Reducing the Incidence of 131I Induced Sialadenitis - The Role of PilocarpineXiu Srithammasit
My presentation
Reducing the Incidence of 131I Induced Sialadenitis - The Role of Pilocarpine.
THE JOURNAL OF NUCLEAR MEDICINE Vol. 49 No. 4 April 2008 by Edward B. Silberstein from Department of Nuclear Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
My Blog : http://ImagingSing.wordpress.com
General anesthesia in pediatric dentistry , Kids DentistryDr. Rajat Sachdeva
To keep your child safe and comfortable during a dental procedure, your child’s dentist might decide to use general anesthesia in the operating room. General anesthesia also may be used if your child needs extensive or complicated procedures that will take a long time to complete, or needs several procedures done all at the same time.
For more information contact :-
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
• Google+ link: https://goo.gl/vqAmvr
• Facebook link: https://goo.gl/tui98A
• Youtube link: https://goo.gl/mk7jfm
• Linkedin link: https://goo.gl/PrPgpB
• Slideshare link : http://goo.gl/0HY6ep
• Twitter Page : https://goo.gl/tohkcI
• Instagram page : https://goo.gl/OOGVig
Reducing the Incidence of 131I Induced Sialadenitis - The Role of PilocarpineXiu Srithammasit
My presentation
Reducing the Incidence of 131I Induced Sialadenitis - The Role of Pilocarpine.
THE JOURNAL OF NUCLEAR MEDICINE Vol. 49 No. 4 April 2008 by Edward B. Silberstein from Department of Nuclear Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
My Blog : http://ImagingSing.wordpress.com
General anesthesia in pediatric dentistry , Kids DentistryDr. Rajat Sachdeva
To keep your child safe and comfortable during a dental procedure, your child’s dentist might decide to use general anesthesia in the operating room. General anesthesia also may be used if your child needs extensive or complicated procedures that will take a long time to complete, or needs several procedures done all at the same time.
For more information contact :-
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
• Google+ link: https://goo.gl/vqAmvr
• Facebook link: https://goo.gl/tui98A
• Youtube link: https://goo.gl/mk7jfm
• Linkedin link: https://goo.gl/PrPgpB
• Slideshare link : http://goo.gl/0HY6ep
• Twitter Page : https://goo.gl/tohkcI
• Instagram page : https://goo.gl/OOGVig
Preoperative sedation and premedication in pediatrics Nida fatima
Sedation and premedication
Why? --Aims of premedication!
When?
How?
Drugs for premedication!
Routes for administration!
Side effects & complications!
Parental Anxiety
SEPARATION ANXIETY
Kids not small adults
Sedative -omitted for neonates and sick infants.
child's age, body weight, drug history, allergic status and medical or surgical conditions
Avoid needles!!
Oral premedication ≠ risk of aspiration pneumonia
Allay Anxiety & fear.
Reduce saliva and airway secretions.
Enhance the hypnotic effects of general anaesthesia.
Reduce postoperative nausea & vomiting.
Chlordiazepoxide 10mg capsules smpc taj pharmaceuticalsTaj Pharma
Chlordiazepoxide Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, Chlordiazepoxide Dosage & Rx Info | Chlordiazepoxide Uses, Side Effects -: Indications, Side Effects, Warnings, Chlordiazepoxide - Drug Information - Taj Pharma, Chlordiazepoxide dose Taj pharmaceuticals Chlordiazepoxide interactions, Taj Pharmaceutical Chlordiazepoxide contraindications, Chlordiazepoxide price, Chlordiazepoxide Taj Pharma Chlordiazepoxide 10mg Capsules SMPC- Taj Pharma . Stay connected to all updated on Chlordiazepoxide Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Doctor Sadgun Bhandari - Management of Aggression - Dr. Sadgun Bhandari is a General Psychiatrist Consultant and an expert at the management of Serious Mental Illness especially Schizophrenia and Bipolar Affective Disorder.
Preoperative sedation and premedication in pediatrics Nida fatima
Sedation and premedication
Why? --Aims of premedication!
When?
How?
Drugs for premedication!
Routes for administration!
Side effects & complications!
