This document discusses various biomarkers for cardiovascular disorders. It begins by defining myocardial infarction and describing typical symptoms. It then discusses biomarkers released after myocardial damage, including troponin and creatine kinase, and how they can help in diagnosis. It also covers biomarkers for heart failure diagnosis like BNP. Risk factors for cardiovascular disease are described, as well as enzymes involved in lipid transport and investigations of plasma lipid abnormalities.
this was the first lecture which i delivered as a doctor. it was about dyslipidemia. i hope you will find information valuable to you here. please read. let me know about your ideas. comment.
this was the first lecture which i delivered as a doctor. it was about dyslipidemia. i hope you will find information valuable to you here. please read. let me know about your ideas. comment.
Heart muscle disease, is a type of progressive heart disease in which the heart is abnormally enlarged, thickened, and/or stiffened. As a result, the heart muscle's ability to pump blood is less efficient, often causing heart failure and the backup of blood into the lungs or rest of the body.
Cardiovascular disease is the leading killer for both men and women among all racial and ethnic groups in the world wide. According to the Centers for Disease Control (CDC) studies among coronary heart disease (CAD) patients, 90% of patients have had prior exposure to at least one heart disease risk factor that contributed to their disease
Lipid Profile test & Cardiac Markers for MBBS, Lab. Med. and Nursing.pptxRajendra Dev Bhatt
The lipid profile is a group of tests that have been shown to be good indicators of whether someone is likely to have a Coronary disease or heart attack or stroke caused by blockage of blood vessels or hardening of the arteries (atherosclerois).
Kaplan Cardiac Anesthesia
Braunwald Textbook Of Cardiovascular Medicine
Fundamentals Of Cardiology For USMLE
Hensley Martin Practical Approach To Cardiac Anesthesia
WWW
1- Biochemical and molecular basis of lung diseases .pptMohamed Afifi
Recognize the biochemical structure and function of pulmonary surfactant
Discuss biochemical basis of respiratory distress syndrome
List the differences between collagen and elastin.
Identify the biochemical basis of lung emphysema due to alpha one antitrypsin deficiency.
Outline the biochemical and molecular basis of cystic fibrosis
Mention the diagnosis and treatment of cystic fibrosis
Definition f microorganism
A microorganism, or microbe, is an organism of microscopic size, which may exist in its single-celled form or as a colony of cells
Heart muscle disease, is a type of progressive heart disease in which the heart is abnormally enlarged, thickened, and/or stiffened. As a result, the heart muscle's ability to pump blood is less efficient, often causing heart failure and the backup of blood into the lungs or rest of the body.
Cardiovascular disease is the leading killer for both men and women among all racial and ethnic groups in the world wide. According to the Centers for Disease Control (CDC) studies among coronary heart disease (CAD) patients, 90% of patients have had prior exposure to at least one heart disease risk factor that contributed to their disease
Lipid Profile test & Cardiac Markers for MBBS, Lab. Med. and Nursing.pptxRajendra Dev Bhatt
The lipid profile is a group of tests that have been shown to be good indicators of whether someone is likely to have a Coronary disease or heart attack or stroke caused by blockage of blood vessels or hardening of the arteries (atherosclerois).
Kaplan Cardiac Anesthesia
Braunwald Textbook Of Cardiovascular Medicine
Fundamentals Of Cardiology For USMLE
Hensley Martin Practical Approach To Cardiac Anesthesia
WWW
1- Biochemical and molecular basis of lung diseases .pptMohamed Afifi
Recognize the biochemical structure and function of pulmonary surfactant
Discuss biochemical basis of respiratory distress syndrome
List the differences between collagen and elastin.
Identify the biochemical basis of lung emphysema due to alpha one antitrypsin deficiency.
Outline the biochemical and molecular basis of cystic fibrosis
Mention the diagnosis and treatment of cystic fibrosis
Definition f microorganism
A microorganism, or microbe, is an organism of microscopic size, which may exist in its single-celled form or as a colony of cells
Fate of Absorbed Amino Acids
Absorbed amino acids from diet are mixed with the amino acids produced from
hydrolysis of body protein and those synthesized in the body to form a common
amino acid pool (about 100g). This pool is drawn upon for anabolism and for
catabolism of amino acids.
