The document discusses organophosphate poisoning, noting that organophosphates inhibit acetylcholinesterase leading to overstimulation of the nervous system. Treatment involves administering atropine to block muscarinic effects along with pralidoxime (2-PAM) to reactivate acetylcholinesterase. Additional treatments discussed are benzodiazepines which can be used to treat agitated delirium, seizures, and reduce respiratory failure caused by organophosphate poisoning.
This is an lecture presentation for MBBS Semester 1 students. Here we discuss cholinergic agonists and anticholinesterase drugs. We end up discussing about OP poisoning in brief.
This is an lecture presentation for MBBS Semester 1 students. Here we discuss cholinergic agonists and anticholinesterase drugs. We end up discussing about OP poisoning in brief.
40 slides that focus on the drugs used to treat epilepsy (anti-epileptic drugs) and their their primary molecular mechanisms of action. Produced by Stephen Kelley (University of Dundee, UK).
40 slides that focus on the drugs used to treat epilepsy (anti-epileptic drugs) and their their primary molecular mechanisms of action. Produced by Stephen Kelley (University of Dundee, UK).
A good read for undergraduate students in Pharmacy studying at the University of Mumbai. I will highly recommend Essentials of Medical Pharmacology by KD Tripathi. All copyright to the original authors and publishers.
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
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.
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.
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
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
4. ACETYLCHOLINESTERASE
1)Present in cholinergic sites,
RBCs, gray matter
2)Very fast hydrolysis of ACh
3)Can hydrolyse methacholine,
4) canot hydrolyse
benzocholine, butyryl choline
5)More sensitive to
physostigmine
6)Termination of Ach action
BUTYRYLCHOLINESTERASE
1)Present in white matter,
plasma, liver, intestine(White PIL)
2)Slow hydrolysis
3)Not hydrolysed
4)benzocholine, butyryl choline
hydrolysed
6)More sensitive to
organophosphates
Hydrolysis of ingested esters
5. Physostigmine
Natural alkaloid
Tertiary amine derivative
Good oral absorption
CNS actions are present
Penetrates cornea
Direct action on cholinoceptors
Absent
Prominent effect on autonomic
effectors
Uses- miotic(glaucoma)
Dose -0.1-1% eye drops
Systemic eff-4-6hrs
Neostigmine
Synthetic derivative
Quaternary ammonium comp
Less oral absorption
Absent
Poor penetration
Action oncholinoceptor is
present
Prominent effect on skeletal
Muscles
Uses –myasthenia gravis
0.5-2.5mg sc
3-4hrs
6. A disease characterized by raised intraocular
pressure(IOP) and progressive optic neuropathy with loss
of retinal neurons and their axons (nerve fiber layer)
resulting in blindness if left untreated.
Aqueous humour pass b/w lens and iris go out
through pupil
Primary –respond to drugs
a)Narrow angle/angle closure/acute congestive-
medical emergency-drug and partial iridectomy
b) simple/open angle/chronic/-loss of trabacular
mesh work patency is lost
Secondary- partly responds
Congenital-less responsive
7.
8. 1) Beta-Blockers [levobunolol, timolol, carteolol,
betaxolol]
Mechanism: Act on ciliary body to production of
aqueous humor
Administration: Topical drops to avoid systemic effects
Use twice a day (except Timolol)
Side Effects: Cardiovascular (bradycardia, asystole,
syncope), bronchoconstriction (avoid with b1-
selective betaxolol), depression
9. 2) Alpha-2 Adrenergic Agonists [apraclonidine,
brimonidine]
Mechanism: production of aqueous humor
May become less effective over time
Administration: Topical drops
Side Effects: Lethargy, fatigue, dry mouth
[apraclonidine is a derivative of clonidine
(antihypertensive) which cannot cross BBB to
cause systemic hypotension]
Brimonidine -never used in infants
In younger children can cause slowed breathing
and heartbeat
In older children Stinging / irritation
10. 3)Carbonic Anhydrase Inhibitors [acetazolamide,
dorzolamide]
Mechanism: Blocks Carbonic Anhlydrase-II enzyme
blocks production of bicarbonate ions (transported
to posterior chamber, carrying osmotic water flow)
production of aqueous humor
Better tolerated in children than adults
Usually used in addition to drops
Administration: Oral
Side Effects: Metabolic disturbances (electrolyte
balance, acid-base balance) malaise, kidney stones,
possible (rare) aplastic anemia
11. 1)Parasympathomimetics [pilocarpine, carbachol,
echothiophate]
Mechanism: contractile force of ciliary body muscle,
outflow via TM
Administration: Topical drops or gel, (slow-release
plastic insert)
Side Effects: Headache, induced miopia. Few systemic
SE for direct-acting agonists vs. AchE inhibitors
(diarrhea, cramps, prolonged paralysis in setting of
succinylcholine).
