This document discusses aerosol therapy and nebulizers. It defines aerosols and outlines factors that influence aerosol deposition in the lungs such as particle size, respiratory anatomy, and breathing patterns. It describes different aerosol delivery devices including metered dose inhalers, dry powder inhalers, and nebulizers. The document focuses on nebulizers, outlining their types (jet and ultrasonic), workings, indications, drugs used, and proper technique for administration. Nebulizers are indicated when precise dosing is needed for critically ill, young, elderly or handicapped patients. Proper technique and positioning can optimize drug deposition in the lungs.
The 6-minute walk test (6MWT) is an easy to perform and practical test that has been used in the assessment of patients with a variety of cardiopulmonary diseases including pulmonary arterial hypertension (PAH). It simply measures the distance that a patient can walk on a flat, hard surface in a period of 6 minutes.
Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors”
Inspiratory Muscle Training or Respiratory Muscle Training or Ventilatory Muscle Training. IMT is the physiotherapy technique, with the help of different breathing exercises.
Application of PEP devices in Cardiorespiratory physiotherapy.
It includes types of PEP devices and their uses in physiotherapy..
It stands for positive expiratory pressure.
It includes spirometry, flutter, rc cornet, acapella, etc.
useful in various cardiorespiratory disorders like COPD, asthma , cystic fibrosis, respiratory failure etc.
The 6-minute walk test (6MWT) is an easy to perform and practical test that has been used in the assessment of patients with a variety of cardiopulmonary diseases including pulmonary arterial hypertension (PAH). It simply measures the distance that a patient can walk on a flat, hard surface in a period of 6 minutes.
Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors”
Inspiratory Muscle Training or Respiratory Muscle Training or Ventilatory Muscle Training. IMT is the physiotherapy technique, with the help of different breathing exercises.
Application of PEP devices in Cardiorespiratory physiotherapy.
It includes types of PEP devices and their uses in physiotherapy..
It stands for positive expiratory pressure.
It includes spirometry, flutter, rc cornet, acapella, etc.
useful in various cardiorespiratory disorders like COPD, asthma , cystic fibrosis, respiratory failure etc.
Island Gate General Trading LLC initially conducted its business in 2004; serving important markets such as industrial, consumer electronics, electrical, and health care. From that humble beginning, the company has come a long way in terms of total business development and expansion.
Introduction
Anatomy and physiology of lungs
Advantage and disadvantage of Pulmonary Drug Delivery system.
Aerosols , propellants & container types.
Current technologies for pulmonary drug delivery.
New technologies for pulmonary drug delivery.
Evaluation of Pharmaceutical Aerosols & PDDS.
Pulmonary drug delivery is primarily used to treat conditions of the airways, delivering locally acting drugs directly to their site of action.
Delivery of anti-asthmatic and other locally acting drugs directly to their site of action reduces the dose needed to produce a pharmacological effect, while the low concentrations in the systemic circulation may also reduce side-effects.
The drugs which are administered by pulmonary route are not only for lungs delivery but it goes to systemic circulation and produce the effect where it is desired through out the body. For Eg. A product containing ergotamine tartrate is available as an aerosolized dosage inhaler for the treatment of migraine & Volatile anesthetics, including, halothane, are also given via the pulmonary route.
Used for inhalation and topical aerosols .
Manufactured by impact extrusion process.
Light in weight, less fragile, Less incompatibility due to its seamless nature.
Greater resistance to corrosion .
Pure water and pure ethanol cause corrosion to Al containers.
Added resistance can be obtained by coating inside of the container with organic coating like phenolic , vinyl or epoxy and polyamide resins.
Administration of drug through nasal route is referred as Nasal drug delivery system.
Nasal administration is a route of administration in which the drug are insufflated through the nose for either local or systematic effect.
Nasal route is an alternative to invasive administrations and provides a direct access to the systemic circulation.
Penetration Enhancers:
Mechanism:
Inhibit enzymatic activity
Reduce mucus viscosity
Reduce MCC
Open tight junctions
Solubilize the drug
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.
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
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
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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!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
2. AIM OF AEROSOL THERAPY
• To deliver a therapeutic dose of the selected
agents to the desired site of action.
• Choice of route for drug delivery
-Directly to the site of action
-Therapeutic action with side
Effects: high therapeutic index,
greater efficacy & safety
3. AEROSOL
• Definition
A suspension of very fine liquid or solid
particles in a gas.
• Key to aerosol therapy is aerosol particle
• Respirable range:1-5 micron
• 80%drugs deposited in oropharynx
• 10% in walls of inhaler
• 10% in the lungs
( SP Newman et.al.1985 )
4. • In mechanically ventilated patients
-51%within nebulizer unit
-2.2%IN Rt LUNG &0.9% IN Lt LUNG
(SH Thomas M fiddler et.Al.1993)
• In clinical settings, medical aerosols are
generated with atomizer, nebulizer or inhalers –
devices that physically disperse matter into
small particles & suspend them into a gas.
