Mrs. J, a 56-year-old female, presented with complaints of pain in her right hip and both knees. She had a history of revision total hip replacement surgery and was diagnosed with osteoarthritis in both knees. She received bone marrow aspirate concentrate injections in both knees to help relieve her pain and accelerate healing. As she also had hypertension, she continued medications including a thiazide diuretic and calcium channel blocker. She was educated on osteoarthritis management, counseled on her medications, and discharged in a stable condition with recommendations to follow-up and maintain a healthy lifestyle.
Beta blockers have a variety of different uses in the management of ischemic heart disease. This presentation by Dr Vivek Baliga, Internal Medicine Physician talks about the role in ST elevation MI.
Beta blockers have a variety of different uses in the management of ischemic heart disease. This presentation by Dr Vivek Baliga, Internal Medicine Physician talks about the role in ST elevation MI.
Antiplatelet therapy there is a gap between guidelines and implementationA.Salam Sharif
platelets play an important role in cardiovascular diseases, the final event leading to ACS is a spontaneous atherosclerotic plaques which initiates a platelet response with platelet adhesion to vascular wall with activation and agregation and finally clot formation with clinical sequences od CV deaths, MI and myocardial ischemia and arrhythmias, so atiplatelet therapy is crucial in treatment of ACS, in the topic I review the traditional agents and new agents , focusing on guidelines and real world of their cinical uses .
With the growing number of individuals prescribed anti-coagulants, a dilemma exists whether to discontinue the medication few days before the dental innervation or to keep continuing it to prevent the chances of stroke. This presentation covers in detail the pros an cons of discontinuing the anti-platelet medication.
What are anti-coagulants?
What are the difference between antiplatelet, anticoagulants and thrombolytics?
Coagulation cascade
Virchows Triad
Classification of anti-coagulants?
Indications of anti-coagulants?
Mechanism and site of action of different anti-coagulants?
Beta Blockers in current cardiovascular practice Praveen Nagula
betablockers are the drug of choice for prevention of progression of heart failure with mortality benefit, after the evolution of neurohormonal regulation as pathogenesis of heart failure
Antiplatelet therapy there is a gap between guidelines and implementationA.Salam Sharif
platelets play an important role in cardiovascular diseases, the final event leading to ACS is a spontaneous atherosclerotic plaques which initiates a platelet response with platelet adhesion to vascular wall with activation and agregation and finally clot formation with clinical sequences od CV deaths, MI and myocardial ischemia and arrhythmias, so atiplatelet therapy is crucial in treatment of ACS, in the topic I review the traditional agents and new agents , focusing on guidelines and real world of their cinical uses .
With the growing number of individuals prescribed anti-coagulants, a dilemma exists whether to discontinue the medication few days before the dental innervation or to keep continuing it to prevent the chances of stroke. This presentation covers in detail the pros an cons of discontinuing the anti-platelet medication.
What are anti-coagulants?
What are the difference between antiplatelet, anticoagulants and thrombolytics?
Coagulation cascade
Virchows Triad
Classification of anti-coagulants?
Indications of anti-coagulants?
Mechanism and site of action of different anti-coagulants?
Beta Blockers in current cardiovascular practice Praveen Nagula
betablockers are the drug of choice for prevention of progression of heart failure with mortality benefit, after the evolution of neurohormonal regulation as pathogenesis of heart failure
* Case presentation: hyperosmolar hyperglycemic state (HHS)
Mortality attributed to hyperosmolar hyperglycemic state (HHS) is considerably higher than that attributed to DKA, with recent mortality rates of 5–20%.
* Agenda:
Historical perspectives and diagnosis.
Pathophysiology.
Treatment issues.
Rhabdomyolysis: an overlooked complication.
Final bottom line and take home message.
Stroke is the 2nd leading death associated disorder. It is also known as cerebrovascular disorder mainly caused by high blood cholesterol levels or rupture of cerebral arteries.
Door Prof. Dr. Hans Bijlsma wordt ingegaan op de balans tussen effectiviteit en veiligheid bij Glucocorticoїden (GC): leiden GC altijd tot botverlies, of kan het ontstekingsremmend effect sterker zijn dan de direct negatieve effecten op het bot? Zijn de bijwerkingen dosis-afhankelijk? Hoe kijken patiënten tegen bijwerkingen aan? Zijn er nieuwe medicamenten in aantocht met minder bijwerkingen?
Similar to Case presentation on osteoarthitis (20)
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
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
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
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
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
2. Patient name: Mrs. J
Gender: Female
Age: 56 years
IP no: 282115
DOA:18/9/2018
DOD: 21/9/2018
2
3. Chief Complaints: Complaints of pain in right hip and both knees
Past Illness History: Past history of revision THR right side.
Knee pains-gradually progressive. No H/o Trauma.
Past Medical History: K/c/o HTN – On medication.
Past Medication History:
T. NEFIDIPINE 30mg PO OD
T.AMILORID(Amiloride 5mg+Hydrochlorthiazide 50mg) OD
ALLERGY: Allergy to blood transfusion.
