The document discusses the actions of adrenocorticotropic hormone (ACTH) and corticosteroids. ACTH stimulates the adrenal cortex to produce corticosteroids like cortisol and aldosterone. Corticosteroids have mineralocorticoid effects like sodium retention and glucocorticoid effects like increasing blood glucose. They suppress inflammation and immune responses. Common glucocorticoids used include hydrocortisone, prednisone, and dexamethasone. Aldosterone is the main mineralocorticoid. Corticosteroids have many beneficial effects but also side effects like high blood pressure, bone loss, and weight gain if overused.
HORMONES OF ADRENAL CORTEX Adrenocortical hormones are steroids in nature. Classification
Based on their functions, corticosteroids are classified into three groups:
Ø1. Glucocorticoids
Ø2. Mineralocorticoids
Ø3. Sex hormones.
Respiratory stimulants: types, complete discussion on indications, contraindications, assessment, patient notes and examples of stimulants both central and respiratory
HORMONES OF ADRENAL CORTEX Adrenocortical hormones are steroids in nature. Classification
Based on their functions, corticosteroids are classified into three groups:
Ø1. Glucocorticoids
Ø2. Mineralocorticoids
Ø3. Sex hormones.
Respiratory stimulants: types, complete discussion on indications, contraindications, assessment, patient notes and examples of stimulants both central and respiratory
Expectorants and Antitussives: types, complete discussion on indications, contraindications, assessment, patient notes and examples of expectorants and antitussives
Complete pharmacology of Non steroidal Anti inflammatory Drugs, classification, Mechanism of action, Pharmacological actions, Indications, Contraindications, Adverse effects
Pharmacology laboratory experiment, both invivo and invitro includes interpolation, matching , bracketing, three point, four point bioassays with a note on hypoglycemic activity, acute skin irritation, acute eye irritaiton, pyrogen test, gastrointestinal motility test, physiological salt solutions
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
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
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
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
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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!
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
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
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
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.
1. Dr. Koppala RVS Chaitanya
ACTH AND CORTICOSTEROIDS
The corticoids (both gluco and mineralo) are 21 carbon compounds having a
cyclopentanoperhydro- phenanthrene (steroid) nucleus. They are synthesized in the adrenal
cortical cells from cholesterol. Adrenal steroidogenesis takes place under the influence of
ACTH which makes more cholesterol available for conversion to pregnenolone and induces
steroidogenic enzymes. Since adrenal cortical cells store only minute quantities of the
hormones, rate of release is governed by the rate of biosynthesis. The circulating
corticosteroids inhibit ACTH release from pituitary as well as CRH production from
hypothalamus.
The normal rate of secretion of the two principal corticoids in man is—
Hydrocortisone—10–20 mg daily (nearly half of this in the few morning hours).
Aldosterone — 0.125 mg daily.
Glucocorticoid Effects on carbohydrate, protein and fat metabolism
Mineralocorticoid Effects on Na+, K+ and fluid balance.
Marked dissociation between these two types of actions is seen among natural as well as
synthetic corticoids.
MINERALOCORTICOID ACTIONS
The principal mineralocorticoid action is enhancement of Na+ reabsorption in the distal
convoluted tubule in kidney.
There is an associated increase in K+ and H+ excretion.
Its deficiency results in decreased maximal tubular reabsorptive capacity for Na+; kidney
is not able to retain Na+ even in the Na+ deficient state → Na+ is progressively lost:
2. Dr. Koppala RVS Chaitanya
kidneys absorb water without the attendant Na+ (to maintain e.c.f. volume which
nevertheless decreases) → dilutional hyponatraemia → excess water enters cells →
cellular hydration: decreased blood volume and raised haematocrit.
The action of aldosterone is exerted by gene mediated increased transcription of m-RNA
in renal tubular cells which directs synthesis of proteins (aldosterone-induced proteins—
AIP). The Na+K+ ATPase of tubular basolateral membrane responsible for generating
gradients for movement of cations in these cells is the major AIP.
The main adverse effect of excessive mineralocorticoid action is fluid retention and
hypertension.
The natural and some of the synthetic glucocorticoids have significant mineralocorticoid
activity responsible for side effects like edema, progressive rise in BP, hypokalaemia and
alkalosis.
The diuretic induced hypokalaemia is aggravated by mineralocorticoid excess.
Aldosterone has been shown to promote CHF associated myocardial fibrosis and
progression of the disease.
3. Dr. Koppala RVS Chaitanya
GLUCOCORTICOID ACTIONS
Carbohydrate and protein metabolism
Glucocorticoids promote glycogen deposition in liver (they are assayed on the basis
of this action) by inducing hepatic glycogen synthase and promoting
gluconeogenesis.
They inhibit glucose utilization by peripheral tissues.
This along with increased glucose release from liver results in hyperglycaemia,
resistance to insulin and a diabetes-like state.
They also cause protein breakdown and amino acid mobilization from peripheral
tissues.
This is responsible for side effects like muscle wasting, lympholysis, and loss of
osteoid from bone and thinning of skin.
