🔵Abdominal incisions

@etamed

🟢Ddimer test

@etamed

🟠CVA protocol

@etamed

🔻 آیا خواب زیاد می تواند خطر ابتلا به سرطان را افزایش دهد؟

▫️طبق مطالعه اخیر در ژاپن، زمان خواب ممکن است یک عامل خطر قابل تغییر برای سرطان باشد.

▫️یافته‌ها نشان می‌دهد که ۱۰ ساعت خواب بیشتر ممکن است خطر ابتلا به سرطان را در زنان افزایش دهد و خطر مرگ بر اثر سرطان را هم در مردان و هم زنان افزایش دهد.

▫️بر اساس یافته‌های جدید، مدت زمان خواب 6 تا 8 ساعت برای مردان و 6 تا 9 ساعت برای زنان "ممکن است ایمن‌ترین" در رابطه با بروز سرطان و خطر مرگ و میر در میان بزرگسالان ژاپنی باشد.

https://onlinelibrary.wiley.com/doi/10.1002/ijc.34133


@etamed

رفلکس گالانت نوزادی😂

با انگشت سبابه, كناره تنه را در ناحيه كمري تحريك مي كنيم. تنه كودك به سمت طرف تحريك خم مي شود. اين رفلكس در حدود 2 تا 3 ماهگي از بين مي رود.

@etamed

🔵Approach to splenomegaly

@etamed

🔵splenomegaly

🔹sign and symptoms:

Signs of cirrhosis - Eg, asterixis, jaundice, telangiectasias, gynecomastia, caput medusa, and ascites

Heart murmur - Endocarditis or congestive failure

Jaundice

Scleral icterus - Spherocytosis or cirrhosis

Petechiae - Any other bleeding manifestation secondary to thrombocytopenia

🔹Laboratory Studies:

Complete blood cell count (CBC) with differential

Liver function testing

Hepatitis B and C testing

Lactate dehydrogenase (LDH)

Erythrocyte sediumentation rate (ESR)

Evaluation of peripheral blood smear for RBC morphology and signs of myeloproliferative disorders or underlying bone marrow disorders

Prothrombin time with international normalized ratio (INR) and activated partial thromboplastin time (aPTT)

@etamed

🔻پروبیوتیکها در درمان افسردگی موثر هستند.


https://www.nature.com/articles/s41398-022-01977-z


@etamed

🔵C1 (atlas) fracture

🔹Classification:

Type I - Fracture of the anterior arch

Type II - Fracture of the posterior arch

Type IIIa/IIIb - Combined fracture of both the anterior and the posterior arch (Jefferson fracture), either nondisplaced (IIIa) or displaced (IIIb) 

Type IV - Fracture of the massa lateralis

Type V - Fracture of the transverse process

🔹history and symptoms:

history of trauma

pain in the neck

neurologic defects

complete spinal cord injury

🔹Imaging study:

for awake, asymptomatic patients who are without neck pain or tenderness, who have a normal neurologic examination, who do not have an injury hindering accurate evaluation, and who are able to complete a functional range-of-motion examination; radiographic evaluation of the cervical spine is not recommended


For symptomatic or obtunded or unevaluable patients, high-quality computed tomography (CT) of the cervical spine is recommended, if available; routine three-view cervical spine radiography is not recommended

@etamed

🔵Treatment:

Specific treatment should be based on analysis of the mechanism and extent of the injury. In a younger patient with limited displacement of the C1, immobilization with a collar or halo and vest may be adequate.

In more severe cases, particularly with associated injuries such as odontoid fracture, bypassing the C1 ring with an occipital-to-cervical fusion extending to C2 or lower may be necessary.

@etamed

🟣c2 (axis) fracture classification

@etamed

🔹clinical examination:

Observe and palpate for deformities and step-offs

Test muscle strength and tone of upper and lower extremities

Perform sensory testing on upper and lower extremities

Perform rectal examination

Test trapezius muscles by asking patient to shrug shoulders

Observe for torticollis

🔹workup:

1.Plain radiography:(AP), lateral, and odontoid views
Plain films tend to be better than CT for detecting subluxations and dislocations
Plain radiography also is better for detecting vertebral body and spinous process fractures

2.CT scan
CT usually is better for detecting most fractures and for characterizing the extent of the pathology

3.MRI

🔹classification:


Type I fractures (29%) are bilateral pedicle fractures with less than 3 mm of anterior C2 body displacement and no angulation.The mechanism of this injury is hyperextension

Type II fractures (56%) demonstrate significant displacement and angulation.The mechanism of this injury is twofold: hyperextension with concomitant axial loading, followed by flexion

Type IIA fractures (6%) demonstrate no anterior displacement, but there is severe angulation.The mechanism for this injury is flexion

Type III fractures (9%) demonstrate severe displacement and severe angulation.The mechanism of this injury is flexion

🔹Treatment:

Treatment for type I C2 (axis) fractures is hard-collar immobilization for 6-8 weeks

Type II fractures can be managed conservatively or surgically. Treatment options include the following:
Halo immobilization

Internal fixation (odontoid screw fixation)

Posterior atlantoaxial arthrodesis

Type III fractures are treated with halo immobilization, odontoid screw fixation, or C1-C2 arthrodesis

@etamed

🔸history and ph.E:

Pain

swelling

deformity

The shoulder may appear shortened

neurovascular status:brachial plexus injury

subclavian venous injury:decreased pulses/Venous stasis, discoloration, and swelling

🔸mechanism:

direct:falls onto the lateral shoulder

indirect:fall onto an outstretched hand

🔸workup:

Radiography of the clavicle and shoulder

Computed tomography (CT) scanning with 3-dimensional (3-D) reconstruction

Arteriography

Ultrasonography

🔸Treatment:

nonoperative:
Reduction and immobilization - Typically with figure-of-eight brace

operative:

Complete fracture

Severe displacement causing tenting of the skin with the risk of puncture

Fractures with 2 cm of shortening

Comminuted fractures with a displaced transverse "zed" (or z-shaped) fragment

Neurovascular compromise

Displaced medial clavicular fractures with mediastinal structures at risk

Polytrauma

Open fractures

An inability to tolerate closed treatment

Fractures with interposed muscle

Established symptomatic nonunion

Concomitant glenoid neck fracture (floating shoulder)

@etamed

🟠fluids of choice

@etamed

مغز انسان برای موفقیت طراحی نشده 👌

@etamed

toxic megacolon

@etamed

قبل و بعد امتحان😂

@etamed