WORLD DAY OF SEXUAL & REPRODUCTIVE HEALTH: 12th February

 

Sexual and Reproductive Health: Issues and Access to Healthcare

Introduction

Sexual and reproductive health is a fundamental part of overall well-being, yet it remains a topic shrouded in stigma, misinformation, and inadequate healthcare access. From contraception and maternal health to sexually transmitted infections (STIs) and gender-based health disparities, millions of people worldwide struggle to access the care and information they need.

Poor sexual and reproductive healthcare doesn’t just affect individuals—it impacts entire communities, leading to unintended pregnancies, preventable diseases, and higher maternal mortality rates. In this blog, we’ll discuss the key sexual and reproductive health issues people face and the barriers to accessing quality healthcare.

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Common Sexual and Reproductive Health Issues

1. Sexually Transmitted Infections (STIs) and HIV/AIDS

STIs remain a significant global health concern. Conditions like chlamydia, gonorrhoea, syphilis, and HPV (human papillomavirus) can lead to serious complications if left untreated. HIV/AIDS continues to affect millions, particularly in marginalised communities. Despite advancements in prevention and treatment, stigma and lack of education prevent many from seeking timely care.

2. Unintended Pregnancies and Contraceptive Access

Unintended pregnancies can have life-altering consequences, particularly for young women and those in low-income communities. Access to contraception is essential for reproductive autonomy, yet many people still face barriers due to cost, lack of education, or cultural taboos.

3. Maternal Health and Pregnancy Complications

Maternal mortality remains a pressing issue, especially in low-resource settings where prenatal and postnatal care is limited. Conditions like preeclampsia, postpartum haemorrhage, and infections can be life-threatening without proper medical intervention.

4. Menstrual Health and Hygiene

For many, menstruation is still a taboo topic, leading to inadequate education and lack of access to menstrual products. Period poverty—where individuals can’t afford proper sanitary products—affects millions and can lead to missed school or work days, infections, and shame.

5. Reproductive Cancers (Cervical, Ovarian, Testicular, and Prostate Cancer)

Cancers affecting reproductive organs often go undiagnosed due to lack of screenings and awareness. Cervical cancer, for example, is highly preventable with regular Pap smears and HPV vaccinations, yet it remains one of the leading causes of death in women globally.

6. Gender-Based Violence and Sexual Health

Sexual violence and coercion have devastating impacts on sexual and reproductive health. Survivors often struggle to access healthcare due to fear, stigma, or legal barriers. Safe, trauma-informed medical care is crucial in supporting their recovery.

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Barriers to Accessing Sexual and Reproductive Healthcare

Despite the importance of sexual and reproductive health, many face significant obstacles when trying to access care.

1. Stigma and Cultural Taboos

Sexual health discussions are often considered inappropriate in many cultures, preventing people from seeking necessary medical attention or information. Stigma surrounding contraception, abortion, and STIs can create shame and misinformation.

2. Lack of Education and Awareness

Many people lack basic knowledge about sexual health due to inadequate sex education. Comprehensive, science-based sexual education in schools is crucial for empowering individuals to make informed choices.

3. Cost and Economic Barriers

High healthcare costs make sexual and reproductive health services inaccessible for many, particularly in countries without universal healthcare. Contraceptives, STI treatments, and pregnancy care can be expensive, forcing people to forgo essential care.

4. Limited Access in Rural and Underserved Areas

Many rural communities lack healthcare facilities, making it difficult for individuals to access reproductive health services. A shortage of trained professionals, lack of transportation, and long distances to clinics worsen the issue.

5. Legal and Policy Restrictions

Laws restricting abortion, contraception, and LGBTQ+ healthcare limit access to essential reproductive services. Political and religious influences often shape policies that restrict individuals’ reproductive rights.

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Solutions: How to Improve Sexual and Reproductive Healthcare Access

• Expand Comprehensive Sex Education – Schools and communities should provide accurate, judgment-free sexual education to help individuals make informed choices about their health.
• Improve Access to Contraceptives – Governments and healthcare organisations should ensure affordable and accessible contraceptive options for all individuals.
• Strengthen Maternal and Prenatal Care – Investing in quality maternal healthcare can significantly reduce maternal and infant mortality rates.
• Increase STI Testing and Treatment Services – Free or low-cost STI screenings and awareness campaigns can help reduce infection rates.
• Combat Stigma Through Awareness Campaigns – Normalising discussions around sexual health can break cultural taboos and encourage individuals to seek necessary care.
• Expand Healthcare Infrastructure in Underserved Areas – Mobile clinics, telemedicine, and community outreach programs can bridge gaps in rural healthcare access.
• Advocate for Policy Changes – Supporting laws and policies that protect reproductive rights and healthcare access is crucial for long-term change.

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Conclusion

Sexual and reproductive health is a human right, yet millions around the world face unnecessary challenges in accessing essential care. By addressing stigma, improving education, and expanding healthcare services, we can create a world where everyone has the knowledge and resources to make informed choices about their bodies and well-being.

Investing in reproductive healthcare isn’t just about improving individual lives—it strengthens communities, promotes gender equality, and leads to healthier future generations. It’s time to prioritise sexual and reproductive health and ensure that no one is left behind.