Anabolic Fate
-These include the synthesis of proteins e.g. tissue, milk, and plasma proteins,
enzymes, and some hormones.
-They also include the synthesis of other nitrogenous substances e.g. glutathione,
adrenaline, thyroxine, melanin, niacin, purines, pyrimidines, aminosugars, and the
nitrogenous bases of phospholipids.
Catabolic Fate
-Most catabolic reactions are preceded by cleavage of the amino acids into ammonia
and the carbon skeleton (usually in the form of an -keto acid).
-The ammonia is mostly converted to urea, which is excreted in urine.
-Little ammonia is also excreted in urine. The carbon skeleton m
Cells of the nervous system: Neurons & Glial cells
▫ Glial cells:
most abundant cells, are of 3 main types
A. Microglia: Phagocytic (immune) cells,
B. Astrocytes: Support & nutrition of the neurons
(provide neurons with lactate from glucose and
regulate the content of ECF by removing K+ &
excess neurotransmitters)
C. Oligodendrocytes: form myelin sheathe in CNS
Schwan cells form myelin sheaths in PNS
Ependymal cells: line brain & spinal cord cavities
using their cilia to allow for the circulation of the
1- metabolism of the brain (I) 2012-13.pdfMohamed Afifi
Cells of the nervous system: Neurons & Glial cells
▫ Neurons:
A neuron is Formed of:
Cell body:
▫ contains most of the cytoplasm & organelles
Cytoplasmic extensions:
▫ include an axon & many dendrites
Overvie
The starting template material is RNA not DNA ( as in PCR assays for the diagnosis of viral infections)
RNA cannot serve as a template for PCR, (RNA is not a substrate for the Taq DNA polymerases commonly utilised in PCR.) Therefore reverse transcription is combined with PCR to convert RNA into a complementary DNA (cDNA)) suitable for PCR
The first step in this procedure is to convert the RNA molecules into single-stranded complementary DNA (cDNA) (Figure 9.20). Once this preliminary step has been carried out, the PCR primers and Taq polymerase are added and the experiment proceeds exactly as in the standard technique
Sanger sequencing: the most popular method first devised by Fred Sanger and colleagues in the mid-1970
DNA to be sequenced serves as a template for DNA synthesis.
A DNA primer is designed to be a starting point for DNA synthesis by DNA polymerase on the strand of DNA to be sequenced.
Four individual DNA synthesis reactions are performed.
The four reactions include normal A, G, C, and T deoxynucleotide triphosphates (dNTPs), and each contains a low level of one of four dideoxynucleotide triphosphates (ddNTPs): ddATP, ddGTP, ddCTP, or ddTTP.
Sanger sequencing: the most popular method first devised by Fred Sanger and colleagues in the mid-1970
DNA to be sequenced serves as a template for DNA synthesis.
A DNA primer is designed to be a starting point for DNA synthesis by DNA polymerase on the strand of DNA to be sequenced.
Four individual DNA synthesis reactions are performed.
The four reactions include normal A, G, C, and T deoxynucleotide triphosphates (dNTPs), and each contains a low level of one of four dideoxynucleotide triphosphates (ddNTPs): ddATP, ddGTP, ddCTP, or ddTTP.Sanger sequencing: the most popular method first devised by Fred Sanger and colleagues in the mid-1970
DNA to be sequenced serves as a template for DNA synthesis.
A DNA primer is designed to be a starting point for DNA synthesis by DNA polymerase on the strand of DNA to be sequenced.
Four individual DNA synthesis reactions are performed.
The four reactions include normal A, G, C, and T deoxynucleotide triphosphates (dNTPs), and each contains a low level of one of four dideoxynucleotide triphosphates (ddNTPs): ddATP, ddGTP, ddCTP, or ddTTP.
Sanger sequencing: the most popular method first devised by Fred Sanger and colleagues in the mid-1970
DNA to be sequenced serves as a template for DNA synthesis.
A DNA primer is designed to be a starting point for DNA synthesis by DNA polymerase on the strand of DNA to be sequenced.
