This document discusses wound healing and its stages. It begins by defining wounds and ulcers, and classifying wounds. The main stages of wound healing discussed are inflammation, proliferation, and remodeling. Inflammation begins immediately after injury and involves vasodilation, increased permeability, and immune cell infiltration. Proliferation involves cell migration, angiogenesis, and re-epithelialization. Remodeling occurs over months as collagen is reorganized and strengthened. Disturbances like infection, radiation, and malnutrition can impair healing. Hypertrophic scarring and keloids represent excessive healing with increased collagen deposition.
Subject: Medical Surgical Nursing / Adult Health Nursing
Title: Shock
Prepared by: Misfa Khatun, Nursing tutor
Content:
- Introduction
- Definition of Shock
- Classify Shock
- Stages of Shock
- Enumerate the Causes of shock
- Pathophysiology of Shock
- Identify the Signs and symptoms of Shock
- First ais management of Shock
- Treatment of Shock
- Management of Shock
- Nursing management of Shock
Subject: Medical Surgical Nursing / Adult Health Nursing
Title: Shock
Prepared by: Misfa Khatun, Nursing tutor
Content:
- Introduction
- Definition of Shock
- Classify Shock
- Stages of Shock
- Enumerate the Causes of shock
- Pathophysiology of Shock
- Identify the Signs and symptoms of Shock
- First ais management of Shock
- Treatment of Shock
- Management of Shock
- Nursing management of Shock
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entist in pune. (BDS. MDS) - Dr. Amit T. Suryawanshi. Seminar- Wound healing in dentistry.
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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
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- 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
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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. Wound
Break in
continuity of skin
or covering
epithelium is
called wound.
Usually When
wound become
chronic then
called ulcer
3. Introduction
Over the ages, many agents have been
placed on wounds to improve healing.
To date nothing has been identified that can
accelerate healing in a normal individual.
Many hinder the healing process.
A surgeon’s goal in wound management is
to create an environment where the healing
process can proceed optimally
9. Clinical examination of chronic
wound
Inspection
Location
Arterial ulcer ( distal part i.e. tip of toe, dorsum of foot)
Venous ulcer (medial side just proximal to medial malleolus
Floor of ulcer
Red with granulation tissue
Necrotic tissue, slough
Pale, scanty granulation
Wash leather slough
Black tissue
11. Edges
This is the junction between normal
epithelial and ulcer bed.
Sloping edges (healing)
Punched out edges ( trophic, bed sore)
Undermined ( tubercular)
Raised ( basal cell Ca)
Everted or rolled out (marzillin’s ulcer in squamous
cell Ca)
17. Wounding
Blood vessels are disrupted,
resulting in bleeding.
Hemostasis is the first goal
achieved in the healing
process.
Cellular damage occurs, this
initiates an inflammatory
response.
The inflammatory response
triggers events that have
implications for the entire
healing process.
Step one then is hemostasis,
resulting in Fibrin.
21. Signs of Inflammation
Immediately after injury, intense
vasoconstriction leads to
blanching, a process mediated by
epinephrine, NE, and
prostaglandins released by injured
cells.
Vasoconstriction reversed after
10min, by vasodilatation.
Now redness and warmth.
Vasodilatation mediated by
histamine, linins, prostaglandins.
22. Inflammation
As microvenules dilate, gaps
form between the endothelial
cells,resulting in vascular
permeability. Plasma leaks out
into extravascular space.
Leukocytes now migrate into
the wound by diapedesis,
adhere to endothelial cells, to
wounded tissues.
Alteration in pH from
breakdown products of tissue
and bacteria, along with
swelling causes the pain.
23. Inflammation
Neutrophils, macrophages and lymphocytes come
into wound.
Neutrophils first on scene, engulf and clean up.
Macrophages then eat them or they die releasing
O2 radicals and destructive enzymes into wound.
Monocytes migrate into extravascular space and
turn into macrophages.
Macrophages very important in normal wound
healing.
24. Inflammation
Macrophages eat bacteria, dead tissue, secrete
matrix metalloproteinases that break down
damaged matrix.
Macrophages source of cytokines that stimulate
fibroblast proliferation, collagen production.
Lymphocytes produce factors like FGF, EGF,
IL-2.
At 48-72 hrs, macrophages outnumber neuts.
By days 5-7 few remain.
PDGF= platelet derived growth factor, FGF= fibroblast growth factor , EGE=Epidermal growth factor,
TGF=transforming growth factor
27. Proliferation
Fibroblasts are the major mesenchymal cells
involved in wound healing, although smooth
muscle cells are also involved.
Normally reside in dermis, damaged by
wounding.
Macrophage products are chemotactic for
fibroblasts. PDGF, EGF, TGF, IL-1, lymphocytes
are as well.
PDGF= platelet derived growth factor, FGF= fibroblast growth factor , EGE=Epidermal growth factor,
TGF=transforming growth factor, VEGF= Vascular endothelial growth factor
28. Proliferation
Angiogenesis reconstructs vasculature in areas
damaged by wounding, stimulated by high lactate
levels, acidic pH, decreased O2 tension in tissues.
Cytokines directly stimulate the endothelial cell
migration and proliferation required for
angiogenesis.
FGF-1 is most potent angiogenic stimulant
identified. Heparin important as cofactor, TGF-
alpha, beta, prostaglandins also stimulate.
