The document discusses treatment modalities for non-union of femoral neck fractures. It describes causes of non-union and investigatory imaging. For the elderly, replacement arthroplasty is recommended, while for young adults a classification system is used to determine treatment. Type I involves bone grafting and fixation, Type II an osteotomy to change shear to compressive forces, and Type III drilling and fixation. Rehabilitation includes restricted weight bearing and physiotherapy. Osteotomies can correct alignment and reduce shearing forces at the non-union site.
This video explains Lumbar Disc Replacement in Detail. When degenerative disc disease begins to affect the spine this is called degenerative disc disease. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Lumbar Disc Replacement feel free to look us up online www.beverlyspine.com or www.santamonicaspine.com OR call toll free 1-8SPINECAL-1
This video explains Lumbar Disc Replacement in Detail. When degenerative disc disease begins to affect the spine this is called degenerative disc disease. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Lumbar Disc Replacement feel free to look us up online www.beverlyspine.com or www.santamonicaspine.com OR call toll free 1-8SPINECAL-1
Non-union fracture neck femur in a young patientApollo Hospitals
Fracture neck of femur in young is rare and usually occur
due to severe injuries like road traffic accident (RTA), fall from height etc. If the displaced fractures are not treated early, then it is often associated with complications. Non-union is one of the commonest complications. Treatment of non-union of these fractures in young is quite challenging.
Bone Trek: The Next Generations of Drugs for Osteoporosis, Osteoarthritis and...CalgaryCentre
Dr. Michael Doschak, Faculty of Pharmacy and Pharmaceutical Science, University of Alberta, presented January 22, 2013 at the University of Alberta Calgary Centre.
Young adult with primary fixation cutting through was treated after six months of initial injury.
Head viability was confirmed by MRI and to have bio mechanical advantage, abduction or valgus osteotmy was carried out resulting in good functional result at the end of 10 months when last seen
The denture-wearing history should provide information on the age of existing dentures, the frequency of denture replacement, the patient's experiences and expectations. It is important to identify whether any previous dentures have been successful as it may be suitable to copy features from a previously successful set. It will be important to manage expectations for those patients with a history of denture intolerance, yet technically satisfactory prostheses.
Clinical examination
Clinical examination should fully evaluate both the patient's anatomy and previous dentures to anticipate challenges and the potential to improve upon retention, stability, support, appearance and/or other factors. This should be undertaken in a systematic manner and would typically involve assessment of anatomy followed by an assessment of any existing dentures. This should follow a diagnostic process to determine if the patient presents with:
Technically adequate dentures on a favourable tissue base
Technically adequate dentures on an unfavourable tissue base
Technically inadequate dentures on a favourable tissue base
Technically inadequate dentures on an unfavourable tissue base.
Disraction Osteogenesi
Distraction osteogenesis (DO) is a tissue engineering method and can be integrated with various craniomaxillofacial surgical techniques to generate new bone via stretching the surgically osteotomized bone with the aid of a mechanical device that is designed to control both the traction rate and the movement vector.
This technique utilizes the fundamental healing properties of the human body by inducing regeneration and remodeling of callus between osteotomized site, also known as distraction gap.
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
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
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
- 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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
Treatment modality of non union fracture neck of femur
1. Treatment Modality
of Non-Union in
Fracture of Neck of
Femur
Dr.Avik Sarkar
KB Bhabha Municipal General Hospital,
Bandra (West), Mumbai
2. Causes of Non-Union in Fracture
Neck of Femur
• FAILURE TO REDUCE OR MAINTAIN REDUCTION
• ABSENCE OF CAMBIUM LAYER OF PERIOSTEUM
(CAMBIUM LAYER PRODUCES CALLUS)
• CUTTING OFF OF BLOOD SUPPLY OF HEAD
• DEVELOPMENT OF SHEERING FORCE AT
FRACTURE SITE AFTER FRACTURE, CAUSING
VERTICAL INCLINATION
• TAMPONADE EFFECT AT FRACTURE SITE DUE TO
INTRACASPULAR NATURE OF FRACTURE
• SECRETION OF INHIBITORY SUBSTANCES AT
FRACTURE SITE
4. Femoral neck non-union occurs in 20–30%
of displaced femoral neck fractures.
Femoral neck fractures should unite by 6
months. If there is no evidence of healing,
or the patient continued to have pain at 3 to
6 months after surgery, then a delayed
union (3 months) or non-union (6 months)
should be suspected.
6. IN THE ELDERLY
Replacement Arthroplasty is the treatment of
choice for elderly patients in fracture of neck
femur non-unions
Total Hip Replacement is the treatment of choice
in a cooperative, independent individual with a
normal life span.
Hemiarthroplasty may be done in a patient with
much less demand and leading a sedentary
lifestyle.
7. IN YOUNG ADULTS (BELOW 40 YEARS)
The type of femoral neck non-union determines
the treatment needed.
