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Missile injuries are classified into: I- Low- velocity missile injuries Comprise missiles fired from hand guns (<400m/s) Injury is limited to the path of the bullet 140 mg malegra fxt mastercard erectile dysfunction karachi. All patients with missile injuries should receive broad spectrum antibiotics and tetanus prophylaxis order malegra fxt from india erectile dysfunction topical treatment. It is mostly seen in developing countries where there is overcrowding buy malegra fxt 140mg lowest price effective erectile dysfunction treatment, poor housing designs and wide spread usage of open fire for cooking purchase malegra fxt online impotence blog. Types of burns, according to the mechanism, include: Flame burn Scalding Chemical burn Electrical burn, etc. The severity of a burn injury is a function of the burn depth (degree) and the extent or percentage of the body surface that is burned. Determining the percentage of burn surface is important to calculate the amount of fluid requirement while determination of burn depth is important for burn wound management. Classification of Burn according to depth (degree) 1- First degree burn: It involves the epidermis only and manifests with erythema. In children, the size of the hand may be used to estimate the burn surface, which is approximately 1%. Endotracheal intubation or tracheotomy may be needed in patients with burns involving the air way. Half of the calculated volume is given in the first 8 hours and the remaining half over the next 16 hours from the time of burn. The choice depends on the degree, size and site of the burn, and availability of facilities and expertise. Emergency escharotomy and fasciotomy should be done for deep circumferential burns of limbs, neck or trunk. Prevention of Infection: Burn patients have impaired resistance against infection. Prophylactic antibiotics (penicillin) are given for severe burns but, routine administration has no value. Nutrition: Naso-gastric tube should be inserted after admission for patients with more than 25% burn and those who have nausea and vomiting. Burn patients are in catabolic state and tend to lose weight very fast, thus special attention to their diet is important. Prophylaxis against tetanus: Tetanus prophylaxis should be supplemented as burn is potentially infected wound. Prevention of contractures and rehabilitation: Patients should constantly be urged and made to move all joints. Failure to do this results in contractures, which may be very disabling, unsightly and difficult to treat. Prevention The magnitude of burn injuries can be reduced by keeping the high risks, like children and epileptics, away from open fire or boiling pots and enforcing strict safety precautions in working places like factories etc. Investing in health research and development: Report of the ad-Hoc committee on health research relating to future intervention options. Craniocerebral trauma is consequently a source of major disability and huge financial and psychological burden. Trauma to the cranium can be either blunt or penetrating and involve the scalp, the skull or the brain. Scalp Injury Scalp lacerations are common and can result in severe hemorrhage if not controlled. Scalp lacerations can be sutured after ruling out possible associated skull or brain injuries. Skull Injury Different clinical forms of skull injury may follow trauma to the skull. These include: Simple Linear Fracture This is a line of fracture which usually marks of severe forces of injury.

Removing the suture: Hold the knot or one end of the thread with the forceps malegra fxt 140 mg cheap erectile dysfunction epilepsy medication, and cut the thread just above the skin buy malegra fxt 140mg with mastercard erectile dysfunction treatment delhi. Vertical mattress stitch (so called Donti-stitch order malegra fxt 140mg without a prescription erectile dysfunction at age of 30, or vertical U-suture) Fix the needle with the needle holder purchase 140 mg malegra fxt impotence symptoms signs. Grab the opposite wound edge with the surgical forceps, and sew into the skin 1,5 cm far from the incision line. Grab the closer wound edge with the forceps and sew out from the incision in at least 1,5 cm distance from the wound edge. Fix the needle again into the needle holder, grab the opposite wound edge with the forceps and sew out form the wound the same, 1-2 mm from the edge. All the 4 points of the suture must be in one line, and perpendicular to the incision line. Horizontal mattress stitch (horizontal U-suture) Fix the needle with the needle holder. Grab the opposite wound edge with the surgical forceps, and sew into the skin 1 cm far from the incision line. Grab the closer wound edge with the forceps and sew out from the incision in at least 1 cm distance from the wound edge. Grab the closer wound edge with the forceps and start sewing 1 cm sidelong to the previous, and 1 cm far from the wound edge. Catch the top of the needle and pull it out, then fix it again backhand into the needle holder. Grab with the forceps the opposite wound edge, and sew out from the wound at least 1 cm far from the wound edge. Simple running suture (with needle-thread combination) We create a 5-6 cm long incision on the liver skin-specimen. We grab the opposite side of the incision with a surgical forceps, and start sewing 1 cm far from the wound edge and without interruption finish the suture on the closer wound edge, exactly 1 cm far from the edge. Continue sewing with the longer end where the needle is in a way, that all the stitches should be 1 cm far from each other. By the last stitch, do not pull the thread totally through, leave short loop, and tight the not with this double end. Removing the suture: Hold the knot or one end of the thread with the forceps, and cut the thread just above the skin, and pull the whole thread out. Intracutaneous running suture Create a 5-6 cm long incision, and fix the needle into the needle holder. We did correctly if the skin is bulk a bit, because the incision gets tensile free, and the scar will be very thin. Removing the suture: Raise the end of the thread or the not, and cut the thread over the skin, under the knot, and pull the thread out from the other end. Practice Basics of the laparoscopic surgery: demonstration of laparoscopic surgical tools, training of eye-hand coordination 1. It is designed for blind insertion with minimal risk of injury to underlying organs. The outer shaft has a sharp beveled needle end, whereas the inner blunt-tipped obturator protrudes beyond the sharp tip of the outer needle in the resting state.