Parental Anxiety
SEPARATION ANXIETY
Kids not small adults
Sedative -omitted for neonates and sick infants.
child's age, body weight, drug history, allergic status and medical or surgical conditions
Avoid needles!!
Oral premedication ≠ risk of aspiration pneumonia
Allay Anxiety & fear.
Reduce saliva and airway secretions.
Enhance the hypnotic effects of general anaesthesia.
Reduce postoperative nausea & vomiting.
Chlordiazepoxide 10mg capsules smpc taj pharmaceuticalsTaj Pharma
Chlordiazepoxide Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, Chlordiazepoxide Dosage & Rx Info | Chlordiazepoxide Uses, Side Effects -: Indications, Side Effects, Warnings, Chlordiazepoxide - Drug Information - Taj Pharma, Chlordiazepoxide dose Taj pharmaceuticals Chlordiazepoxide interactions, Taj Pharmaceutical Chlordiazepoxide contraindications, Chlordiazepoxide price, Chlordiazepoxide Taj Pharma Chlordiazepoxide 10mg Capsules SMPC- Taj Pharma . Stay connected to all updated on Chlordiazepoxide Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Doctor Sadgun Bhandari - Management of Aggression - Dr. Sadgun Bhandari is a General Psychiatrist Consultant and an expert at the management of Serious Mental Illness especially Schizophrenia and Bipolar Affective Disorder.
Danielle Yuill: Giving patients a VOICE project (Patients helping in research at NAC) http://www.uhsm.nhs.uk/racrf/Pages/involved.aspx.
NB this meeting was confidential so audio is not broadcast in the second part of this support meeting.
A discussion to collect ideas and discuss the forthcoming new handout for the purpose of communicating our support with patients who do not use computers
Aspergillosis Support Group Christmas Quiz 2013Graham Atherton
The December meeting of the Aspergillosis Support Group for Patients & Carers is a quiz played for the David MacIntyre Trophy. Questions are based around the information presented in the previous years meeting and other information about aspergillosis. See how you do!
Poet in Residence Caroline Hawkridge talks about our achievements in holding events to raise awareness of fungal infections using poetry written with patients & carers at earlier meetings.
Graham Atherton talked about GAFFI and about how antifungal drugs work to kill fungal infections
Involving Patients (and carers) in research at NWLC & NACGraham Atherton
Danielle Yuill tells us about her project to discover how best to involve patients and carers in research at the North West Lung Centre & National Aspergillosis Centre - amd not just reviewing grant requests and providing tissue samples.
Graham Atherton takes us through some of the many features & structures we can see in a lung x-ray - what does aspergillosis look like??.
Comparing parts of UK & US Healthcare systems, IgG explainedGraham Atherton
NAC consultant Eavan Muldoon introduces herself as our new medic and talks a little about her background, part of which was spent at Tufts Medical Centre, Boston, USA. Then Graham Atherton talks about IgG, what they are and how they work.
Management of Chronic Pulmonary Aspergillosis and IgE for the LaypersonGraham Atherton
Professor Denning summarises how we manage CPA at the National Aspergillosis Centre, what we have learned, what we are still learning.
Graham Atherton describes IgE and how it affects Aspergillosis
Julia Hamer, Directorate Manager of Respiratory Medicine at University Hospital South Manchester talks to our patients about the new structure of the NHS and how it effects us.
Graham Atherton talks about health precautions when we are experiencing a heatwave and speaks of a subject suggested by patients: Adverse effects of medications.
Steve Webster of the Manchester Carers Centre, UK talks about the support and services offered by the centre in Manchester and the other centres throughout the UK. Graham Atherton talks about our progress in the understanding of the health effects caused by damp homes, and how to avoid them!
Chronic illness health psychologist Alison Wearden talks about how stress effects our health and our recovery from illness, and specialist physiotherapist Phil Langridge talks about breathlessness and what we can do to control it.
Graham Atherton discusses gardening for those with allergies, the signs of heart disorder to be aware of if you are taking itraconazole and advice on travel.
