The ARIA initiative was developed in collaboration with the World Health Organization to provide evidence-based guidelines for diagnosing and treating allergic rhinitis. The goals of ARIA were to update healthcare professionals' knowledge of rhinitis, highlight its impact on asthma, provide guidance on diagnosis and treatment options, and propose a stepwise management approach. ARIA developed evidence-based guidelines in 1999 and produced additional materials to help improve rhinitis care delivery, particularly in developing countries where rhinitis prevalence is high.
Triệu chứng viêm mũi dị ứng thời tiết | Venus GlobalVENUS
Biến đổi khí hậu, nhiệt độ thay đổi thất thường làm ảnh hưởng nghiêm trọng đến đường hô hấp, đặc biệt là các triệu chứng về bệnh viêm mũi dị ứng thời tiết. Thời tiết là một tác nhân khách quan mà chúng ta không thể nào tránh được, nên cách tốt nhất là hãy tự bảo vệ bản thân mình. Vậy thực chất bệnh viêm mũi dị ứng thời tiết là gì? Làm cách nào để thoát khỏi loại bệnh này? Hãy tìm hiểu cùng chúng tôi cách điều trị viêm mũi dị ứng do thời tiết ngay tại nhà cực kỳ an toàn và hiệu quả.
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SARI CRITICAL CARE TRAINING CLINICAL SYNDROMESSandro Zorzi
OPENWHO PORTAL PRESENTATION ON CORONAVIRUS
At the end of this lecture, you will be able to:•Describe the importance of early recognition of patients with SARI.•Recognize patients with severe pneumonia.•Recognize patients with ARDS.•Recognize patients with sepsis and septic shock.
what is community acquired pneumonia(CAP),what is the prevalence of (CAP) ,what are the risk factors and what are the causative agents ,what are the clinical presentations ,how to diagnose it,what are the needed investigations ,what is the management ,what are the procedures to decrease the incidence,
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. The ARIA initiative was developed
as a state-of-the-art for the specialist, the general
practitioner and for health care workers:
• to update their knowledge of allergic rhinitis,
• to highlight the impact of allergic rhinitis on asthma,
• to provide an evidence-based documented revision on
the diagnosis methods,
• to provide an evidence-based revision on the
treatments available,
• to propose a stepwise approach to the management of
the disease,
• to assess the magnitude of the problem in developing
countries and to implement guidelines (with IUATLD)
3. ARIA program
First phase:
• Development of evidence-based guidelines
during a workshop held at WHO in December
1999 (J Allergy Clin Immunol, suppl, Nov 2001).
• Document has been endorsed by several allergy,
respiratory, ENT and paediatric associations.
4.
5. ARIA program
First phase:
•
Development of evidence-based guidelines during a workshop held
at WHO in December 1999 (J Allergy Clin Immunol, suppl, Nov 2001).
•
Document has been endorsed by several allergy, respiratory, ENT
and pediatric associations.
Second phase:
• To produce materials to help improve delivery of
care to those with rhinitis. In particular a pocket
guide
• To implement ARIA guidelines
• To update the workshop report
6.
7. 1- Why ARIA ?
2- New classification of rhinitis
3- Importance of nasal
inflammation
4- Treatment based on evidence
5- Impact of rhinitis on asthma
8. Prevalence of hay fever: 13-14 yr olds - ISAAC
Strachan et al, Pediatr Allergy Immunology 1997
≥20%
10-20%
<10%
11. Increase in prevalence of rhinitis with age in
Denmark
- Study 1: children 7-17 yrs studied at 6 yr intervals
Ulrik et al, Allergy 2000
- rhinitis increased from 15 to 22%
- often linked with IgE sensitization
- Study 2: adults 15-41s yr studied at 8 yr intervals
Linneberg et al, J Allergy Clin Immunol 2000
- rhinitis increased from 25 to 32%
- often linked with IgE sensitization
12. SF-36 in seasonal and perennial rhinitis
Bousquet, Burtin et al J Allergy Clin Immunol 1994
Ciprandi et al, Allergy 2002
100
controls
Mean score
perennial rhinitis
75
pollen rhinitis
50
25
0
PF
SF
PA
SA
MH
EF
BP
GH
13. Needs for new guidelines in the
management of allergic rhinitis
• The International Consensus on Rhinitis was a
•
•
major step forward and was recently validated
for the treatment of seasonal allergic rhinitis.