Hence a classification of femoral neck non-unions
was established to elucidate treatment protocols
8. Leighton's Classification of
Femoral Neck Non-union [1]
TYPE I - INADEQUATE FIXATION OR NON-ANATOMIC
REDUCTION
TYPE II - LOSS OF FIXATION WITH FRACTURE
DISPLACEMENT
TYPE III - FIBROUS NON-UNION WITH NO
DISPLACEMENT AND INTACT FIXATION
[1]
CLASSIFICATION AND TREATMENT OF FEMORAL NECK NONUNIONS IN YOUNG PATIENTS. Leighton R.
J Bone Joint Surg Br 2008 vol. 90-Bno. SUPP I 124
9. Type I (Inadequate fixation or non-anatomic reduction)
The surgical plan
(a) removal of fixation
(b) realignment of the femoral head on the neck
A Meyer's bone graft is used
with a vascular Quadratus
Femoris muscle pedicle.
This muscle pedicle may be
added to support the posterior
comminution and provide a
vascularized graft to ensure
union.
Fixation is performed with
multiple screws or a
combination of sling hip screw
with a superior de-rotation
screw. Meyer’s Technique
10. a. Fracture neck femur non-union – AP view
b. 2 year follow-up – AP view
c. 2 year follow-up – Lateral view
11. TYPE II (Loss of fixation with fracture displacement)
The Surgical Plan
(a) removal of initial fixation
(b) deformity correction by osteotomy with
an osteotomy plate using a compression device
GOAL
To change a shear force on the neck fracture into a
compression force.
12. PREPLANNING
Identification and documentation of the vascular
status of the femoral head
A preoperative drawing to determine the change
that will occur in leg lengths
A preoperative drawing to determine the position
of the femoral head after the osteotomy (this drawing
should be present in the OR while the surgery is performed)
13. TYPE III (Fibrous non-union with no displacement and intact fixation)
The Surgical Plan
(a) drill out the non-union
(b) fix the fracture with a fixed angled device
(sliding hip screw or blade plate).
(c) add bone graft (optional)
The primary aim of this procedure is to drill out or open the
endosteal canal to allow revascularization and endosteal
healing in a previous fibrous non-union.
There is thick fibrous union between the two ends of the
femoral neck and will prevent osseous union if canal is not
freshened.
14. By placing numerous drill holes (4.5 to 8.0 mm in
diameter) from the lateral cortex into the head,
through the femoral neck, the canal is
revascularized. These are inserted over guide pins,
using cannulated drills.
A Meyer's vascularized graft should be added, to
stimulate bone union of the femoral neck,
posteriorly.
Application of a four-hole osteotomy plate, placed
under compression. Subtrochanteric osteotomy was
done and subsequently a secondary Meyer's graft
was performed later to achieve fracture union.
15. REHABILITATION
The patient is generally mobilized at 25% weight-
bearing over the first 6 weeks.
Once adequate healing is evident, full weight-
bearing can be allowed, initially with crutches for
2 weeks, a single crutch for 2 weeks, and then
weight-bearing with a cane.
PHYSIOTHERAPY
Abductor strengthening should be initiated at week 6 to
prevent development of Trendelenburg gait
16. OSTEOTOMY
An Osteotomy is a surgical corrective procedure
used to obtain a correct biomechanical alignment
of the extremity, so as to achieve equivocal load
transmission, performed with or without removal of a
portion of the bone.
PRINCIPLE
o Increases the contact area
o Restores Biomechanical advantage
o Moves normal articular cartilage into weight bearing zone
o Improves coverage of head
17. PROXIMAL FEMORAL OSTEOTOMY
PROXIMAL FEMORAL OSTEOTOMIES can be classified
according to
(A) Anatomic Location
High Cervical
Intertrochanteric
Subtrochanteric
Greater Trochanteric
(B) Displacement of Distal Fragment
Transpositional Osteotomy
Angulation Osteotomy
Sagittal Plane
Coronal Plane
Adduction Osteotomy (Varus)
Abduction Osteotomy (Valgus)
18. PRINCIPLES OF OSTEOTOMY IN
NONUNION FRACTURE NECK FEMUR
Line of weight bearing is shifted medially.
Shearing force at the non-union is decreased,
because the fracture surface has become more
horizontal
19. Types of Osteotomies
McMurray’s Displacement Osteotomy
Schanz Angulation Osteotomy
Dickson’s High Geometric Osteotomy
Pauwel’s Y Osteotomy
20. PAUWEL’S VALGUS OSTEOTOMY
Valgus Intertrochanteric Femoral Osteotomies
transfer the centre of hip rotation medially from the
superior aspect of the acetabulum to decrease the
weight bearing area of femoral head.
Normally 15o
of correction is required
INDICATIONS
Trendelenburg Limb
Adduction Deformity
Motion in adduction beyond adduction deformity
Painful abduction
CONTRAINDICATIONS
Flexion of less than 60 o
Knock Knees (It will increase the deformity)