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Studies with another fruits can be deter mining its effectiveness in the prevention of arteriosclerosis discount 140 mg malegra fxt amex impotence in men. Another fruit that has been investigated for its antioxidant and cardiovascular protec tive effects are blueberries generic malegra fxt 140mg fast delivery erectile dysfunction doctor edmonton. Studies realized in Arkansas State University buy discount malegra fxt on line impotence existing at the time of the marriage, evaluated the effect on two groups of mice for twenty weeks buy generic malegra fxt online erectile dysfunction medications injection. The researchers suggest incorporating blueberries to the diet to improve cardiovascular health and recommended as the ideal fruit for the treatment of hypercholesterolemia. It is known that fruits such as cranberries have high antioxidant levels and tested their effec tiveness in promoting cardiovascular health [73-75]. Work is to show whether supplementation based cranberry juice may have the same antioxidant capacity and the same protective benefit as red wine, if so would avoid alcohol. In another study conducted at the University of Buffalo studied the effect of resveratrol as an antioxidant and its possible use in treating atherosclerosis. In this investigation were not used fruits or vegetables, but was used an extract of the plant. The extract containing resver 366 Oxidative Stress and Chronic Degenerative Diseases - A Role for Antioxidants atrol was administered at doses of 40 mg daily to a group of 10 people, another group of 10 people also served as a target. During the six weeks of the study, blood tests were per formed on the results; researchers concluded that Polygonum cuspidatum extract has a ther apeutic effect against oxidative stress. Obesity and metabolic syndrome The metabolic syndrome has been identified as a target for dietary therapies to reduce risk of cardiovascular disease; however, the role of diet in the etiology of the metabolic syn drome is poorly understood. The metabolic syndrome consists of a constellation of factors that increase the risk of cardiovascular disease and type 2 diabetes. The etiology of this syn drome is largely unknown but presumably represents a complex interaction between genet ic, metabolic, and environmental factors including diet [77-79]. The diet designed to increase consump tion of foods rich in phytochemicals, antioxidants, -linolenic acid, and fiber prevent Metabolic Syndrome. One of the mechanisms responsible for the cardioprotective effect of such a diet may be through reduction of the low-grade inflammatory state associated with the met abolic syndrome. If antioxidants play a protective role in the pathophysiology of diabetes and cardiovascular disease, understanding the physiological status of antioxidant concentrations among people at high risk for developing these conditions, such as people with the metabolic syndrome, is of interest. Because the prevalence of obesity, which is associated with decreased concentrations of antioxidants [83], is high among peo ple with the metabolic syndrome, they are probably more likely to have low antioxidant concentrations. Consequently, our purpose was to examine whether concentrations of sever al antioxidants are lower among those with than those without the metabolic syndrome. For example a retinol from the liver, the main storage site for retinol is transported to pe ripheral tissues by retinol binding protein. Thus, the higher retinyl ester concentrations among those who did not have the metabolic syndrome may indicate that they consumed larger amounts of vitamin A com pared with people who have this syndrome. Our ndings may have implications for people with the metabolic syndrome, health care professionals who care for them and researchers who study the metabolic syndrome. People with the metabolic syndrome are at increased risk for diabetes and cardiovascular disease, and a role for oxidative stress in the patho physiology of these conditions has been postulated. Free radical species is one of the princi pal mechanisms of action of antioxidants, other mechanisms that affect the pathophysiology of diabetes and cardiovascular disease may be operating as well [83]. Studies demonstrated profound effects on ethanol-induced liver injury by intake of nutrients such as polyunsaturated fat and iron in quantities that were never thought to be important. The sensitization is a conditioning that makes the target cells, hepato cytes, more vulnerable to harmful effects triggered by ethanol and priming as the effect that promotes specic injurious mechanisms. The sensitizing and priming are rendered by the complex interactions of primary mechanistic factors and secondary risk factors. For exam ple, intake of polyunsaturated fat in ethanol-fed rats, but not in pair-fed controls, results in a synergistic priming effect on induction of cytochrome P4502.

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