5. AEROSOL DELIVERY SYSTEMS
The three principle types of devices widely
used are :
1.MDI-metered dose inhalers
2.DPI-dry powder inhalers
3.Nebulizers
6. METERED DOSE INHALERS
• Most widely used
• Aerosol flow rate 30
m/s or 100 km/h
• Propellants were
CFC
7. ADVANTAGES OF MDI
• Inexpensive
• Light, compact
• Quick delivery of drugs
• Precise and consistent doses
8. DISADVANTAGES OF MDI
• Difficulty in coordination of activation &
inspiration
• Time consuming to teach
• Contains CFC
• Cannot be used in children & elderly
• Cannot be used in seriously ill patients
• Cannot be used in mechanically ventilated
patients
11. SPACERS
• Holding chambers or reservoirs
• Attachment to a MDI
• Advantages :
1.No need to activate coordination
With inspiration
2.Increases drug deposition in lung
3.Reduces drug deposition in mouth
4.Used in children with face mask
5.Decreases incidence of oral
thrush
12. DRY POWDER INHALERS
• Introduced in 1960’s
• No propellants
• Requires patient’s own Inspiratory effort
to form aerosol
• Powder is delivered only when patient
inhales
13. ADVANTAGES OF DPI
• Light weight
• No hand breath coordination
• Quick delivery of drugs
• Useful in children above 5 yrs of age
Disadvantages of DPI
• Require high inspiration flow >28 l/min
14. COMPARISION BETWEEN MDI &DPI
• High velocity aerosols • Aerosol velocity
depends on inspiratory
flow rate
• No coordination
• Requires coordination
needed
• Time consuming to
• Easy to teach
teach
• Requires slow & deep • Requires high insp
breathing only flow >28 l/min
15. CHARACTERISTICS OF THERAPEUTIC
AEROSOLS
• Effective use of aerosols requires an
understanding of characteristics of the
aerosols.
• Aerosol output (wt /minute)
• Emitted dose
This tells little about the amount of
drug reaching the targeted site of action.
16. • A substantial proportion of particles that leave
a nebulizer may never reach the lungs.
• Effectiveness of medical aerosols depends on
amount of aerosol particles deposition to the
lower respiratory tract & deposition of aerosol
influenced by many other factors.
17. FACTORS INFLUENCING DEPOSITION
• Physical & chemical properties of
aerosols
• Anatomy of the respiratory tract
• Physiological factors
(J E Agnew, D Pavian, S W Clarke et.al.1984)
18. PHYSICAL & CHEMICAL PROPERTIES
OF AEROSOLS
GRAVITY
• Aerosol size must be >1 microns because at this
mass gravity loses its influence on particles.
( Chantal Darquenne , G Kim Prisk et.al.2000 )
• Gravity influence is in direct relation with particle
mass
• Greater mass—tendency to undergo proximal
airway deposition
20. PARTICLE SIZE
• Aerosol particle size depends upon :
-- nebulizer chosen
--Method used to generate aerosol
• It is not possible to visually determine whether a
nebulizer is producing an optimal size
particles…
• Aerosols traverse tubular strs in which turbulent
flow is the rule…
• >Particle size---- gravity influence
21.
22. • 1-5 micron MMAD important determinant of its
deposition efficacy in LRT
• 1-3 micron greater deposition
23. TONICITY OF THE FLUID
• Hypertonic fluid tend to absorb water.
• Hypotonic aerosols may evaporate
• Normally, mucous membrane is neutral in
relation to electrical charges
24. ANATOMY OF THE RESPIRATORY TRACT
• Diameter
Infants and children have small diameter of an
airway suggest that having low level of drug
deposition , even that is adequate when
considered in terms of body weight (mg of
drug deposited per kg of BW ).
(Fok T F , S.Monkman , M Dolvich et.al.1996 )
• Length
• Branching angles of airway segments
25. PHYSIOLOGICAL FACTORS
• Airflow
Increasing flow 6,8,10 L / min increased the
mass output of particles in the respirable
range of 1-5 microns.
( D Hess , P Williams , S Pooler et.al. 1996 )
• Breathing pattern
Deposition of particles are directly related
to inhaled volume & inversely related to
ventilatory rate.
• Inspiratory hold
27. • 1872 - NEBULIZER derived from the Latin
“nebula” meaning “mist”
• 1874 –definition as “an instrument for converting
a liquid into a fine spray, especially for medical
purposes”
• The logic of creating a vapor or aerosol for the
inhalation treatment of lung disease is at least as
old as written records of medicine.
