This document provides an overview of biomedical therapies for autism, including dietary modifications, supplements, pharmacological interventions, and experimental treatments. It presents a case study of a child diagnosed with autism and discusses the family's questions. It then outlines 10 rules for considering biomedical therapies, emphasizing that they should not replace behavioral therapies and have limited evidence for treating core autism symptoms. Various therapy options are described along with theories for their mechanisms and potential benefits and risks. Experimental therapies with little evidence are also mentioned.
To determine anti-anxiety of beta sitosterol , Chandan Chauhan M.S. Research Scholar, Dept. of Pharmacology & toxicology, National Institute of Pharmaceutical Education & Research (NIPER), Hajipur.
How to Transition from Allopathic to Integrated Practice - IMM Brazil 2015Louis Cady, MD
In this lecture, Dr. Cady compares and contrasts the significance differences, both conceptually and practically, between the conventional practice of medicine and a more rational, functional, integrated approach. Tactical concepts and didactic tools to make the transition are reviewed.
We live in an era of medication, but what else can we do to improve mental health? Are we excessively prescribing, can we approach medicine in a more holistic way?
Providing quality pediatric pain management during end of life carecassidydanielle
Author: Danielle Cassidy, PharmD, BCPS
Audience: continuing education for hospice nurses
Background: describes common developmentally appropriate tools for assessing pain in children, general principles of pediatric pharmacology, common pharmacological interventions, side effects commonly associated with opioid medications & side effect management strategies.
To determine anti-anxiety of beta sitosterol , Chandan Chauhan M.S. Research Scholar, Dept. of Pharmacology & toxicology, National Institute of Pharmaceutical Education & Research (NIPER), Hajipur.
How to Transition from Allopathic to Integrated Practice - IMM Brazil 2015Louis Cady, MD
In this lecture, Dr. Cady compares and contrasts the significance differences, both conceptually and practically, between the conventional practice of medicine and a more rational, functional, integrated approach. Tactical concepts and didactic tools to make the transition are reviewed.
We live in an era of medication, but what else can we do to improve mental health? Are we excessively prescribing, can we approach medicine in a more holistic way?
Providing quality pediatric pain management during end of life carecassidydanielle
Author: Danielle Cassidy, PharmD, BCPS
Audience: continuing education for hospice nurses
Background: describes common developmentally appropriate tools for assessing pain in children, general principles of pediatric pharmacology, common pharmacological interventions, side effects commonly associated with opioid medications & side effect management strategies.
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Autism is a treatable disorder .OSHA is an intensive integrated protocol of behavior modification sessions and is applied with success in our center in Alexandria , Egypt since 2011.
NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com
Presentation by Dr. Jacob Kagan on addiction psychiatry, covers the neurobiology of addiction, diagnosis and management od dually-diagnosed patients, relapse prevention, psycopharmacology interventions and more. http://www.jacobkaganmd.com
Complementary and Alternative Therapies For LupusLupusNY
A presentation by Swamy Venuturupalli, MD from Lupus LA's 4th annual patient education conference at Cedars-Sinai Medical Center in Los Angeles, CA on June 28th, 2008.
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.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Biomedical Therapies
1. Autism 200 SeriesBiomedical TherapiesA Practical Approach Gary Stobbe, MD Clinical Assistant Professor University of Washington Attending Neurologist Seattle Children’s Autism Center
2. What are Biomedical Therapies? Can be defined as any agent or therapy that directly influences the body’s internal environment Includes diet/nutrition, nutraceuticals, pharmaceuticals, etc. Traditionally excludes “hands-on” therapies (ABA, speech, OT, vision, AIT, CST, neurofeedback, etc.)