However,
• it was not evidence-based
• new drugs have been available since 1995.
• it was mainly applicable to developed countries.
Moreover, the ARIA guidelines are targeting the
patient globally instead of treating each target
organ individually
14. Needs for guidelines in the management
of allergic rhinitis
• Allergic rhinitis is a global health problem
affecting 5 to 50 % of the population
• Its prevalence is increasing.
• Although it is not usually a severe disease,
rhinitis alters social life and affects school
performance and work productivity.
• Costs incurred by rhinitis are substantial.
• Implementation of guidelines improves the
condition of patients with allergic rhinitis.
15. Needs for guidelines in the management
of allergic rhinitis in developing countries
• ISAAC study: seasonal allergic rhinitis (hay
fever) affects up to 50% of adolescents in
certain developing countries: Guinea
(Conakry), Ivory Coast (Abidjan) or Nigeria
(Lagos).
• However, the validity of the questionnaire used
should be checked in these countries
• Rhinitis may be a problem in some parts of
developing countries only
• Risk factors should be understood for
preventive measures
16. 1- Why ARIA ?
2- New classification of rhinitis
17. ARIA
The classification "seasonal" and
"perennial" allergic rhinitis
has been changed to
"intermittent" and "persistent"
allergic rhinitis
18. Pollen season in Montpellier (1990)
6000
grass
cypress
pollens/m
3
air
.
5000
4000
3000
2000
1000
0
0
10
20
weeks
30
40
threshold level
for symptoms
19. Concept of "minimal persistent inflammation"
Ciprandi et al, J Allergy Clin Immunol 1996
mite allergen (µg/g of dust)
Mechanisms of house dust mite induced rhinitis
100
10
.
theshold level
for symptoms
1
0,1
0
2
minimal
persistent
symptoms inflammation
inflammation
4
6
8
10
12 Months
20. ARIA Classification
Intermittent
Persistent
. < 4 days per week
. or < 4 weeks
. ≥ 4 days per week
. and ≥ 4 weeks
Mild
Moderate-severe
normal sleep
& no impairment of daily
activities, sport,
leisure
& normal work and
school
& no troublesome
symptoms
in untreated patients
one or more items
. abnormal sleep
. impairment of daily
activities, sport, leisure
. abnormal work and
school
. troublesome symptoms
21. 1- Why ARIA ?
2- New classification of rhinitis
3- Importance of nasal inflammation
25. Statement of evidence: Strength of evidence
Shekelle et al, BMJ 1999
A directly based on randomized controlled trials
and meta-analyses
B
C
evidence from at least one controlled study without
randomization or
extrapolated recommendation from
category A evidence
evidence from at least one other type of quasiexperimental study or extrapolated
recommendation from
category A or B evidence
D evidence from expert committee reports or
opinions or clinical experience of respected
authorities, or both
26. Strength of evidence for treatment of rhinitis
ARIA
intervention
SAR
adult
PAR
children adult
children
oral anti-H1
intranasal anti-H1
intranasal CS
intranasal chromone
anti-leukotriene
subcutaneous SIT
sublingual / nasal SIT
allergen avoidance
A
A
A
A
A
A
A
D
A
A
A
A
A
A
A
D
A
A
A
A
A
A
A
A
A
A
D
A
D
28. Mild intermittent rhinitis
ARIA
Options (not in preferred order)
- oral or intranasal anti-H1
- intranasal decongestants
- oral decongestants (not in children)
29. Moderate-severe intermittent rhinitis
Mild persistent rhinitis
ARIA
Options (not in preferred order)
- oral or intranasal anti-H1
- oral anti-H1 + decongestant
- intranasal CS
- (chromones)
Patient should be re-assessed after 2-4 wks
30. Moderate-severe persistent rhinitis
ARIA
Step-wise approach
- intranasal CS as a first line treatment
- if major blockage: add short course of oral CS
or decongestant
Re-assess after 2-4 weeks
- if symptoms present add:
- oral anti-H1 (± decongestants)
- ipratropium
31. Conjunctivitis rhinitis
ARIA
Options (not in preferred order)
- oral or ocular anti-H1
- ocular chromones
- saline
Do not use ocular CS without care and eye
examination
32. Treatment of allergic rhinitis (ARIA)
Allergic Rhinitis and its Impact on Asthma
mild
intermittent
moderate
severe
intermittent
mild
persistent
moderate
severe
persistent
intra-nasal steroid
local chromone
oral or local non-sedative H1-blocker
intra-nasal decongestant (<10 days) or oral decongestant
allergen and irritant avoidance
immunotherapy
33. ARIA in low-income countries
•
The rationale for treatment choice in
developing countries is based upon:
• level of efficacy
• low drug cost affordable for the majority
of patients
• inclusion in the WHO essential list of drugs:
only chlorpeniramine and BDP are listed
•
It is hoped that new drugs will be
available on this list
35. 1- Why ARIA ?