28. • The Ayurvedic tradition of medicine in India
which dates back perhaps 4,000 yrs or more ,
used inhaled substances for managing
respiratory disorders.
• 19th century-inhalation devices were described
• 1930-atomizers
29. • 1940-collison nebulizer
It used baffle to filter out larger particles,
thus distinguishing a “nebulizer” from
“atomizer”.
• 1950-wright nebulizer
Much more compact than collison, closely
resembled today’s pneumatically powered neb.
• 1960-ultrasonic nebulizer
A diff method of creating liquid aerosols .
33. • It is a system in which high velocity gas flow
is directed into a tube that is immersed in a
water reservoir.
• It operates from a pressurized gas
• working mechanism :
Venturi Principle : As the gas flow
through the tube, water is drawn up in
between the surfaces and come across the
way of gas flow through fine spore. this gas
stream impacts upon the fluid surface and
dispersing liquid as an aerosol.
34. FEATURES OF JET NEBULIZER
• Cools during operation
• Less expensive
• More noise
• More Rx time
• small particle size
• Small output rate
38. • It is an electric nebulizer
• Working principle : piezoelectric effect
ultrahigh frequency current
piezoelectric transducer
ultrahigh frequency vibrations
disk vibration
couplant (water bath)
39. FEATURES OF ULTRASONIC NEBULIZER
•More expensive
•Heats up during operation , Less noise
•Less Rx time
•Large average particle size ( Joseph L Rau
et.al.2002 )
•Large output rate
•0.5 to 3 microns – 90 % of particles within effective
range
40. INDICATIONS FOR NEBULIZER
• Useful in children ,
Handicapped person ,
Seriously ill patients
• Ventilated patients
• Elderly individuals
• High doses can be given
• Combination drugs can be given
41. • Enhancement of secretion clearance
• Sputum induction
• Humidification of respired gases
• Prevent dehydration
• Prevent or relieve bronchospasm
42. HAZARDS OF NEBULIZER
• Bronchospasm
• Over hydration
• Delivery of contaminated aerosols
• Tubing condensation
• Swelling of retained secretions
44. Distilled water/NS
• Cheapest / very economical
• Easily available
• Effective Mucolytic
• Free of ions (distilled water)
• Routinely used in practice
50. Nebulizer as an adjunct to chest
physiotherapy
• Nebulized NS enhances mucociliary clearance ,
given thrice in a day before chest
physiotherapy & also salbutamol before NS to
prevent bronchoconstriction
( J.Morton , J.A.Douglass , J.Reidler et.al.1996 )
• With the patient resting in an upright position;
chest physiotherapy, by the forced expiration
technique with postural drainage; and chest
physiotherapy following five minutes' inhalation
of either nebulized normal saline or nebulized
terbutaline 5 mg
51. • Use of both nebulized saline and nebulized
terbutaline immediately before chest
physiotherapy gave a significantly greater yield
of sputum than did physiotherapy alone, and
terbutaline.
(Sutton PP, Davidson J , Smith FW et.al.1988 )
• In mechanically ventilated patients , those
having low lung volume chest PNF technique
should be used to improve lung volume & thus
maximum aerosols can be administered.
• Lung segment which is to be drained out
require to positioned up so that aerosols reach
to upper area.
52. TECHNIQUE FOR USING NEBULIZER
• 1. Place drug solution in nebulizer,
employing a fill volume 2-6 ml
• 2. Place nebulizer in Inspiratory line
• 3. Ensure airflow of 6-8 L/min through the
nebulizer.
• 4. Ensure adequate tidal volume ( 500 ml in
adults). Attempt to use duty cycle > 0.3, if
possible.
53. • 5. Observe nebulizer for adequate aerosol
generation throughout use.
• 6. Disconnect nebulizer when all medication is
nebulized or when no more aerosol is being
produced.
54. CONCLUSION
• Nebulizer is the key component as a rule for
gaining chest clearance on mech.vent Pts.
• physiotherapist must give chest physiotherapy
following neb to augment secretion drainage
• Ensure proper position for nebulization.
• Choice of a nebulizer on the basis of need of
therapeutic effectiveness & availability of a
device.
• Only about <10% drug reaches to the desired
site , so try to optimize drug deposition.
• use cleaned nebulizer & prepare fresh solution.
55. • Adjust adequate oxygen flow 6-8 L/min to
produce particles in respirable range.
• Aerosol particle deposition is directly related to
inhaled volume & inversely related to
ventilatory rate , so maintain inspiration for 3-5
sec & breath holding for 2-4 sec or as long as
possible.
• Determine the therapeutic effectiveness
following nebulization + chest physiotherapy.
