1. There are four criteria for diagnosing diabetes: A1C ≥6.5%, FPG ≥126 mg/dL, 2-hr PG ≥200 mg/dL during OGTT, or random PG ≥200 mg/dL.
2. Lowering A1C below 7.0% can reduce microvascular complications and macrovascular disease.
3. Gestational diabetes is diagnosed using a one-step 75g OGTT or two-step 50g GLT and 100g OGTT, with defined plasma glucose thresholds.
This talk was delivered for postgraduates and faculty of Dr. TMA Pai Hospital, Udupi on 07 March, 2017. This talk covered pathophysiology, screening, diagnosis, complications and management of diabetes mellitus in pregnancy.
diabetes is very common disorder in all age group i.e from infancy to secondary childhood age so intake of good healthy diet is very important for the production of insulin which is needed for body for regular activities
Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
This talk was delivered for postgraduates and faculty of Dr. TMA Pai Hospital, Udupi on 07 March, 2017. This talk covered pathophysiology, screening, diagnosis, complications and management of diabetes mellitus in pregnancy.
diabetes is very common disorder in all age group i.e from infancy to secondary childhood age so intake of good healthy diet is very important for the production of insulin which is needed for body for regular activities
Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy and is defined as glucose intolerance that first emerges or is first recognized during pregnancy. Gestational diabetes mellitus (GDM) affects between 2% and 5% of pregnant women. Data show that increasing levels of plasma glucose are associated with birth weight above the 90th percentile, cord blood serum C-peptide level above the 90th percentile, and, to a lesser degree, primary cesarean deliveries and neonatal hypoglycemia
Important core knowledge about management of diabetic female in pregnancy and what are the possible fetal and neonatal complications and risk factors.
book: Obstetrics by Ten teachers.
Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy and is defined as glucose intolerance that first emerges or is first recognized during pregnancy. Gestational diabetes mellitus (GDM) affects between 2% and 5% of pregnant women. Data show that increasing levels of plasma glucose are associated with birth weight above the 90th percentile, cord blood serum C-peptide level above the 90th percentile, and, to a lesser degree, primary cesarean deliveries and neonatal hypoglycemia
Important core knowledge about management of diabetic female in pregnancy and what are the possible fetal and neonatal complications and risk factors.
book: Obstetrics by Ten teachers.
A comprehensive guide to the management of hyperglycaemia in pregnancy aimed at the primary care physician and based on latest evidenced based criteria. Includes information from latest studies such as HAPO study and ACHOIS, and involves guidelines from the IADPSG, ADA, WHO and Malaysia.
Gestational diabetes mellitus (GDM) is a condition that develops during pregnancy when the body is not able to make enough insulin. GDM affects 2-10% of women during pregnancy.It is important to recognize and treat gestational diabetes as soon as possible to minimize the risk of complications to mother and baby.
High risk pregnancies are admitted in the Fetomaternal Unit, Department of Obstetrics and gynaecology, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka, Bangladesh. As a part of academic activities, all the cases admitted in the previous week are presented in the morning session by one of the Doctor working in the Unit.
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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
- 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
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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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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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
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!
