Diabetes mellitus is a major global public health problem. The rise in global prevalence is expected to reach 5.4% or 300 million worldwide by 2025, with developed countries carrying a larger burden (1). Malaysia is not spared from this phenomena, with an alarming rise in prevalence of Type 2 diabetes mellitus (T2DM) over the past fifteen years, from 8.3% (NHMS 1, 1996) to 20.8% (NHMS IV, 2011) (2). What is most worrying is the figure for undiagnosed diabetics, which recorded almost a ten-fold increase (from 1.8% to 10.1%) within the same period. The national economic burden for provision of ambulatory or outpatient care for diabetes patients alone was estimated to cost the Ministry of Health RM 836 million, which took up 2.2% of the nation’s total health expenditure for 2009 (3). The average provider cost per outpatient visit for diabetes treatment at primary care was RM393.24, compared to RM 2707.44 at Specialist diabetic clinics. Treatment at primary care health centres was also highly cost effective compared to Specialist diabetic clinics (4). Due to the chronic nature of the disease, its many related complications and the progress in medical expertise, the costs to provide health care for the this group can only be expected to escalate in years to come. Strategies to effectively treat the chronic diseases (i.e. NCDs and T2DM) have been in place since the 1990s, however, the National Strategic Planning for Non-Communicable Diseases, (NSPNCD)(5) recommends that efforts should be channeled towards primary prevention, early NCD risk factor identification and NCD risk factor intervention or “clinical preventive services”. The clinical preventive services however, need to be emphasised, as early preventive measures can reduce long-term complications and morbidity related to diabetes. The risk factors which should trigger clinicians to provide clinical preventive measures include: obesity, sedentary lifestyles, dietary indiscretions, elderly (for late onset diabetes, pancreas insufficiency), family history of diabetes (risk in offspring of one diabetic parent: 30%, both parents: 60%). The 10th Malaysian Plan : Country Health Plan aims to restructure the national healthcare financing and healthcare delivery system to ensure universal health coverage of healthcare services to be provided at minimal cost using the existing infrastructure in delivering continuity of care across programmes, across healthcare settings and across healthcare providers (6). To reduce the fragmentation of care which commonly occurs in most NCD programmes, there is a need to involve healthcare providers within the healthcare service to be orientated in their roles and contribution in providing a seamless long-term care programme. It is hoped that this effort will benefit not only the patients but also provide relevant feedback on quality of healthcare service provision by the stakeholders. The current public health centre set up which combines Outpatient Primary Care
Diabetes mellitus (DM) is a significant public health problem associated with many debilitating health conditions
This presentation will briefly tackle management of Diabetes
Diabetes mellitus (DM) is a significant public health problem associated with many debilitating health conditions
This presentation will briefly tackle management of Diabetes
Pathophysiology of Diabetes Mellitus (Harrison’s Principles of Internal Medic...Batoul Ghosn
This presentation talks about the Pathophysiology part of Diabetes Mellitus I & II as well as Diabetic Ketoacidosis & Hyperglycemic Hyperosmolar State and Finally with Medical Nutrition Therapy in DIabetes Mellitus. It is made entirely from the Harrsion's Book 19th edition.
Pathophysiology of Diabetes Mellitus (Harrison’s Principles of Internal Medic...Batoul Ghosn
This presentation talks about the Pathophysiology part of Diabetes Mellitus I & II as well as Diabetic Ketoacidosis & Hyperglycemic Hyperosmolar State and Finally with Medical Nutrition Therapy in DIabetes Mellitus. It is made entirely from the Harrsion's Book 19th edition.
A detailed view of National Control Programme for Diabetes, 1987 and the changes in the programme.. for nursing students.
From Community health nursing..
My STSH Scholary Article about TREATMENT of PRE-DIABETES with SSDDDr. Sutanu Patra
I had done research on "Scope of Individualistic treatment with Serially Succussed and Diluted Drugs in treating Pre-diabetic condition: an Open-label Exploratory trial – in search of Prevention of Diabetes" and this was got awarded in Short Term Studentship in Homeopathy (STSH) 2014 by Central Council for Research in Homeopathy (CCRH), Ministry of AYUSH, Govt. of India.