29. Epithelialization
The process of epithelial renewal after injury.
Particularly important in partial thickness
injuries, but plays a role in all healing.
Partial thickness wounds have epidermis and
dermis damaged, with some dermis preserved.
Epithelial cells involved in healing come from
wound edges and sweat glands, sebaceous glands
in the more central portion of wound.
30. Epithelialization
In contrast in an incisional wound, cellular
migration occurs over a short distance.
Incisional wounds are re-epithelialized in
24-48h.
The sequence of events here are cellular
detachment, migration, proliferation,
differentiation.
31. Epithelialization
First 24h, basal cell layer thickens, then elongate,
detach from basement membrane and migrate to
wound as a monolayer across denuded area.
Generation of a provisional BM which includes
fibronectin, collagens type 1 and 5.
Basal cells at edge of wound divide 48-72 h after
injury.
Epithelial cells proliferation contributes new cells
to the monolayer. Contact inhibition when edges
come together.
33. Collagen
Synthesized by fibroblasts beginning 3-5 days
after injury.
Rate increases rapidly, and continues at a rapid
rate for 2-4 weeks in most wounds.
As more collagen is synthesized, it gradually
replaces fibrin as the primary matrix in the
wound.
After 4 weeks, synthesis declines, balancing
destruction by collagenase.
34.
35. Collagen
Age, tension, pressure and stress affect rate of
collagen synthesis.
TGF-b stimulates it, glucocorticoids inhibit it.
19 types identified. Type 1(80-90%) most
common, found in all tissue. The primary
collagen in a healed wound.
Type 3(10-20%) seen in early phases of wound
healing. Type V smooth muscle, Types 2,11
cartilage, Type 4 in BM.
36. Collagen
Three polypeptide chains, right handed
helix.
Most polypeptide chains used in collagen
assembly are alpha chains.
37.
38. Collagen
Every third AA residue is Glycine.
Another critical component is hydroxylation of
lysine and proline within the chains.
Hydroxyproline is necessary for this. Requires
Vit C, ferrous iron, and alpha ketoglutarate as co-
enzymes. Steroids suppress much of this,
resulting in underhydroxylated collagen, which is
incapable of making strong cross-links leading to
easy breakdown.
39. Wound Contraction
Begins approximately 4-5 days after
wounding.
Represents centripetal movement of the
wound edge towards the center of the
wound.
Maximal contraction occurs for 12-15
days, although it will continue longer if
wound remains open.
40. Wound Contraction
The wound edges move toward each other
at an average rate of 0.6 to .75 mm/day.
Wound contraction depends on laxity of
tissues, so a buttocks wound will contract
faster than a wound on the scalp or
pretibial area.
Wound shape also a factor, square is faster
than circular.
41. Wound Contraction
Contraction of a wound across a joint can
cause contracture.
Can be limited by skin grafts, full better
than split thickness.
The earlier the graft the less contraction.
Splints temporarily slow contraction.
43. Remodeling
After 21 days, net accumulation of collagen
becomes stable. Bursting strength is only
15% of normal at this point. Remodeling
dramatically increases this.
3-6 weeks after wounding greatest rate of
increase, so at 6 weeks you are at 80% to
90% of eventual strength and at 6mos 90%
of skin breaking strength.
44. Remodeling
The number of intra and intermolecular cross-
links between collagen fibers increases
dramatically.
A major contributor to the increase in wound
breaking strength.
Quantity of Type 3 collagen decreases replaced
by Type 1 collagen
Remodeling continues for 12 mos, so scar
revision should not be done prematurely.
46. Local Factors
Infection versus contamination
Infection is when number or virulence of
bacteria exceed the ability of local defenses
to control them.
100000 organisms per gram of tissue.
Foreign bodies, hematomas promote
infection, impaired circulation, radiation.
Systemic: AIDS, diabetes, uremia, cancer.
48. Local Factors
Radiation damages the DNA of cells in exposed
areas.
Fibroblasts that migrate into radiated tissues are
abnormal.
Collagen is synthesized to an abnormal degree in
irradiated tissue causing fibrosis.
Blood vessels become occluded.
Damage to hair and sweat glands
Vitamin A has been used to counteract this.
49. Systemic Factors
Malnutrition
Cancer
Old Age
Diabetes- impaired neutrophil chemotaxis,
phagocytosis.
Steroids and immunosuppression suppresses
macrophage migration, fibroblast proliferation,
collagen accumulation, and angiogenesis.
Reversed by Vitamin A 25,000u per day.
50. IMPROPER HEALING
Hypertrophic Scars and Keloids
Excessive healing results in a raised, thickened scar,
with both functional and cosmetic complications.
If it stays within margins of wound it is hypertrophic.
Keloids extend beyond the confines of the original
injury.
Dark skinned, ages of 2-40. Wound in the presternal
or deltoid area, wounds that cross langerhans lines.
51. Keloids and Hypertrophic Scars
Keloids more familial
Hypertrophic scars develop soon after
injury, keloids up to a year later.
Hypertrophic scars may subside in
time, keloids rarely do.
Hypertrophic scars more likely to cause
contracture over joint surface.
52. Keloids and Hypertrophic Scars
Both from an overall increase in the
quantity of collagen synthesized.
Recent evidence suggests that the
fibroblasts within keloids are different from
those within normal dermis in terms of
their responsiveness.
No modality of treatment is predictably
effective for these lesions.