This document discusses best practices for early management of acute ischemic stroke cases at Apollo Hospitals in Hyderabad, India. It outlines a multidisciplinary approach involving a dedicated stroke team that works to ensure patients receive rapid diagnosis, treatment, and rehabilitation according to established guidelines and timelines. The goals are to complete initial evaluations within set time periods and provide organized care through protocols, algorithms, and a stroke activation system to minimize mortality and disability from stroke.
This talk covers the most important aspects of treatment of acute ischemic stroke, such as thrombolysis, use of antiplatelets, BP and sugar control and general supportive care.
Acute stroke management
IV thrombolysis guidelines
IV thrombolysis side effects
Early CT changes in stroke
ASPECTS scoring
AHA stroke guidelines
Thrombolysis controversies
Stroke is a leading cause of death and disability. All doctors should have a basic knowledge about stroke management. This presentation gives a summary of treatment options in acute brain stroke.
This talk covers the most important aspects of treatment of acute ischemic stroke, such as thrombolysis, use of antiplatelets, BP and sugar control and general supportive care.
Acute stroke management
IV thrombolysis guidelines
IV thrombolysis side effects
Early CT changes in stroke
ASPECTS scoring
AHA stroke guidelines
Thrombolysis controversies
Stroke is a leading cause of death and disability. All doctors should have a basic knowledge about stroke management. This presentation gives a summary of treatment options in acute brain stroke.
University of Calgary researchers have found a ground-breaking procedure developed through a clinical trial, which drastically reduces the likelihood of death or disability for stroke patients. Dr. Michael Hill and Dr. Mayank Goyal, two of the key researchers behind this breakthrough, shed light on how the procedure helps treat stroke and provides them with better chances of recovery. To watch the webinar recording, go to http://www.ucalgary.ca/explore/faster-way-treat-stroke
Stroke thrombolysis Dr Sanjay Jaiswal,consultant nerologist,Jaiswal Hospital ...Sanjay Jaiswal
We are presenting our personal experience regarding thrombolytic therepy in ac ischaemic stroke patients at jaiswal hospital and neuro institute ,kota,Rajasthan,INDIA
2015 AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment
Stroke. 2015;46:3020-3035.
Stroke is common. This presentation discusses the broad outlines of acute stroke management, especially in the first 24 hours after onset of symptoms. It would be useful for physicians as well as neurologists.
University of Calgary researchers have found a ground-breaking procedure developed through a clinical trial, which drastically reduces the likelihood of death or disability for stroke patients. Dr. Michael Hill and Dr. Mayank Goyal, two of the key researchers behind this breakthrough, shed light on how the procedure helps treat stroke and provides them with better chances of recovery. To watch the webinar recording, go to http://www.ucalgary.ca/explore/faster-way-treat-stroke
Stroke thrombolysis Dr Sanjay Jaiswal,consultant nerologist,Jaiswal Hospital ...Sanjay Jaiswal
We are presenting our personal experience regarding thrombolytic therepy in ac ischaemic stroke patients at jaiswal hospital and neuro institute ,kota,Rajasthan,INDIA
2015 AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment
Stroke. 2015;46:3020-3035.
Stroke is common. This presentation discusses the broad outlines of acute stroke management, especially in the first 24 hours after onset of symptoms. It would be useful for physicians as well as neurologists.
Stroke is a medical emergency, with a mortality rate higher than most forms of cancer. It is the second leading cause of death in developed countries and is the most common cause of serious, long-term disability in adults. The incidence of stroke is increasing with the aging of populations and hence there is a major challenge to health planners.
Evidence-based advances in acute stroke have included proof of the benefit of organized care in stroke units, modern brain imaging, and thrombolytic therapy, the modest benefit of acute aspirin in ischemic stroke clearly, a lack of awareness of the common symptoms of stroke remains a major educational challenge, and the urgency of stroke treatment is still poorly appreciated. Despite the proven benefit of stroke units, the majority of patients in most countries cannot access specialized stroke care.
The article focuses on current treatment guidelines and new therapeutic prospects, emphasizing the importance of early intervention and the need for a multidisciplinary approach to the management of stroke patients.
American Journal of Emergency Medicine: Stroke and first responders strategyEmergency Live
Background
Improving access to thrombolytic therapy for patients with ischemic stroke is challenging. We assessed a prehospital process based on firemen rescuers under strict medical direction, aimed at facilitating thrombolysis of eligible patients.
Methods
This was a prospective observational study conducted over 4 months in Paris, France. Prehospital patients with suspected stroke were included after phone consultation with a physician. If the time since the onset of symptoms was less than 6 hours, patients were transported directly to a neurovascular unit (NVU), if symptom onset was over 6 hours ago; they were transported to an emergency department. Confirmation of stroke diagnosis, the rate of thrombolysis, and the time intervals between the call and hospital arrival and imaging were assessed. Comparison used Fisher's exact test.
