The document discusses the epidemiology, clinical presentation, prevention, and management of diabetic foot problems. Some key points:
- Diabetic foot problems are a major cause of hospitalization and lower limb amputations in Trinidad and Tobago, disproportionately affecting those of East Indian descent.
- Risk factors include age, diabetes duration over 10 years, gender, poor glycemic control, obesity, smoking, and previous foot ulcers or trauma.
- Presentation involves neuropathy, peripheral vascular disease, foot deformities, calluses, and skin changes which can lead to foot ulcers and infections.
- Prevention requires patient education on foot care, monitoring for problems, and treatment of risk factors. Management involves a
Presentation of information for a comprehensive diabetic foot examination that is used in conjunction with the exam. Healthcare guide to diabetes and your feet can be obtained at www.drpelto.com
Presentation of information for a comprehensive diabetic foot examination that is used in conjunction with the exam. Healthcare guide to diabetes and your feet can be obtained at www.drpelto.com
The Diabetic Foot: What You Need to KnowOmar Haqqani
Authored by Dr. Jeffrey Stone, DPM. Presented at the First Annual Omar P. Haqqani MD Vascular Symposium, November 10, 2106, Midland Country Club, Midland, MI.
The Diabetic Foot: What You Need to KnowOmar Haqqani
Authored by Dr. Jeffrey Stone, DPM. Presented at the First Annual Omar P. Haqqani MD Vascular Symposium, November 10, 2106, Midland Country Club, Midland, MI.
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Vascular ulcers presented to the department of surgery, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria as resident postgraduate presentation
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Diabetic foot refers to a range of complications that can occur in individuals with diabetes, particularly those who have poor blood sugar control over an extended period of time. It is a serious condition that can lead to various foot problems, such as ulcers, infections, and even amputations if not properly managed.
The underlying cause of diabetic foot is neuropathy, which is nerve damage that occurs due to high blood sugar levels. Neuropathy can lead to loss of sensation in the feet, making it difficult for individuals to detect injuries or areas of pressure. Additionally, diabetes can impair blood circulation, which reduces the body's ability to heal wounds effectively.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
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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.
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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- 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
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3. Definition
WHO
• The foot of a Diabetic Patient that has the
potential risk of pathologic consequences
including infection, ulceration and/or
destruction of deep tissues associated with
neurologic abnormalities, various degrees
of peripheral vascular disease and/or
metabolic complications of diabetes in the
lower limb.
4. Definition
Any foot pathology that results from Diabetes
or its long-term complications
(Boulton. 2002). Diabetes, 30 : 36, 2002
5. Epidemiology
• WHO estimates approx 60,000 persons in
T&T were diabetic in 2000
• Projected increase to 125,000 by 2030
• MOH estimates 1 in 5 adults are diabetic;
as much as 175,000
• 450 children with Type 1 DM
• More prevalent in the East Indian
community, but 33% of African attendees
of the public health services are both
Diabetic and Hypertensive
• Cause for about 25% Hospital Admissions
6. Epidemiology
• More than 450 non traumatic lower limb
amputations in 2010
• DM foot problems account for 14% of
admissions, 29% of bed occupancy
• 50% of persons who had lower limb
amputations develop depression; 20% die
within 2 years
• V Naraynsingh et al - 822 clinic patients
who had amputations between 2000-2004
reviewed; 515 (80%) due to DM
7. Risk Factors
• Age
• Duration of DM
>10yrs
• Gender M>W
• Poor glycemic
control
• Social situation and
support
• Obesity
• Alcohol
• Smoking
• Depression or
Mental illness
• Previous Ulcer
• Trauma
• Retinopathy
• Nephropathy
• Willful self neglect
8. Pathology
Neuropathy
• Sensory: lack of sensation Repetitive
Trauma
• Motor: Changes in Foot anatomy
Pressure Points
• Autonomic: Lack of sweat Dry Skin
Distended veins AV Shunting
Osteoarthropathy: Changes in foot structure
Charcot’s foot
9. Pathology
Callus: separates dermis Ulcer Formation
Infection: Disruption of skin barrier, warmth
and moisture
Peripheral Vascular Disease: reduced blood
flow decreased O2 supply increased
risk of infection and poor healing
12. History
General Hx
• Medical Hx
• Surgical Hx
• Drug Hx
• Allergies
Foot History
• PC for Foot
• Neuropathic vs
Ischaemic Pain
• Daily activities &
use
• Foot Care
• Callus Formation
• Deformities
• Prev Surgeries
• Skin & Nail
13.
