The document discusses lipid abnormalities and cardiovascular risk in patients with insulin resistance and diabetes. It notes that lipid abnormalities affect all lipid fractions, characterized by elevated triglycerides, remnant lipoproteins, small dense LDL, and low HDL. Lifestyle modifications and medical therapies can help treat diabetic dyslipidemia and reduce cardiovascular risk. The guidelines recommend statin therapy along with lifestyle changes to lower LDL and reduce risk, and address other lipid abnormalities as needed.
Cardiovascular disease - more common in diabetic patients than in the general population
Dyslipidemia – common in patients with both types of diabetes.
Aggressive lipid treatment goals have been recommended for patients with type 2 diabetes
Diabetic Dyslipidemia is highly prevalent in the Indian diabetic population
Dyslipidemia in diabetes differs significantly with hypertriglyceridemia and small dense LDL-C
Cardiovascular disease - more common in diabetic patients than in the general population
Dyslipidemia – common in patients with both types of diabetes.
Aggressive lipid treatment goals have been recommended for patients with type 2 diabetes
Diabetic Dyslipidemia is highly prevalent in the Indian diabetic population
Dyslipidemia in diabetes differs significantly with hypertriglyceridemia and small dense LDL-C
Dyslipidemia
Disorder of Lipid & Lipoprotein Metabolism
A common form of Dyslipidemia is characterized
by three lipid abnormalities:
Elevated triglycerides,
Elevated LDL and
Reduced HDL cholesterol.
Important Modifiable Risk Factor for CAD
India has a large pool of diabetic patients
ICMR-INDIAB study – extrapolated estimations suggest 62.4 million people with diabetes and 77.2 million are prediabetic
Estimates show ~ 85.5% men and 97.8% women who are diabetic in India have concomitant dyslipidemia
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Dyslipidemia
Disorder of Lipid & Lipoprotein Metabolism
A common form of Dyslipidemia is characterized
by three lipid abnormalities:
Elevated triglycerides,
Elevated LDL and
Reduced HDL cholesterol.
Important Modifiable Risk Factor for CAD
India has a large pool of diabetic patients
ICMR-INDIAB study – extrapolated estimations suggest 62.4 million people with diabetes and 77.2 million are prediabetic
Estimates show ~ 85.5% men and 97.8% women who are diabetic in India have concomitant dyslipidemia
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Introduction, Integration of CM risk factors, Targeting obesity, Management of hypertension, Management of dyslipidemia, Antiplatelet therapy, Management of microalbuminuria, CB1 blockade
This presentation will show the diagnosttic criteria of metabolic syndrome and life style modification to cope up with this common disease .
also shows some quiz for medical students
Infertility is defined as the inability of a couple to conceive after at least one year of regular unprotected intercourse.
Male infertility refers to a male's inability to cause pregnancy in a fertile female.
IDD situation in our country has improved
A good number of thyroid disorder patients are either undiagnosed and or untreated
Thyroid disorder in pregnancy- Rate high
As a sound thyroid functioning status is crucial for growth, development in children; reproduction, psychological and general wellbeing in adults, we must be proactive in screening, diagnosing and treating our patients.
Over the past several years it has been proved that maternal thyroid disorder influence the outcome of mother and fetus, during and also after pregnancy. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. It is associated with fetal loss, placental abruptions, pre-eclampsia, preterm delivery and reduced intellectual function in the offspring.1 In pregnancy, overt hypothyroidism is seen in 0.2% cases2 and sub clinical hypothyroidism in 2.3% cases3. Fetal loss, fetal growth restriction, pre-eclampsia and preterm delivery are the usual complications of overt hyperthyroidism (low TSH and high T3, T4) seen in 2 of 1000 pregnancies whereas mild or sub clinical hyperthyroidism (suppressed TSH alone) is seen in
1.7% of pregnancies and not associated with adverse outcomes4. Autoimmune positive euthyroid pregnancy shows doubling of incidence of miscarriage and preterm delivery. Worldwide more than 20 million people develop neurological sequel due to intra uterine, iodine deprivation5. Other problems of thyroid disorders in pregnancy are post partum thyroiditis, thyroid nodules and cancer, hyper emesis gravidarum etc. Debates and disputes persist regarding several protocol and management plan in this specific spectrum of diseases.
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.
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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!
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
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.
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.
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
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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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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1. Dr Shahjada Selim
Associate Professor
Department of Endocrinology
Bangabandhu Sheikh Mujib Medical University
Email: selimshahjada@gmail.com, info@shahjadaselim.com
2. The lipid abnormalities associated with
insulin resistance affect all lipid fractions.
They are characterised by elevated fasting
triglyceride levels, elevated postprandial
triglyceride-rich remnant lipoproteins, low
HDL cholesterol, and small dense LDL
particles. This pattern correlates strongly
with cardiovascular risk, and treatment
decreases this risk.