Four individual DNA synthesis reactions are performed.
The four reactions include normal A, G, C, and T deoxynucleotide triphosphates (dNTPs), and each contains a low level of one of four dideoxynucleotide triphosphates (ddNTPs): ddATP, ddGTP, ddCTP, or ddTTP.
The starting template material is RNA not DNA ( as in PCR assays for the diagnosis of viral infections)
RNA cannot serve as a template for PCR, (RNA is not a substrate for the Taq DNA polymerases commonly utilised in PCR.) Therefore reverse transcription is combined with PCR to convert RNA into a complementary DNA (cDNA)) suitable for PCR
The first step in this procedure is to convert the RNA molecules into single-stranded complementary DNA (cDNA) (Figure 9.20). Once this preliminary step has been carried out, the PCR primers and Taq polymerase are added and the experiment proceeds exactly as in the standard technique
The starting template material is RNA not DNA ( as in PCR assays for the diagnosis of viral infections)
RNA cannot serve as a template for PCR, (RNA is not a substrate f
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Care must be taken to preserve protein structure and function after it is removed
from its natural environment where it was stable.
• pH – To prevent denaturation or loss of function, proteins are placed in buffered
solutions at or near their native pH.
• Temperature – Protein purification is normally carried at low temperature ~ 0°C.
while some proteins are thermally stable at high temperatures.
• Inhibition of proteases
• Retardation of microbes that can destroy proteins
Sodium azide is often used
Salting-In: Most globular proteins tend to become
increasingly soluble as the ionic strength is raised due to
the addition of salt. This phenomenon is known as saltingin of proteins.
• Salting-out: As the salt concentration increases, this
lead to diminishment of electrostatic attraction between
protein molecules by the presence of abundant salt ions.
This phenomenon is known as salting-out of proteins.
• The salt concentration at which protein precipitates differs
from one protein to another.
• Salting out is one of the most commonly used protein
purification procedures.
• Ammonium sulfate is the most commonly used reagent
- High solubility (3.9 M in water at 0 ºC)
- High ionic strength solution can be made (up to 23.5 in
water at 0 ºC)
There are four steps of ion-exchange chromatography:
1. Equilibration – stabilization of the ion-exchangers with oppositely
charged ions in the buffer. E.g: Na+Cl2. Sample application and wash (Protein bound to the ion-exchangers
remain attached while other gets removed during wash)
3. Elution – Removal of bound protein from the ion exchangers with the
help of increased concentration of elution buffer.
4. Regeneration – Preparing the ion exchangers for the next round of
protein purification
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Size-Exclusion (or molecular
exclusion) Chromatography
•Molecules are separated
according to differences in their
size as they pass through a
hydrophilic polymer
•Polymer beads composed of
cross-linked dextran (dextrose)
which is highly and uniformly
porous (like Swiss cheese)
•Large proteins come out first
(can’t fit in pores), small proteins
come out last (get stuck in the
por
There are four steps of ion-exchange chromatography:
1. Equilibration – stabilization of the ion-exchangers with oppositely
charged ions in the buffer. E.g: Na+Cl2. Sample application and wash (Protein bound to the ion-exchangers
remain attached while othe
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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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!
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.
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.
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
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
2. Myocardial Infarction
■ Myocardial infarction or acute myocardial infarction
(AMI) is the medical term for an event commonly known
as a heart attack.
■ It happens when blood stops flowing properly to part of
the heart and the heart muscle is injured due to not enough
oxygen.
■ Usually this is because one of the coronary arteries that
supplies blood to the heart develops a blockage due to an
unstable buildup of white blood cells, cholesterol and fat.
The event is called "acute" if it is sudden and serious.
Dr.Amal Hamza
4. ■ A person having an acute myocardial infarction usually
has sudden chest pain that is felt behind the breast bone
and sometimes travels to the left arm or the left side of
the neck.
■ Additionally, the person may have shortness of breath,
sweating, nasusea, vomiting, abnormal heartbeats, and
anxiety.
■ Women experience fewer of these symptoms than men,
but usually have shortness of breath, weakness, a feeling
of indigestion, and fatigue.