WORLD DAY OF THE SICK: 11th February

 

The Power of Compassionate Care: Why Kindness Matters in Healing

Introduction

Illness is more than just a physical struggle—it can be an emotional and psychological battle as well. Whether someone is facing a temporary illness or a chronic condition, the experience can be overwhelming, isolating, and frightening. While medical treatments address the body, compassionate care nurtures the mind and soul, playing a vital role in the healing process.

Compassionate care is more than just a kind gesture; it’s an essential part of healthcare that improves patient outcomes, enhances emotional well-being, and strengthens the patient-caregiver relationship. In this blog, we’ll explore why compassionate care is so important and how it can transform the experience of sickness for both patients and caregivers.

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Why Compassion Matters in Healthcare

1. Promotes Faster Healing and Recovery
   Research suggests that patients who feel cared for and emotionally supported tend to recover more quickly. When stress and anxiety levels decrease, the body's immune system functions better, allowing for faster healing. Compassion helps reduce fear and instils a sense of hope, both of which are crucial in the recovery process.

2. Reduces Anxiety, Fear, and Depression
   Being sick often brings uncertainty and fear, which can be just as distressing as the illness itself. Compassionate caregivers provide reassurance, helping patients feel safe and supported. A simple act of kindness, such as holding a patient’s hand or offering encouraging words, can significantly ease emotional distress.

3. Builds Trust Between Patients and Caregivers
   When patients feel genuinely cared for, they are more likely to trust their healthcare providers. This trust leads to better communication, improved adherence to treatment plans, and ultimately, better health outcomes. Compassionate care turns a medical experience into a human one, where patients feel seen and valued.

4. Improves the Quality of Life for Chronically Ill Patients
   For individuals living with chronic illnesses or terminal conditions, compassionate care can make a significant difference. It doesn’t change their diagnosis, but it can ease their pain, offer comfort, and improve their overall quality of life. Emotional support helps patients cope with their conditions in a more positive way.

5. Reduces Burnout Among Healthcare Providers
   Compassionate care doesn’t just benefit patients—it also helps caregivers. When healthcare professionals approach their work with empathy, they find deeper meaning in their roles, reducing the risk of burnout. Feeling connected to patients on a human level can remind caregivers of the profound impact they have on people’s lives.

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How to Practise Compassionate Care

Compassion isn’t just about big gestures—it’s often the small, everyday moments that make the biggest difference. Here are some simple ways to integrate compassionate care into daily interactions with the sick:

• Listen Actively – Truly hear what patients are saying. Acknowledge their fears, validate their emotions, and offer reassurance.
• Show Empathy – Imagine yourself in their situation and respond with kindness, understanding, and patience.
• Use Small Gestures of Kindness – A warm smile, gentle touch, or kind words can provide immense comfort.
• Respect Individual Needs – Each patient’s experience is unique. Being flexible and responsive to their needs helps them feel valued.
• Offer Emotional Support – Sometimes, what a patient needs most isn’t medical advice, but simply someone to sit with them and show they care.

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Conclusion

Compassionate care is not an extra—it’s a necessity. It transforms healthcare from a cold, clinical process into a meaningful human connection. It fosters trust, reduces suffering, and improves both physical and emotional well-being.

Whether you’re a doctor, nurse, caregiver, or simply someone looking after a sick loved one, your kindness and empathy can make a world of difference. Because while patients may forget what was said or done, they will always remember how they were made to feel.

Let’s make compassion the foundation of care, ensuring that healing isn’t just about medicine, but about humanity. 💙

PATELLA

The patella is the largest sesamoid bone in the human body. It is a flat and rounded triangular bone which is distally tapered and proximally curved. It is commonly known as the kneecap. It is embedded in the tendon of the quadriceps femoris muscle, lying anterior to the distal femur, i.e. near to the femoral condyles.

The patella is located deep to the fascia lata and rectus femoris tendon & anterior to the knee joint. The patella can be felt by touching the knee.

FUNCTION OF PATELLA

·       The patella acts as a mechanical advantage for the quadriceps.

Ø Moment arm: Imagine a lever. The distance between the fulcrum (pivot point) and where the force is applied (effort arm) is the moment arm. A larger moment arm translates to greater force output.

Ø Patella as a fulcrum: The patella acts as a fulcrum for the quadriceps tendon, effectively increasing the moment arm of the quadriceps force acting on the tibia. This translates to more efficient force generation during knee extension.

Ø Increased torque for full extension: As the knee straightens, the patella's position relative to the femur and tibia changes. This strategically increases the moment arm, particularly during the final 15 degrees of extension. This allows the quadriceps to generate the additional torque (rotational force) needed to achieve full knee extension.

 

·       Multiple factors influence how the kneecap (patella) glides and interacts with the femur during knee movement:

Ø Active quadriceps contraction: The quadriceps muscle pulling on the patellar tendon directly influences patellar motion. As the quadriceps contract during extension, they pull the patella upwards (superior glide).

Ø Connective tissue extensibility: The flexibility of ligaments and tendons surrounding the patella can affect its gliding ability. Tightness in these tissues can restrict proper movement.

Ø Patellar and trochlear groove shape: The specific shape of the patella and the groove on the femur (trochlear groove) where it glides can influence tracking and stability. Abnormalities here can lead to malalignment.

