Pulmonologist, Jenny Kim, MD, FCCP of our Sleep Disorders Center partnered with the Livingston Health Department to present, Can’t Sleep? The ABCs of Your ZZZs to the community. During the session, Dr. Kim discussed tips for improving sleep and treatment options for common sleep disorders.
Heart of the Matter - Ali Ahmad, MD, FACC - Livingston Library - 1.6.2020Summit Health
Heart disease is the leading killer of adults nationwide and it carries a significant morbidity for the population at risk. Learn about traditional and non-traditional risk factors associated with coronary artery disease, and how to modify your risk and prevent heart disease. Also, learn about how heart disease affects different ethnic backgrounds, particularly the high-risk groups, such as South Asians.
Why Does My Stomach Ache? - Dennis Han, MD, Gastroenterologist - Morristown &...Summit Health
Do you have stomach issues which are bothering you and you can't figure out why? Learn about conditions that could be causing abdominal pain or discomfort at this virtual program. Our expert will discuss different conditions such as: Irritable Bowel Syndrome; Inflammatory Bowel Disease; Celiac Disease and other conditions that require a gluten-free diet; and GERD (Reflux). He will explain the differences between these various conditions, how they are diagnosed, and treatment options available. Hosted by Morristown & Morris Township Public Library.
Know Your Numbers and What They Mean for Your Overall Health - Madison Public...Summit Health
What does your blood pressure, BMI, cholesterol, blood sugar and vitamin levels tell you about your health? Our expert will discuss how these numbers tell a story, and why it’s important to understand what that story means to your overall health. Dr. Im-Imamura will also share tips for helping you get these numbers where they should be, and how increasing physical activity and improving nutrition are key factors that can impact those numbers in a good way.
Presented as part of the Madison Public Library Virtual Seminar Series.
Heart of the Matter - Ali Ahmad, MD, FACC - Livingston Library - 1.6.2020Summit Health
Heart disease is the leading killer of adults nationwide and it carries a significant morbidity for the population at risk. Learn about traditional and non-traditional risk factors associated with coronary artery disease, and how to modify your risk and prevent heart disease. Also, learn about how heart disease affects different ethnic backgrounds, particularly the high-risk groups, such as South Asians.
Why Does My Stomach Ache? - Dennis Han, MD, Gastroenterologist - Morristown &...Summit Health
Do you have stomach issues which are bothering you and you can't figure out why? Learn about conditions that could be causing abdominal pain or discomfort at this virtual program. Our expert will discuss different conditions such as: Irritable Bowel Syndrome; Inflammatory Bowel Disease; Celiac Disease and other conditions that require a gluten-free diet; and GERD (Reflux). He will explain the differences between these various conditions, how they are diagnosed, and treatment options available. Hosted by Morristown & Morris Township Public Library.
Know Your Numbers and What They Mean for Your Overall Health - Madison Public...Summit Health
What does your blood pressure, BMI, cholesterol, blood sugar and vitamin levels tell you about your health? Our expert will discuss how these numbers tell a story, and why it’s important to understand what that story means to your overall health. Dr. Im-Imamura will also share tips for helping you get these numbers where they should be, and how increasing physical activity and improving nutrition are key factors that can impact those numbers in a good way.
Presented as part of the Madison Public Library Virtual Seminar Series.
Lifestyle Diseases - An Emerging Issue in Working WomenIndus Health Plus
The daily 'multitask' requirement on working women is affected on their health and hence working female's are suffering from some life-style diseases such as obesity, depression, chronic backache, diabetes, hypertension, high cholesterol, heart and kidney diseases.
For this it is advisable that the women has to aware about specific women health problems & need to take preventive health checkup to identify the future potential health risk factors.
Indus Health Plus provides best preventive health checkup packages such as heart checkup, full body checkup packages, fitness checkup, annual corporate checkup, executive checkup, couple checkup and family health checkup at 50% less than market cost with same day reports.
