing difficulty during
destabilizing activities like
walking, turning and
functional reach.
Extensor muscles of the trunk
demonstrate greater weakness
than flexor
Muscles, contributing to the
adoption of a flexed, stooped
posture with increased flexion
of the neck, trunk, hips, and
knees.
Postural instability.
www.globalstemgenn.com
15. • An abnormal stooped
posture contributes to
development of a
festinating gait,
characterized by a
progressive increase in
speed with a shortening
of stride.
Posture POSTURE
16. What are the other
symptoms?
Other symptoms include
anxiety,
stress,
confusion,
dementia,
depression,
fainting spells,
hallucinations and
memory loss.
www.globalstemgenn.com
18. Conventional Treatment
MEDICAL aim to control symptoms, mostly
by increasing the levels of dopamine in the
brain. At certain points during the day, the
helpful effects of the medication often wears
off, and symptoms can return . Eventually,
symptoms such as stooped posture, frozen
movements, and speech difficulties may not
respond very well to drug treatment.
www.globalstemgenn.com
19. Conventional Treatment
SURGERY may be an option for
patients with very severe Parkinson’s
disease who no longer respond to
medication.
These surgeries do not cure Parkinson’s,
but may help destroy symptoms and
stimulate movement.
20. Case study
In 2005, my mother 65 yrs old, a patient of Parkinsonism
for 20 yrs ,Underwent Brain stimulation surgery as a last
option as conventional medicines had failed to work.
The surgery failed miserably and she passed away in 4
months.
It was then that I was told that if stem cells therapy
( in research at that time) would have been available , she
would have been with me today.
The day has come – when every one will have a healthy
parent by their side.
Dr Jyoti Bhaskar
www.globalstemgenn.com
21. World Research with
Stem Cell Treatment
Numerous clinical trials are
going on all over the world to
explore the potential of stem
cells in parkinson’s disease.
Stem cell therapy has shown
to form dopamine producing
cells in the substantia nigra
of the brain.
www.globalstemgenn.com
22. • Stem cell therapy is helpful in patients
not responding to conventional
treatment.
• Stem cell therapy - does improve the
quality of life and helps getting rid of
most of the manifestations of
Parkinson’s disease.
World Research with
Stem Cell Treatment
23. Stem cell therapy improves the
quality of life.
However the response
Varies from patient
to patient
www.globalstemgenn.com
WORLD RESEARCH ON PARKINSONISM
WITH STEM CELL THERAPY
25. Our USP
• World class clinicians and experts from
Regenerative medicine.
• State of the art, in-house stem cell lab to maximize the
yield of good quality Stem Cells
• Accurate treatment protocols for “relevant disorders”
• Proven results and experience in handling complex case
• We use Autologous stem cells for Stem Cell Therapy
(Bone Marrow, Fat, Blood)
26. We offer
Global stemgenn makes suitable
stem cell therapy available to
the ailing patient only after
thorough scientific
deliberations and meticulous
counseling of patient & family
with experts.
www.globalstemgenn.com
27. • Autologous cells for homologous use
• Same setting surgery
• Minimal manipulation of cells
• Don’t promote therapeutic results
You should know
FDA – guidelines…
28. • This is a patient-funded clinical trial
• Stem Cell Therapy is NOT COVERED
BY INSURANCE
• Public undertakings DO ALLOW
in GUJARAT
• The cost of the therapy ranges & mainly
depends on the complexity of the case
Fees and Insurance
cover
www.globalstemgenn.com
29. Global stemgenn offer you stem cell
therapy using latest technology.
These stem cells could be of various types viz.
Hematopoietic (CD 34+), Mesenchymal stem
cells (MSCs) that are processed and isolated
using Good Manufacturing Practice (GMP)
and Good Lab Practice (GLP) in accordance
with AABB standards.
Our Lab USP
30. Our experience of
Stem cell therapy at Global Stemgenn
- It is completely safe,
Non –Toxic and totally devoid of side
effects with good probability of homing
and engraftment with the parent cell,
tissue or organ.
Patient - Safety
www.globalstemgenn.com
33. ADDRESS
11 Gagan Vihar, Near Karkari Morh
Flyover, Delhi - 51
CONTACT US
9599044357(Help line),
9650511339, 9811011690
011-22414049,22058865
WEBSITE :
www.globalstemgenn.com
www. Stemgenn.com
www.lifecarecentre.in
E-MAIL ID
Contact@globalstemgenn.com
Contact @stemgenn.com
A UNIT
OF ISO 14001:2004 (EMS)
…..Caring hearts, healing
hands
ISO 9001:2008
ISO 9001:2008