- A 25-year-old female presented with dizziness, palpitations and fatigue upon waking and standing that improved when lying down. Her blood pressure was 90/50 mmHg sitting and dropped to 70/50 mmHg after standing.
- Her workup revealed no underlying causes and she was initially treated with oral etilefrine but stopped due to side effects. Her symptoms were exacerbated by dehydration and antidepressant use.
- Proper treatment involved increasing fluid intake, stopping coffee and antidepressants, and using compression stockings. This resolved her symptoms without need for further medication. The case demonstrates the importance of identifying and treating the underlying cause of hypotension.
Nusing Management of CHF(English) Symposia presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
This Slideshare includes the introduction of congestive heart failure, signs and symptoms, pathogenesis, epidemiology, etiology, pathophysiology, classification of drugs which is used to manage CHF, and recent drugs used to manage CHF.
A Global Problem
HIGHLY LETHAL 5 yr Survival rate “50%”
More M.I. cases now survive More Incidence of CHF due to damaged myocardium
Better options than before now available to treat CHF
Nusing Management of CHF(English) Symposia presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
This Slideshare includes the introduction of congestive heart failure, signs and symptoms, pathogenesis, epidemiology, etiology, pathophysiology, classification of drugs which is used to manage CHF, and recent drugs used to manage CHF.
A Global Problem
HIGHLY LETHAL 5 yr Survival rate “50%”
More M.I. cases now survive More Incidence of CHF due to damaged myocardium
Better options than before now available to treat CHF
This Will Give Detail Information On HYPERTENSION likes Types, Sign and Symptoms, Causes , Identification Test, Treatment, Drug Use for It .
Plz Share and Give Suggestions for Improvement.
THANK YOU
pulmonary hypertension with left to right shunts .pptxHaytham Ghareeb
this presentation discuss the management step by step approach style of pulmonary hypertension due to congenital heart disease and left to right shunts
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
1. A case of hypotension
Haytham Soliman Ghareeb
Lecturer of cardiovascular medicine
Fayoum university
2. •25 year old female
•Not diabetic or hypertensive
•Average built BMI 23
•On continuous diet
•Came complaining of low blood pressure
3. •Condition started one year ago soon after she started her
diet
•Dizziness, palpitation and fatigue specially when she
wakes up
•The condition partially improve during the day
•It also improves when she lies flat
•She sought medical advice in a primary health care center
4. Primary health care center
• Her blood pressure was 90/50 mmHg in sitting position and
one minute after standing
• Her ECG was normal
• Her physical examination was normal
• Ordered echocardiogram was normal
• Her CBC was within normal range
• She was given oral Etilefrine-HCL 5mg tab BID
5. •Patient partially improved but she stopped the
treatment due to headache
•Symptoms regain soon after
•The condition was exaggerated and she needed IV
fluid for this hypotension once at a local hospital
•Then she came to our hospital seeking medial advice
What should we do?
7. Definition
• Its is decrease in blood pressure that cause hypo perfusion of vital organs
specially the brain and heart
• Its not always related to a number so (90/60 mmHg) is not hypotension in
asymptomatic individual
• Usually a blood pressure below 80/50 mmHg cause hypotension
• A drop in systolic blood pressure of 20mmHg can cause hypotension
symptoms
• Severe hypotension can cause serious hypo-perfusion and shock
8. Mechanism hypotension
• decrease in cardiac output
• dilation of blood vessels
• decrease in blood volume
• Inhibition of brain centers that control blood pressure
• Impairment of the autonomic nervous system
10. • Dehydration:
– Even minor dehydration can cause hypotension
– This effect is exaggerated in elderly people
• Blood loss:
– bleeding cause hypotension via volume depletion
– major bleeding cause sever hypotension and shock
• Cardiac disease:
– obstructive valvular lesions – myocardial infacrtion
– advanced heart failure – bradychardia
– myocarditis – cardiotoxic drugs
11. • Severe allergic reactions:
Reaction cause capillary vasodilation and blood pressure to drop
• Pancreatitis:
Fluids enters the inflamed tissues around the pancreas concentrating
the blood and reducing its volume
• Severe infection:
Any infections that enter the bloodstream can cause potentially fatal
drops in blood pressure
• Endocrinal disorders:
– hyper and hypo thyroidism – Diabetes
– Postgastrectomy – primary hypoaldosteronism
– pheochromocytoma
12. • Pregnancy:
– Hypotension is due to blood pulled into fetal circulation
– This condition recovers after delivery
• Medications:
– Diuretics, beta-blockers, alpha-blockers, calcium channel blockers
– Certain antidepressants (e.g. tricyclic )
– Drugs for Parkinson disease (carbidopa and levodopa)
– PDE5 inhibitor (Sildenafil) specially when combined with
nitroglycerin
13. Classification
• Postural or orthostatic hypotension (OH)
• Postprandial hypotension
• Neurally mediated hypotension
• Multiple system atrophy with orthostatic hypotension
14. Postural or orthostatic hypotension (OH)
• Decrease in systolic BP≥20 mm Hg or decrease in diastolic BP≥10 mm
Hg within 3 minutes of standing or Similar drop in BP within 3
minutes in a head up position on tilt table test at angle ≥60°
• strongly age-dependent, with prevalence ranging from 5% to 11% in
middle age to 30% or higher in the elderly
• Its due to failure of neuro and chemoreceptor mechanisms that
counteract decrease of blood volume during standing
15. Sequence
Rapid decrease in venous return to heart
Reduce ventricular filling
↓CO ↓BP
Provoke compensatory mechanisms
↓Parasympathetic ↑sympathetic
↑Peripheral resistance
↑venous return
Maintain BP with
•Small fall in SBP
(5-10mmHg)
•↑Diastolic Bp (5-10mmHg)
•↑Pulse rate 10-25 beat/min
Absent
16. • Postprandial hypotension:
– Occurs when blood pressure drops suddenly after eating
– due to pooling of blood in the intestine for digestion
– More common than postural hypotension
– Occurs mainly in the elderly
– Risk factors includes Parkinson disease, autonomic neuropathy
17. • Neurally mediated hypotension:
Occurs when blood pressure drops after standing for a long period of
time
• Multiple system atrophy with orthostatic hypotension:
– Also known as Shy-Drager syndrome
– Progressive damage to the autonomic nervous system
– It causes hypotension when standing and hypertension when lying
down.