Get your checkup done today @ http://bit.ly/2gmXBNk
Call Us: 0-90490-22222
this presentation will contains problem of old age, how can they affect the life of geriatric peoples, prevention and control of geriatric problems, national program for better health of old peoples, initiations done by private trusts to improve their health
A lifestyle of a person is the way of living his/her life. In recent times, India has started to observe an increase in various kinds of health-related problems due to change in lifestyle regardless of their gender or age. Lifestyle disorders may occur due to different factors such as dietary patterns, habits and behavior, preferences, and more. An article by the business world states that nearly 61% of people in India die due to lifestyle or non-communicable diseases (NCDs). Lifestyle diseases are not limited to adults alone; nowadays, it is affecting kids as well.
Here is an article providing some of the profound insights on the most common lifestyle disorders, its causes and symptoms, and the preventive measures to be taken to avoid them.
Source : https://blog.tauedu.org/the-most-common-lifestyle-disorders/
Standards of medical care in diabetes—2015,
http://professional.diabetes.org/admin/UserFiles/0%20-%20Sean/Documents/January%20Supplement%20Combined_Final.pdf
The ABCs of Your ZZZs - Alison S. Kole, MD, MPH, FCCP, Pulmonologist Kerry K...Summit Health
Learn from our Sleep Disorder Center experts about the basics of good sleep and the physical impact of poor sleep. We will also discuss tips for improving sleep and the treatment options for common sleep disorders, such as sleep apnea, restless legs syndrome, and insomnia, among others.
Lifestyle Diseases - An Emerging Issue in Working WomenIndus Health Plus
The daily 'multitask' requirement on working women is affected on their health and hence working female's are suffering from some life-style diseases such as obesity, depression, chronic backache, diabetes, hypertension, high cholesterol, heart and kidney diseases.
For this it is advisable that the women has to aware about specific women health problems & need to take preventive health checkup to identify the future potential health risk factors.
Indus Health Plus provides best preventive health checkup packages such as heart checkup, full body checkup packages, fitness checkup, annual corporate checkup, executive checkup, couple checkup and family health checkup at 50% less than market cost with same day reports.
Get your checkup done today @ http://bit.ly/2gmXBNk
Call Us: 0-90490-22222
this presentation will contains problem of old age, how can they affect the life of geriatric peoples, prevention and control of geriatric problems, national program for better health of old peoples, initiations done by private trusts to improve their health
A lifestyle of a person is the way of living his/her life. In recent times, India has started to observe an increase in various kinds of health-related problems due to change in lifestyle regardless of their gender or age. Lifestyle disorders may occur due to different factors such as dietary patterns, habits and behavior, preferences, and more. An article by the business world states that nearly 61% of people in India die due to lifestyle or non-communicable diseases (NCDs). Lifestyle diseases are not limited to adults alone; nowadays, it is affecting kids as well.
Here is an article providing some of the profound insights on the most common lifestyle disorders, its causes and symptoms, and the preventive measures to be taken to avoid them.
Source : https://blog.tauedu.org/the-most-common-lifestyle-disorders/
Standards of medical care in diabetes—2015,
http://professional.diabetes.org/admin/UserFiles/0%20-%20Sean/Documents/January%20Supplement%20Combined_Final.pdf
The ABCs of Your ZZZs - Alison S. Kole, MD, MPH, FCCP, Pulmonologist Kerry K...Summit Health
Learn from our Sleep Disorder Center experts about the basics of good sleep and the physical impact of poor sleep. We will also discuss tips for improving sleep and the treatment options for common sleep disorders, such as sleep apnea, restless legs syndrome, and insomnia, among others.
It focuses on sleep medicine - sleep disorders, sleep stages, DSM classification, types, classifications, and pharmacological and non pharmacological management.
How to Sleep Better 101 - Drew University - 9.8.19Summit Health
Thank you to Drew University’s Health Services Department for hosting Summit Medical Group Sleep experts, Vicky Seelall, MD, FCCP, and Kerry Kelley, RN, RRT, RPSGT, for a lecture on How to Sleep Better 101. Studies have shown that seven hours of sleep is crucial for better academic performance and maintaining a higher GPA. A better night sleep in also key for improving memory retention. One way to ensure you get that beneficial shut eye, is to reduce screen time at least two hours before bed.