Results
Of the 271 patients transported to an NVU, 218 were diagnosed with a stroke (166 with ischemic stroke), 69 received thrombolytic therapy, and the mean stroke-thrombolysis interval was 150 minutes. Over 64 patients admitted to ED, 36 patients suffered a stroke (ischaemic: 24). None were thrombolysed. Globally, 36% of ischaemic strokes were thrombolysed (27% of all strokes diagnosed). The mean interval call-hospital was 65 min (ED vs NVU: p=0.61). The interval call-imaging was 202 min [IQR: 105.5-254.5] for ED and 92 min [IQR: 77 116] for NVU (p<0.001).
Conclusions
The prehospital management of stroke by rescuers, under strict medical direction, seemed to be feasible and effective for selection of patients suffering from stroke in an urban environment, and may improve the access to thrombolysis.
Objective To address, in a practical way, the acute treatment of ischemic cerebrovascular accident CVA based on the scientific recommendations latest. Methods A bibliographic search was performed in the PubMed, Scopus, Scielo and Uptodate database from January 2012 to April 2018, using the descriptors stroke , early management , therapeutic , intravenous thrombolysis , combined treatment , mechanical thrombectomy and its combinations. The selection of the articles was made by listing those of greater relevance according to the proposed theme, both in the foreign and Brazilian literature, in a non systematic way. Results Intravenous thrombolysis with recombinant tissue plasminogen activator rtPA within 4.5 hours of onset of symptoms is considered the therapy of choice in eligible patients. According to the new guidelines, mechanical thrombectomy can be performed within 24h and, for prevention of subsequent ischemic events, revascularization between 48h and seven days of the index event in candidate patients is reasonable. Conclusions As an essential cause of death and disability in the world, acute ischemic stroke treatment has advanced rapidly in recent years, improving therapeutic methods and their combinations. In clinical practice, recognizing, stratifying and listing, quickly and effectively, the best therapy for stroke patients is paramount. Renato Serquiz E Pinheiro | Yanny Cinara T Ernesto | Irami Araújo-Neto | Fausto Pierdoná Guzen | Amália Cinthia Meneses Do Rêgo | Irami Araújo-Filho ""Ischemic Brain Vascular Accident: Acute Phase Management"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-3 , April 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23499.pdf
Paper URL: https://www.ijtsrd.com/biological-science/neurobiology/23499/ischemic-brain-vascular-accident-acute-phase-management/renato-serquiz-e-pinheiro
Detection of myocardial infarction on recent dataset using machine learningIJICTJOURNAL
In developing countries such as India, with a large aging population and limited access to medical facilities, remote and timely diagnosis of myocardial infarction (MI) has the potential to save the life of many. An electrocardiogram is the primary clinical tool utilized in the onset or detection of a previous MI incident. Artificial intelligence has made a great impact on every area of research as well as in medical diagnosis. In medical diagnosis, the hypothesis might be doctors' experience which would be used as input to predict a disease that saves the life of mankind. It is been observed that a properly cleaned and pruned dataset provides far better accuracy than an unclean one with missing values. Selection of suitable techniques for data cleaning alongside proper classification algorithms will cause the event of prediction systems that give enhanced accuracy. In this proposal detection of myocardial infarction using new parameters is proposed with increased accuracy and efficiency of the existing model. Additional parameters are used to predict MI with more accuracy. The proposed model is used to predict an early diagnosis of MI with the help of expertise experiences and data gathered from hospitals.
Background: Cardiac catheterization is considered as the gold standard practice for the recognition and diagnosis coronary heart disease. The hazard physically and emotionally occurs from this procedure can disturb the patient’s perception of their health. Nursing care is vital in survival and avoids the patients from post cardiac catheterization problems. So the competence of nurses about knowledge and practice regarding patient care after cardiac catheterization is very crucial. Aims: the aim of this study to investigate the effect of creating learning guideline for nurses caring for patients safety undergoing cardiac catheterization. Methods: A quasi experimental research design was conducted. The study was conducted at the Cardiac Catheterization intensive care, cardiac care and emergency units at general Port Said hospital in Port Said city – Egypt. Subjects: A purposive sample of 51 nurses was working in those departments. Tools: two tools were utilized. Tool I: consisted of the following: Part 1: Socio-demographic data of the nurses. Part II: nurses’ knowledge about cardiac catheterization. Tool II: Nursing care after cardiac catheterization to providing patient safety. Results: The study revealed that the majority of nurses have a highly satisfactory level of knowledge and performance regarding patient safety on cardiac catheterization post implementation the learning guideline than pre learning guideline. It was reflected positive correlation between nurses qualification, experience and knowledge regarding patient’s safety at post learning guideline with significant difference regarding experience. While, there was a strong positive correlation between the performance of studied nurses and their qualification regarding the post learning guideline implementation with significant. Finally, positive correlation between performance and knowledge regarding patient safety at post learning guideline implementation. Conclusion: it can be concluded that learning guideline considerably improved the nurses’ level of knowledge and performance regarding Caring For Patients Safety Undergoing Cardiac Catheterization. Overall knowledge score between pre learning guideline and post learning guideline was found to be significant. While, total performance score between pre learning guideline and post learning guideline was found to be not significant. Therefore, the learning guidelines are recommended for educating these nurses to promote knowledge and performance regarding patient safety to decrease hazards following cardiac catheterization.