Dr.Amal Hamza
5. ■ The diagnosis of myocardial infarction has been
based on WHO criteria which comprise a typical
history of chest pain, the presence of diagnostic ECG
abnormalities and a rise in biochemical markers.
■ The presence of two or more of these three has
defined the diagnosis.
■ Troponins are more sensitive biochemical markers.
Many studies have shown that troponins are released
in some patients without ECG changes of infarction.
Dr.Amal Hamza
6. ■ After myocardial infarction, a number of intracellular
proteins are released from the damaged cells.
■ The proteins of major diagnosis interest include:
■ Troponin I and troponin T.
■ Enzymes, such as creatine kinase (CK), CK-MB,
(AST), and (LDH).
■ Myoglobin
■ Ischaemia-modified albumin.
Dr.Amal Hamza
7. ■ Troponins and CK are the most widely established
biochemical indices of myocardial damage.
■ Myoglobin is also a sensitive index of myocardial
damage and it rises very rapidly after the event.
■ However, it is non-specific, since it is raised
following any form of muscle damage.
■ Ischaemia-modified albumin is a new early and
sensitive biochemical marker of myocardial
ischaemia, but is non-specific and not widely
available.
Dr.Amal Hamza
8. Time course of changes
■ After a myocardial infarction, the time-course of
plasma biochemical markers always follows the same
general pattern.
Dr.Amal Hamza
9. ■ A sample taken on admission, if elevated, will
make the required diagnosis, but if not
elevated will not rule out the diagnosis.
■ A sample taken between 6 and 12 h after the
onset of symptoms will give more reliable
results.
Dr.Amal Hamza
11. Troponin
■ Troponin is a complex of three regulatory proteins
(troponin C, troponin I, and troponin T) that is
integral to muscle contraction in skeletal and
cardiac muscel, but not smooth muscle.
■ The troponin complex is exclusively present in
straited muscle fibers and regulates the calcium
mediated interactions of actin and myosin.
■ Troponin T binds tropomyosin, troponin I is an
inhibitory protein and troponin C is responsible for
binding calcium.
Dr.Amal Hamza
12. ■ In human heart the cardiac-specific troponin T and
troponin I are largely insoluble, but 3-5% exists as a
soluble cytoplasmic pool.
■ Following cardiac myocyte necrosis, this soluble fraction
accounts for the early and rapid release of troponin into
the circulation and the slower release of the insoluble
fraction accounts for the prolonged plateau of troponin
release.
■ The existence of the cardiac-specific isoforms of these
troponins makes them the most specific of all the
biochemical markers for cardiac damage.
Dr.Amal Hamza
13. ■ Under normal circumstances there is no
cardiac troponin T or I detectable in the
circulation by currently available assays, so
any detectable rise is of significance.
■ Troponin may also be elevated in renal
failure, sever heart failure and acute
pulmonary embolism.
Dr.Amal Hamza
14. Creatine Kinase
■ There are three principal CK isoenzymes, each comprising
two polypeptide chains, either B or M these give the dimers
BB,MB and MM.
■ Skeletal muscle has a very high total CK contents, over 98%
normally comprises CK-MM and less than 2 % CK-MB,
CK-MB may rise to 5-15% in some patients with muscle
disease and also in athletes in training.
■ Cardiac muscle also has a high CK content. It comprises 70-
80% CK-MM and 20-30% CK-MB.
■ Its use has been largely overtaken by the widespread
availiability of troponin measurement.
Dr.Amal Hamza
15. ■ As a general rule, cardiac muscle is the only
tissue with more than 5% CK-MB.
■ Ck-MB is a more sensitive and specific test
for myocardial damage than total CK.
Dr.Amal Hamza
16. The Diagnosis of heart failure
■ Heart failure is a complex clinical condition which the
heart’s ability to pump is compromised by one or more of
a number of underlying conditions , commonly ischemic
heart disease, but also heart valve abnormalities.
■ The prognosis is poor if untreated, with a 2-years survival
rate.
■ The diagnosis of heart failure can be difficult especially
since the usual presenting symptoms such as
breathlessness or ankle swelling are common and can be
due to many different conditions.