 

·       Patellar movement during knee flexion and extension:

Ø Superior and inferior glide: During knee extension, the patella glides upwards (superiorly) on the femoral trochlear groove as the quadriceps contract. Conversely, as the knee flexes, the patella glides downwards (inferiorly).

Ø Medial and lateral glide: In normal movement, the patella should have minimal side-to-side (medial or lateral) gliding. However, with full knee extension, the patella may have a slight lateral position due to leg rotation.

 

·       Patellar contact area changes with knee flexion:

Ø Contact point shift: As the knee flexes, the area of the patella contacting the femur changes. The contact point moves downwards and backwards on the femoral condyles, and upwards on the patella itself.

Ø Initial contact: During early flexion, the patella's outer side (lateral facet) makes contact with the top of the outer femoral condyle.

Ø Equal distribution: By 30 degrees of flexion, the contact area spreads more evenly across both sides of the patella and femoral condyles.

Ø Expanding contact surface: With increasing flexion, the area of contact between the patella and femur increases, distributing pressure and reducing stress on the joint. This expands from around 2 cm² at 30° flexion to 6 cm² at 90° flexion.

Ø Deep flexion contact: In very deep flexion (around 90° and beyond), the patella glides over the notch between the femoral condyles, with contact only on the inner and outer edges. Finally, at full flexion, the only contact point is between a specific area of the patella (odd facet) and the outer surface of the inner femoral condyle.

 

STRUCTURE OF PATELLA

Patella is having anterior surface which is concave and posterior surface is convex. The anterior and posterior surfaces are joined by a thin margin and towards the centre by a thicker margin. It has 2 surfaces, 3 borders and an apex which is all palpable.

·       There are surfaces Anterior and posterior which is also articular:

     § Anterior Surface: The surface is subcutaneous, convex and is perforated by nutrient vessels. It is longitudinally ridged and is separated from the skin by the subcutaneous prepatellar bursa and is covered by the tendon of quadriceps femoris.

    §   Posterior Surface: It has a smooth proximal surface, oval articular area which is crossed by a smooth vertical ridge, which fits the intercondylar groove on the femoral patellar surface. The patellar articular area divides into 2 facets: medial and lateral.

§ Lateral Facet: It is larger than the medial surface. It articulates with the lateral condyle of the femur.

§  Medial Facet: It articulates with the medial condyle of the femur. It has an attachment of the patellar ligament and contains fatty pad known as infrapatellar fat pad.

There are 3 borders to the patella:

·       Medial and Lateral Borders: They are located medial and lateral to the patella. They are relatively thin, converge inferiorly and provides attachment to the muscles through the expansions of the lateral retinaculum.

·       Superior Border: It is also known as the base. It is thickest and slopes anteroinferiorly.

Apex

·       The apex is positioned proximally to the line of knee joint by 1 to 2 cm.

·       It is pointy, directing downwards and is non articular on the tip of bone.

MUSCLE ATTACHMENTS

·       Quadriceps femoris is attached to the superior surface of patella except near posterior margin. It extends distally onto the anterior surface.

·       Rectus femoris is attached anteroinferior to the vastus intermedius.

·       At the lateral upper 1/3^rd  and medial upper 2/3^rd  borders represent attachment to the vastus lateralis and medialis respectively.

·       At the apex of patella, there is attachment to the patellar ligament.

·       The non-articular area on the posterior surface provides attachment to the ligamentum patellae below.

BLOOD SUPPLY

The patella is having a huge vascular network which is separated into extraosseous and intraosseous:

·       Extraosseous anastomosis ring has anterior tibial recurrent arteries form a ring around patella and also the geniculate arteries

·       Intraosseous anastomosis has mid patellar vessels which enter the vascular foramina on the anterior surface of middle 1/3^rd of patella and the polar vessels enter between ligamentum patellae and articular surface of patella.

NERVOUS SUPPLY

The anterior cutaneous innervation of the knee is derived from L2 to L5 nerve roots. The genitofemoral, femoral, obturator and saphenous nerves supply the anteromedial part of the knee joint. The lateral femoral and lateral sural cutaneous nerves supply the anterolateral part of the knee joint.

OSSIFICATION

The patella develops from a continuous band of fibrous connective tissue in the mesenchymal interzone along the knee joint surface at the distal femoral margin. At about the 9^th week of gestation, chondrification of this fibrous band which begins and gives rise to the quadriceps tendon superiorly and the patellar ligament inferiorly. Patella becomes completely cartilaginous by 14^th week of the gestation. The medial and lateral patellar facets are equal in size at first but by the 23^rd week of gestation lateral facet becomes larger than the medial facet.

Primary ossification may be present by the age of 2 to 5 years. Periosteum forms early on the anterior patellar surface. All the ossifying centres fuse at the puberty.

FEMUR

 

The femur or the thigh bone is the only bone in thigh. It is the longest, heaviest and the strongest human bone. The name of the bone is derived from the Latin word ‘femur’ meaning ‘thigh’. The proximal end of the femur fits into the socket in the pelvis called as hip joint, and the bottom of the femur connects to the tibia and patella to form the knee joint.

The femur length on an average is 26.74% of an individual height.