Introduction
The sleep – wakefulness cycle is genetically determined rather than learned and is established sometime after birth.Sleep is a naturally recurring state of mind and body, characterized by altered consciousness, relatively inhibited sensory activity and [inhibition of nearly all voluntary muscle during REM sleep] reduced interactions with surroundings.
Sleep can be regarded as a physiological reversible reduction of conscious awareness. Nearly one third of human life is spent in sleep. Disorders of sleep can affect activities of daily living (ADL) of an individual.
Definition
It is an easily reversible state of relative unresponsiveness and serenity which occurs more or less regularly and repetitively each day.
The EEG recordings show typical features of sleep which is broadly divided into two broadly different phases:
1. D-sleep (desynchronised or dreaming sleep), also called as REM- sleep (rapid eye movement sleep),active sleep, or paradoxical sleep.
2. S-sleep (synchronised sleep), also called as NREM-sleep (non-REM sleep), quiet sleep, or orthodox sleep. S-sleep or NREM-sleep is further divided into four stages, ranging from stages 1 to 4. As the person falls asleep, the person fifi rst passes through these stages of NREM-sleep.
Stages of sleep
The EEG recording during the waking state shows alpha waves of 8-12 cycles/sec. frequency. The onset of sleep is characterised by a disappearance of the alpha-activity.
Stage 1, NREM-sleep is the first and the ligh test stage of sleep characterised by an absence of alphawaves, and low voltage, predominantly theta activity.
Stage 2, NREM-sleep follows the stage 1 within a few minutes and is characterised by two typical EEG changes:
i. Sleep spindles: Regular spindle shaped waves of 13-15 cycles/sec. frequency, lasting 0.5-2.0
seconds, with a charac teristic waxing and waning amplitude.
ii. K-complexes: High voltage spikes present intermittently.
Stage 3, NREM-sleep shows appearance of high voltage, 75 μV, δ-waves of 0.5-3.0 cycles/sec.
Stage 4, NREM-sleep shows predominant δ-activity in EEG. NREM-sleep is followed by REM-sleep, which is a light phase of sleep. The EEG is characterised by a return of α-waves (α-wave sleep); other changes are similar to stage 1 NREM-sleep. One of the most characteristic features of the REM-sleep is presence of REM or rapid (conjugate) eye move ments. The other features include generalised mus cular atony, penile erection, autonomic hyperactivity (increase in pulse rate, respiratory rate and blood pressure), and movements of small muscle groups, occurring intermittently. Although it is a light stage of sleep, arousal is diffificult. These stages occur regularly throughout the whole duration of sleep. The first REM period occurs typically after 90 minutes of the onset of sleep, although it can start as early as 7 minutes after going off to sleep, e.g. in narcolepsy, in major depression, and after sleep deprivation.
Primary sleep disorders:
Primary sleep disorders are those disorders not attributable to another cause, which includes dyssomnias and parasomnias.
Dyssomnias: are primary disorders of initiating or maintaining sleep/ excessive sleepiness, characterized by abnormalities in the amount, quality, or timing of sleep.
Insomnia:
Difficulty initiating or maintaining sleep or nonrestorative sleep that lasts for 1 month and causes significant distress or impairment in social, occupational, or other important areas of functioning.
Hypersomnia:
Excessive sleepiness for atleast 1 month that involves either prolonged sleep episodes or daily daytime sleeping that causes significant distress or impairment in social, occupational or other functioning.
Narcolepsy:
A rare sleep disorder in which a person, usually under the age of 20, has recurrent sudden episodes of irresistible sleep attacks of short duration 10 - 15 minutes (directly enters into REM sleep).
