This document discusses hypertensive emergencies in children, including definitions, etiology, management, and the updated AAP guidelines. It defines hypertensive urgency as elevated blood pressure without end organ damage, while hypertensive emergency involves acute elevation with end organ damage. Common causes in children include kidney disease, endocrine disorders, and drugs. Management involves stabilizing vital signs, confirming hypertension and end organ damage, evaluating for the underlying cause, and lowering blood pressure gradually using drugs like labetalol, sodium nitroprusside, and nicardipine. The updated AAP guidelines revised blood pressure classifications, recommended ambulatory blood pressure monitoring, and suggested screening investigations based on risk factors.
Hypertension Emergencies and their managementpptxUzomaBende
This Presentation talks about Hyprtension, the mode of presentation of hypertensive crisis and the effective management of hypertensive crisis to prevent case fatalities.
childhood hypertension is unique presentation by Dr. Hemraj Soni,
very compressive, complied,upgraded, presentation......will definative helpfull for paediatrician n resident doctor............
pediatric hypertension workup and evaluation Balqees Majali
pediatric rotation seminar
hypertension in pediatrics workup and evaluation
ps: obtain renal US in all children with HTN as a part of your evaluation whether they have risk factors or not and whatever the age.
principles of preoperative evaluation and preparation.pptxMahmood Hasan Taha
The importance of preoperative assessment and evaluation to prepare the patient to surgical procedure is directly proportional with the degree of successful of any surgical procedure.
So, good preoperative assessment and evolution is necessary to avoid the morbidity and mortality that expected to the surgical procedures.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
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
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.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
3. Definition
Classification Children aged 1-12 y Adolescents ≥13 y
Normotensive <90th centile <120/80mmHg
Elevated BP ≥90th centile to ≤95th
centile
120/<80 to
129/<80mmHg
Stage 1 HTN ≥95th centile < 95th
centile +12mmHg
130/ 80 to 139/
89mmHg
Stage 2 HTN ≥95th centile
+12mmHg
>140/90mmHg
4. Contd..
• Hypertensive Urgency: elevated blood pressure without the presence of end
organ damage, although these patients may still manifest symptoms such as
headache and nausea.
• Hypertensive Emergency: acute elevation of blood pressure with presence of
end organ damage
IJPP Vol.14 No.3 JUL-SEPT 2012
6. Pathophysiology of hypertensive emergencies. (Kitiyakara C, Guzman NJ. Malignant hypertension
and hypertensive emergencies. J Am Soc Nephrol 1998;9:135.)
CPP= MAP- ICP
7. Vitals
Tachycardia
Hypertension
Low SpO2 (Pulm edema)
RS
B/L Basal Crepts (Pulm edema)
CVS
Gallop
CCF
CNS
Altered sensorium Coma
Seizures
Head ache/ dizziness
Nausea
Vomiting
+/- FND
Eye
Blurring of vision
Papilledema
Retinal hemorrhage
Renal
Cola colored urine
Reduced u/o
Puffiness of face, edema
Clinical Features
PA
Palpable mass
Hepatomegaly
8. Management
ABC- Care
Confirm Hypertension &
Brief history- etiological clue
End organ damage
Hypertensive Urgency Hypertensive Emergency
Drugs to lower BP
no more than 25% within the first 24
hours using conventional oral therapy
Drugs to lower BP
reduced by less than
25% over the first 2 to 8 hours and
gradually the blood pressure should be
normalized over the next 24 to 48 hours
Continuous BP monitoring- preferably arterial
Hemodynamic monitoring in PICU
NO YES
Primary problem
Raised ICP- Rx
Raised ICP
9. Evaluation
History:
• Head ache, vomiting, altered sensorium, seizures, facial palsy, FNDs
• Chest pain, exertional dyspnea, palpitations
• Reduced u/o, cola colored urine, edema
• Prolonged Fever, rash, oral ulcers
• Drug abuse/ Corticosteroids/ Anabolic steroids/ Abrupt clonidine
withdrawal/ erythropoietin/ Cyclosporine
• Past H/O- UAC. F/H/O HTN, Endocrinopathy.
Etiology?
End organ
damage?