The proximal end has a pyramid shaped neck attaches the spherical head at the top and the cylindrical shaft at the bottom. There are two prominent bony protrusions, greater and lesser trochanter which attaches muscles that helps in the motion of both hip and knee joints. The angle between neck of the femur and the shaft is known as the inclination angle which is about 128 degrees in an average adult which decreases with the age. In general population without any severe tibiofemoral deformities, the femoral-tibial angle is almost about 175 degrees.

The head of the femur is directed medially upwards and slightly forwards. The shaft is directed obliquely downwards and medially so that the lower surfaces of the two femoral condyles lie in the same horizontal plane.

The femoral length is associated with a striding gait, strength, weight and muscular forces it is required to withstand. The femur supports all the body weight while standing or doing other activities like running, walking, jumping, etc., stability of the gait and is an essential component of the lower kinetic chain. The weight of the upper body rests on the femoral heads. The degree of the femoral obliquity varies between individuals but is greater in women than in men.

The femur is divided into three parts: Proximal, Shaft and Distal.

PROXIMAL FEMUR

The proximal femur contains head, neck, greater trochanter, lesser trochanter, Intertrochanteric line and intertrochanteric crest.

FEMORAL HEAD

It faces antero-supero-medially to articulate with the acetabulum. The head is of a spheroidal shape. Its smoothness is interrupted posteroinferior to its centre by a small, rough fovea which is an ovoid depression. The fovea is connected through the round ligament to the sides of the acetabular notch known as the ligamentum teres. The head of femur articulates with the acetabulum to form a ball and socket joint known as hip joint. The femoral head is intracapsular and is encircled distal to its middle line by the acetabular labrum. The articular margin is distinct except anteriorly, where the articular surface extends to the femoral neck.

NECK

The femoral head narrows considerably to form a cylindrical neck that connects the head with the shaft with an average angle of 127 degrees also known as angle of inclination or neck-shaft angle. The neck is almost 4-5 cm long. The angle of inclination provides movement at the hip joint, allows the limb to swing and also provides a lever for the action of the muscles at the hip joint. The angle is widest at the birth and diminishes gradually until the age of 10 years and is smaller in the females due to wider pelvis. It is strengthened by a thickening of bone called calcar femorale present along the concavity. The neck is laterally rotated with respect to the angle of anteversion which is almost 10-15° and this varies from person to person. The neck is rounded, upper surface is almost horizontal and slightly concave, while the lower surface is straighter, oblique, directed inferolaterally and backwards to the shaft near the lesser trochanter.

The neck has 2 borders and 2 surfaces. The upper border is concave and horizontal which meets the shaft at the greater trochanter. The lower border is straight and oblique which meets the shaft near the lesser trochanter. The anterior surface is flat and meets the shaft at the intertrochanteric line, which is entirely intracapsular. The posterior surface is convex from above downwards and concave from side to side and meets the shaft at the intertrochanteric crest.

GREATER TROCHANTER

The greater trochanter is large, irregular, box shaped apophysis present laterally and posteriorly and is the most lateral prominent of the femur. The highest point of the greater trochanter is higher than the neck of the femur and it reaches the midpoint of the femur. It can be palpated very easily. It has an upper border with an apex which is inturned posterior part of the posterior border. The greater trochanter also has three surfaces: Anterior, Medial and Lateral. The anterior border is rough in the lateral part. The medial surface has a rough impression above and a deep trochanteric fossa below which presents a tubercle. The lateral surface is crossed by an oblique ridge directed downwards and forwards, it is palpable when muscles are relaxed.

LESSER TROCHANTER

The lesser trochanter is a cone shaped extension of the lowest part of the femoral neck. It is smaller than the greater trochanter. It projects from the postero-medial side of the femur. The lesser trochanter is not palpable.

INTERTROCHANTERIC LINE

The intertrochanteric line is a prominent ridge at the junction of the anterior surface of the neck and shaft which descends medially from a tubercle on the upper part of the anterior aspect of the greater trochanter to a point on the lower border of the neck and anteriorly to the lesser tubercle. Distally this line is known as the pectineal line which serves as the anterior attachment of the hip joint capsule.

INTERTROCHANTERIC CREST

The intertrochanteric crest marks as a junction of the posterior surface of the neck with shaft of femur. It is a smooth rounded ridge, which starts above at the posterosuperior angle of the greater trochanter and ends at the lesser trochanter. The rounded elevation, a little above its middle is called as the quadrate tubercle (linea quadrata) which is almost 5cm in length.

SHAFT

The shaft or the body of the femur is large, thick and almost cylindrical in form. It is little broader above than in the center, widest and somewhat flattened from before backward below. It is slightly arched hence it is convex in anterior side and concave in posterior side, where it is strengthened by a prominent longitudinal ridge known as linea aspera which divides proximally and distal as the medial and lateral ridge.

In the upper 1/3^rd of the shaft, two lips of linea aspera diverge to enclose an additional posterior surface. It has 4 borders: Medial, Lateral, Spiral line and Lateral lip of the gluteal tuberosity. It also has 4 surfaces: Anterior, Medial, Lateral and Posterior. The gluteal tuberosity is a broad roughened ridge on the lateral part of the posterior surface.

In the middle 1/3^rd shaft has 3 borders: Medial, Lateral and Posterior & 3 surfaces: Anterior, Medial and Lateral. The medial and lateral borders are rounded and ill-defined, but the posterior border is in the roughened ridge as linea aspera. The medial and lateral surfaces are directed more backwards than towards the sides. Its subjacent compact bone is augmented to withstand compressive forces which are concentrated here by the anterior curvature of the shaft. Nutrient foramina, directed proximally, appear in the linea aspera, varying in number and site, one usually near its proximal end, a second usually near its distal end.