3. Case Study 3 ½ yo male Normal pregnancy and delivery Normal motor milestones “Picture perfect” baby At 16 months, says first word Enjoys physical play, investigates environment Likes to play by himself
4. Case Study (cont.) At 18 months, no more words and not responding to his name Told probably just “late talker” 24 months, hearing test normal 30 months, hand flapping when excited Speech therapy started; referred for evaluation to r/o autism
5. Case Study (cont.) 36 months, diagnosed with autism Enrolled in developmental preschool, ABA therapy, OT, speech therapy Now echoes some words Eye contact improved Loose stools, poor attention, poor sleep
6. Questions What caused this (“if I could just figure it out”)? He’s improving, but is it fast enough? Am I doing everything I can? Do I believe the stories and try unproven (and potentially risky) treatments? What do I do first?
7. Fast Forward… Age 7, 1st grade with 1:1 aide Struggling with social skills Impulsive behaviors difficult to control, can be violent Severe anxiety over “trivial” events Unable to stay on complex tasks Teachers suggesting medication trial
8. Fast Forward (again) Age 16, ritualistic behavior interfering with daily activities Explosive behaviors which were gone have recurred Becoming more isolated Now what?
10. Rule #1Psychoeducational therapy is the foundation of treatment. Biomedicals should never replace behavioral approaches. Highly unlikely that any biomedical will have maximal effect without an appropriate psychoeducational program.
11. Rule #2No biomedical therapy has proven to be effective in treating “core features” of autism. Minimal “class 1” evidence exists for biomedical therapies in ASD.
12. Social Impairment ASD – Core Features ASD Language/ Comm. Deficits Repetitive Behaviors/ Restricted Interests
13. Rule #3Autism treatment is symptom-based. Stratify treatment options based on risk. Classic decision making for symptom-based diagnosis. Because treatments generally have little or no efficacy data, risk plays heavy role in decision-making.
22. Common Co-morbid Symptom Clusters in ASD - Medical Sleep (initiating, night-time awakening) GI (IBS, food sensitivities, inflammatory) Esophagitis responsible for severe abarrent behaviors Seizures 30-40% classic autism with seizures by teens Epileptiform discharges associated with poor progress? (causal vs. epiphenomenon)
23. Rule #4Maximizing health goes a long way. Don’t always assume aberrant behaviors are purely due to autism. Follows similar rule as other CNS conditions. Physical exercise, sleep very important.
24. Rule #5Don’t go out on a limb if making good progress. The opposite is also true – a lack of expected progress through conventional treatments warrants consideration of biomedical therapies.
25. Measuring Progress in ASD Clinical Global Impression – Parent Rating Accurate, although often won’t know why Clinical Global Impression – Clinician Rating Objective Measures Difficult to obtain in clinical setting
26. Biomedical Therapies – Barriers to Clinical Research Poorly understood mechanisms/etiology Probable multiple causes Lack of biomarkers Pediatric population Poor funding Minimal pharmaceutical industry support
27. Rule #6Implement new treatment in “controlled” setting if possible. Avoid starting or changing therapies simultaneously, including hands-on therapies and changes in schedule or routine.
28. Rule #7Define your endpoints. Likelihood of successful treatment will increase if goals of treatment are clearly defined. Define duration of treatment and objective (target symptom).
29. Rule #8Use “on-off” protocol if benefit not clear. Difficult to see subtle benefit when improving anyway. Trial of discontinuation to observe regression – suggest “on” phase of 1-3 months.
30. Rule #9Combinations usually work better than pushing the dose of a single agent. Pervasive nature of the disorder often requires addressing multiple neurotransmitter systems. The population is sensitive. Start low and go slow. Remember to identify your target.
31. Rule #10A treatment that gives benefit today is not necessarily beneficial tomorrow. Some treatments may be age-specific. The reverse may also be true regarding treatment tolerability.