18. Symptoms and signs
• Orthostatic Hypotension and Neurally Mediated Hypotension :
- Dizziness or light-headedness - Blurred vision
- Confusion - Weakness
- Fatigue - Nausea
• Orthostatic hypotension happen within a few seconds or minutes of
standing up and disappear with sitting or lying down
• NMH occur after standing for a long time or in response to a stressful
situation. The drop in blood pressure doesn't last long and often
disappear after sitting down.
19. Diagnostic tools other than blood pressure
measurement
• Laboratory work up:
CBC, blood electrolyte measurement, thyroid profile, cortisol levels,
blood and urine cultures if infection is suspected
• Radiologic studies:
ECG, echocardiogram, Holter monitor, lower limbs vemous duplex , CT
scan of the chest and abdomen and tilt-table tests
20. Treatment
• Mainly treatment of the cause ( endocrine disorders, heart failure,
medication side effects)
• Mild dehydration is treated with oral fluids and electrolytes
• Moderate-to-severe dehydration is usually treated in the hospital or
emergency room with IV fluids and electrolytes
21. Drug therapy
• Fludrocortisone
– very potent mineralocorticoid that Increase reabsorption of sodium
from distal renal tubules
– Recommended as first-line drug therapy in dehydration
– Given as 0.1 mg/day , increased by 0.1 mg per week; the maximum daily
dose is 1 mg/day .
22. • Midodrine:
– Alpha agonist that increases arteriolar and venous tone
– Rise standing, sitting, and supine systolic and diastolic blood pressure in
patients with orthostatic hypotension
– Dose is 10 mg three times per day during daytime (maximum dose is 40
mg/day)
– In the prevention of hemodialysis-induced hypotension (unlabeled use),
2.5 to 10 mg is given 15 to 30 minutes prior to a dialysis session
– The major side effect of this drug is supine hypertension
23. • Norepinephrine:
– A vasoactive agent that stimulates beta and alpha-adrenergic receptors
– It increased contractility and heart rate and thereby systemic blood pressure
– IV infusion in shock patients with an initial dose of 8 to 12 mcg/min
• Octreotide:
– A somatostatin analogue that inhibits release of gastrointestinal peptides, some
of which may cause vasodilation
– Subcutaneous doses given 30 minutes before a meal may be used to reduce
postprandial orthostatic hypotension
– Octreotide does not increase supine hypotension
24. Prevention
• Water Intake:
– Combat dehydration and increases blood volume
– Dehydrating drinks like alcohol and coffee should be avoided
– Triggers such as a high temperature environment must be avoided
• Compression stockings:
– They reduce pooling of blood in the legs and can prevent
hypotension
• Body positions:
– Patients should sit up and breathe deeply as they get out of bed in
the morning or when standing up from a sitting position
– Dorsiflexing their feet first and even crossing the legs while upright
can be helpful.
25. Back to our patient
• We took a carful history and we discovered that:
– She do not drink more than 1 liter of fluid/day
– She drinks a lot of coffee and tea
– In her diet she is taking a tricyclic antidepressant to help her reduce weight
– symptoms occur more when changing position form siting to prone
26. Examination and laboratory tests
• She had a baseline BP of 90/56 mm Hg in sitting position
• She has a marked drop of blood pressure after 3 min of standing
reduced to 70/50 with beginning of symptoms
• She had normal thyroid functions, cortisol level, kidney functions and
electrolytes
27. Treatment
• She was advised to:
– Drink at least 3 liters of fluid/day
– To stop coffee
– To stop antidepressant
• At follow up:
– Symptoms improved markedly but still present only in sudden rise
from sitting
– She refused to take any other medications
– She was advised to wear an elastic stoking with disappearance of
the symptoms
28. Take home message
• Hypotension is an important symptom with many causes
• It is not related to a fixed BP level
• BP must be measured both sitting and standing in all cases
• Proper history about patient hydration and drugs is a must
• Further investigations are guided by clinical presentation
• Prevention comes first
• Don’t begin drug therapy before knowing the cause of hypotention