Update on the 18th International Conference on Co-morbidities and Adverse Drug Reactions in HIV
Daniel Lee, M.D.
January 20th, 2017
UCSD HIV & Global Health Rounds
A Study to Evaluate the Effectiveness of Planned Teaching Programme on Manage...ijtsrd
Introduction Interstitial lung diseases ILDs are a diverse group of lung diseases that are characterized by chronic inflammation and progressive fibrosis of the pulmonary interstitium. The interstitium is defined as the alveolar walls including epithelial cells and capillaries , septae, and the perivascular, perilymphatic, and peribroncheolar connective tissues. 1. Objectives To develop planned teaching program on management of Interstitial Lung Disease ILD . 2. To assess and evaluate the quality of life among newly diagnosed ILD patients before and after the administration of planned teaching program on management of Interstitial Lung Disease ILD . 3. To assess and evaluate the functional capacity in terms of 6MWD, protein value and Fat Free Mass Index FFMI among newly diagnosed Interstitial Lung Disease ILD patients before and after the administration of planned teaching program on management of Interstitial Lung Disease ILD . 4. To determine relationship between quality of life and functional capacity after administration of planned teaching on management of interstitial lung disease ILD . 5. To seek association between quality of life among newly diagnosed Interstitial Lung Disease ILD patients after administration of planned teaching program on management of Interstitial Lung Disease ILD with selected variables like A. Age B. Sex C. Education D. Medical illness E. Occupation F. Socio economic status 6. To seek association between functional capacity among newly diagnosed Interstitial Lung Disease ILD patients after administration of planned teaching program on management of Interstitial Lung Disease ILD with selected variables like A. Age B. Sex C. Education D. Medical illness E. Occupation’ F. Socio economic status Methods The research adopted a quasi experimental design with pre and post test of the intervention of the patients availing the planned teaching management programme of ILD. Exit interviews of ILD patients were conducted to 60 randomly selected patients among those who avail the facility in the hospital. International standardized questionnaire based on the St. George Respiratory Questionnaire SGRQ and Six Minute Walk Distance 6MWD , protein and fat free mass index FFMI by Bio Impedance Non Invasive are the tools used in this study. Further, a structure questionnaire to assess demographic data and a follow up pro forma for weekly telephone call, and planned teaching program on management of ILD were developed. Result The data was analyzed with descriptive and inferential statistics. The analysis of the newly diagnosed ILD patients showed that 45 was from 40 59 years of age 53 from the experimental group and 37 from the control group . In both experimental and control group majorities 63 of newly diagnosed interstitial lung disease patients were females from both the groups.It has 35 that has below 10 standard levels 40 in control group and 30 in experimental group and 29 had a family income range from 0 10,000 30 from control gr
Presented by Jane Dematte, MD at the Scleroderma Patient Education Conference hosted by the Scleroderma Foundation on Saturday, October 12, 2019 in Chicago, IL
Clinical Impact of New HIV Data From the 2016 Comorbidities-Adverse Drug Reac...hivlifeinfo
In this downloadable slideset, expert faculty members Todd T. Brown, MD, PhD, and Jordan E. Lake, MD, MSc, review key studies presented at the 2016 Comorbidities/Adverse Drug Reactions Workshop.
Format: Microsoft PowerPoint (.ppt)
File size: 1.37 MB
Date posted: 10/14/2016
Advances in the diagnosis and treatment for benign and malignant thyroid diseaseHealthXn
Thyroid disorders are common. This presentation reviews the causes of benign thyroid disease as well as therapy, including new therapies for advanced thyroid cancer.
Medicines For Respiratory Diseases
Apneas: Types, Their Measurement, Epidemiology, and Economics
Dronabinol: Breakthrough Treatment for Obstructive Sleep
Apnea
"Breath is the universal factor of life. We are born the first time we inspire, and we die the last time we expire. Breath is life itself. In Sanskrit, the same word means both breath and life."