12. 2)Nonspecific Adrenergic Agonists [epinephrine,
dipivefrin]
Mechanism: uveoscleral outflow of aqueous
humor
Administration: Topical drops
Side Effects: Can precipitate acute attack in patients
with narrow iris-corneal angle, headaches,
cardiovascular arrhythmia, tachycardia
13. The defect in neuromuscular transmission in Myasthenia
Gravis is due to:
The muscle end-plate membrane is distorted
Acetylcholine receptors are lost from the tips of the folds,
and antibodies attach to the postsynaptic membrane
Ach is released normally but absence of receptors prevents
the transmitter binding to the muscle membrane
14. Immuno-precipitation assay
Edrophonium (Tensilon test)-2mg IV
Patients with MG have low numbers of AChR at the
NMJ
Ach released from the motor nerve terminal is
metabolized by Acetylcholine esterase
Edrophonium is a short acting Acetylcholine Esterase
Inhibitor that improves muscle weaknessmyasthenia
Condition worsens cholinergic crisispersistant
depolarisation of motar end plate
15. 1.Reversible anti-AchE
Neostigmine-15-30 mg, per day orally
0.5-0.25mg im/sc
Pyridostigmine-60mg-tid orally
Ambenonium-2.5-5mg orally
2.Glucocorticoids –prednisolone-10mg OD
3.Immunosuppressants
Azathioprine 2.5mg/kg per day
Cyclosprine-2-5mg/kg per day
4.Thymectomy –myasthenia with thymoma
5.Plasmapheresis –for non responders to thymectomy and
treatment with steroids
16. Organophosphates = Organic Compounds + Phosphate
Group
No Clinical Uses For These Compounds.
Agricultural Insecticides And Fungicides
Household Garden Sprays
Fly And Insect Sprays
Poisoning -Cutaneous
Ingestion (Accidental Or Suicidal)
Inhalation
Injection
17. op inactivate acetyl cholinesterase (Ach E).
establishment of a covalent bond with ache.
once Ach E - inactivated, ach accumulates
throughout the nervous system →
overstimulation of muscarinic and nicotinic
receptors.
18. Muscarinic Effects By organ systems include the following:
Cardiovascular - Bradycardia, Hypotension
Respiratory - Rhinorrhea, Bronchorrhea, Bronchospasm, Cough,
Severe Respiratory Distress
Gastrointestinal - Hypersalivation, Nausea And Vomiting,
Abdominal Pain, Diarrhea
Genitourinary - Incontinence
Ocular - Blurred Vision, Miosis
Glands - Increased Lacrimation, Diaphoresis
19. Once an organophosphate binds to AChE, the enzyme
can undergo one of the following:
• Endogenous hydrolysis of the phosphorylated enzyme
by esterases or paraoxonases
• Reactivation by a strong nucleophile such as
pralidoxime (2-PAM)
• Irreversible binding and permanent enzyme
inactivation (aging)
The onset and severity of symptoms depend on the
specific compound, amount, route of exposure, and
rate of metabolic degradation
20. Mild ( ≥ 40% ache)
No specific treatment
Clearing the airway,
Adequate ventilation-consider oxygenation
Remove soiled clothes
Wash contaminated skin to prevent further absorption.
21. 2. Patients With Systemic Features –
Gastric lavage within an hour followed by activated
Charcoal administered via nasogastric tube
Wash the patient – to prevent cutaneous absorption
Wash soiled clothes
IV Atropine 2mgs every 15 minutes till signs of
atropinization are seen
Add an oxime E.G. Pralidoxime
Consider ICU Care If In Coma Or Unconscious
Organophosphorus poisoning-
treatment
22.
23. PAM-pralidoxime-Current Recommendation Is
Administration Within 48 H Of OP Poisoning.,
Administer Atropine Concomitantly-↓ Respiratory
Secretions.
1-2 G (20-40 Mg/Kg) IV In 100 ml NS/D5W Over 15-30
Min ; Repeat In 1 H If Muscle Weakness Is Not Relieved;
Then Repeat Q3-8h If Signs Of Poisoning Recur.
Alternatively, Continuous Drip; Start With Bolus Of 25-
50 Mg/Kg And Then 10-20Mg/Kg/h
Organophosphorus poisoning-treatment
24. Potentiate Effects Of GABA And Facilitate Inhibitory
GABA Neurotransmission
For Treatment Of Seizures. Depresses All Levels Of CNS
(Eg, Limbic And Reticular Formation) By Increasing
Activity Of GABA.
5-15 Mg IV Q5-10 Min, Repeat As Needed; Consider
Higher Doses If Needed
Routinely Used In OP Poisoning For Treatment Of
Agitated Delirium And Seizures
Diazepam Reduces Respiratory Failure (Rats) And
Cognitive Deficit (Primates)