Dr Mike Bromley talks about the role of Manchester University in the research and development of new antifungal drugs, followed by Dr Iain Page talking about our research projects in Africa that have the potential to reveal much larger numbers of people suffering from Chronic Pulmonary Aspergillosis (CPA) than is currently thought.
Creative Writing Projects at the National Aspergillosis CentreGraham Atherton
Caroline is the Writer-in Residence at the National Aspergillosis Centre. We are using creative writing as a means to open up communication between established relationships such as those between clinical professionals and the patient.
Maintaining or Improving your health status in CPA (Khaled Al-shair)Graham Atherton
Khaled summarises why many people do not improve as much as they could while being treated for chronic pulmonary aspergillosis, what they can do to help themselves if they are not already doing it.
Dr Libby Radcliffe talks about the aches & pains suffered by aspergillosis patients, the different causes and what can be done to reduce them. Professor Malcolm Richardson talks about the types of moulds we all come across every day and the damage they can cause in the wrong places. Dr Graham Atherton talks about the correct specification for facemasks used to reduce the inhalation of mould spores when carrying out routine daily tasks & hobbies.
Support meeting for aspergillosis patients with Paul Bowyer, Senior Scientist on recent advances in research on susceptibility to Chronic Pulmonary Aspergillosis
Cheryl Pearse, Specialist Nurse in Smoking Cessation at UHSM, Manchester gives the Aspergillosis Patients Meeting a presentation on giving up smoking. July 2012
- 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
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
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Hot Selling Organic intermediates
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
How to Give Better Lectures: Some Tips for Doctors
Antifungals, Quality of Life study and Inhalers
1. Support Meeting for
Aspergillosis Patients
LED BY GRAHAM ATHERTON
SUPPORTED BY
GEORGINA POWELL, DEBBIE KENNEDY & DEB HAWKER
NAC CENTRE MANAGER CHRIS HARRIS
ORAL ANTIFUNGAL: DEBBIE KENNEDY
NATIONAL ASPERGILLOSIS CENTRE
UHSM
MANCHESTER
Fungal Research Trust
2. Programme
1.30 Debbie Kennedy Oral antifungals and TDM
2.00 Khaled Al-Shair- 4 things we have learned from QOL
2.20 Break
2.30 Phil Langridge- Correct use of inhalers
2.50 Graham Atherton Short story on some recent
research/discuss social support via phone
3.10 Q & A
4. Drugs that are used to treat Aspergillosis
– There are 3 oral drugs that are used to treat
aspergillosis
– Itraconazole
– Voriconazole
– Posaconazole
– Known as azoles
5. Why monitor drug levels?
– It is important that the concentration of the
drug in the body is kept within a threshold for
it to suppress the fungus
– It may be effective below the lower expected
level but this runs the risk of resistance
– Above the higher level may mean the patient
experiences side effects or increased side
effects
6. Drug Management
Itraconazole is available as 100 mg pink and blue capsules with the brand
name brand name Sporanox.® Always remember it is very important to take
the Itraconazole capsules whole with food or an acidic drink,
like coca-cola.
Itraconazole is available as an oral liquid again with the brand name
Sporanox® and comes in a 150ml bottle with a concentration of 10mg/mL. It is
sugar free and is cherry flavoured. Always remember it is very important to
take Itraconazole oral liquid on an empty stomach.
7. Drug Management
Voriconazole is available as 50mg or 200mg tablets with the brand name Vfend®
should be taken at a dose of 200mg twice daily, 12 hours apart. Voriconazole, brand
name Vfend® is also available as an orange flavoured oral liquid of 200mg/5mL.
The amount of Voriconazole in your body is measured through a small blood test. This
helps us to make sure you are on the right dose for you, that is, not too much or not too
little.
8. Drug Management
Posaconazole is available only as an oral liquid 200mg/mL
Noxafil® and should be taken at a dose of 400mg twice daily,
12 hours apart, with food.
If patients cannot tolerate food it should be taken 200mg 4
times daily.