Abbot George Burke
Although there are no large epidemiological studies from India, mortality data on total number of deaths from lower respiratory tract infection are available. Whereas the world wide mortality of CAP in hospitalised patients varies from 14%–50%, the reported mortality in India varies from 3.3% to 40% with higher rates in elderly & in those requiring intensive care unit (ICU) care. Use of clinical scores like CURB-65, & CRB 65 help to stratify risk of severe disease & need for hospitalisation & ICU care. Early initiation of appropriate antibiotic based upon the knowledge of local resistant patterns of existing pathogens is the key for successful treatment.
Using primary care databases to evaluate drug benefits and harms: are the res...David Springate
Databases of electronic medical records and in particular primary care databases (PCDs) are increasingly used in research. The largest PCDs contain full data on all primary care consultations by millions of patients over two or more decades. They provide a means for investigating important healthcare questions which cannot be practically addressed in a Randomised Controlled Trial. However, concerns remain about the validity of studies based on data from PCDs. Most work around validity has attempted to confirm individual data values within a dataset. We take a different approach and instead replicate published PCD studies in a second, independent, PCD. Agreement of results then implies that the conclusions drawn are independent of the data source (though this doesn’t rule out that such as confounding by indication are commonly influencing both).
We replicated two previous PCD studies using the Clinical Practice Research Datalink (CPRD). The first was a retrospective cohort study of the effect of Beta-blocker therapy on survival in cancer patients using DIN-LINK. The second was a nested case-control analysis of the effects of Statins on mortality of patients with ischaemic heart disease using QRESEARCH.
Our analyses produced several important quantitative differences compared to the original studies, altering conclusions. These could not be fully explained by either demographic differences in the patient samples or structural differences between the datasets. Our study highlights both the caution that needs to be applied when assessing the findings from analysis of just a single database and the difficulties in performing replications of existing PCD studies.
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.
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.
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.
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!
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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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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
COPD Asthma Workshop
1. Dr SUNDEEP SALVI MD, DNB, PhD(UK)
CHEST RESEARCH FOUNDATION
Pune
WHY DO WE NEED A REFRESHER COURSE
ON OBSTRUCTIVE AIRWAYS DISEASES?
www.crfindia.com
2. LUNGS: THE ORGAN OF RESPIRATION
420 Lts of oxygen delivered every day
350 Lts of carbon dioxide removed every day
10,000 Lts air pass
in and out every 24
hours
10,000 Lts blood
pass every 24
hours
3. WHY DO WE NEED A REFRESHER
COURSE ON
OBSTRUCTIVE AIRWAYS DISEASES?
• Is OAD a major health problem in
India?
• A good history and a good clinical
examination are enough to diagnose
OAD. Or is it not?
• Are we not managing patients with
OAD better in our practice?
5. 0
5
10
15
20
25
30
35
ESTIMATED NUMBER OF OBSTRUCTIVE
AIRWAY DISEASE PATIENTS IN INDIA
Million
Asthma
COPD28 million
17 million
35 million
22.2 million
25% 30%
2006 2016
( Murthy KJR, NCMH Background Papers – Burden of Diseases in India, 2005 )
6. PREVALENCE OF ASTHMA IN SCHOOL
CHILDREN IN INDIA
(ISAAC STUDY)
(n = 15,621)
0
5
10
15
20
25
30
35
1979 1984 1989 1994 1999
Pune, Nagpur Bangalore
5 – 6%
Prevalence of asthma in Indian school children
varies from 2% - 30%
7. TOBACCO SMOKING
5- times more harmful
1 cigarette = 1 bidi
Not 15-20%, but close to 50% of smokers develop COPD
1 BILLION SMOKERS WORLD-WIDE
8. NON-SMOKING COPD
70% of Indian homes
50% of COPDs are non-smokers
3 BILLION PEOPLE WORLD-WIDE EXPOSED
9. 0
1
2
3
4
5
6
7
8
Cancer IHD Stroke Diabetes Chronic Resp
diseases
Injuries
2.92
1.20
1.02
0.21
5.77
7.49
ESTIMATED MORTALITY FOR NON COMMUNICABLE
DISEASES IN INDIA
(Nongkynrih B et al, JAPI 2004 Feb; 52: 118-123)
WHO, 2002 data
Number in
lacs
13. HOW DO WE DIAGNOSE
OBSTRUCTIVE AIRWAYS DISEASES IN
CLINICAL PRACTICE?
