Reverse Sural Artery and Sural Neurocutaneous Flaps are two different Flaps. This PPT. identifies the inclusion of Additional perforators which though happen by default, knowledge of which helps in augmenting Sural neurocutaneous flap and extend its reach
HRCT in Diffuse Lung Diseases - I (Techniques and Quality)Bhavin Jankharia
The first part of a series on HRCT in diffuse lung diseases. This covers how to obtain good quality scans, which are the basis of learning how to interpret HRCT studies in the setting of diffuse lung diseases.
Micro vascular free flaps used in head and neck reconstruction /certified fi...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
HRCT in Diffuse Lung Diseases - I (Techniques and Quality)Bhavin Jankharia
The first part of a series on HRCT in diffuse lung diseases. This covers how to obtain good quality scans, which are the basis of learning how to interpret HRCT studies in the setting of diffuse lung diseases.
Micro vascular free flaps used in head and neck reconstruction /certified fi...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
Detailed presentation on Varicose veins, examination and management
Detailed presentation on Deep Vein Thrombosis, categories, staging and scoring systems and management.
Management also includes Endovascular and Surgical techniques.
Short notes made on IVC filters
Journal Club - Extra axial Endoscopic Third Ventriculostomy.pptxDr. Rahul Jain
journal club including 2 journals from same authors on topic of extra axial subfrontal endoscopic thord ventricuostomy, its techniques, advantages, limitations, principles
Dr. Aria Fallah, a fellowship trained pediatric neurosurgeon who practices at UCLA Mattel Children’s Hospital and Ronald Reagan UCLA Medical Center and Assistant Professor of Neurosurgery and Pediatrics at the David Geffen School of Medicine at UCLA, discusses hydrocephalus after hemispherectomy and other procedures at the 2017 Pediatric Epilepsy Surgery Conference and Family Reunion.
Presentation made by Dr. Hiranya A. Rajasinghe about Popliteal Artery Aneurysms: When to Treat Inclusion and Exclusion Criteria for Endovascular Repair
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
Detailed presentation on Varicose veins, examination and management
Detailed presentation on Deep Vein Thrombosis, categories, staging and scoring systems and management.
Management also includes Endovascular and Surgical techniques.
Short notes made on IVC filters
Journal Club - Extra axial Endoscopic Third Ventriculostomy.pptxDr. Rahul Jain
journal club including 2 journals from same authors on topic of extra axial subfrontal endoscopic thord ventricuostomy, its techniques, advantages, limitations, principles
Dr. Aria Fallah, a fellowship trained pediatric neurosurgeon who practices at UCLA Mattel Children’s Hospital and Ronald Reagan UCLA Medical Center and Assistant Professor of Neurosurgery and Pediatrics at the David Geffen School of Medicine at UCLA, discusses hydrocephalus after hemispherectomy and other procedures at the 2017 Pediatric Epilepsy Surgery Conference and Family Reunion.
Presentation made by Dr. Hiranya A. Rajasinghe about Popliteal Artery Aneurysms: When to Treat Inclusion and Exclusion Criteria for Endovascular Repair
Similar to Sural Neurocutaneous Flap by Dr Sumita Shankar, Amaze MedSpa (20)
offloading is an important aspect in Diabetic foot ulcer patients.There are two major aspects of offloading. Offloading is immensely useful in helping ulcers heal and secondly in prevention of recurrence of ulcers.
Endoscopically Assisted Repair of Diastasis Rectii by Dr Sumita Shankar, Amaz...Dr Sumita Shankar
A case series of successfully repairing Diastasis Recti endoscopically assisted and minimally invasive. Abdominal Divarication of Rectii causing Bulge repaired without mesh.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Sural Neurocutaneous Flap by Dr Sumita Shankar, Amaze MedSpa
1. Inclusion of an additionalInclusion of an additional
perforator to augmentperforator to augment
suralneurocutaneoussuralneurocutaneous
(SNC) flap(SNC) flap
Dr. Sumita ShankarDr. Sumita Shankar
6. Advantages of SNC flapAdvantages of SNC flap
Work horseWork horse
Ease of dissectionEase of dissection
ReliabilityReliability
Major limb vesselMajor limb vessel
sparedspared
Single stage procedureSingle stage procedure
10. Doppler study
Hand held doppler, 5Mhz probe
24 limbs studied
(7 healthy, 10 injured)
4-6cms prox. to lat. malleolus
Along the lateral
border of TA
19. Caveats for success…
Patent perforators onPatent perforators on
dopplerdoppler
Inclusion of sural nerve ’n’Inclusion of sural nerve ’n’
short saphenous veinshort saphenous vein
Inclusion of addl. PerforatorInclusion of addl. Perforator
Inset without any tensionInset without any tension
30. Complications
classical variant
Tip necrosis 8 nilTip necrosis 8 nil
Venous congestion 2 nilVenous congestion 2 nil
Transient infection 4 2Transient infection 4 2
Subflap collection 1Subflap collection 1
(secondary)(secondary)
Donor graft loss 3 2Donor graft loss 3 2
* Total flap loss nil nil* Total flap loss nil nil
31. ConclusionConclusion
Inclusion of an extraInclusion of an extra
perforatorperforator
Ensures perfusion thro’ dual
axis
Larger flaps can be raised
Significant reduction in
complication rate
It is a successful alternative
to free flap
38. Findings… Pr. of a constantPr. of a constant
perforatorperforator
4-6cms from tip of4-6cms from tip of
lat. Malleoluslat. Malleolus
along either side ofalong either side of
TATA
arising fromarising from
communicating branchcommunicating branch
between post.tibial &between post.tibial &
peroneal arteriesperoneal arteries
40. Complications
(33)
Tip necrosis 8
Venous congestion 2
Transient infection 2
Sub flap collection 1
(secondary)
Donor graft loss 4
* Total flap loss nil
Editor's Notes
Respected chairpersons, members of the jury and senior colleagues and dear friends, Greetings from Andhra Pradesh . In this study we will see as to how we were able to extend the utility of the sural neurocutaneous flap by including an additional perforator.