Dr.Amal Hamza
18. ■ The definitive diagnosis is best made by echocardiography,
but access to this may be limited or delayed.
■ BNP (B-type natriuretic peptides) is a neurohormone
secreted by cardiac myocytes in response to volume
expansion and pressure overload, and plays a role in
circulatory homeostaisis.
■ In heart failure the level of BNP increases, enabling
differentiation of cardiac and pulmonary causes of
breathlessness.
■ It costs considerably less than echocardiography.
■ Levels rise with age, so age related cut –offs should be
used.
Dr.Amal Hamza
19. Cardiovascular Risk Factors
■ Many factors are associated with or cause increased
cardiovascular risk.
■ These can be divided into those which cannot be influenced
and those which can be influenced and reduction of which
has been demonstrated to reduce risk.
■ Those that cannot be influenced include a family history of
premature vascular disease, age and pre-exisiting vascular
disease.
■ Those whose modification has an established role include
cigarette smoking and hypertenstion, diabetes and
hyperlipidaemia, espcially hypercholesterolaemia.
Dr.Amal Hamza
20. Enzymes involved in lipid transport
■ Four enzymes related to clinical disorders need to be
described:
■ Lecithin cholesterol acyltransferase (LCAT) transfers an acyl
group (fatty acid residue) from lecithin to cholesterol. Forming a
cholesterol ester.
■ Lipoprotein lipase is attached to tissue capiliary endothellium
and splits triglycerides into glycerol and free fatty acids.Its
activity increase after a meal as a result of activation by apoC-II.
■ Hepatic lipase has an action similar to that of lipoprotein lipase
■ Mobilising lipase, present in adibose tissue cells, controls the
release of fatty acids from adipose tissue into plasma. It is
activated by catecolamines, GH and gluocorticoids and inhibited
by glucose and insulin.
Dr.Amal Hamza
21. Investigation of plasma lipid
abnormalities
■ Most laboratories measure
■ Plasma total cholesterol
■ HDL cholesterol
■ Triglycerides
■ Further tests to characterize the lipoprotein
abnormalities may be done in a few patients.
■ The investigations are mainly of value in the
investigation and management of ischaemic vascular
disease.Dr.Amal Hamza
22. Plasma total cholesterol
■ Random cholesterol can be measured to assess cardiovascular risk. The
following factors affect cholesterol levels:
■ Diet: The amount and the composition of dietary fat affect plasma
cholesterol. [polyunsaturated fatty acids lower plasma cholesterol while
saturated fatty acid tend to raise cholesterol level].
■ Dietary fiber may have a small effect in lowering plasma cholesterol.
■ Exercise: regular exercise tends to cause a rise in plasma HDL
cholesterol.
■ Age: In developed countries, plasma cholesterol rises with age.
■ Sex: in pre-menopausal women, plasma cholesterol is lower than in men
and plasma HDL-C is higher. These differences disappear after the
menopause.
■ Race
Dr.Amal Hamza
23. -
- Incidence of ischaemic heart disease is directly correlated
with cholesterol, even within the reference range.
- LDL-C is associated with an increased risk of ischaemic heart
disease while raised plasma HDL-C is associated with a
decreased risk of heart disease and have protective effect.
- Plasma TG also show variations with age and sex, but more
especially with diet.
Dr.Amal Hamza
24. Plasma LDL
■ Plasma LDL can be measured by ultracentrifugation, but
this is not a practical method for routine clinical
laboratory use.
■ The following formula can be used to calculate LDL on
fasting sample:
■ LDL-C = Total cholesterol - (HDL-C) - TG/2.2
■ Where all measurements are in mmol/L.
■ The molar ratio of TG to cholesterol VLDL is 2.2 as long
as the TG is less than 4.5mmol/L.
■ The formula is not valid if TG is greater than 4.5mmol/L.
Dr.Amal Hamza
25. ■ It is important to collect specimens for plasma lipid and
lipoprotein under the appropriate conditions:
■ The patients should have been leading a normal life (diet,
exercise) for at least the previous night.
■ Blood samples should be collected after an overnight fast
of 10-14 h.
■ Routine investigations:
■ Plasma cholesterol
■ Plasma HDL-C
■ Plasma fasting triglycerides.