The amino acids so mobilized funnel into liver → used up in gluconeogenesis, excess
urea is produced → negative nitrogen balance. Glucocorticoids are thus catabolic.
Their function appears to be aimed at maintaining blood glucose levels during
starvation—so that brain continues to get its nutrient.
When food is withheld from an adrenalectomized animal—liver glycogen is rapidly
depleted and hypoglycaemia occurs.
Glucocorticoids also increase uric acid excretion.
Fat metabolism
They promote lipolysis due to glucagon, growth hormone, Adr and thyroxine.
cAMP induced breakdown of triglycerides is enhanced.
Fat depots in different areas of the body respond differently—redistribution of body
fat occurs. Subcutaneous tissue over extremities loses fat which is deposited over
face, neck and shoulder producing ‘moon face’, ‘fish mouth’ and ‘buffalo hump’.
Explanation offered is—because
Peripheral adipocytes are less sensitive to insulin and
More sensitive to corticosteroid-facilitated lipolytic action of GH and Adr, break
down of fat predominates,
Whereas truncal adipocytes respond mainly to raise insulin levels caused by
glucocorticoid induced hyperglycaemia.
Calcium metabolism
Glucocorticoids inhibit intestinal absorption and enhance renal excretion of Ca2+.
Loss of osteoid (decreased formation and increased resorption) indirectly results in
loss of Ca2+ from bone, producing negative calcium balance.
Spongy bones (vertebrae, ribs, pelvis, etc.) are more sensitive.
4. Dr. Koppala RVS Chaitanya
Water excretion
The effect on water excretion is independent of action on Na+ transport;
hydrocortisone and other glucocorticoids, but not aldosterone, maintain normal G.F.R.
In adrenal insufficiency, the capacity to excrete a water load is markedly reduced—
such patients are prone to water intoxication from i.v. infusions.
Glucocorticoids also enhance secretory activity of renal tubules.
CVS
Glucocorticoids restrict capillary permeability, maintain tone of arterioles and
myocardial contractility.
Applied topically, they cause cutaneous vasoconstriction.
They also play a permissive role in development of hypertension—should be used
cautiously in hypertensives.
Adrenal insufficiency is attended by low cardiac output, arteriolar dilatation, poor
vasoconstrictor response to Adr (repeated doses of Adr cause destructive changes in
blood vessels) and increased permeability of capillaries.
These changes along with hypovolemia (due to lack of mineralocorticoid) are
responsible for cardiovascular collapse.
Skeletal muscles
Optimum level of corticosteroids is needed for normal muscular activity.
Weakness occurs in both hypo- and hypercorticism, but the causes are different.
Hypocorticism: diminished work capacity and weakness are primarily due to
hypodynamic circulation.
Hypercorticism: excess mineralocorticoid action → hypokalaemia → weakness;
Excess glucocorticoid action → muscle wasting and myopathy → weakness.
CNS
Mild euphoria is quite common with pharmacological doses of glucocorticoids.
This is a direct effect on brain, independent of relief of disease symptoms, and
sometimes progresses to cause increased motor activity, insomnia, hypomania or
depression.
On the other hand, patients of Addison’s disease suffer from apathy, depression and
occasionally psychosis.
Glucocorticoids also maintain the level of sensory perception and normal level of
excitability of neurones.
High doses lower seizure threshold. Use in epileptics requires caution.
This action is independent of electrolyte changes in the brain and is not shared by
aldosterone.
5. Dr. Koppala RVS Chaitanya
Stomach
Secretion of gastric acid and pepsin is increased—may aggravate peptic ulcer.
Lymphoid tissue and blood cells
Glucocorticoids enhance the rate of destruction of lymphoid cells (T cells are more
sensitive than B cells); but in man the effect on normal lymphoid tissue is modest.
However, a marked lytic response is shown by malignant lymphatic cells.
This is the basis of their use in lymphomas.
Glucocorticoids increase the number of RBCs, platelets and neutrophils in circulation.
They decrease lymphocytes, eosinophils and basophils. This is not due to destruction
of the concerned cells, but due to their sequestration in tissues.
Blood counts come back to normal after 24 hours.
Inflammatory responses
Irrespective of the type of injury or insult, the attending inflammatory response are
suppressed by glucocorticoids.
This is the basis of most of their clinical uses. The action is nonspecific and covers all
components and stages of inflammation.
This includes attenuation of—increased capillary permeability, local exudation,
cellular infiltration, phagocytic activity and late responses like capillary proliferation,
collagen deposition, and fibroblastic activity and ultimately scar formation.
This action is direct and can be restricted to a site by local administration.
The cardinal signs of inflammation— redness, heat, swelling and pain are suppressed.
Immunological and allergic responses
Glucocorticoids impair immunological competence.
They suppress all types of hypersensitisation and allergic phenomena.
At high concentrations and in vitro they have been shown to interfere with practically
every step of the immunological response, but at therapeutic doses in vivo there is no
impairment of antibody production or complement function.
The clinical effect appears to be due to suppression of recruitment of leukocytes at
the site of contact with antigen and of inflammatory response to the immunological
injury.