Diabetic Dyslipidemia
3. Apolipoprotein B (apo B) is typically
associated with LDL cholesterol; however,
in insulin resistant atherogenic dyslipidemia,
in response to increased delivery of free
fatty acids to the liver, there is an
overproduction of apo B and increased
VLDL triglyceride synthesis.
Diabetic Dyslipidemia
4. This includes VLDL particles which contain apo B.
Low HDL cholesterol levels are an independent risk
factor for cardiovascular disease; the low HDL seen
in atherogenic dyslipidemia relates to a reduced
HDL particle size.
The low HDL particle size relates to exchange of
VLDL triglycerides for cholesterol esters in LDL and
HDL via cholesterol ester transfer protein. When the
triglycerides in LDL and HDL undergo hydrolysis,
small, cholesterol depleted LDL and HDL remain.
Diabetic Dyslipidemia
5. Small dense LDL particles are reported to
be more atherogenic possibly because of
their increased propensity to oxidation and
greater proportion of apo B. Compared with
non-insulin resistant states, a given LDL
cholesterol level represents a greater
number of apo B containing small dense
LDL particles and this confers increased
risk.
Diabetic Dyslipidemia
6. Lifestyle modification focusing on weight loss (if
indicated); application of a Mediterranean style or
Dietary Approaches to Stop Hypertension (DASH)
eating pattern; reduction of saturated fat and trans
fat; increase of dietary n-3 fatty acids, viscous fiber,
and plant stanols/sterols intake;
Increased physical activity should be recommended
to improve the lipid profile and reduce the risk of
developing atherosclerotic cardiovascular disease in
patients with diabetes.
Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes - 2020. Diabetes Care 2020;43(Suppl. 1):S111-S134
7. Intensify lifestyle therapy and optimize glycemic
control for patients with elevated triglyceride
levels (≥150 mg/dL [1.7mmol/L]) and/or low HDL
cholesterol (<40 mg/dL [1.0 mmol/L] for men,
<50 mg/dL [1.3 mmol/L] for women).
Cardiovascular Disease and Risk Management:
Standards of Medical Care in Diabetes - 2020. Diabetes Care 2020;43(Suppl. 1):S111-S134
8. • This is the equivalent of doubling the
daily dose of a statin
• Therefore, successful dietary therapy
reduces drug therapy by over 50%
• Dietary therapy reduces LDL cholesterol
by 7-10%
9. Dietary Therapy for Elevated Blood Cholesterol
30% of total calories
55% of total calories
~ 15% of total calories
To achieve and maintain
desirable weight
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA. 1993;269:3015-3023.
Nutrient*
* Calories from alcohol not included.
<10% of
total calories
< 300 mg/day
Total fat
Saturated fatty acids
Carbohydrates
Protein
Cholesterol
Total calories
< 7% of
total calories
< 200 mg/day
Recommended intake
Step I Diet Step II Diet
10. Side Effects of HMG CoA
Reductase Inhibitors
• Myopathy (0.1%)
• Abnormal Liver Function Tests (1-2%)
• Gastrointestinal Distress and Diarrhea
• CNS – Insomnia
• Diabetes
17. • Triglycerides 150 -1000. Treat to prevent CAD*
• Triglycerides > 1000. Treat to prevent
pancreatitis
* If in doubt measure Apo B 100.
Median 100 mg/dl; > 125 mg/dl likely atherogenic
18. Primary target of therapy: identification of LDL-C;
goal for persons with diabetes: <100 mg/dL
Therapeutic options:
LDL-C 100–129 mg/dL: increase intensity ofTLC; add
drug to modify atherogenic dyslipidemia (fibrate or
nicotinic acid); intensify risk factor control
LDL-C 130 mg/dL: simultaneously initiateTLC and
LDL-C–lowering drugs
TG 200 mg/dL: non–HDL-C* becomes secondary
target
JAMA. 2001;285:2486-2497.
Note: Diabetic dyslipidemia is essentially atherogenic dyslipidemia in persons with type 2
diabetes.
*Non–HDL-C goal is set at 30 mg/dL higher than LDL-C goal.
19. Fibric Acid Derivatives
• Gemfibrozil (Lopid) 600-1200 mg/day
Clofibrate (Atromid S) 1000-2000 mg/day
Fenofibrate (Tricor) 54-160 ug/ day
• Mechanism: Increases clearance of
triglyceride-rich lipoproteins (Chylos, VLDL,
remnants) through downregulation of Apo CIII
and increased LPL activity
• Effects on Lipids:
TG 20-50 %
HDL-C 10-15 %
LDL-C variable
20. Fibric Acid Derivatives -
Indications
• Severe Hypertriglyceridemia (TG > 1000 mg/dl)
• ? Combination therapy for mixed hyperlipidemia or
moderate hypertriglyceridemia
• Reduces risk of CHD in subjects with High TG
/Low HDL-C
• May raise homocysteine levels
21. Fibric Acid Derivatives
• Side Effects
Myopathy
Hepatitis (increases in transaminases)
Gallstones, Nausea, Diarrhea
•Contraindications
Absolute: Relative:
Gallstones Use with statins
Hepatic Insufficiency Inhibitors of CYP 3A4
Pregnancy
22. In adults not taking statins or other lipid-lowering
therapy, it is reasonable to obtain a lipid profile at
the time of diabetes diagnosis, at an initial medical
evaluation, and every 5 years thereafter if under
the age of 40 years, or more frequently if
indicated.