Team as Treatment: Driving Improvement in DiabetesCHC Connecticut
NCA Clinical Workforce Development, Team-Based Care 2019 Webinar Series
Webinar broadcast on: June 11, 2019 | 3 p.m. EST
This webinar will share evidence-based models that will provide a framework for health centers to optimize the team in primary care. Experts will describe how utilization of extended team members and technology can reduce gaps in care for prediabetics and diabetics. With a focus on lifestyle and community based projects, this webinar will highlight the strategies and resources to improve the health and behaviors of patients at risk for diabetes and manage uncontrolled diabetes. Through early detection and providing diabetes management through a team-based care, health centers can help patients’ live long, healthy lives.
FIGO Initiative for Gestational diabetes as its a Global health Priority,one in sixth pregnant women have gestational Diabetes,84% of them is due to GDM.
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
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.
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.
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
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
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
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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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.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Diabetes mellitus in Malaysia: Nation's strategies for control
1. Diabetes mellitus:
Strategies for control
Aznida Firzah Abdul Aziz
MBBS MMed (Fam Med)
Department of Family Medicine
Faculty of Medicine
Universiti Kebangsaan Malaysia
2. Introduction
• Diabetes mellitus is a major global public health problem.
• Estimated world prevalence of diabetes among adults
(aged 20–79 years) in 2010: 6.4%, affecting 285 million
adults.
• In 2030: increase to 7.7%, and 439 million adults.
• 69% increase in numbers of adults with diabetes in
developing countries
• 20% increase in developed countries.
Diabetes Research and Clinical Practice 2010 87, 4-14
3. Fig. 1
Diabetes Research and Clinical Practice 2010 87, 4-14DOI: (10.1016/j.diabres.2009.10.007)
Diabetes Research and Clinical Practice 2010 87, 4-14DOI: (10.1016/j.diabres.2009.10.007)
Global estimates of the prevalence of diabetes 2010 & 2030
4. Epidemiology- Malaysian scenario
• Prevalence of diabetes 15.2%, 2.6 million Malaysians,
≥ 18yrs1
• 7.2% known diabetics, 8% previously undiagnosed
• Inpatient: 188 admissions per 100 0001
• Outpatient: 3,123,981 attendances at MOH Health clinics /
Klinik Kesihatan, 10% of total outpatient attendances2
1NHMS IV (2011)
2MOH Annual Report 2011
7. Economic burden
• Ambulatory or outpatient care for diabetes patients cost
the Ministry of Health RM 836 million, which took up 2.2%
of the nation’s total health expenditure for 2009
• Average provider cost per outpatient visit for diabetes
treatment at primary care was RM393.24, compared to
RM 2707.44 at Specialist diabetic clinics.
3Wan Norlida I. 2014. The economic burden of type 2 diabetes mellitus
outpatient care and comparing cost-effectiveness of diabetes care in
primary health clinics and tertiary diabetic clinics. (Phd Thesis)
9. Risk factors
• Life-style related:
sedentary lifestyles5,
dietary indiscretions
• Age –related: late onset
diabetes, pancreas
insufficiency
• Hereditary: risk in
offspring of one diabetic
parent: 30%, both
parents: 60%
• Gen Y?
5Biswas, A. Ann Intern Med. 2015;162:123-132, 146-147
10. Risk factor: Obesity
• Adults (≥18yrs)
• 33.3% (5.4 million) pre obese
• 27.2% (4.4 million) obese
• Children (<18yrs, based on weight for age)
• 3.9% (0.3 million) obese
11. Who should be screened?
Individuals with symptoms suggestive of DM (tiredness,
lethargy, polyuria, polydipsia, polyphagia, weight loss, pruritis
vulvae, balanitis)
Criteria for testing for pre-diabetes and diabetes in
asymptomatic adult individuals:
All adults who are overweight [body mass index (BMI) >23
kg/m2 or
waist circumference (WC) ≥80 cm for women & ≥90 cm for men]
CPG on DM 2009. Malaysian Endocrine & Metabolic Society, Ministry of Health
Malaysia, Academy of Medicine Malaysia & Persatuan Diabetis Malaysia
American Diabetes Association (ADA).
12. and have additional risk factors:
• Dyslipidaemia either HDL
cholesterol <0.9 mmol/L or TG >1.7
mmol/L
• History of cardiovascular disease
(CVD)
• Hypertension (≥140/90 mmHg or
on therapy for hypertension)
• Impaired Glucose Tolerance (IGT)
or Impaired Fasting Glucose (IFG)
on previous testing
• First-degree relative with diabetes
• Other clinical conditions
associated with insulin resistance
(e.g. severe obesity and acanthosis
nigricans)
• Physical inactivity
• Women with polycystic ovarian
syndrome (PCOS)
13. Glycaemic control* of patients
with DM- what is the status?