2- New classification of rhinitis
3- Importance of nasal inflammation
4- Treatment based on evidence
5- Impact of rhinitis on asthma
36. First description of hay fever
John Bostock, Med Chir Trans, 1819; 10: 161
"About the beginning or middle of
June in every year …..
…. A sensation of heat and fulness is
experienced in the eyes ….
…. To this succeeds irritation of the
nose producing sneezing ….
…. To the sneezings are added a
further sensation of tightness of the
chest, and a difficulty of breathing"
37. Links between rhinitis and asthma:
Epidemiologic evidence
1- Asthma prevalence is increased in
allergic and non-allergic rhinitis
2- Rhinitis is almost always present in
asthma
3- Rhinitis may be a risk factor for
asthma
4- Non-specific bronchial hyperreactivity
is increased in persistent rhinitis
38. Perennial rhinitis: an independent risk factor
for asthma
Leynaert et al, J Allergy Clin Immunol 1999
% subjects with asthma
25
controls
20
rhinitis
15
10
5
0
atopic
non-atopic
39. Frequency of asthma related to allergens
Frequency of asthma related
to allergens (%)
Linneberg et al, Respir Med 2001
60
50
no rhinitis
rhinitis
40
"allergy"
assessed by
questionnair
e
30
20
10
0
pollen
animal dander
allergy
mite
40. Early allergic rhinitis as a risk factor for
asthma
Wright et al, Pediatrics 1994
children with symptoms (%)
80
60
cough, wheeze
asthma
40
20
0
rhinitis allergic allergic non-allergic none
ND
in prick test
pos.
neg.
ND
ND
neg.
41. Bronchial hyperreactivity in ECHRS patients
Leynaert, Bousquet, Neukirch, Am J Respir Crit Care
Med 1997
80
- Paris + MPL
% subjects
60
- 821 adults
- 20-44 yr
40
- PC20 methacholine
≤4mg
20
0
controls seasonal perennial seasonal asthma
rhinitis
rhinitis + perennial
rhinitis
non-asthmatic
without wheeze
42.
43. Eosinophils (EG2+ cells)
in biopsies of asthmatics
Bronchial mucosa
Bousquet J et al. N Engl J Med 1990
Nasal mucosa
Chanez P et al. Am J Respir Crit Care Med 1999
53. QOL in a population-based study (ECRHS)
Leynaert et al, Am J Respir Crit Care Med 2000
60
p<0.001
p<0.001
p<0.001
p<0.001
Mean score
50
allergic rhinitis (N=297)
asthma + AR (N=76)
40
30
20
10
0
controls (N=448)
Physical Summary
Mental summary
score
54.
55. ARIA program
•
•
•
•
Guideline implementation in low income
developing countries in collaboration with
IUATLD
need of adaptation to the local situation as
well as to social and cultural barriers.
A joined ARIA-IUATLD program started to
assess the magnitude of allergic rhinitis in
these countries to confirm the results of
the ISAAC study using a more detailed
questionnaire.
Then, a pocket guide specifically devoted to
low income countries will be developed.
56. Ultimate goals of ARIA
• To translate evolving science on rhinitis into
recommendations for the management and
prevention of the disease
• To better assess the interactions between
rhinitis and asthma
• To increase awareness of rhinitis and its
public health consequences
• To make the effective treatment of rhinitis
available and affordable for every patient in
the world
57. Recommendations
1- Patients with persistent rhinitis should be
evaluated for asthma
2- Patients with persistent asthma should be
evaluated for rhinitis
3- A strategy should combine the treatment of
upper and lower airways in terms of
efficacy and safety