9. Drug Management
~£109.20
~£109.20 ~£4410.96
~£4410.96
28 days
28 days 28 days
28 days
~£3000.00
~£3000.00
28 days
28 days
10. Therapeutic Drug Monitoring
TDM
• Itraconazole Levels – random level
• Voriconazole Levels – trough level
• Posaconazole Levels – record time of last dose
Aim is to keep blood concentration at a therapeutic level
• Too low can lead to resistance
• Too high can result in increased side effects
11. Side effects of Azoles
Itraconazole
• GI Intolerance
• Hepatitis
• Peripheral neuropathy
• Fluid retention
• Rash
• Hypertension
• Cardiac Failure
• Headache
• Tremor
• Insomnia
12. Side effects of Azoles
Voriconazole
• Photosensitivity – even trivial light Visual
Disturbance
• Peripheral neuropathy
• Poor concentration
• Abnormal thinking
• Headache
• Dry painful lips
• Abnormal LFTs
• Dry eyes
• Tightening feeling of the skin
13. Side effects of Azoles
Posaconazole
• GI Intolerance
• Neuropathy
• Rash
• Headache
• Sleep disturbance
• Anorexia
• Abnormal LFTs
• Arrhythmias & palpitations
14. TDM as part of Long Term Management
Blood tests
Aspergillus precipitins and titre
Inflammatory markers, CRP, Plasma Viscosity
Total IgE
Aspergillus specific IgE (RAST)
Microscopy
Sputum – sensitivities Asp PCR
Radiology
X-ray
CT scan
History
MRC – Medical Research Council Dyspnoea Score
16. Measuring health status in
Chronic pulmonary aspergillosis
(CPA): lessons we have learned
Dr Khaled Al-shair MD PhD
National Aspergillosis Centre
South Manchester University Hospital
17. A year ago, we discussed:
1. What is chronic pulmonary aspergillosis
(CPA)?
2. What is aspergillus?
3. Is there a standardized measure to assess these
most frequent symptoms of the disease, its
burden on physical, social, cognitive and
psychological aspects of life?
4. What this questionnaire stands for?
5. What are the components of this questionnaire?
6. Is it valid and standardized?
7. Why I should fill the questionnaire every three
months?
19. • The disease is slowly progressive if left with out
treatment and monitoring,
• Further destruction to the lung tissue may happen,
• More cavities or aspergilloma may develop,
• More symptoms e.g., shortness of breath, fatigue,
haemoptysis or loss of weight
21. Radiology
Laboratory investigation
Standard symptomatology measurement
(Patients Reported Outcomes)
22. The 50 items of the SGRQ -
which cover 76 levels - are
sub-scaled to three main
aspects.
The first 8 items cover the
respiratory symptoms and
their frequency and severity,
the Symptom domain.
The next 16 items concern
limitation in activities due to
shortness of breath, the
Activity domain.
The last 26 items cover the
consequent social and
psychological implications of
the respiratory diseases, the
Impact domain. The scale
covers 0-100; the higher the
score, the worse the health
status.
23. I am really keen to use my medication,
does that help me, when I may see
improvement?
24. Improved Stable Deteriorated
n= 107 97 44 n= 37 31 14 n= 27 28 16 n= 41 36 13
All patients Itraconazole Voriconazole Posaconazole
Response after treatment for 3, 6 or 12 months on either
itraconazole, voriconazole or posaconazole
26. After treatment:
- 47-50% gained substantial health improvement
with a reduction of score of 14 at both 6 and 12months,
- 32% deteriorated with a rise of 11 and 14 scores after 6
and 12 months of treatment and observation respectively,
- 21% were not much different (stable).
27. n= 107 97 44 n= 37 31 14 n= 27 28 16 n= 41 36 13
All patients Itraconazole Voriconazole Posaconazole
Response after treatment for 3, 6 or 12 months on either
itraconazole, voriconazole or posaconazole
Improved Stable Deteriorated
28. I’ve been told that my case is poor/very
poor, ANY HOPE to get better?
29. Patients gained therapeutic benefit irrespective of their
illness severity where >50% of those who had “poor”
and “very poor” at baseline improved with reduction of
≥4 scores after 6 months of treatment.
Using much wider scale, we found that at least 50% of
“poor/very poor” health status category at baseline
improved significantly to “fair” or “good/very good”
categories.
