This document discusses wound healing and suture materials. It covers the classification and normal sequence of wound healing, factors that affect healing, potential complications, and different types of suture materials and needles. Wound healing involves hemostasis, inflammation, proliferation, and maturation phases. Factors like infection, blood supply, wound tension, and patient health can influence healing. Complications include infection, dehiscence, scarring, and contractures. A variety of suture materials exist with different properties, and the appropriate material depends on factors like strength needed and tissue reactivity. Needle shape also matters based on the tissue being sutured.
Wound healing refers to a living organism's replacement of destroyed or damaged tissue by newly produced tissue. In undamaged skin, the epidermis and dermis form a protective barrier against the external environment
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
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
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
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
- 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
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.
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.
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
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
Wound healing and suture material
1. WOUND HEALING AND
SUTURE MATERIAL
1. Classification of wound healing
2. Normal sequence of wound healing
3. Factors affecting healing
4. Complication of wound healing
5. Suture material
2. Classification of wound healing
Primary intention
• Clean, close edges. Edges can be
bridged directly.
• Small scar tissues involved.
• United in 2 weeks. Dense scar
tissue formed 1 month
Secondary intention
• Edges separated; cannot be
bridged directly.
• Larger amount of scar tissue
involved.
• Heal slow, from bottom towards
surface by granulation.
• Complication: shrinkage
contracture.
3. Normal sequence of wound healing
HEMOSTASIS
• Epinephrine is released to
minimize bleeding into soft tisses
• When: initial injury to 3 hours post
injury
• cells involved: platelet cells (clot
formation + releasing cytokines)
INFLAMMATORY
• Leukocytes + macrophages destroy
bacteria, cleaning wound of
cellular debris
• When: immediately following
hemostasis phase (0-3 days post
injury)
• Cells: host of cells infiltrate wound
site, such as leukocytes and
macrophages. Leukocytes destroy
bacteria.
• Macrophages (1) cleanse the
wound of cellular debris (2)
replace leukocytes (3) produce
cytokines and other growth
factors (chemoattractant to other
PROLIFERATION
• Angiogenesis + granulation tissue
formation
• When: 3 – 21 days post injury
• Cells: macrophages; fibroblasts;
immature collagen; blood vessels;
ground substance make up
granulation tissue, which fills the
wound’s cavity.
• 3 stages:
• Granulation: fibroblast stimulate
collagen production tensile
strength + structure
• Contraction
• Epithilialization
MATURATION
• Collagen fibers in the scars are
reorganized to improve tensile
strength
• When: 21 days post injury and up
to 1.5 years later
• Cells: fibroblasts secret
procollagen (under affect of GF –
platelet + macrophages) then
mature into collagen fibril, which
then connect to one another to
create collagen fibers. MMPs
5. Factors affecting healing: Local
Wound
sepsis
Hair removal: performed at necessary area, just prior to surgery
Antiseptic wash skin with Chlorhexidine and povidone-iodine; double scrub needed area
Hand wash with antiseptic
Poor blood
supply
Areas with good blood supply heal wellwhereas those with poor blood supply (pretibial skin) heal poorly.
Surgical technique also have a significant effect on the blood supply to the area.
Wound
tension
Foreign
bodies
Traumatic wound: Extraneous material infection; excess scar formation
Surgical wounds: endogenous material (devascularised pieces of fat, necrotic tissue resulting from excess use of
the diathermy, or the patient's hair) Thorough wound cleaning before closure
6. Factors affecting healing: Local
Previous
radiation
Cause patchy vasculitis impair blood supply reduce healing potential.
Damages skin stem cells poor reepithelialisation
Poor technique The incision should be made vertically through the skin.
Gentle handling of tissues. Rough handling, damaging of tissues tissue edge necrosis, predisposing to poor
healing and infection
Careful haemostasis: (1) good visualization during surgery; (2) reduces tissue bruising and
haematoma formation.