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
To interrupt blood supply to the acardiac twin in a case of TRAP sequence of monochorionic diamniotic multiple pregnancy to allow for continuation of the normal twin.
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Turner syndrome (gonadal dysgenesis) is one of the most common chromosomal abnormalities occuring 1 in 2500 to 1 in 3000 live-born girls. It is an important cause of short stature in girls and primary amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This review briefly summarises the current knowledge about the syndrome and the management strategies.
Due to pregnancy thyroid economy is affected with changes in iodine metabolism, TBG and development of maternal goiter. The incidence of hypothyroidism in pregnancy is quite common with autoimmune hypothyroidism being the most important cause. Overt as well as subclinical hypothyroidism has a varied impact on maternal and neonatal outcome. After multiple studies also, routine screening in pregnancy for hypothyroidism can still not be recommended. Management mainly comprises of dosage adjustments as soon as pregnancy is diagnosed based on results of thyroid function tests. The aim should be to keep FT4 at the upper end of normal range.
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Advances in the management of thalassemia have led to marked improvements in the life span and quality of life of children and young adults. This poses new challenges for the treating physicians. There is now increasing recognition that thalassemics have impaired bone health which is multifactorial in etiology. This paper aims to highlight the factors that predispose these patients to osteoporosis and suggests measures to minimise the impact on bone health.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Occupational Blood Borne Infections: Prevention is Better than CureApollo Hospitals
Viral infections like HIV, hepatitis Band C virus pose a big risk to the contacts of individuals with high risk behaviour as well as to the attending health care workers. Blood, semen, vaginal and other potentially infectious materials can transmit the infection to the susceptible contacts. Universal precautions should be strictly implemented during clinical examination, laboratory work and surgical procedures to prevent transmission to the health care providers. Health care workers should receive vaccination for hepatitis B infection. An inadvertent exposure should be managed with proper first aid and infectivity of the source and severity of exposure should be assessed. Severity of exposure is based on the nature and area of exposed surface, mode of injury and volume of infective material. Post-exposure prophylaxis (PEP) should be started as soon as possible after a proper counseling about the effectiveness of post-exposure prophylaxis, side effects and risk of carrying the infection to his familial contacts and its prevention.
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Apollo Hospitals
Storage of red cells causes a progressive increase in hemolysis. Inspite of the use of additive solutions for storage and filters for leucoreduction some amount of hemolysis is still inevitable. The extent of hemolysis however should not exceed the permissible threshold for hemolysis even on the 42nd day of storage.
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Apollo Hospitals
Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
Severe skin adverse drug reactions can result in death. Toxic epidermal necrolysis (TEN) has the highest mortality (30–35%); Stevens-Johnson syndrome and transitional forms correspond to the same syndrome, but with less extensive skin detachment and a lower mortality (5–15%). Hypersensitivity syndrome, sometimes called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), has a mortality rate evaluated at about 10%. It is characterised by fever, rash and internal organ involvement. Prompt diagnosis is vital, along with identification and early withdrawal of suspect medicines and avoidance of re-exposure to the responsible agent is essential. Cross-reactivity to structurally-related syndrome caused by Carbamazepine medicines is common, thus first-degree relatives may be predisposed to developing this syndrome. We report a case of DRESS secondary to use of Carbamazepine.
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
The spread of dengue and dengue haemorrhagic fever is increasing, atypical manifestations are also on the rise, although they may be under reported because of lack of awareness. We report two such cases of dengue hemorrhagic fever with hepatitis, intraocular hemorrhage, ARDS and myocarditis.
A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine revealed diffuse ossification of the anterior longitudinal ligament. This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level.