3. A1C <7.0%
Lowering A1C below or around 7.0% has been shown to
reduce:
Microvascular complications
Macrovascular disease
Preprandial capillary PG 80-130 mg/dL (4.1-7.2 mmol/L)
Peak postprandial capillary PG
<180 mg/dL (<10.0 mmol/L)
4. Individualize targets based on:
Age/life expectancy
Comorbid conditions
Diabetes duration
Hypoglycemia status
Individual patient considerations
5. “One-Step” Strategy
75-g OGTT with PG measurement of fasting, at 1 h and 2 h
at 24-28 wks in women not previously diagnosed with overt
diabetes
GDM diagnosis made if PG values meet or
exceed:
Fasting: 92 mg/dL (5.1 mmol/L)
1 h: 180 mg/dL (10.0 mmol/L)
2 h: 153 mg/dL (8.5 mmol/L)
6. “Two-Step” Strategy
50-g GLT (nonfasting) with PG measurement at 1 h
(Step 1) at 24-28 wks in women not previously
diagnosed with overt diabetes
If PG at 1 h after load is ≥140 mg/dL (7.8mmol/L),
proceed to 100-g OGTT (Step 2), performed while
patient is fasting
GDM diagnosis made when two or more PG levels
meet or exceed:
Fasting: 95 mg/dL or 105 mg/dL (5.3/5.8)
1 hr: 180 mg/dL or 190 mg/dL (10.0/10.6)
2 hr: 155 mg/dL or 165 mg/dL (8.6/9.2)
3 hr: 140 mg/dL or 145 mg/dL (7.8/8.0
8. Premeal, bedtime, overnight glucose: 60-99 mg/dL (3.3-5.4
mmol/L)
Peak postprandial glucose: 100-129 mg/dL (5.4-7.1
mmol/L)
A1C: <6.0% (alteration in blood cell turnover that lower the
normal A1C level in pregnancy)
9. A1C - 7% prior to conception to minimize risk
Uncontrolled diabetes: fetal anomalies, preeclampsia,
macrosomia, intrauterine fetal demise, neonatal
hypoglycemia, and neonatal hyperbilirubinemia, among
others. In addition, diabetes in pregnancy increases the risk
of obesity and type 2 diabetes in offspring later in life.
Fetal anomalies: anencephaly, microcephaly, and
congenital heart disease, that increases directly with
elevations in A1C
10. Potentially teratogenic medications (ACE inhibitors, statins,
etc.) : avoided.
GDM should be managed first with diet and exercise, and
medications should be added if needed
Women with pregestational diabetes - baseline
ophthalmology exam in the T1 and then be monitored every
trimester as indicated by degree of retinopathy
11. Women with type 1 diabetes have an increased risk of
hypoglycemia in the first trimester. Frequent hypoglycemia
can be associated with intrauterine growth restriction. In
addition, rapid implementation of tight glycemic control in the
setting of retinopathy is associated with worsening of
retinopathy.
Insulin resistance drops rapidly with delivery of the placenta,
and women become very insulin sensitive, requiring much
less insulin than in the prepartum period.
12. Pregestational type 2 diabetes is often associated with
obesity. Recommended weight gain during pregnancy for
overweight women is 15–25 lb and for obese women is 10–
20 lb. Glycemic control is often easier to achieve in type 2
diabetes than in type1 diabetes, but hypertension and other
comorbidities often render pregestational type 2 diabetes as
high or higher risk than pregestational type 1 diabetes.
13. Medical nutrition therapy (MNT) is central to the control of
GDM, and most women are adequately treated with diet
alone.
All women should be referred to a registered dietician, if
available.
Expert opinion suggests that women should be advised to
try to choose carbohydrates from low-glycaemic-index
sources and lean proteins.
Diet should contain a balance of polyunsaturated and
monounsaturated fats. Saturated fats should be limited.
14. Caloric needs are determined by pre-pregnancy ideal body
weight according to expert opinion: 30 kcal/kg for those
with normal weight and 35 kcal/kg for underweight patients.
Reducing carbohydrates to 40% to 45% of total daily
calories reduces post-prandial hyperglycaemia;
15. Moderate-intensity exercise (e.g., brisk walking, easy jogging,
or swimming) during pregnancy has been associated with
lowering of maternal glucose levels in some but not all
studies. (recommended by NICE and ADA).
16. A study of women with GDM treated with dietary therapy for 4
weeks before initiating insulin found that most women who
achieved good control with diet did so within 2 weeks and had
baseline fasting plasma glucose levels of <5.3 mmol/L (<95
mg/dL). Accordingly, the authors have reasonably recommended
that patients with a fasting plasma glucose <5.3 mmol/L (<95
mg/dL) attempt dietary therapy for at least 2 weeks before starting
insulin, whereas insulin should be started at diagnosis or within a
week of failed dietary therapy in patients with fasting glucose
levels >5.3 mmol/L (>95 mg/dL). Such severe elevations imply
overt diabetes, probably occurring before pregnancy, and the need
for aggressive therapy with prompt initiation of insulin.
17. According to NICE, hypoglycaemic therapy such as insulin
should be considered if blood glucose targets are not
maintained 1 to 2 weeks after introducing changes to diet
and initiating exercise.
