A 45-year-old male presented with severe central chest pain and loss of consciousness. He was found to be in ventricular fibrillation and resuscitated. He was diagnosed with cardiac arrest due to acute myocardial infarction. He underwent percutaneous coronary intervention where a stent was placed in his left anterior descending artery. He was discharged on medical treatment and advised coronary angiography, which later showed single vessel coronary artery disease.
This ppt briefly summaries the major drugs used in the management of respiratory disease and are used in their treatment. We will also have a look at the moa, contraindications, pharmacokinetics of drugs used in their treatment.
This ppt briefly summaries the major drugs used in the management of respiratory disease and are used in their treatment. We will also have a look at the moa, contraindications, pharmacokinetics of drugs used in their treatment.
Communication problem & its management.Srinivas Nayak
what is communication ? Types of communication problems and how to identify communication problems and their ways of management and multi disciplinary TEAM approach
What is COPD, what causes COPD? What is the pathophysiology?How can we diagnose COPD. What is it's classification depending on severity. How can we diagnose COPD clinically as well as under microscope.How can we treat and manage COPD with the help of medicine as well as socially. Let's discuss.
Management of mental health disorders in the communityTuti Mohd Daud
Intended learning outcomes:
a) describe the rationale of providing mental health services in the community
b) identify mental health & psychiatric services at the levels of primary care, general hospital and mental institutions settings
c) describe the role of the different levels & profession of multidisciplinary team members in providing services
Case Presentation of a patient presented with polyradiculoneuropathy and bilateral bulbar palsy. Detailed evaluation finally pinpoints to Guillian barre syndrome.
Communication problem & its management.Srinivas Nayak
what is communication ? Types of communication problems and how to identify communication problems and their ways of management and multi disciplinary TEAM approach
What is COPD, what causes COPD? What is the pathophysiology?How can we diagnose COPD. What is it's classification depending on severity. How can we diagnose COPD clinically as well as under microscope.How can we treat and manage COPD with the help of medicine as well as socially. Let's discuss.
Management of mental health disorders in the communityTuti Mohd Daud
Intended learning outcomes:
a) describe the rationale of providing mental health services in the community
b) identify mental health & psychiatric services at the levels of primary care, general hospital and mental institutions settings
c) describe the role of the different levels & profession of multidisciplinary team members in providing services
Case Presentation of a patient presented with polyradiculoneuropathy and bilateral bulbar palsy. Detailed evaluation finally pinpoints to Guillian barre syndrome.
Anesthetic Management of a Patient with Peripartum Cardiomyopathy for LUCSMd Rabiul Alam
Peripartum cardiomyopathy is one of the leading causes of death in obstetric patients since it is usually diagnosed incidentally. Echocardiogram remains the mainstay to diagnose it. Many of the peripheral hospitals are deficient of echocardiogram facilities, so there are possibilities to send the patient to OR without diagnosis. To manage such a case and bring out the success depends on quick detection of the problems & immediate medical intervention after confirming the diagnosis. Obviously, any surgical intervention requires lot of clinical experiences of the whole team, particularly the anesthesiologists.
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
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
1. Dr Md Seebat Masrur
Indoor Medical Officer
Department of
Cardiology, TMC and RCH
Welcome to today`s
Case presentation
2.
3. A 45 years old
male admitted
into
cardiology
department
with severe
central chest
pain and
sudden loss of
consciousness.
4. Particulars of the Patient:
Name: Mr. Amzad Hossain
Age: 45 years
Sex: Male
Religion: Islam
Marital status: Married
Occupation: Service holder
Address: Ghoria, Rohobol, Shibganj, Bogra.
Date of Admission:24.04.2021
Date of Examination:24.04.2021
Department: Cardiology
6. History of Present illness
According to the statement of the patient’s
attendant, he was reasonably well 6 hours back.
Then he felt sudden central chest pain, which
was severe, compressive and squeezing in
nature. Pain radiated towards left arm and
associated with profuse sweating, nausea &
vomiting. There was no aggravating or relieving
factor. No history of cough, fever or
breathlessness.
7. Continued…….
While Emergency medical officer was
examining, the patient suddenly collapsed.
Basic life support was started immediately and
measures to transfer the patient to CCU were
taken outright. At CCU basic life support was
continued while making a quick assessment. At
CCU, his pulse was not palpable, BP was not
recordable, respiration was agonal, blood sugar
was within normal limit,SP02 54%, pupil was
mid-dilated & response to light was sluggish,
GCS 3/15.Immediately Defibrillator monitor
was attached to the patient and monitor
showed Ventricular Fibrillation. Then advanced
cardiac life support was started.
