Ultrasonography is a useful first-line screening tool for evaluating the neonatal spine and detecting spinal dysraphism and other pathologies. It can accurately identify abnormalities of the spinal cord, meninges, vertebrae and surrounding tissues without the need for sedation or radiation. The optimal time to perform spinal ultrasound is before 6 months of age when the posterior vertebral elements are still cartilaginous. The technique involves surveying and then detailed scanning of the cord, cauda equina, filum terminale, conus position and bony structures to identify any variations from normal anatomy.
In this presentation we will discuss role of high resolution in characterizing normal variant and pathologies of spinal pathologies.
This is a pictoral review.
In this presentation we will discuss role of high resolution in characterizing normal variant and pathologies of spinal pathologies.
This is a pictoral review.
Error of Dorsal Induction
Results in defect of closure of neural tube which leads to various anomalies like anencephaly, encephalocoele, spinal dysraphism and chiari malformations.
By dr Rabab Hashem, MRCPCH, pediatrician at El Nasr hospital Port said.
Cranial sonography is the most widely used neuroimaging procedure in premature infants. US helps in assessing the neurologic status of the child, since clinical examination and symptoms are often nonspecific. It gives information about immediate and long term prognosis.
Error of Dorsal Induction
Results in defect of closure of neural tube which leads to various anomalies like anencephaly, encephalocoele, spinal dysraphism and chiari malformations.
By dr Rabab Hashem, MRCPCH, pediatrician at El Nasr hospital Port said.
Cranial sonography is the most widely used neuroimaging procedure in premature infants. US helps in assessing the neurologic status of the child, since clinical examination and symptoms are often nonspecific. It gives information about immediate and long term prognosis.
Interpretation of Xrays of the spine.pptxVigny Tsamo
interpretation of the spine xrays, brief anatomy of the back, followed by approach in the interpretation of xray of the cervical spine, then thoracolumbar spine, with common pathologies and their radiological manifestations on xrays.
Surgical approach for tumors in the lateral and third ventricleSherif Watidy
Professor Sherif Elwatidy explains in this lecture the approach to the lateral and third ventricle with emphasis on the anatomy of the region and through the trajectory.
- 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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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.
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. Introduction
•Ultrasonography (US) is a well-established method of
investigating the spinal canal and cord as well as the
meningeal coverings in newborns and infants
•It is the first line screening test in neonates suspected
of spinal dysraphism, and also useful in detecting
tumours, vascular malformations and cases of trauma
3. • In experienced hands diagnostic accuracy equal to MRI
• performed portably, without the need for sedation or general anaesthesia
• MRI is highly dependent on factors affecting resolution, including patient
movement, physiological motion from cerebral spinal fluid (CSF) pulsation
and vascular flow, factors that do not affect SUS
Spinal U/S VS MRI
4. • Lumbosacral stigmata known to be associated with spinal
dysraphism
• Evaluation of suspected defects such as cord tethering,
diastematomyelia, hydromyelia, and syringomyelia
• Detection of sequelae of injury
• Visualization of fluid with characteristics of blood products within
the spinal canal in patients with intracranial hemorrhage;
• Guidance for lumbar puncture
• Postoperative assessment for cord retethering
When to request for spinal U/S
5. •Preoperative examination in patients with open spinal
dysraphism;
• Examination of the contents of a closed neural tube
defect if the skin overlying the defect is thin or no longer
intact.
Contraindications
6. •Best time is before the 6 month of age as neonate
owing to a lack of ossification of the predominantly
cartilaginous posterior arch of the spine
•However the quality of ultrasound assessment
decreases after the first 3–4 months of life as
posterior spinous elements ossify.
•In most children SUS is not possible beyond 6
months of age
When best time to perform?
8. • The spinal cord lies in the spinal canal within
anechoic CSF of the subarachnoid space.
• Surrounding the canal is the dura mater, which
is shown by anechogenic line dorsal and ventral
to the canal.
• Is lined with the arachnoid sheet, which exhibits
an echogenic line parallel to the cord’s surface
• It lies one third to one half of the way between
the dorsal and ventral walls of the spinal canal.
• Cervical spinal cord appears as an oval shape,
whereas the thoracic and lumbar portions are
more circular
Anatomy- the spinal cord
9. • The filum terminale images as an echogenic cordlike structure that is
surrounded by echogenic nerve roots of the cauda equin.
• The filum terminale is commonly more echogenic than the surrounding
cauda equina.
• The filum terminale normally measure less than or equal to 2 mm.
Anatomy- filum terminale
10. • The level of the conus usually ends
between T12 and L1 or L2 .