33. Biomedical Therapies – Dietary Modification Gluten and casein free most common Possible improvements in hyperactivity, sleep, GI, and core feature Improve health vs. core feature? Additional behavioral benefit www.gfcfdiet.com
34. Biomedical Therapies – Dietary Modification (cont.) Theories “Opioid excess theory” related to undigested proteins interfering with brain function “Autoimmunity theory” related to immune response (IgG Abs) to specific undigested protiens Both theories imply “leaky gut” Improvement over time expected (healing vs. development)
36. Biomedical Therapies – Supplements (cont.) Methylcobalamin/folinic acid Cofactors in methylation/sulfation enzyme pathways Important for integrity of CNS, immune, GI (Moretti, Neurology, 2005) Improved biomarkers in 20 autistic children (James, J. DAN! Meeting, Portland, 2003) Clinically unproven
37. Biomedical Therapies – Antifungal/bacterial/viral Antifungal based on “gut dysbiosis” theory ? Antiinflammatory effect 2 small group studies of antibacterial therapy showing unsustained benefit Antiviral based on “stealth virus” theory or latent GI viral infection (Wakefield, Lancet, 1998 – data later shown to be falsified)
38. Biomedical Therapies – Sleep Disorder Most effective for sleep initiation Melatonin Clonidine Trazadone Tricyclics Gabapentin Neuroleptics Consider sleep study
39. Biomedical Therapies – GI Dysfunction IBS symptoms common 24% of autistics with GI symptoms (Molloy, Autism, 2003) Consider GI study for unexplained severe behaviors Prevacid trial (possible esophagitis)
41. Biomedical Therapies – Pharmacological (cont.) SSRIs Supported by studies implicating 5-HT (PET, blood) Supported by open label studies (fluoxetine, sertraline, citalopram) and blinded study (fluvoxamine) Targets anxiety, ritualistic/compulsive/repetitive behaviors, maladaptive behavior, aggression
42. Biomedical Therapies – Pharmacological (cont.) Stimulant/non-stimulant ADD meds Targets ADHD symptoms (attention, hyperactivity) Frequent paradoxical worsening Good safety data Stimulants (methylphenidate, lisdexamfetamine) alpha-adrenergic agonists (guanfacine, clonidine) Newer non-stimulants (atomoxetine, modafinil) Consider amantadine as alternative
43. Biomedical Therapies – Pharmacological (cont.) Neuroleptics Targets irritability, aggression, impulsivity, ritualistic behavior Good class 1 evidence (risperidone, aripiprazole) Higher risk profile (weight gain, ? Diabetes, movement disorders)
44. Biomedical Therapies – Pharmacological (cont.) Anti-convulsants ? Association with regression Up to 46% with EEG epileptiform findings Target mood stabilization, irritability, compulsions, agressiveness ? Language improvement (Stobbe, AES Meeting, 2006) Better safety with newer agents (oxcarbazapine, lamotrigine)
45. Biomedical Therapies – Experimental Goal to find treatments of “core” features (language, social) not just symptom management No good supportive data currently
46. Biomedical Therapies – Experimental (cont.) Chelation therapy Based on mercury/toxic metal theory Oral DMSA approved for acute mercury and lead toxicity ? risk Newborn hair study (Holmes, 2003) Urine DMSA challenge study (Bradstreet, 2003) Urinary porphyrin study discredits theory (Woods JS, 2010)
47. Biomedical Therapies – Experimental (cont.) Acetylcholinesterase Inhibitors FDA approved for Alzheimer’s Targets system important for language/memory Acetylcholine neurons diminished in path. Studies Several positive open-label studies Good safety data in adults
48. Biomedical Therapies – Experimental (cont.) Immunomodulatory therapy Supported by studies of immune system irregularities Increased 1st-degree relatives with auto-immune disorders Regressive pattern Small studies with prednisone, IVIg
49. Biomedical Therapies – Experimental (cont.) Hyperbaric Oxygen Therapy (HBOT) Based on oxidative stress theory Two studies presented, conflicting data Needs more research Stem cell research (Duke University) Oxytocin (Hollander E, 2008) Transmagnetic Stimulation (TMS) Neurofeedback Therapy Naltrexone Secretin Center for Neurological Health (Bastyr U.)
50. Thanks! Contact Us Seattle Children’s Autism Center 206-987-8080 www.seattlechildrens.org