In the lower 1/3^rd of the shaft the two lips of linea aspera diverge as supracondylar lines to accommodate popliteal surface. This part of the shaft also has 4 surfaces: Anterior, Medial, Lateral and Popliteal. Anterior surface is smooth and convex for most of the part. The upper portion of this surface has a roughened area called the patellar fossa. Posterior surface also known as popliteal surface is smooth and concave throughout most of its length. The linea aspera extends upwards from the upper two-thirds of the posterior surface and ends just above the condyles. Medial surface is relatively flat and smooth. Contains the adductor tubercle, a roughened area near the upper part of this surface for attachment of the adductor muscles, which pull the thigh towards the midline. The medial condyle, a rounded bony prominence, forms the lower part of the medial surface. Lateral surface is convex and smoother than the medial surface. The lateral condyle, a rounded bony prominence, forms the lower part of the lateral surface.

DISTAL END

The distal end of the femur is cuboid in form and widely expanded as a bearing surface for the transmission of the weight to the tibia. It has 2 condyles, medial and lateral. Anteriorly, the condyles are merging and continues into the shaft. The condyles are slightly prominent and are separated by a smooth shallow articular depression called patellar surface. Posteriorly, the condyles are separated by a deep intercondylar fossa or intercondylar notch and project beyond the plane of the popliteal surface. The distal end articulates with tibia and patella which forms the knee joint. The articular surface for knee joint is a broad area like an inverted U shape and has 2 surfaces, Tibial and Patellar.

PATELLAR SURFACE

The patellar surface extends anteriorly on both the condyles, especially the lateral then medial. It is transversely concave, vertically convex and grooved for the posterior patellar surface. The anterior border is therefore oblique and runs distally and medially, separated from the tibial surfaces by two small grooves that crosses the condyles obliquely. The lateral groove runs laterally and bit forwards from the front of the intercondylar fossa and expands to form a small triangular depression which rests on the anterior edge of the lateral meniscus when the knee is fully extended. The medial groove is restricted to the medial part of the medial condyle and rests on the anterior edge of the medial meniscus in full knee extension.

TIBIAL SURFACE

The tibial surface is divided by the intercondylar fossa but is anteriorly continuous with the patellar surface and is convex in all the directions. The medial part of the tibial surface is a broad strip on the convex infero-posterior surface of the medial condyle and is gently curved with a medial convexity. The lateral part of the tibial surface is broader and passes slightly back. Both the medial and lateral surfaces have dis-similar antero-posterior curvatures.

MEDIAL CONDYLE

The medial condyle is longer and when femur is held with its body perpendicular projects to a lower level. The condyle is convex medially, has a bulging and is easily palpable. Posterosuperior to the epicondyle there is projection known as the adductor tubercle. This tubercle is an important landmark as an epiphyseal line for the lower end of the femur passes through it. The lateral surface of the condyle is the medial wall of the intercondylar fossa. A curved strip which is 1cm wide and adjoining the medial articular margin, is covered by the synovial membrane and is inside the joint capsule.

LATERAL CONDYLE

The lateral condyle is more prominent and is broader both in its antero-posterior and transverse diameters. The condyle is thicker, stronger and flat laterally and is more in the line of the shaft of femur hence it takes greater part in the transmission of the body weight to the tibia. the popliteal grove just below the epicondyle has a deeper anterior part and a shallower posterior part.

INTERCONDYLAR FOSSA OR NOTCH

The intercondylar fossa separates both the condyles distally and behind. The fossa is intracapsular but moreover extracapsular. The distal border of the patellar surface limits the fossa in front and at back intercondylar line limits the fossa separating from the popliteal surface. Its lateral wall, the medial surface of the lateral condyle, bears a flat posterosuperior impression that spreads to the floor of the fossa near the intercondylar line for the proximal attachment of the anterior cruciate ligament. The medial wall of the fossa, i.e. the lateral surface of the medial condyle, bears a similar larger area, but far more anteriorly, for the proximal attachment of the posterior cruciate ligament. Both impressions are smooth and largely devoid of vascular foramina, whereas the rest of the fossa is rough and pitted by vascular foramina. A bursal recess between the ligaments may ascend to the fossa. The capsular ligament and, laterally, the oblique popliteal ligament are attached to the intercondylar line. The infrapatellar synovial fold is attached to the anterior border of the fossa.