Dr.Amal Hamza
26. Specialised investigations
■ A large number of specialized investigations,
including:
■ Ultracenterfugation
■ Apolipoprotein
■ Enzyme studies
■ Molecular genetic studies
Dr.Amal Hamza
27. Primary hyperlipoproteinaemias
■ The causes of hyperlipoproteinaemia are complex and different disease
mechanisms can give rise to similar lipid patterns.
Increased plasma lipid concentration may be due to:
■ Genetic factors -Environmental factors
■ A combination of the above -Other disease (secondary)
Types of hyperlipoproeinaemias
■ Primary hypercholesterolaemia
■ Familial hypertriglyceridaemia
■ Familial combined hyperlipidaemia
■ Remnant hyperlipoproteinaemia
■ Lipoprotein lipase deficiency
■ Secondary hyperlipidaemia
Dr.Amal Hamza
28. Primary
hypercholesterolaemia
■ In about 95% of patients with primary
hypercholesterolaemia, the abnormality is due to a
combination of dietary factors and a number of genetic
abnormalities in handling cholesterol.
■ In the minority of patients who have familial
hypercholesterolaemia, there is a specific genetic defect in
the production or nature of high-affinity tissue apoB100
itself, so that it is not recognized by the normal receptor.
Dr.Amal Hamza
29. Familial
hypertriglyceridaemia
■ This group of condition is associated with defects either in the
production or in the catabolism of VLDL.
■ Plasma triglycerides and VLDL are increased but, whereas
plasma cholesterol is also moderately increased, plasma HDL is
often reduced.
■ Patients have an increased risk of ischaemic heart disease.
Dr.Amal Hamza
30. Lipoprotein lipase deficiency
■ This is a rare autosomal recessive disorder causing
hypertriglyceridaemia and chylomicronaemia.
■ The incidence of ischaemic heart disease and acute pancreatitis
is increased.
■ The primary defect is deficiency of either lipoprotein lipase or its
activator, apoC-II.
■ Treatment involves restriction of normal dietary fat and
replacement by means of triglycerides containing fatty acids of
medium chain length (C8-C11); these are less prone to lead to
chylomicron formation.
Dr.Amal Hamza
31. ■ Three rare familial disease related to lipoprotein metabolism may
include:
■ Tangier disease is due to an increased rate of apoA-I catabolism.
■ Only traces of HDL are detectable in plasma and plasma LDL-C
ia also reduced.
■ Cholesterol esters accumulate in the lymph system.
■ A betalipoproteinaemia is associated with a complete absence of
apoB. Plasma cholesterol and TG are very low.
■ Hypobetalipoproteinaemia is due to decreased synthesis of
apoB. Plasma VLDL and LDL although reduced are not absent.
Dr.Amal Hamza
32. Other biochemical cardiovascular
markers
■ Very high levels of homocysteine, up to 50-fold normal,
are seen in homocystinuria, an inborn error of metabolism
due to deficiency of the enzymes cystathionine β-
synthase.
■ Patients develop ocular, skeletal and vascular problems
with increased arterial and venous thrombotic events at an
early age and a markedly increased mortality.
■ Lowering homocysteine in this group of patients has been
demonstrated to lower the risk of cardiovascular disease.
Dr.Amal Hamza
33. ■ Elevation in homocysteine levels are associated with
an increased risk of cardiovascular disease.
■ Homocysteine prove to be a marker of increased
vascular risk rather than a causative risk factor.
■ Homocysteine levels are strongly influenced both by
genttic factors and by diet. Folic acid and vitamins B6
and B12 are involved in the catabolic pathways of
homocysteine.
■ Patints with high CRP, an inflammatory marker or
hsCRP are at risk of cardiovascular disease.
Dr.Amal Hamza
34. ■ The origin of this increased CRP can be due to
endothelial inflammation in association with
atherosclerotic plaques.
■ It is possible to lower plasma LDL-C by dietary and
other lifestyle means but the most effective therapy,
usually leading to reduction of up to 30% or more is
achieved by HMG-CoA reductase inhibitors (statins).
Dr.Amal Hamza