30. Good/Very good
Fair
Poor/Very poor
n= 18 18 51 51 44 38
At baseline Good/Very good Fair Poor/Very poor
Changes in health status at 6 and 12 months from baseline
34. Metered-Dose Inhaler (MDI)
• Pressurised aerosol inhaler
• How to use:
• Remove Cap
• Shake canister
• Place mouthpiece in mouth
• Press Canister once to release a dose of drug
• Breathe in
• Hold breath 10 seconds
• If another dose is needed take inhaler out of
mouth, shake and repeat above steps
35. Using MDI with Spacer
• Remove cap and insert inhaler into
aerochamber/spacer
• Place mouthpiece in mouth and take slow
breath in
• Whistles if breathe too quickly
• Can be used with or without breath hold
36. Easi-breathe
• Breath Activated
• Shake inhaler and open cap
• Hold upright and breathe out gently
• Place mouthpiece in mouth
• Breathe in slowly and deeply
• Hold for 10 seconds and remove inhaler from
mouth
37. Accuhaler
• Dry powder inhaler
• Open lid fully
• Slide lever down until it clicks to load inhaler
• Breathe out gently
• Place mouthpiece in mouth
• Take deep breathe in
• Hold Breath 10 seconds and remove
mouthpiece
38. Turbohaler
• Dry powder inhaler
• Remove lid
• Hold upright and twist forwards and
backwards (should hear a click)
• Breathe out gently
• Place inhaler in mouth and take deep breathe
in
39. HandiHaler
• Open cap
• Open mouthpiece
• Remove capsule from blister and place in chamber
• Close mouthpiece until it clicks
• Press green button in once and release
• Breathe out gently away from mouthpiece
• Put mouthpiece between teeth without biting and close lips to form good seal
• Breathe in slowly and deeply, so capsule vibrates
• Continue to breathe in as long as comfortable
• While holding breath, remove inhaler from mouth
• Breathe out gently away from mouthpiece
• Put mouthpiece back between teeth without biting and close lips to form good seal
• Breathe in slowly and deeply again, so capsule vibrates
• Continue to breathe in as long as comfortable
• While holding breath, remove inhaler from mouth
• Breathe out gently away from mouthpiece
• Open mouthpiece and remove used capsule
• Close mouthpiece and cap
40. Final Thought….
• Remember intended purpose!
• Please use medication as advised and
prescribed by your medical practitioner
41.
42. Social Support
Online support groups – support around 1250 people
But 49% of our patients are not online – reasonable to
suggest that this is representative?
Offline support – How?
43. Offline Support
This meeting!
About 12-16 people per month – estimate 50 people per year
How many here access support online?
What proportion of the ‘offline people’ are we reaching?
44. Offline support
Local support groups
7 groups in the UK (all in England)
3-6 people per group = a maximum of 40 people
Some of these are new people (not our patients)
Many of these are offline – approx 50%
45. Offline Support – How?
Still left with people who cannot reach support
groups – mobility problems, access to IT, socially
awkward
Everyone gets newsletter in clinic – so all of OUR
patients are reachable
Everyone has a phone!
46. New Year Honours List
A extraordinary man was honoured for organising &
providing a phone support service to a large group of
patients
48. Volunteer Phone Support - discussion
Suggestions
We ask for volunteers who are already ‘expert
patients’ – e.g. come to this meeting, use online
support, experienced
Volunteers man a phone line for a short time each
week
Clinic puts people in touch – i.e. volunteers phone
number is not publicised
Doctors/nurses will suggest people who need
support and who cannot use current support
49. What would phone support consist of?
Social contact – informal
Empathy
An intermediary for information
50. Your opinions
Is this a workable idea?
What would be a reasonable time to ask someone to
volunteer?
How frequently?
Do you think training would be needed?
Should we try to protect personal home numbers
somehow?
51. Vote
Is this a good idea?
Is this the right way to go about it?
What changes should we make before starting?
Any volunteers – help us run service and help us
decide what to do?
52. Thank You
“The best chance we have of beating this illness is to
work together”
Living with it, Working with it, Treating it
Fungal Research Trust