10. Examination-GPE
• Vitals- including 4 limb pulse and BP
• Growth failure anemia- CKD, truncal obesity- Cushing
• Head to toe:
• Pallor, flushing, diaphoresis- Pheochromocytoma
• Dysmorphism- Turner, Marfan
• Café au-lait spots- Neurofibromatosis
• Adenoma sebaceum- Tuberous sclerosis
• Malar rash- SLE
• Acanthosis Nigricans- Metabolic syndrome
12. Investigations- Guided by history and
examination
• Urinalysis (RBC casts, proteinuria)- PSGN, AKI
• Blood urea, Serum creatinine, 24hr urine protein, urine protein creatinine ratio
• CBC and PS (HUS, anemia in CKD)
• CXR and ECG- look for pulm edema and Ventricular hypertrophy
• ECHO: Ventricular hypertrophy, structural abnormalities
• Suspected SLE: C3, ANA profile
• Suspected renal: Renal doppler, USG KUB
• CT/MRI brain: Look for cerebral edema/ Stroke/ SOL
• Urine toxicology: Drug abuse
• Urine catecholamines: Pheochromocytoma
13. Drugs in hypertensive emergencies
Labetalol
1st line IV medication for
Hypertensive emergency
In our set-up
Group
α+β blocker
MOA Reduce both
systolic &Diastolic
BP, HR same or
slightly low
S/E Postural
hypotension
C/I Asthma and
overt CCF
Onset 2.5min,
peak 15min, ½ life
5.5hr
Dose
0.25–3.0mg/kg/hr
14. Sodium Nitroprusside
Group
Vasodilator
MOA
Direct arterial and
venous smooth
muscle dilator
S/E Cyanide toxicity-
monitor levels if >72hrs
or infused with
thiosulphate
Onset & ½ life
Rapid onset short
acting
C/I Renal and hepatic
dysfunction
Dose
0.53–10 mcg/kg/min
16. Esmolol Group
Cardio selective β
blocker
MOA
Reduces HR
S/E Bronchospasm,
profound
bradycardia, CCF
Onset & ½ life
Rapid onset ultra
short acting
Well suited for
critically ill
Dose
100–500
mcg/kg/min
17. Nicardipine Group
Calcium Channel
Blocker
MOA reduces
peripheral vascular
resistance
S/E headache,
nausea,
tachycardia and
hypotension, ↑ICP
Onset & ½ life
15mins, 10-15mins
C/I Raised ICP
Dose
0.5 to 1 μg/kg/min
max- 3 μg/kg/min
Can be used in
bronchospasm and
renal dysfunction
Need to be diluted in large
volume
18. Trinitroglycerine
Group
Arterio and venodilator
MOA
Release NO which
causes vascular smooth
muscle relaxation
S/E
Headache,
hypotension,
Abd pain
Route
Oral/sublingual/transder
mal
IV
C/I Concurrent use of
PDE5inhib,
Raised ICP,
pericardial tamponade
Dose
1-5mcg/kg/min up to
10mcg/kg/min
21. AAP HTN UPDATE
• New blood pressure charts for boys and girls.
• Blood pressure classification revised-
• Elevated BP for pre hypertension – 90th to 95th centile 90th to 95th centile
• Stage 1 HTN: 95th to 99th +5mmHg 95th to 95th +12mmHg
• Stage 2 HTN: >99th centile +5mmHg >95th centile +12mmHg
• Stepwise guide lines to manage BP
• Increased stress on ABPM for pediatric HTN diagnosis
• Children >6 y of age were recommended to not routinely require extensive
investigation for secondary causes of HTN if they have a positive family
history of HTN, are overweight or obese, and/or do not have history or
physical examination findings suggestive of a secondary cause of HTN.
22. Contd..
• Monogenic HTN should be suspected in patients with a family history of early-
onset HTN, hypokalemia, suppressed plasma renin, or an elevated Aldosterone
Renin Ratio (ARR).
• Renovascular HTN should be suspected in children with stage 2 HTN, significant
diastolic HTN, discrepant kidney sizes on ultrasound, hypokalemia on screening
investigations, or an epigastric and/or upper abdominal bruit on physical
examination
• Electrocardiogram not recommended for assessing left ventricular hypertrophy.
• Echocardiography strongly recommended to assess for target organ damage at
the time of consideration of pharmacologic treatment of HTN.
23. Contd..
• Doppler renal ultrasonography may be useful in evaluation of renal artery
stenosis in normal weight children and adolescents >8 years of age who will
cooperate with the procedure.
• Indication to initiate treatment
• In hypertensive children and adolescents who have failed lifestyle modifications.
• Those with target organ damage such as left ventricular hypertrophy.
• Symptomatic HTN, or stage 2 hypertension without a clearly modifiable factor (e.g., obesity).
• Target BP: Reduction in systolic BP and diastolic BP to <90th percentile
• Beta blocker should not be used as initial anti- hypertensive. Usual choice of anti-
hypertensive should include ACEi, ARB, long-acting calcium channel blocker, or
thiazide diuretic.
24. References
1. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and
Adolescents- AAP 2017
2. Evaluation and management of Hypertension- IP statement 44__17, 2007 volume feb
3. Evaluation and management of pediatric hypertensive crises: hypertensive urgency and hypertensive
emergencies- Nirali H Patel et al. Dovepress journal, open access emergency medicine nov 2012.
4. IJPP article- Hypertensive crisis in children- Vol.14 No.3 JULY SEPT 2012
5. American Academy of Pediatrics Clinical Practice Guidelines for Screening and Management of High Blood
Pressure in Children and Adolescents: What is New?- IP Update VOLUME 56__APRIL 15, 2019