Breathing related sleep disorder:
Sleep disruption leading to excessive sleepiness or, less commonly, insomnia, caused by abnormalities in ventilation during sleep. These disorders include obstructive sleep apnea (repeated episodes of upper airway obstruction), central sleep apnea (episodic cessation of sventilation without airway obstruction), and central alveolar hypoventilation (hypoventilation resulting in low arterial oxygen levels).
Circadian Rhythm Sleep Disorder:
Persistent or recurring sleep disruption resulting from altered functioning of circadian rhythm or a mismatch between circadian rhythm and external demands. Subtypes include; delayed sleep phase, jet lag, shift work and unspecified.
Delayed sleep phase: A persistent pattern of late sleep onset and late awakening times, with an inability to fall asleep and awaken at a desired earlier time.
Jet lag: Sleepiness and alertness that occur at an inappropriate time of day relative to local time, occurring after repeated travel across more than one time zone.
Shift work: Insomnia during the major sleep period or excessive sleepiness during the major awake period associated with night shift work or frequently changing shift work.
Parasomnias: are disorders characterized by abnormal behavioral or psychological events associated with sleep, specific sleep stages, or sleep–wake transition. These disorders involve activation of physiological systems, such as the autonomic nervous system, motor system, or cognitive processes, at inappropriate times during sleep.
Nightmare disorder:
Repeated occurrence of frightening dreams that lead to waking from sleep.
Sleep terror disorder:
Repeated occurrence of abrupt awakenings from sleep associated with a panicky scream or cry.
Sleepwalking disorder (Somnambulism):
Repeated episodes of complex motor behavior initiated during sleep, including getting out of bed and walking around.
Similar to Can't Sleep? The ABCs of Your ZZZs (20)
Pediatric Talk: Managing Arthritis During the Holidays - Dr. Marla Guzman - ...Summit Health
While holiday celebrations and activities are great fun, it’s also a disruptor to the daily routine. Our expert will share tips to help you navigate holiday season stressors to minimize your child’s risk of a potential flare-up. This virtual event is hosted by the Arthritis Foundation.
Safety and Success in a Post-Pandemic Society - Daniela Accurso, MD, MPH - 7...Summit Health
The Covid-19 Pandemic has been a health crises that we have been fighting for the last year and a half. Dr. Accurso’s presentation is focused on reviewing how far we have come as a society and to address the questions, health concerns, and important precautions we need to take as we integrate ourselves back into a healthy community.
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Sun safety needs to start at an early age, and continue throughout life, in order to reduce the risk for skin cancer. Learn about prevention and ways to reduce your risk, screening for skin cancer and innovations in treatments.
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Shoulder Pain Relief: Common Rotator Cuff Injuries & Treatment Options - And...Summit Health
If you are experiencing shoulder pain, a rotator cuff tear could be the issue. Learn about how, and why, rotator cuff tears happen, how the condition and severity is diagnosed, and the non-surgical and surgical treatment options available.
My Knee Hurts! A Look at Joint Pain in Children - Marla Guzman, MD - 1.12.2021Summit Health
Is your child complaining of joint pain? Learn about concerning symptoms and when to seek medical advice. Our expert discusses the various causes of joint pains in children, how a pediatric rheumatologist evaluates musculoskeletal complaints, and available treatment options.
Mildred “Mitch” Bentler, MA, RD, CSP, CDE, presented a virtual lecture at on diabetes prevention. According to Ms. Bentler,
“A combination of small changes can really make an impact on lowering your blood sugar. Increasing physical activity and adopting healthier eating habits can go a long way to reducing your diabetes risk.”
Understanding Knee Arthritis and Cartilage Disorders - Maurice M. Pine Free P...Summit Health
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Christina Lavner, RDN, Nutrition Services, presented Healthy Eating for Cancer Survivorship, as the second session of our Now What? A Cancer Survivorship Speaker Series for patients wanting to learn more about nutrition that will benefit them during and after treatment. Be sure to check out upcoming presenters in this series and pass the word on to any patients you think would be interested in the information. The next presentation in this series is November 16, Coping with Treatment Side Effects, presented by Constance Gore, RN-APN
Guide to Eating an Anti-Inflammatory Diet Virtual Lecture - Christina Lavner,...Summit Health
An anti-inflammatory diet, along with exercise, can yield many health benefits, such as improved symptoms of many chronic conditions, reduced cancer risk, and a lower risk of obesity, heart disease, and diabetes. Learn more about this healthy way of eating and how to get started.