Cardiovascular Disease and Risk Management:
Standards of Medical Care in Diabetes - 2020. Diabetes Care 2020;43(Suppl. 1):S111-S134
23. Obtain a lipid profile at initiation of statins or other
lipid-lowering therapy, 4–12 weeks after initiation
or a change in dose, and annually thereafter as it
may help to monitor the response to therapy and
inform medication adherence.
Cardiovascular Disease and Risk Management:
Standards of Medical Care in Diabetes - 2020. Diabetes Care 2020;43(Suppl. 1):S111-S134
24. For patients with diabetes aged 40–75 years
without atherosclerotic cardiovascular disease,
use moderate-intensity statin therapy in addition
to lifestyle therapy.
For patients with diabetes aged 20–39 years with
additional atherosclerotic cardiovascular disease
risk factors, it maybe reasonable to initiate statin
therapy in addition to lifestyle therapy.
Cardiovascular Disease and Risk Management:
Standards of Medical Care in Diabetes - 2020. Diabetes Care 2020;43(Suppl. 1):S111-S134
25. In patients with diabetes at higher risk, especially
those with multiple atherosclerotic cardiovascular
disease risk factors or aged 50–70 years, it is
reasonable to use high-intensity statin therapy.
In adults with diabetes and 10-year ASCVD risk of
20% or higher, it may be reasonable to add
ezetimibe to maximally tolerated statin therapy to
reduce LDL cholesterol levels by 50% or more.
Cardiovascular Disease and Risk Management:
Standards of Medical Care in Diabetes - 2020. Diabetes Care 2020;43(Suppl. 1):S111-S134
26. For patients of all ages with diabetes and
ASCVD, high-intensity statin therapy should
be added to lifestyle therapy.
For patients with diabetes and ASCVD
considered very high risk using specific
criteria, if LDL cholesterol is ≥70 mg/dL on
maximally tolerated statin dose, consider
adding additional LDL-lowering therapy (such
as ezetimibe or PCSK9 inhibitor).
Ezetimibe may be preferred due to lower cost.
Cardiovascular Disease and Risk Management:
Standards of Medical Care in Diabetes - 2020. Diabetes Care 2020;43(Suppl. 1):S111-S134
27. For patients who do not tolerate the intended
intensity, the maximally tolerated statin dose
should be used.
In adults with diabetes aged >75 years already
on statin therapy, it is reasonable to
continue statin treatment.
Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes - 2020. Diabetes Care 2020;43(Suppl. 1):S111-S134
28. In adults with diabetes aged >75 years, it may
be reasonable to initiate statin therapy after
discussion of potential benefits and risks.
Statin therapy is contraindicated in pregnancy.
Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes - 2020. Diabetes Care 2020;43(Suppl. 1):S111-S134
29. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes - 2020. Diabetes Care 2020;43(Suppl. 1):S111-S134
30. For patients with fasting triglyceride levels ≥500 mg/dL,
evaluate for secondary causes of
hypertriglyceridemia and consider medical therapy to
reduce the risk of pancreatitis.
In adults with moderate hypertriglyceridemia (fasting or
non-fasting triglycerides 175–499 mg/dL),
clinicians should address and treat lifestyle factors
(obesity and metabolic syndrome), secondary factors
(diabetes, chronic liver or kidney disease and/or
nephrotic syndrome, hypothyroidism), and
medications that raise triglycerides.
Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes - 2020. Diabetes Care 2020;43(Suppl. 1):S111-S134
31. In patients with atherosclerotic cardiovascular
disease or other cardiovascular risk factors on a
statin with controlled LDL cholesterol but
elevated triglycerides (135–499 mg/dL), the
addition of icosapent ethyl can be considered
to reduce cardiovascular risk.
Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes - 2020. Diabetes Care 2020;43(Suppl. 1):S111-S134
32. Statin plus fibrate combination therapy has not
been shown to improve atherosclerotic
cardiovascular disease outcomes and is
generally not recommended.
Statin plus niacin combination therapy has not
been shown to provide additional
cardiovascular benefit above statin therapy
alone, may increase the risk of stroke with
additional side effects, and is generally not
recommended.
Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes - 2020. Diabetes Care 2020;43(Suppl. 1):S111-S134