Attachments on the Femur

1. Fovea: Attachment for ligamentum teres.
2. Greater Trochanter:
• Piriformis at apex.
• Gluteus minimus on anterior surface.
• Obturator internus and gemelli on medial surface.
• Obturator externus in trochanteric fossa.
• Gluteus medius on lateral surface; trochanteric bursa behind it.
3. Lesser Trochanter:
• Psoas major on apex and anterior surface.
• Iliacus on base and below.
• Bursa covers posterior surface.
4. Intertrochanteric Line:
• Capsular ligament attachment.
• Iliofemoral ligament upper and lower bands.
• Vastus lateralis and medialis origin from ends of the line.
5. Quadrate Tubercle: Quadratus femoris insertion.
6. Shaft:
• Medial head of gastrocnemius on popliteal surface.
• Vastus intermedius from anterior and lateral surfaces.
• Articularis genu below vastus intermedius.
• Suprapatellar bursa related to lower anterior surface.
• Vastus lateralis from greater trochanter and linea aspera.
• Vastus medialis from intertrochanteric line and linea aspera.
• Gluteus maximus, adductors, and pectineus insertions detailed along linea aspera.
7. Lateral Condyle:
• Fibular collateral ligament attachment.
• Popliteus origin in popliteal groove.
8. Medial Condyle:
• Tibial collateral ligament attachment.
• Adductor tubercle receives adductor magnus insertion.
9. Intercondylar Notch:
• Cruciate ligaments attached to condyles.
• Capsular and oblique popliteal ligament attachments.

Nutrient Artery: From second perforating artery, enters via foramen on linea aspera.

This summary maintains the original description’s essence while being more concise for easier reference.

BLOOD SUPPLY

1. Deep Femoral Artery: Supplies blood to the shaft and distal portion of the femur.

2. Medial and Lateral Circumflex Femoral Arteries: Supplies blood to the head and neck of the bone.

3. Obturator Artery: Supplies blood to the femoral head.

4. Foveal Artery: Supplies blood to the femoral head.

 

OSSIFICATION

The femur, the long bone in your thigh, has distinct growth regions at its ends called epiphyses. These epiphyses are capped with cartilage and separated from the main shaft (diaphysis) by growth plates (physes). Understanding these regions is important for various reasons, including bone development, forensic analysis, and proper imaging techniques.

Structure and Fusion:

• Upper end: There are three epiphyses at the top of the femur:
• The head (capital epiphysis) forms the ball-shaped joint with the hip socket.
• The greater trochanter, a large bony prominence for muscle attachment.
• The lesser trochanter, a smaller ridge on the posterior aspect.
• Lower end: A single epiphysis exists at the lower end of the femur.

These fuse with the shaft at different times: * Upper epiphyses (lesser trochanter, greater trochanter, head): Fuse around 18 years old. * Lower epiphysis: Fuses around 20 years old.

Ossification and Forensic Importance:

The presence of an ossification center (bone formation starting point) in the lower femoral epiphysis of a newborn found dead indicates the child was viable, meaning it could have survived independently outside the womb.

Growth and Development:

• The lower end of the femur is the primary growth region during childhood and adolescence.
• The lower epiphyseal line (growth plate) interestingly passes through the adductor tubercle, a bony bump for muscle attachment.
• In contrast, the upper head epiphysis is entirely cartilaginous in infants and not visible on standard X-rays. Ultrasound is preferred for early visualization.
• The growth plate of the head starts ossifying around 10 years old. Initially, it has a horizontal orientation, incorporating the inferomedial part of the articular surface (joint surface) into the neck region.
• Over time, the medial part of the epiphysis grows down, covering this previously neck-related articular surface. This process transforms the head into a hollow cup shape sitting atop the femoral neck.
• Notably, the epiphyseal line of the head generally follows the articular margin, except for a superior non-articular area allowing blood vessel passage into the head.

Fusion Timeline:

• Lesser trochanter: Fuses shortly after puberty.
• Greater trochanter: Fuses after the lesser trochanter.
• Capital epiphysis (head): Fuses around 14 years in females and 17 years in males.
• Distal epiphysis (lower end): Fuses around 16 years in females and 18 years in males.
• Distal epiphyseal plate: Notably, this growth plate runs through the adductor tubercle.

Ossification Process:

The femur has one primary ossification center in the shaft that appears between the 5th and 7th week of fetal development. Secondary ossification centers then emerge at different times:

• Distal end: 9th month of fetal development
• Head: 6th month after birth
• Greater trochanter: 4th year
• Lesser trochanter: 12th to 14th years

 

TOOTHACHE DAY: 9th FEBRUARY

 

Toothaches: Causes and How to Prevent Them

Introduction

A toothache can range from a mild annoyance to unbearable pain, making everyday activities like eating, drinking, and even talking difficult. Whether it's a sharp, sudden pain or a constant dull ache, a toothache is often a sign that something is wrong with your oral health.

The good news? Most toothaches can be prevented with proper dental care and lifestyle habits. In this guide, you’ll learn about the common causes of toothaches and effective preventive measures to keep your teeth healthy and pain-free.

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Common Causes of Toothaches

Tooth pain can be caused by various factors, from dental decay to gum infections. Here are the most common reasons:

1. Tooth Decay (Cavities)

Cavities are the leading cause of toothaches. They occur when bacteria in the mouth break down sugars and produce acids that erode tooth enamel. If untreated, cavities expose the inner layers of the tooth, causing pain and sensitivity.

🔹 Symptoms: Sharp pain when eating sweets or drinking hot/cold beverages.

2. Gum Disease (Gingivitis & Periodontitis)

Infected or inflamed gums can cause pain in the teeth and surrounding areas. In advanced cases, gum disease can lead to gum recession, exposing tooth roots and increasing sensitivity.

🔹 Symptoms: Red, swollen, or bleeding gums; bad breath; loose teeth.