While most common in teens, the onset of acne can be troubling at any age. Depending on its severity, acne can cause emotional distress and scar the skin. The earlier you start treatment, the lower your risk of such problems. Learn about the causes of acne and effective treatment options for adolescents and adults.
Living a Heart Healthy Life - Liliana Cohen - West Orange Public Library - 2....Summit Health
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Living with Arthritis - Lauren Kennish - 10.15.19Summit Health
By conservative estimates, nearly 40 million people in the U.S. are affected by some form of arthritis. Slightly more than half of those cases suffer from osteoarthritis, which is degenerative, and a small percentage suffer from rheumatoid arthritis and psoriatic arthritis, autoimmune disorders that inflame the lining of the joints. Our expert will provide an overview of different types of arthritis, with a focus on symptoms, diagnosis, and new treatment and management strategies.
Urgent or Emergent - How Do You Decide? - Dr. Carrozza - Livingston Library -...Summit Health
When faced with a sudden illness or injury for yourself or loved one, trying to decide where to seek treatment can be a harrowing decision. Does the illness or injury warrant a trip to a hospital's emergency room, or should you seek care at an urgent care center? When should you seek treatment from your primary care physician?
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
- 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
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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
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
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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.
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.
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
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!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. Can’t Sleep?
The ABCs of Your ZZZs
Jenny H. Kim, MD, FCCP
75 E. Northfield Road
Livingston NJ 07039
2. The Essentials of Sleep
• Basics of “Good Sleep” – Sleep Overview
• Sleep Requirements – Sleep Deprivation
• Sleep Hygiene
• Sleep Disorders
Obstructive Sleep Apnea
Restless Legs
REM Behavior Disorder
Insomnia
Narcolepsy
3. Importance of Healthy Sleep
• AASM and SRS Consensus Statement1
“Adults should sleep 7 or more hours per night on a
regular basis to promote optimal health”
• American Thoracic Society Statement2
“Sleep is an essential biological function with major roles
in recovery, energy conservation, and survival”
“It is clear that good-quality sleep is critical for good
health and overall quality of life”
6. CDC Declares Sleep Disorders a
Public Health Epidemic
• In 2014 the Centers for Disease Control described
sleep deprivation as so pervasive in the United States
that it is considered a public health epidemic.
• Research conducted by the CDC indicates that large
numbers of Americans experience problems associated
with lack of sufficient sleep. For example:
Almost 50 million people reported problems
concentrating during the day
24 million people indicated lack of sleep interfered with
driving
18 million people reported that sleep deficiency
interfered with job performance.
7. Third Pillar of Health
• Sleep is the third of the of 4 pillars of health which include
nutrition, physical fitness, sleep and stress control.
• The estimated cost of lost productivity is 63.2 billion dollars a
year!
• A primary factor for lost productivity is presenteeism, employees
showing up for work but operating at subpar levels due to sleep
loss.
8. Sleep Vs. Technology
• The biggest sleep distraction?
1 in 2 people check right away if
they wake up in the middle of the
night
1 in 4 people don’t silence their
phones while sleeping
1 in 10 people are awoken by
their phones at least once a week
10. Leptin and Ghrelin
• Leptin - the appetite
suppressor, is the
hormone that tells
your brain when you're full.
• Ghrelin - the appetite
increaser, is the hormone
released primarily in the
stomach to signal hunger to
the brain.
• Just two nights of restricted
sleep were found to
significantly impact
hormones related to
appetite and drive to eat, as
well as self-reported
hunger.
11. Sleep Deprivation
Getting adequate sleep is not a luxury.
It is essential for good health.