HOW RELIABLE IS THIS?
14. UNDERDIAGNOSIS OF OLD IN OUT-PATIENT
CLINICS AND COMMUNITY SURVEYS
• American Study – NHANES III, >20,000 US
adults underwent spirometry (1988-1994)
Prevalence of OAD – 8.5%
63.3% under-diagnosis
(NHANES Study, Mannino et al, Arch Int Med 2000; 160: 1683-1689)
• Similar observations in UK, France, Spain and
other European countries
(Huchon, ERJ 2002; Pena, Am J Respir Crit Care Med 2001)
15. • More than 75% of patients with OAD have never
had a spirometry done in their life
• Spirometry is poorly utilized in India
• Myths about of Spirometry in India –
- Not really necessary for diagnosis of OAD
- Expensive test for the patients
- Difficult test to perform
- Difficult test to interpret
- Doesn’t make any difference in the management
of OAD
USE OF SPIROMETRY IN INDIA
16. HOW GOOD ARE WE AT
MANAGING ASTHMA AND COPD IN
CLINICAL PRACTICE?
17. • 420 cases of Obstructive Airways Disease
• 43.8% Asthma; 56.2% COPD
• Exacerbations - Daily: 52.6%
- Monthly: 31.2%
- < 1 mthly: 16.2%
• History of hospital admissions: 52%
• Usual treatment: - Antibiotics: 94.1%
- Oral theophylline: 93.1%
- Parenteral theophylline: 41.9%
- Salbutamol Inhaler: 81.2%
- Steroid Inhaler: 29.3%
- Oral steroids: 23.6%
EXPERIENCE OF OADs BY A CHEST
PHYSICIAN IN MUMBAI
(Kamat SR et al, Lung India, August 2006)
18. Tablet Salbutamol 2-4mg thrice daily
Versus
Inhaled Salbutamol 100-200mcg thrice daily
1000 excess tablets over a period of 6 months
19. 0
10
20
30
40
50
60
UQMP QMP Specialist Institute
Use of pMDI by asthmatic subjects
(Rohtak, India)
Prescribed inhaler Correct use
(n = 1400)
(Gupta PP et al, Ind J Chest Dis Allied Sci 2001; 43: 91-95 )
%
20. (Chest Research Foundation and B.J. Medical College Pune, 2006)
DO MEDICAL PERSONNEL KNOW HOW TO USE
pMDI CORRECTLY?
21. 1. Educate Patients
2. Assess and Monitor Severity
3. Avoid Exposure to Risk Factors
4. Establish Medication Plans for Chronic
Management: Adults and Children
5. Establish Plans for Managing Exacerbations
6. Provide Regular Follow-up Care
Six-Part Asthma Management
Program
22. 0
2000
4000
6000
8000
10000
12000
14000
1995 2000 2005 2010 2015
Current If we follow guidelines
7641 crores
(Murthy KJR et al, NCMH Background Papers, 2005)
ECONOMIC BURDEN OF ASTHMA AND COPD
IN INDIA
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
50000
25,209 crores
1996 2001 2006 2011 2016
23. SUMMARY
• Obstructive Airways Diseases are a major health
burden in India.
• The prevalence of OAD is only going to increase in
the future
• A large number of OADs remain undiagnosed in
clinical practice because of want of use of Spirometry
• Inhalation therapy is poorly used in India
• Patients suffering with OAD in India remain poorly
managed
• Doctors do not communicate effectively with patients
suffering with OADs
• OADs contribute to a huge economic loss in India