3. Tooth Abscess (Infection)

A tooth abscess is a pus-filled infection at the root of a tooth or between the gums. It occurs when bacteria enter the tooth due to deep cavities, gum disease, or cracks in the enamel.

🔹 Symptoms: Severe, throbbing pain; swelling in the face or gums; fever.

4. Cracked or Broken Teeth

A cracked or fractured tooth can expose the sensitive inner layers, leading to pain when chewing or temperature sensitivity. Cracks may result from injuries, grinding, or biting hard foods.

🔹 Symptoms: Pain when biting down, sensitivity to hot or cold foods.

5. Tooth Sensitivity

Worn enamel, exposed tooth roots, or cavities can lead to tooth sensitivity, causing discomfort when consuming hot, cold, sweet, or acidic foods.

🔹 Symptoms: Sudden, sharp pain when eating/drinking something hot or cold.

6. Impacted Wisdom Teeth

Wisdom teeth that don’t have enough space to emerge properly can become impacted, pressing against other teeth and causing pain, swelling, or even infections.

🔹 Symptoms: Jaw pain, swelling, difficulty opening the mouth.

7. Sinus Infections

Surprisingly, sinus infections can cause toothaches, especially in the upper molars, because the sinuses are located close to the tooth roots.

🔹 Symptoms: Pressure in the cheeks, forehead, and around the eyes; congestion.

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How to Prevent Toothaches

Prevention is always better than treatment! Here’s how you can protect your teeth and gums:

1. Brush and Floss Daily

🦷 Brush twice a day with fluoride toothpaste to remove plaque and food particles.
🦷 Floss once a day to clean between teeth and prevent cavities and gum disease.

2. Use a Fluoride Mouthwash

Fluoride strengthens enamel and helps prevent cavities. Use a mouthwash after brushing, especially if you’re prone to decay.

3. Eat a Tooth-Friendly Diet

✅ Eat more: Dairy (cheese, yogurt), crunchy fruits/veggies (apples, carrots), and nuts.
❌ Avoid: Sugary snacks, acidic foods, and carbonated drinks that wear down enamel.

4. Drink Plenty of Water

Water helps wash away food debris and bacteria that cause decay and bad breath. It also keeps your mouth hydrated and prevents dry mouth.

5. Avoid Smoking and Alcohol

🚭 Smoking and excessive alcohol use increase the risk of gum disease, tooth decay, and oral infections.

6. Use a Mouthguard (If You Grind Your Teeth)

Bruxism (teeth grinding) can wear down enamel and cause pain. A custom mouthguard can protect your teeth while you sleep.

7. Don’t Ignore Dental Check-Ups

Visit your dentist every six months for cleanings and check-ups. Early detection of cavities and gum disease prevents serious issues.

8. Seek Treatment for Any Pain Early

If you experience persistent tooth pain, don’t ignore it! Early treatment can prevent complications like infections or tooth loss.

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Final Thoughts

Toothaches can be painful and disruptive, but most of them are avoidable with good oral hygiene and regular dental care. By brushing, flossing, eating a healthy diet, and seeing your dentist regularly, you can protect your teeth and keep painful toothaches at bay.

Key Takeaways:

✔ Toothaches are often caused by cavities, gum disease, infections, or cracks.
✔ Good oral hygiene (brushing, flossing, fluoride) helps prevent tooth problems.
✔ Avoid sugary foods, quit smoking, and stay hydrated to protect your teeth.
✔ Regular dental check-ups detect problems early before they become painful.
✔ If you have tooth pain, see a dentist immediately to prevent complications.

Taking care of your teeth today means avoiding painful toothaches tomorrow! 🦷😊

PUBIS

 

The pubis is one of the three main bones that forms the pelvis. It is also known as the pubic bone or pelvic girdle. It constitutes the lower and anterior part of each side of the hip. Pubis bone is the most forward-facing and the smallest bone of the three bones that make up the hip bone. It is located at the front of the body, just below the abdomen.

The primary function of the pubis is to protect the urinary and reproductive organs. Its structure and function differ between individuals assigned female at birth and those assigned male at birth.

The pubis bone has two halves: right and left. It is connected by a cartilage called pubic symphysis. In most adults, the pubic symphysis is not completely rigid and can move by around 2 millimeters. It is covered by a layer of fat – the mons pubis.

The pubis bone is divided into three sections: 

A. Body 

B. Superior Pubic Ramus 

C. Inferior Pubic Ramus.

A.   BODY

The body is the largest portion of the pubis, forming the wide, strong, middle and flat part of the pubic bone. The body has a superior border or pubic crest, pubic tubercle at the lateral end of the pubic crest and three surfaces: anterior, posterior & medial.

The rough upper edge is the pubic crest, ends laterally at the pubic tubercle. The pubic crest separates the anterior and posterior surface of the bone. The tubercle is roughly 3cm from the pubic symphysis. The tubercle has a distinctive feature on the lower part of the abdominal wall and is important when localizing the superficial inguinal ring & femoral canal of inguinal canal. Both pubic crest and pubic tubercle are palpable and are partly obscured in males by the spermatic cord that crosses above it from the scrotum to the anterior abdominal wall

Surfaces

A. Anterior or External Surface: The smooth anterior surface faces the inferolateral side. The smooth posterior surfaces face upwards and backwards as the oblique anterior wall of the lesser pelvis and is related to the urinary bladder. The rough surface faces superomedially.