Sleeping less than 7 hours is associated with:
12. While it still can’t cure the common cold…
Getting enough sleep can help prevent
catching a cold
13. Drowsy Driving
• National Highway Traffic Safety
Administration estimates that at
least 100,000 police reported
crashes are the direct effect of
driver fatigue
• Driving after 18 hours without
sleep = 2 alcoholic beverages
• Driving after 24 hours without
sleep = 4 alcoholic beverages
14. Sleep Hygiene
• Sleep hygiene - Habits and practices that are conducive to
sleeping well on a regular basis.
Ensure an inviting sleep environment
Ensure exposure to light during the day
Limit daytime naps to 20-30 minutes
Exercising improves sleep quality
Avoid stimulants and alcohol prior to bed
Limit foods high in fat and sugar – hydrate
Establish a regular schedule and bedtime routine
Limit screen use for two hours prior to bedtime
15. The Essentials of Sleep
Basics of “Good Sleep” – Sleep Overview
Sleep Requirements – Sleep Deprivation
Sleep Hygiene
Sleep Disorders
Obstructive Sleep Apnea
Restless Leg/Periodic Limb Movement Disorder
REM Behavior Disorder
Insomnia
Narcolepsy
18. Obstructive Sleep Apnea (OSA)
• Apnea
Pause in breath for ≥ 10 seconds
• Hypopnea
Flow of breath decreases by 30% of baseline
for ≥ 10 seconds associated with a fall in
oxygen saturation by 4%
3. AASM Scoring Manual Version 2.2, 2015
23. Risk Factors for OSA
• Personal history
• Family and ethnic risk
• Post menopausal women
Picture reference: https://utswim.wordpress.com/tag/pulmona
28. Preventative Strategies
• WEIGHT LOSS
Diet, exercise, weight loss surgery
• Avoidance of alcohol
• Avoidance of prescription sleep aids
• Quit smoking!
Picture reference: http://users.rowan.edu/~blondi74/Expert.page.2.html
30. Willis-Ekbom disease
(Restless Leg Syndrome)
Diagnostic criteria:
• Urge to move (“bugs crawling up the leg”)
• Rest induced
• Gets better with activity
• Evening and nighttime worsening
31. Causes of Restless Legs Syndrome (RLS)
Causes:
• Genetics (up to 50%!)
• Low iron levels
• Chronic diseases
• Pregnancy
• Medication side effect
33. Treatment of RLS
**AIM TO TREAT THE UNDERLYING CAUSE
AASM Guidelines (2012):
• Treatment is targeted to increase Dopamine in the
brain
• Medications for Parkinson's disease
pramipexole (Mirapex®), pergolide (Permax®), ropinirole
(Requip®), and a combination of carbidopa and Levodopa
(Sinemet®).
• Alternative medications:
gabapentin (Neurontin®), pregabalin (Lyrica®), opiates
34. Treatment of RLS
Our Favorite
Recommendations:
1. Get your ferritin and Vit D
level checked
Supplemental Iron
Supplemental Vit D
2. EXERCISE – regularly!
3. Stretch before bed
(restorative yoga)
4. Hydrate well during day
5. Magnesium
6. Tonic water
36. REM Behavior Disorder (RBD)
• Physically acting out dreams
• Episodes occasionally in the latter part of the night.
• Noises, such as talking, laughing, shouting, emotional
outcries or even cursing
• Common movements: kicking, punching, arm flailing or
jumping from bed, in response to action-filled or violent
dreams, such as being chased or defending yourself from
an attack
37. RBD Risk Factors
• Being male and over 50 years old
• Medications: antidepressants (SSRIs, TCAs)
• Withdrawal from: alcohol, benzodiazepines
• Stress
• Co-morbid conditions:
Neurodegenerative disorders, such as
Parkinson's disease, multiple system atrophy,
stroke or dementia with Lewy bodies
Narcolepsy
Untreated OSA (PseudoRBD)
38. REM Behavior Disorder Diagnosis
• Physical and neurological
exam
• Talking with your sleeping
partner
• Nocturnal sleep study
(polysomnogram)
39. REM Behavior Disorder Treatment
Physical safeguards – SAFE
sleep environment:
• barriers on the side of the
bed
• Move furniture
• Padding the floor near the
bed
• Removing dangerous
objects
• Separate beds
Medications:
• Melatonin
• Clonazepam
(Klonopin)
40. There are 84 SLEEP DISORDERS
WHICH IMPACT
100 MILLION AMERICANS
Can anyone guess the
most common sleep
complaint?