Pharmacological therapy should also be considered at the
time of diagnosis of GDM if fetal macrosomia is suspected
by ultrasound investigations
18. The American Congress of Obstetricians and
Gynecologists (ACOG) recommends these guidelines for
insulin initiation: when fasting plasma glucose is >5.3
mmol/L (>95 mg/dL), 1-hour post-prandial plasma glucose
is >7.2 to 7.8 mmol/L (>130 to 140 mg/dL), or 2-hour post-
prandial plasma glucose is >6.7 mmol/L (>120 mg/dL).
19. Insulin needs are highly variable. Requirements increase
throughout pregnancy and average 0.8 units/kg/day in the
first trimester, 1.0 unit/kg/day in the second trimester, and 1.2
units/kg/day in the third trimester.
Insulin therapy requires highly individualised titration. For
isolated fasting hyperglycaemia, a useful approach is to start
10 units of NPH (Neutral Protamine Hagedorn) long-acting
insulin at bedtime and then adjust the dose to achieve fasting
blood sugar <5.3 mmol/L (<96 mg/dL).
20. To address post-prandial hyperglycaemia, one approach is to
use long-acting insulin once or twice daily, with short-acting
prandial insulin (e.g., lispro, aspart) titrated to meet glycaemic
targets.
Insulin is titrated with the goal of normalising blood sugar.
Target glucose levels are below the criteria for insulin
initiation (see ACOG and ADA criteria above).
21. FM monitoring for women with GDM beginning at 32 to 34
weeks’ gestation is recommended: sufficient in women with
good glycaemic control with only dietary therapy, but
randomised trials are lacking.
For women with poor GDM control and those requiring
insulin therapy, more intensive fetal monitoring with non-
stress tests, contraction stress tests, or biophysical profile
assessments is worth considering as per recommendations
from ACOG and the Fifth International Workshop-
Conference on Gestational Diabetes Mellitus
22. USG is recommended to assess for congenital fetal
anomalies in women with GDM presenting with an HbA1c
≥53 mmol/mol (≥7%) or a FPG >6.7 mmol/L (>120 mg/dL).
If ultrasound estimates are used, an abdominal
circumference >75th percentile should prompt
consideration of initiating or intensifying insulin therapy to
lower the risk of large for gestational age offspring.
Ultrasonography is also used to assess fetal size and may
have utility in planning route of delivery. Although
ultrasound estimates of fetal weight have limitations,
particularly in women with a high BMI, ultrasound is a non-
invasive tool that can provide additional data to guide
delivery planning.
23. As increasing fetal size - increased risk of shoulder
dystocia and birth trauma - assessment of fetal size
(clinically/ultrasound), may be useful in planning delivery
route.
Fetal macrosomia is not itself an indication for delivery;
however, c/s may be offered to women with an EFW of
>4500 g.
Intrapartum glycaemic monitoring is particularly advisable
in women with GDM requiring insulin.
controlling maternal plasma glucose levels to <6.1 mmol/L
(<110 mg/dL) during labour is recommended.
24. When labour is planned or already initiated in women with
insulin-treated GDM, long-acting insulin is held and plasma
glucose of <6.1 mmol/L (<110 mg/dL) is maintained by
infusing insulin and glucose if needed. If insulin has already
been delivered, glucose infusions with delayed initiation of
intravenous insulin can be used as guided by the maternal
glucose levels.
Immediately after placental delivery, a large reduction in
insulin requirement occurs, and this must be anticipated to
avoid hypoglycaemia. Initial postpartum insulin needs are
generally as low as, or lower than, pre-pregnancy
requirements.
25. All women should continue taking folic acid (started before
conception) to reduce the risk of neural tube defects. Some
experts recommend higher doses of folic acid for women
with high BMI or with diabetes.
In the long term, therapeutic lifestyle changes such as diet,
exercise, and smoking cessation are important to reduce
the risk of cardiovascular disease.
26. Source: American Diabetes Association. Standards of
medical care in diabetes—2015. Diabetes Care.
2015;38(suppl 1):S1-S93.