*HbA1c reflects overall glucose control over a 3 month period
16. National Diabetes Registry (2009-2012)
• From 644 primary healthcare
clinics (Klinik Kesihatan or KK)
• 657,839 patients registered
• Mean age 59.7 yrs
• 58.4% females
• Mean age at diagnosis: 53 yrs
• Mean duration of f/up 6.5 yrs
• Malays 58.9%, Chinese 21.4%,
Indians 15.3%
• Mean HbA1c 8.1%
• 23.8% achieved HbA1c < 6.5%
• 70.1% hypertensive
• 55.1% dyslipidaemia
17. Glycaemic control
Table 6 below shows the mean HbA1c and the percentage of patients reaching clinical targets for
HbA1c. Mean HbA1c has decreased slightly over 4 years, from 8.3% in 2009 to 8.1% in 2012 with most
audited patients recording HbA1c between 8.0% to 10.0%. In 2012, 23.8% of patients achieved the
Malaysian glycaemic target of HbA1c <6.5% compared to 19.4% in 2009. Assessed against the
international treatment target of HbA1c <7.0%, 37.9% of patients in 2012 would be considered to have
achieved glycaemic control.
Table 6. Mean HbA1c and patients achieving glycaemic targets* [Audit Dataset]
HbA1c 2009 2010 2011 2012
Mean %, (95% CI) 8.3 (8.3 - 8.3) 8.0 (8.0 - 8.0) 8.2 (8.2 - 8.2) 8.1 (8.1 - 8.1)
Distribution, n (%)
<6.5%** 10,559 (19.4) 12,079 (24.8) 11550 (22.6) 22,992 (23. 8)
<7.0% 17,266 (31.3) 18,948 (38.9) 18002 (35.3) 36,620 (37.9)
<8.0% 28,822 (52.9) 28,584 (58.6) 28169 (55.2) 55,635(57.5)
≥10.0% 11,480 (21.1) 8,803 (18.1) 10327 (20.2) 18,764 (19.4)
No. of patients with
HbA1c test results*
54,440 48,774 51,026 96,694
Note:
*The denominator for the percentage achieving target was the number of patients with HbA1c test results
**Good glycaemic control as defined by the Malaysian CPG on T2DM (2009)
Table 7 below shows that the achievement of HbA1c treatment target (<6.5%) varied across the states.
The national HbA1c treatment achievement rate was 23.8% in 2012. The achievement rate by states
ranged from 54.0% in Labuan and 39.1% in Sarawak to 17.6% and 14.9% in Terengganu and Kelantan,
respectively. In line with the overall increasing proportion of patients achieving treatment target at
18. In summary
• Diabetes IS a major public health problem for Malaysia
• Economic burden is huge
• Efforts to control disease and reduce complications need to
improve
• Prevention is the best investment
• So, what is the plan?
19. 10th Malaysia Plan
• Restructuring of healthcare financing and healthcare
delivery system, to ensure universal health coverage at
minimal cost
• Using existing infrastructure
• Ensuring continuity of care across:
• programmes
• healthcare settings
• healthcare providers
20. Primary Healthcare Clinic set up
Health
centreOutpatient
Department
Diagnostic Lab
Rehabilitation
Pharmacy
Maternal &
Child Health
Dental Health
Services
21. 10th Malaysia Plan
• Restructuring of healthcare financing and healthcare
delivery system, to ensure universal health coverage at
minimal cost
• Using existing infrastructure
• Ensuring continuity of care across:
• programmes
• healthcare settings
• healthcare providers
22. Public Healthcentre set up
Health
centreOutpatient
Department
Rehabilitation
Diagnostic Lab
Pharmacy
Maternal &
Child Health
Dental Health
Services
23. Recommendationsto enhance
Clinical PreventiveServicesat
PublicPrimaryCare Healthcentres
• Identification of risk factors for diabetes
among patients attending Dental Care Services
• Overweight/obese, family history of DM, past
history of GDM, poor wound healing i.e. poor
response to periodontal treatment?
• ±Screen for DM at Dental Clinic OR
• Referral to Primary Care / Outpatient Clinic at
Healthcentres TRO DM
• Feedback from Primary Care to Dental Care,
vice versa
24. Recommendations
• Increase awareness
among healthcare
providers i.e. Primary
healthcare and Dental
Healthcare regarding
shared care approaches
• Include Dental health
check schedules into
current DM monitoring
schedule (“DM
Greenbook”)