Skin closure: (1) should include the strength-supplying dermis within the bite; (2) Sutures removal at the correct
time (variable between sites) helps prevent scarring.
Foreign
bodies
Traumatic wound: Extraneous material infection; excess scar formation
Surgical wounds: endogenous material (devascularised pieces of fat, necrotic tissue resulting from excess use of
the diathermy, or the patient's hair) Thorough wound cleaning before closure
7. Factors affecting healing: systemic
Nutritional deficiencies
• Vitamin A: epithialisation + collagen production
• Vitamin C: production and modification of collagen
• Zinc: (1) acts as an enzyme cofactor (2) has a role in cell proliferation (accelerates wound healing). Deficiency may be
encountered in patients on long-term total parenteral nutrition.
• Protein: (1)main building block in wound healing; (2) essential for collagen production
Systemic diseases
• diabetes, uraemia and jaundice
Therapeutic agents
• Immunosuppressive drugs: chemotherapeutic agents for malignancy and immunosuppressive and antiprostaglandin
drugs used for inflammatory conditions. (e.g. corticosteroid therapy: increase the fragility of small blood vessels)
Age: wound healing increase prior to puberty, decrease postpuberty
8. complications
Infection
Dehiscence Cause by
Conditions impair wound healing
Suture breakage, knott slipping, cutting out of sutures,
excess tension on sutureline
Incision hernia
Dehiscence of the deeper layers of a wound in which the skin layer
remains intact will result in incisional hernia
Hypertrophic scarring
scarring is essentially excess collagen
scarmtissue formation - almost an
overhealing of a wound
Characteristics
Non progressive after 6 months
Does not extend beyond the edges of the wound
Occurs most frequently around joints, where langers’ lines of tension are
crossed by the incision
Cause Overlapping skin edges
Treatment:
Difficult: injection of corticosteroids directly into the scars several times
Avoid surgery at least 6 months
Keloid scarring
due to abnormal
collagen metabolism.
Characteristic:
scar tissue extends out beyond the wound edges
might continue to enlarge after 6 months.
Prevalence
higher in patients with dark skin, in younger patients
and in those with burn wounds.
the face, dorsal surfaces of the body, sternum and
deltopectoral region.
Treatment:
Excision: excision followed by compression bandaging
can have slightly better results
Corticoids injections have some improvement.
Contractures
Charateristics: Occurs in any wound but more commonly
associated with wounds that experience delayed
healing, burns, cut across the Langers’ lines
Treatment: Surgical treatment; (skin grafting,
local flaps or wound Z-plasty)
11. 1. Different materials has different handling properties. Prolene has memory difficult to knot
2. Absorbable/ Non-absorbable: absorbable for deep layers; non absorbable for vascular anastomoses.
For absorbable sutures, time to dissolve aka lose strength should be considered.
3. Strength: braided sutures > monofilament
4. Tissue reactivity: the higher, the more likely to cause inflammation and produce scarring.
12. Needles
Round bodied needles:
• Used for suturing delicate
structures (bowel anastomosis)
• Designed to push tissues to
either side rather than cutting
through them
Blunt needlts:
• Used for closing the muscle of
an abdominal wound or
suturing liver
Cutting/ reverse cutting:
• Used for closing the tough
tissues (skin, fascia)
• Skin clips as replacement
13. Quality of a good incision
• Good access to structures being explored
• Can be extended to give greater access if needed
• Easy to perform
• Avoid tissue, skin damage (avoid excess use of diathermy, esp. at skin
edges; meticulous haemostasis, avoid haematoma formation)
• Consider cosmetic results
• Wound closure:
• Higher tissue tension on deeper layer of wound strong suture (avoid excess
tension to prevent wound edges necrosis and wound dehiscence)
• Skin tension (+) interrupted sutures or clips
• Skin tension (-) subticular suturing with braided absorbable sutures (Vicryl) or
non-absorbable monofilament (Prolene)