SUBJECTIVE
3
6. Procedure: BMAC injection was given to both knees.
Drug chart
BRAND GENERIC DOSE FRE
Q.
RO
A
CATEGORY INDICATION
T.NEFIDIPINE Nefidipine 30mg OD PO CCB HTN
T.AMILORID Amiloride
Hydrochlor
thiazide
5mg,
50mg
OD PO K+ Sparing
agent,
Thiazide
diuretic
HTN
6
7. GOALS OF THE THERAPY
To educate the patient and family members.
To relieve pain and stiffness
To maintain or improve joint mobility
To limit functional impairment and
to maintain or improve quality of life
To maintain a blood pressure of below 140/80 mm Hg (K/C/O HTN)
7
8. ASSESMENT
• A 54YOF, Mrs. J came with complaint of pain in right hip and both
knees. Knee pain gradually progressive.
• On evaluation patient was diagnosed with K/C/O OSTHEO ARTHRITIS
both knees.
• Patient has past H/o right revision TOTAL HIP REPLACEMENT (long
stem with trochanteric wiring) 4 times , which is usually done when all
other treatment options have failed to provide adequate pain relief.
• Bone scan of right hip done-Scan negative for loosening or infective
pathology involving the right hip prothesis.
So, now patient may need injection BONE MARROW ASPIRATE
CONCENTRATE to both knees which is natural alternative to surgical
intervention.
8
9. Bone Marrow Concentrate(BMC) Therapy, also known as Bone Marrow
Aspirate Concentrate(BMAC) Therapy, is a promising non surgical
regenerative therapy to accelerate healing in severe osteoarthritis.
The bone marrow contains a reservoir of “pluripotent” stem cells that
can be withdrawn from the patient’s hip bone and used for the procedure.
With BMC, the concentrate of regenerative cells provides a more robust
healing of the damaged tissue and aids in growth and repair by
accelerating the body’s natural healing mechanism.
BMAC was done to both knees and post BMAC was uneventful.
• Patient was a known case of hypertension and
T.AMILORID(Amiloride 5mg+Hydrochlorthiazide 50mg) OD was
continued in hospital.
A thiazide is the preferred type of diuretic for hypertension and is
considered a first-line therapy option in most patients with
hypertension.
9
10. Hydrochlorothiazide is a “thiazide-type” agent;usual dose is 12.5-50
mg/day.
Potassium sparing agents(Amiloride) are used only in conjunction with
a thiazide diuretic to prevent K+ loss and to augment the
antihypertensive action.
T. NEFIDIPINE 30mg PO OD was continued in hospital.
A long-acting dihydropyridine CCB should be strongly considered as
preferred add-on therapy when a thiazide is not controlling BP in a
patient and no other compelling indications.
Nifedipine usual dose is 30-90 mg/day OD.
It reduces CV morbidity and mortality as add on therapy with thiazide
diuretic.
• Patient was discharged in heamo-dynamically stable condition.
10
11. PLAN
Monitoring parameters:
Disease related
• Post-injection soreness at the injection site is some times present because
of an inflammatory response caused by BMC therapy.
• Monitor Blood pressure.
Drug related
• BIDURET(Amiloride + Hydrochlorothiazide):Monitor Potassium levels.
RECOMMENDATIONS:
Pain killers like Tramadol should be given to control the pain.
DVT prophylaxis is must because patient is obese in this case.
11
12. Patient counselling:
DISEASE RELATED:
• For the first 2-7 days, swelling and discomfort are typical in the injected
area. By the end of the first week, these symptoms usually begin to
resolve.
• Most patients notice some level of improvement by 2-6 weeks
following BMC. Increased stability and strength are typically reported
along with the decrease in pain.
• A second level of benefits may be obtained between 6 weeks and 3
months.
• It is important that anti inflammatory medications such as Ibuprofen,
Naproxen and Aspirin should be avoided following treatment because
these medicines may block the effects of the intended healing response
facilitated by the post injection inflammation.
12
13. DRUG RELATED
• OSTEOARTH 2g(Nutritional supplement-Chondroitin sulfate,Collagen
peptide,Curcumin,Ginger extract,Glucosamine,Piperine,Vitamin C ) to
be taken twice daily orally after food for 6 months.(given for
osteoarthritis)
• BIDURET 50mg(Amiloride 5mg + Hydrocholorothiazide 50mg) 1 tab
to be taken once daily orally after food.(continue it for hypertension).
• NICARDIA RETARD 20mg (Nifedipine 20mg) 1 tab to be taken once
daily orally after food.(continue it for hypertension).
• NICARDIA RETARD 10mg (Nifedipine 10mg) 1 tab to be taken orally
once daily orally after food.(continue it for hypertension).
13
14. Life style modifications
• Maintain normal body weight - body mass index 18.5-24.9 kg/m2
• Consume a diet rich in fruits, vegetables, and low-fat dairy products with
a reduced content of saturated and total fat.
14