8.
9. Continued…
DC shock was given at 200J and CPR (30:2)
continued for 2 minutes. But ventricular
fibrillation did not reverted to sinus rhythm.
Again, DC shock at 200J was given and
CPR(30:2) continued. Ventricular fibrillation
reverted to sinus rhythm. Then patient`s
pulse became palpable which was feeble, BP
was 60/40mm hg, respiratory rate 12
breaths/min,SpO2 90%,GCS 7/15. The
patient was still unconscious and frequent
seizure occurred.
10. History of Past illness:
He had no history of Ischemic Heart
Disease, Hypertension, Diabetes
mellitus, Cerebrovascular disease or
any other comorbid condition.
12. Family history
His parents are alive. He has one brother,
two sisters and one child. His father and
elder brother were suffering from
Ischemic Heart Disease.
17. Continued:
• Body hair:
Normally
distributed
• Deformities:
Absent
• Lymph node: Not
palpable
• Thyroid gland:
Not enlarged
JVP: Not raised
Pulse: Not palpable
BP: Not recordable
Respiration: Agonal
respiration
Temperature: 98 F
19. Continued:
2. Blood pressure: Not recordable
3. JVP: Not raised
4. Examination of precordium:
a)Inspection:
Size and shape: Normal
Visible pulsation: Absent
Epigastric pulsation: Absent
Venous engorgement: Absent
No scar mark, no deformity.
20. Continued:
b) Palpation:
Apex beat: Not palpable
Thrill: Absent
Left parasternal heave: Absent
P2: Not Palpable
Any pulsation in Aortic area: Absent
Epigastric pulsation: Absent
Enlarged, Tender Liver: Absent
21. Continued:
C) Percussion: Not done
D) Auscultation:
1st heart sound: Not Audible
2nd heart sound: Not Audible
Added Sound: Absent
Bilateral basal crepitation: Absent
22. B.RESPIRATORY
SYSTEM:
Respiratory rate:3-5 agonal breaths per
minutes.
Inspection:
Shape of the chest: Elliptical shaped
Movement of the chest: Silent Chest
Intercostal indrawing: Absent
Subcostal recession: Absent
Scar mark: Absent
Any visible pulsation : Absent
23. Palpation:
Position of trachea: Centrally placed
Position of apex beat: Not palpable
Chest expansion: Not expanding
Chest expansibility: Not expansible
Vocal fremitus: Not performed
26. Alimentary system
Examination of oral cavity: Gum, teeth,
tongue, buccal mucosa –normal
Abdomen proper:
Inspection: normal
Palpation:
Superficial palpation:
•Tenderness: Absent
27. Deep palpation:
• Liver: Not palpable
• Spleen: Not palpable
• Kidney Not ballotable
• No lump or mass
• Genitalia :normal
28. Continued…
Percussion: Percussion note was tympanic
No shifting dullness.
Auscultation: Bowel sound normal
Bruits: Absent
Digital Rectal Examination: Not Done
29. Examination of Nervous
system
GCS E1 M1 V1(3/15) after defibrillation 7/15
Higher psychic function : Cannot be
performed as the patient was unconscious
• Orientation :
• Intelligence :
• Speech :
• Consciousness :
• Memory :
• Cranial nerves :
33. Salient features:
Mr Amzad hossain 45 years old male,
normotensive, nondiabetic, smoker,
nonalcoholic, non beetle nut chewer, with a
positive family history for IHD was admitted in
this hospital with the complaints of chest pain
for 6 hours, which was severe, compressive
and squeezing in nature. Pain radiated towards
left arm and was associated with profuse
sweating, nausea & vomiting. There was no
aggravating and relieving factors. No history of
cough, fever or breathlessness.
34. Continued…
While Emergency medical officer was examining,
the patient suddenly collapsed. Basic life
support was started immediately and the patient
transfer to CCU while maintaining CPR. In CCU
basic life support was continued and the
diagnosis of Cardiac arrest in the form of VF
was confirmed by ECG. Advanced cardiac life
support was started. At first DC shock at 200j
was given and CPR continued for 2 minutes. But
VF not reverted to sinus rhythm. Again DC shock
at 200j was given and CPR continued. VF
reverted to sinus rhythm and patient’s pulse, BP
& respiration reappeared. The patient was still
unconscious and frequent seizure occurred.