14. Ulcer History
• Site, size, shape, duration, odor, type
• Precipitating event or Trauma
• Recurrence
• Infection
• Hospitalization & Treatment
• Wound Care
• Patient Compliance
• Previous Foot Trauma or Surgery
• ? Charcot’s Foot
34. Radiological
• Plain Films
• Osteomyelitis
• Fractures
• Dislocations
• Charcot foot
• Foreign Body
• Gas
• CT
• Technetium bone scan – early detection
• MRI – Soft tissue
35.
36. Vascular
• Doppler; pulses, Ankle Brachial Pressure
Index
• <1 ischaemia
• Patients with arterial calcification
elevated systolic pressure, hence the
pressure index may be >1 in spite of
ischaemia
• Investigate Popliteal and Femoral Arteries
42. Edmonds Classification
• Stage 1 – The foot is not at risk
Sensation and pulses good
No deformities, calluses or swelling
• Stage 2 – One or more risk factors for
ulceration
Neuropathy and Ischaemia are the
main risk factors
Deformity, oedema and callus may not
lead to ulceration unless one or both of the
main risk factors are present
43. Edmonds Classification
• Stage 3 – Skin breakdown occurs usually
as an ulcer, but injuries such as grazes,
bruises and blisters can eventually
become ulcers
• Stage 4 – Infection can complicate both
the neuropathic and ischaemic foot
• Stage 5 – Necrosis can further lead to
tissue destruction
• Stage 6 – The foot cannot be saved
45. Management
• Regular inspection and examination
• Multidisciplinary team
• Patient education
• Assess risk of foot
• Non ulcer pathology
• Ulcers and related pathology
46. Patient Education
• Optimum Glycemic control
• Management of co-morbid conditions
• Stop Smoking
• Warning signs
47. Foot Care
• Daily Routine and Inspection
• Between toes and below foot
• Nail Care: trim wet, straight across, proper
clippers (NO KNIVES)
• Skin Care: Moisture, Callus
• Footwear: Proper fit, clean
• Avoid excessive heat (Radiators, Hot
water, hot pitch)
• Avoid OTC Corn/Callus medications
• NEVER WALK BAREFOOT
50. Ulcer Pathology
• Treat the Cause(s) and co-morbid factors
• Psychosocial Factors
• Relief of mechanical pressure and protect
ulcer from stress
• Local Wound Care
• Treatment of Infection: Abx (Broad
Spectrum, multiple), Drainage,
Debridement
• Moisture control: Dressings
• Outpatient or Inpatient Care
53. Ulcer Pathology
• Low Threshold for Referral
• Stage 3 and above associated with poor
control
54.
55. Conclusion
• Diabetic foot is a serious complication
• Associated with poor control
• Prevention requires vigilance and patient
education
• Treated by a multidisciplinary team
57. References
1. Edmonds ME, Foster AVM, Sanders LJ.
A Practical Manual of Diabetic Foot Care
2nd Ed. Blackwell Publishing 2008
2. Radwan M. The Diabetic Foot: An
Overview [Internet] cited 1st June 2012
Available from:
www.mansdf.edu.eg/Videos_presentation
s/DF-overview.pdf
3. National Institute of Health. Feet can last
a Lifetime NIH and CDC. 2010