This is the sequence in which this study will be dealt with. We will c in brief abt SNC flp n problems associated with it . While elevating these flaps an additionaql perf was found at the base of the flap. This stimulated us to follow it up with doppler and cadaveric study. Finally we will see how we utilised this finding in to reconstruction of larger and most challenging defects without any significant complications.
According 2 cormack n lamberty’s classf, it has multiple small perf at the base n which run along the sural nerve.. The ant border is along fibular border, postly it is along the lat border of TA. In its classic description SNC flap can be raised up to the jus behind lat malleolus where the perforator is commonly found to be located on doppler This is the max dimensions mentioned
These r the most common defects where Snc flp finds its major role- the so called free flap zone
This is jus 2 enumerate what r the other options 2 our flap in question. As we notice here free flap is the Rx of choice. This is esp in pr of acute limb trauma, major injuries, n coverage of larger defects. But its use is limited by the cost and technical expertise. Local flaps - use limited by size of the defect and its limited mobility -premalleolar flap is the exception,a fairly large flap can be raised but - technically difficult to raise
Cross leg, poor patient acceptance, it does have its use. Immobilization with ExFix gives better acceptance and result.
‘given the circumstances in the general hospitals and in most of the peripheral setups, Snc remains the flap of choice for coverage of distal 1/3rd leg n foot defects . It’s a most versatile flp. If gd the difficulty of elevating the flp it can counted in gd1. it does not involve sacrifice of any major vessel
- An otherwise good result is spoilt by tip necrosis, superficial/ deep. Though in most of the cases if planned judiciously, critical parts do get covered. In most of such cases we have got away with wound debridement , ssg or flp advancement
The other significant problem we encountered was venous congestion
Post cellulitis defect in an elderly, long standing diabetic with exposure of TA. In this case we could limit the distal tip loss retaining TA functn as is depicted in the lowermost flup pic
Leecheshave been used with good result in a couple of cases
While raising these flps an xtra perforator was visualised along the lateral border of TA. We investigated the consistency an size of the perforator.
The constancy of this perforater was verified with doppler finding aft studying healthy volunteers and injured limbs. Its location was consistently found 4-6 cm proximal to tip of lat malleolus and on either side of TA.
On color doppler we found it to be a sizeable enough to be of significant in enhancing the bld supply of snc flp
To confirm these 10 limbs in 5 fresh cadavers were studied by dye injection.
This was carried out by injecting the major vessels of the limb with 4-7 ml of dye after identifying each vesseln cannulating it individually
In some cases the popliteal artery was cannulated an all three vessels injected the same color.
This is the appearance of the dissected limb
As is seen here the communicating br bet PTA n peroneal vessels giving of a perforator. This perforator entered the base of flp at approx 4-6 cms frm the tip of lat malleolus along the lat border of TA
The plane of the vessel is anterior to the TA.
This is a diagramatic representation of what we saw earlier. The perforator found entering the base of flap is arising frm this communicating br.
Next we will c how we utilised these findings and achieved these desired results
We had an occasion 2 use Snc variant in 10 of the cases . Out of which only one case was female pt
Keeping these points in mind it is possible to raise SNC variant reliably n regularly
This is an animated sequence showing the flap as it covers the defect on the heel. This has been done as a single stage by raising a dermal flap over the skin bridge bet the base of the flap and the defect. Flap margins r attached to the raised dermal flap.
Explain the difficulties of covering this area with ipsilateral flaps as the patient acceptance of cross leg and other distant flaps is not good. On the other hand ,free flaps are the best alternative but centers doing free tissue transfer are limited, not to mention the costs involved.
In all the cases the flap sizes far exceeded the dimensions mentioned for snc flap. It is a good substitute for free flap.Inclusion of an extra sizeable perforator reduces complication rate.
Larger flap can be designed with safety
Concept has been confirmed by cadaveric dissection and doppler study
Perfusion thro’ dual axis
Mention flap size & dimensions – mehaboob khan