41.
42. Insomnia
• Onset Insomnia - difficulty initiating sleep at the beginning of the night
• Maintenance Insomnia – The inability to stay asleep or those who
have difficulty returning to sleep or experience early morning
awakening.
• Comorbid Insomnia - Insomnia that occurs with another condition -
such as anxiety and depression. Certain medical conditions can either
cause insomnia or make a person uncomfortable at night (pain) which
may make it hard to sleep
• Further broken down into by duration….
Acute/Primary insomnia – is brief – typically less than a month –
tends to be related to life circumstances.
Chronic/Secondary insomnia – effects 3 nights/week for at least
3 months – can have many causes.
Inadequate or poor-quality sleep
43. Causes of Primary Insomnia
• Significant life stress (job loss or change, death of a loved one,
divorce, moving)
• Environmental factors like noise, light, or extreme temperatures
(hot or cold) that interfere with sleep
• Interferences in normal sleep schedule (jet lag or shift work)
44. Causes of Secondary Insomnia
• Conditions that cause chronic (ongoing) pain, such as
arthritis and headache disorders
• Conditions that effect heart and lungs such as asthma,
heart failure, and stroke
• Certain medications that delay or disrupt sleep
• Caffeine or stimulants
• Tobacco or alcohol
• An overactive thyroid
• Gastrointestinal disorders, such as heartburn
• Sleep disorders, such as restless legs syndrome and
sleep-related breathing problems
• Menopause and hot flashes
• Delayed and advanced sleep phase syndrome
46. Treatment of Insomnia
• Lifestyle changes
• cognitive-behavioral therapy (CBTi) can help relieve
the anxiety linked to chronic (ongoing) insomnia. Anxiety
tends to prolong insomnia.
• Medications, prescription or OTC also can help relieve
insomnia and re-establish a regular sleep schedule.
• Treat the underlying cause (if possible).
47. Medications for Insomnia
• WEAK
recommendations
• Short term use
• NOT first line treatment
• Side effects can be
serious
48. Summit Medical Group
CBT Resource
Locations throughout Essex, Union, Morris, Warren counties with
services that include telepsychiatry
50. Narcolepsy
• Most patients have inherited a gene that codes for the human
leukocyte antigen (HLA) DQB1*06:02
• 25% population has this gene, but only 1% population affected by
narcolepsy
• A triggering factor that activates the immune system, such as
infection with strep
• A vulnerable age during which the immune response or some
characteristics of the brain make an autoimmune attack on the
hypocretin neurons more likely (classically younger age patients)
• PSG/MSLT required for diagnosis
51. Narcolepsy Treatment
• Lifestyle and home remedies including:
• Sticking to a schedule. Go to sleep and
wake up at the same time every day, including
weekends.
• Taking naps. Schedule short (20 minute)
naps at regular intervals during the day.
• Avoid nicotine and alcohol.
• Get regular exercise.
52. Let’s Connect the Dots
Sleep is as important as diet and exercise
only easier!
Make sleep the foundation of good health
53. • Set yourself up for
optimal sleep by
practicing good sleep
behaviors
• Listen to your bed
partner – they offer
insight as to nocturnal
behavior
• Think you have a sleep
disorder? Talk to a
sleep specialist!
Closing Remarks
55. Recommended Reading
• Sleep Smarter: 21 Essential
Strategies to Sleep Your Way
to A Better Body, Better Health,
and Bigger Success, by Shawn
Stevenson
• The Promise of Sleep, by
William Dement
• Say Goodnight to Insomnia, by
Gregg Jacobs
• Goodnight Mind, by Colleen
Carney