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Operative approach and exposure is carefully considered to balance the need to correct the deformities but also to prevent further aesthetic disruption and complications.Factor XIII is the last factor in the coagulation cascade with unique chemical properties and physiological functions. The history of discovery of factor XIII can be traced back to 1923 when Barkan and Gasper first demonstrated that fibrin clots formed in the presence of calcium ions (Ca2+) were insoluble in weak bases. In 1948, Laki and Lorand first reported a non-dialyzable, thermolabile serum factor, which made fibrin clots insoluble in concentrated urea solution. They called this serum factor as 'protein fibrin stabilizing factor.' In 1961, Lowey et al. purified the factor from plasma and reported its enzymatic nature. However, the clinical importance of this factor was realized after Duckert et al. (1961) published the report of a pediatric patient with impaired wound healing, abnormal scar formation, and severe bleeding diathesis who was found to be deficient in this factor. The International Committee on Blood Clotting Factors recognized this 'protein fibrin stabilizing factor' as a clotting factor in eficiency can be formulated to minimize the bleeding episodes.Acute mountain sickness (AMS) is a syndrome that arises in non-acclimatized individuals who ascend to high altitudes. It is a form of acute altitude illness that occurs due to a decrease in the atmospheric partial pressure of oxygen as the altitude increases, inducing hypoxia. This condition typically occurs at an altitude of >2500 meters; however, it can occur at lower elevations in high-risk individuals.St. John's Wort (Hypericum perforatum) is an herbal medication that consists of anthraquinones, which have displayed anti-inflammatory and anti-cancer effects. It has also been used as an antidepressant. It derives from a flowering plant found in Europe and Asia. It is common in the form of a tablet, capsule, tea, or liquid extract used to treat a handful of medical conditions which include but are not limited to the followingThe World Health Organization recognizes palliative care as a method of improving quality of life by preventing and treating pain and other physical, psychosocial, and spiritual issues. In 2006, the American Board of Medical Specialties approved the creation of a Hospice and Palliative Medicine (HPM) subspecialty. As technology has improved over the last 20 years, it has played a vital role in medical education, especially in simulation. Simulation-Based Medical Education (SBME) has been shown to improve clinical competence, patient safety, and is cost-effective if used appropriately. Many educational principles must be considered when developing an effective SBME curriculum, including curriculum integration, feedback, deliberate practice, and mastery learning. Simulation has also been used in palliative care education, especially early on in medical trainees’ careers. Ann Faulker was a medical educator in the UK who was one of the first to advocate for simulation in palliative care in 1994. Palliative care simulation is different than procedural based simulation, and this must be taken into consideration when developing a successful simulation technique. There should be more emphasis on communication tools, interpersonal skills, self-reflection, and end of life care.Calcium gluconate is the calcium salt of gluconic acid. Gluconic acid is an oxidation product of glucose. There is 93 mg of elemental calcium in a 10 ml ampoule of 10% calcium gluconate. In comparison, there is 272 mg of elemental calcium in a 10 mL of 10% solution of calcium chloride, another calcium salt. Calcium gluconate is typically preferred over calcium chloride due to lower the risk of tissue necrosis if the fluid is extravasated.The ankle joint is one of the most commonly injured joint and the most common type of fracture to be treated by orthopedic surgeons. The estimated incidence of ankle fractures is approximately 187 per 100,000 people per year. It appears that the incidence of these fractures is increasing in developed countries, presumably secondary to the increasing number of people involved in athletic activity, including physically active elderly patients. Most ankle fractures are malleolar fractures. Approximately 60% to 70% are unimalleolar fractures (predominately lateral malleolus), 15% to 20% bimalleolar, and only 7% to 12% are trimalleolar fractures. The overall incidence is fairly equivalent between sexes, though higher in young males and older females. selleck compound Due to the fairly common presentation of ankle fractures, knowledge of the proper imaging evaluation of this complex anatomy is important. Though the initial evaluation is with radiography, an understanding of further evaluation with more advanced cross-sectional imaging is also important.Anatomically, the forefoot is considered the portion of the foot that extends from the tarsal-metatarsal joint to the tips of the toes, and pathology of the toes are typically subdivided into the pathology of the hallux, or great toe, and pathology of the lesser toes. The fifth toe is the most distal and lateral structure in the forefoot is comprised of the proximal, middle, and distal phalanges. The proximal phalanx articulates with the metatarsal at the metatarsophalangeal joint, and in turn, the proximal phalanx articulates with the middle phalanx at the proximal interphalangeal joint, and the middle phalanx articulates with the distal phalanx at the distal interphalangeal joint. Layer 1, or the most superficial layer, is comprised of the following structures. The abductor hallucis muscle serves to abduct the great toe, the flexor digitorum brevis muscle which inserts on the base of the middle phalanx of toes 2 to 5 and flexes the proximal interphalangeal joints and the abductor digiti minimi muscle which um of the middle and distal phalanges of toes 2 to 5 serving to extend the toes and assist in ankle dorsiflexion while the extensor hallucis longus inserts on the dorsal base of the distal phalanx of the great toe and thus extends the interphalangeal (IP) joint of the hallux. Understanding the anatomy of the foot is critical to understanding its various deformities. Deformities of the fifth toe are often congenital and include deformities such as an overlapping fifth toe or a congenital curly toe.