35. Continued…
Patient was defibrillated with DC shock of
200J and CPR (30:2) continued. But rhythm
still showed ventricular fibrillation. So
again, 200J DC shock was given and
CPR(30:2) continued. VF reverted to sinus.
Then upon assessment patient`s pulse was
feeble, BP was 60/40mm hg, respiratory
rate 12 breaths/min,SpO2 90%,GCS 7/15.
The patient was put on inotrope. The
patient was still unconscious and frequent
seizure occurred over the next 3 hours.
36. Continued:
Cardiovascular system: All arterial pulses
were not palpable. Examination of
precordium: Inspection-there were no
visible pulsation, no scar, no deformity.
Palpation- not palpable. There was no thrill,
left parasternal heave absent,P2 not
palpable, No pulsation in Aortic area and
epigastric pulsation absent. On auscultation
– 1st and 2nd heart sounds were not audible,
No added sound found, there was no basal
crepitation.
37. Continued:
Respiratory system examination: on inspection-
patient chest was silent, palpation trachea was
centrally placed, no chest expansion noticed,
percussion note was tympanic ,auscultation- breath
sound : absent, no added sound found. Alimentary
system, nervous system and other system revealed
normal findings.
47. Final Diagnosis
So final diagnosis is-
Cardiac Arrest in the form of
Ventricular Fibrillation due to Acute
Myocardial Infarction(Ant+Inf)
48. Treatment:
On admission
Immediate management:
1. Airway clearance by sucker machine
2. Maintenance of breathing and O2
supplementation via AMBU Bag
3. Maintenance of circulation by external cardiac
massage and IV channel access
4. Cardiac defibrillation twice(200J and 200J)
49. Pharmacological Management
Inj Dobutamine-I/V @ 3 ml/Hr via syringe
pump
Tab Aspirin- Loading and maintenance dose
Tab Clopidogrel- Loading and maintenance
dose
Tab Atorvastatin 40mg-0+0+1(B/M)
Tab Trimetazidine 35mg-1+0+1
Inj Enoxaparin 60mg-1 PFS S/C was given
Tab Frusemide+ Spironolactone
Tab Phenytoin 100mg-1+1+1
50. Continued…
Inj Diazepam 10mg-I/V slowly stat
Inj Phenobarbitone 200mg-1 Vial I/V stat
Inj Levetiracetam 500mg-1 amp I/V slowly
and TDS
Inj Pethidine 100mg-25 mg I/V stat
Inj Prochlorperazine 12.5mg-1 amp I/V stat
Inj Pantonix 40mg-1 vial I/V stat & BD
Inj Ceftriaxone 1gm-1 vial I/V stat & 12 hrly
51. Treatment on Discharge
Tan Aspirin+Clopidogrel…0+1+0(After Meal)….Continue
Tab Amiodarone 200mg….. ½+0+½ ……………….Continue
Tab Atorvastatin 40mg…….0+0+1(before Meal)..Continue
Tab Nitroglycerin 2.6 mg….1+0+1+0………………….Continue
Tab Trimetazedine mr 35mg…1+0+1……………………Continue
Tab Furosemide+Spironolactone 20/50mg..1+0+0..Continue
Tab Pantoprazole 20 mg…1+0+1(Before meal)…….Continue
Tab Bromazepam 3 mg….0+0+1…………………………..Continue
Nitroglycerin Spray..2 puff under the tongue……..If severe
central chest pain
54. Coronary
Angiogram report
LAD Type IV vessel & 80-
85% Stenosis in its proximal
segment.D1 has got 80-90%
stenosis in its proximal
segment.
Comment-Single Vessel
Disease
Recommendation-PCI to
LAD
65. Prognosis
Acute MI has a high mortality. At least one
third of the patient die before reaching
the hospital & another 40-50% are dead
upon arrival. Another 5-10% die within the
first 12 months. Readmission rate is about
50% with first 12 months.
The overall prognosis actually depends on
extent of muscle damage. That's why TIME
IS MUSCLE.
66. Prognosis
Incidence of Shockable rhythm is
24%.Survival rate is over 30%
Whereas in Nonshockable rhythm
incidence is 76%.Survival rate is
less than 10%
Furthermore, decrease in survival
by 8-10% for every minute delay
after collapse to defibrillation
67. Key message
The overall mortality &^morbidity can
be reduced by providing Optimum
care at Right Time in Right place.