• it must be noted that a normal cord may
lie around L3, mainly in preterm infants.
• The normal position of the cord should be
central in the spinal canal. The spinal cord
is held in place by echogenic dentate
ligaments passing laterally from each side
of the cord.
• The normal spinal cord produces a
rhythmic movement
Anatomy- conus medullaris
11. • The normal nerve roots pulsate freely with cardiac and respiratory
motion.
• M-mode imaging can also be very helpful in documenting motion of
the cord and nerve roots.
12. • Sonographic examination of the neonatal
spine is performed with the infant in a
warm room lying in a prone, lateral
decubitus, or semi-erect position.
• Feeding the infant before examination
helps him or her to relax.
• Placing a towel under the infant’s pelvis will
flex the spine enough to separate the
midline posterior arches .
• The knees may be flexed to the abdomen to
allow adequate spacing of the spinous
processes and visualization of the spinal
canal contents.
Preparation
13. • Should be performed with real-time scanners using high frequency
linear array transducers, typically 7 to 10 MHz or higher in neonates.
• Extended field-of-view (EFOV) / panoramic views are very helpful in
providing an overview of the anatomy and termination of the cord and
thecal sac.
Equipment Specifications
14. SURVEY
• Firstly in transverse, sweep from the mid
thoracic region to the sacro-coccygeal
region.
• Then a sagittal sweep from one side to
the other.
Are the posterior neural arches, paired and uniform.
- Are there any obvious, gross pathologies.
Scanning Technique
15. DETAIL SCANNING:
•Is the cord and CSF space uniform in shape?
•Where is conus? (i.e. what spinous level)
•Identify Filum Terminale.
•Examine Cauda Equina
•Examine the bony anatomy
•Examine the Dimple
Scanning Technique
16. • Follow the cord along in transverse
assessing the shape and central position.
• -Any variation in position or shape of the
cord is suggestive of mass effect and
scrutiny for the cause is needed.
• Similarly the CSF space should be
uniform.
Scanning Technique Is the cord and CSF space uniform in shape?
17. There are two primary methods to
determine the level of conus.
• Identify the 12th rib, and thus
T12 and count down.
• identify the lumbo-sacral
junction and count up from L5.
• Normal conus position is: No
lower than the top of L3 in a
term infant or the bottom L3 in a
pre-term infant.
Scanning Technique Where is conus? (i.e. what spinous level)
Search for cause
18. • It should appear as thin closely
related parallel lines extending from
conus to the lowest reaches of the
thecal space (approximately S2).
• - Filum is approximately 2mm in
diameter.
Scanning Technique Identify Filum Terminale.
19. • The nerve roots comprising cauda
equina should lie in the dependent
portion of the thecal sac.
• - Should see gentle oscillating
movements with the baby's cardiac
pulsations and respiration.
• - Symmetry. Look for asymmetry
indicative of pathology (space
occupying mass or unilateral
abnormality)
Scanning Technique Examine Cauda Equina.
20. • Particular attention
should be paid to the
integrity the posterior
neural arches in the
transverse plane.
• - Check the vertebral
bodies for alignment,
shape and symmetry in
both transverse and
sagittal planes.
Scanning Technique Examine the bony anatomy
21. • If there is a dimple or skin
defect, this should be
carefully examined with a
high frequency probe to
look for a skin - thecal sac
fistula.
• - If CSF is leaking, an MRI
should be performed.
Scanning Technique Examine the Dimple
22. • Filar Cyst
• Cystic ventriculus
terminalis
• Pseudomass” due to
Positional Nerve Root
Clumping
• Pseudosinus Tract
• Dysmorphic Coccyx
Normal Variants
23. • Spinal dysraphism is defined as incomplete or
absent fusion of midline neural, mesenchymal,
and cutaneous structures and can be classified
into three categories:
• OVERT DYSRAPHISM
spina bifida aperta represents the most severe
form of a midline fusion defect with protrusion
of non–skin-covered neural tissue
• OCCULT DYSRAPHISM
cleft or tethered spinal cord covered by intact
skin
• Caudal spinal anomalies that correspond to an
association of malformations of the distal spine
and spinal cord and hindgut, renal, and
genitourinary anomalies
Spinal dysraphism
Editor's Notes
On a sagittal image, the spinal cord appears as a hypoechoic cylindrical structure with two echogenic complexes centrally.
Children in the low-risk group included those with simple skin dimples as the sole manifestation or newborns of diabetic mothers.
Children in the intermediate-risk group included those with complex skin stigmata and low and intermediate anorectal malformations.
Children in the high-risk group included those with high anorectal malformations, cloacal malformation, and cloacal exstrophy.