B. Posterior or Internal Surface: It faces posterosuperiorly, forming the anterior wall of the lesser pelvis. It is separated from the urinary bladder by the retropubic fat.

C. Medial or Symphyseal Surface: The medial surface which is elongated and oval, of the pubic bone of left and right hip bones articulate with each other via symphyseal cartilage forming the pubic symphysis joint. Removing the cartilage it has an irregular surface of small ridges and furrows or nodular elevation carrying considerably with age, features that are of forensic interest. The curved area below the pubic symphysis is known as the pubic arch, one of the sexually dimorphic areas of the pelvis. The males, this arch is a V-shaped whereas in females it is usually broader.

 

B.   SUPERIOR PUBIC RAMUS

The superior pubic ramus is 1/3^rd of the pubic bone. It starts at the pubic tubercle and extends postero-laterally and upwards to the acetabulum, joining the ilium and ischium. It forms the upper edge of the obturator foramen. It appears triangular in cross section and has three surfaces and three borders:

SURFACES

Anterior (Pectineal) surface: It is tilted slightly up, is triangular in outline and extends from the pubic tubercle to the iliopubic ramus. It is bounded in front by the rounded obturator crest and behind by the sharp pecten pubis also known as pectin line which with the crest, is the pubic part of the linea termanilis that is anterior part of the pelvic brim. Pelvic brim separates the greater and lesser pelvis.

Obturator Surface: It faces posteroinferiorly and is bounded anteriorly by the obturator crest and inferiorly by its sharp inferior border. It also gives attachment to the obturator membrane.

Inferior Surface: It part of the anterior boundary of the lesser pelvis. The surface is medially inclined, smooth, convex from downward. It is limited by the pecten pubis above and the sharp inferior border below.

BORDERS

Superior Border: It is also known as the pectin line or pecten pubis. The superior border has a sharp crest which extends from just behind the pubic tubercle to the posterior part of iliopubic eminence. It projects forward, the inferior crus of the subcutaneous inguinal ring and inguinal ligament are attached to it. The pectin line marks the brim of the lesser pelvis.

Anterior Border: It is also known as the obturator crest. The border is a rounded ridge, extending from the pubic tubercle to the acetabular notch. The junction of the pubic crest and to the medial part of the pubic bone is known as the angle. The border is articular and is marked by 8 to 9 transverse ridges which serve for the attachment of a thin layer of cartilage which intervenes between it and the interpubic fibrocartilaginous lamina.

Inferior Border: It is a sharp and forms the upper margin of the obturator foramen.

C.   INFERIOR PUBIC RAMUS

The inferior ramus is thin and flat, which passes laterally and downward from the medial end of the superior ramus and makes up 1/3^rd part of the pelvis. It becomes narrower as it descends and joins with the inferior ramus of the ischium below the obturator foramen. The joint may be locally thickened but not so obviously in adults. It has two surfaces and two borders.

SURFACES

Anterolateral Surface: The surface is rough and is directed towards the thigh, running superiorly to the body of the pubis. The surface is limited laterally by the margin of the obturator foramen.

Posteromedial Surface: It is continuous above with that of the body and is transversely convex. The medial part is often everted in males and gives attachment to the crus of the penis in males and clitoris in females. This surface faces the perineum medially; its smooth lateral part tilted up towards the pelvic cavity.

BORDERS

Medial Border: The border in the females is thick, rough and everted. It has two ridges separated by an intervening space. The ridge extends downwards and are continuous with the similar ridges on the inferior ramus of the ischium.

Lateral Border: It is thin and sharp; forms part of the circumference of the obturator foramen.

 

MUSCLE ATTACHMENTS

Originating from the pubis

1.     Gracilis and adductor brevis muscle: From the external surface of the body and inferior ramus

2.    Obturator externus muscle and obturator internus muscle: From the external surface of the body

3.    Adductor longus: From the upper body of the pubis just below the pubic crest

4.    Pectineus muscle: From the external surface of the superior ramus

5.    Sphincter urethrae: From the conjoint ramus

Inserting into the pubis

1.    Rectus abdominis muscle: On the lateral side of the pubic crest

2.    Pyramidalis muscle: Just below the attachment of the rectus abdominis muscle

3.    Levator ani muscle (levator prostatae and puborectalis): on the medial surface of the body

Ligament Attachments

1.    Pubofemoral and obturator ligament: At the obturator crest.

2.    Inguinal ligament (Poupart ligament): At the pubic crest.

3.    Ventral pubic ligament: At the medial aspect of the anterior surface of the body.

4.    Puboprostatic ligament: At the pelvic surface of the body.

5.    Lacunar and pectineal ligament: At the pecten pubis.

Ossification

Ossification of the pubis occurs at two ossification centers; these are found in the:

- superior pubic ramus, which appears in utero during the fourth to fifth months.

- body of pubis, which appears during early to middle adolescence.

These ossification centers fuse with each other during middle adolescence to early adulthood. Fusion between the body of ilium, body of ischium, and superior pubic ramus occurs at the acetabulum during middle to late adolescence, forming the fused hip bone. Fusion between the ramus of ischium and inferior pubic ramus occurs within the seventh to eighth years, forming the fused ischiopubic ramus.

Compiled & Written by Dr. Palak Shah