Pediatric Liver Transplant (LT) is now an established procedure for End Stage Liver Disease (ESLD) with biliary atresia being the commonest indication. Intensive pre-transplant evaluation, nutritional buildup and immunization are the fundamental pre-requisites of a successful LT. With improvement in surgical micro-anastomotic techniques and superior immunosuppressive regimens the success rate of pediatric LT is in excess of 90%. Most of the transplants in our country however are Living related, due to which a fairly large number of children expire awaiting a donor liver. There should be a concerted effort to evolve the cadaveric donation program, so that majority of the children are benefitted.
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
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.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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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
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!
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.
2. a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 3 2 8 e3 3 6
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier.com/locate/apme
Article on Quality
Early management of acute ischemic stroke cases
(Acute Stroke Protocols & Guidelines/Algorithms) @ Apollo
Hospitals, Hyderabad
Jammala Saritha Margaret a, Gaurav Loria b,*
a
b
Senior Executive Quality, Apollo Hospitals, Hyderabad, India
Group Coordinator Quality, Apollo Hospitals, Hyderabad, India
article info
abstract
Article history:
Stroke is a medical emergency, with a mortality rate higher than most forms of cancer. It is
Received 2 November 2013
the second leading cause of death in developed countries and is the most common cause of
Accepted 5 November 2013
serious, long-term disability in adults. The incidence of stroke is increasing with the aging
Available online 4 December 2013
of populations and hence there is a major challenge to health planners.
Keywords:
care in stroke units, modern brain imaging, and thrombolytic therapy, the modest benefit
Ischemic stroke
of acute aspirin in ischemic stroke clearly, a lack of awareness of the common symptoms
Thrombolysis
of stroke remains a major educational challenge, and the urgency of stroke treatment is
Stroke survivors
still poorly appreciated. Despite the proven benefit of stroke units, the majority of patients
Evidence-based advances in acute stroke have included proof of the benefit of organized
in most countries cannot access specialized stroke care.
The article focuses on current treatment guidelines and new therapeutic prospects,
emphasizing the importance of early intervention and the need for a multidisciplinary
approach to the management of stroke patients.
Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
1.
Introduction
Stroke is a medical emergency, with a mortality rate higher
than most forms of cancer. It is the second leading cause of
death in developed countries and is the most common cause
of serious, long-term disability in adults. The incidence of
stroke is increasing with the aging of populations and hence
there is a major challenge to health planners.
Evidence-based advances in acute stroke have included
proof of the benefit of organized care in stroke units, modern
brain imaging, and thrombolytic therapy, the modest benefit
of acute aspirin in ischemic stroke clearly, a lack of awareness
of the common symptoms of stroke remains a major educational challenge, and the urgency of stroke treatment is still
poorly appreciated. Despite the proven benefit of stroke units,
the majority of patients in most countries cannot access
specialized stroke care.
The article focuses on current treatment guidelines and
new therapeutic prospects, emphasizing the importance of
early intervention and the need for a multidisciplinary
approach to the management of stroke patients.1
* Corresponding author.
E-mail address: gaurav_l@apollohospitals.com (G. Loria).
0976-0016/$ e see front matter Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.apme.2013.11.002
3. a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 3 2 8 e3 3 6
329
(iv) Rapid and accurate diagnosis and intervention at the
hospital. This ‘chain of recovery’ has also been
described as a five-stage process, comprising the five Rs
of successful stroke management: recognition (of
symptoms), reaction (emergency services are called),
response (medical assessment), reveal (brain imaging)
and Rx (treatment initiation).1
3.
Fig. 1 e NINDS* and ACLS** recommended stroke
evaluation time benchmarks for potential thrombolysis
patient.8
2.
Successful care of acute stroke patients
relies on a four-step process
(i) Prompt recognition and reaction to warning signs.
(ii) Immediate use of emergency services.
(iii) Priority transport with notification of the receiving
hospital and
Emergency department assessment
Once a diagnosis of acute ischemic stroke is suspected, the
duration since symptom onset should be determined as
accurately as possible, as time from onset is the single most
important determinant of therapeutic options. Patients
arriving at hospital with a symptom onset of <3e4.5 h should
be evaluated for potential treatment with rt-PA, although a
‘door to needle time’ of around 60 min usually means a hospital arrival time within 2 h for rt-PA candidates.1
Every minute counts in brain stroke e “Time” has always
been an essential component in the early treatment and management of stroke.
Urgent and early treatment of acute ischemic stroke holds
a better promise of better neurological outcomes after acute
ischemic stroke.
Fig. 2 e Acute stroke algorithm.
4. 330
a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 3 2 8 e3 3 6
Fig. 3 e Pathway timelines.
Guidelines focus on a multidisciplinary team of healthcare
professionals including pre-hospital personnel (EMS), ED
physicians, nurses, inpatient nurses, stroke team members,
general medicine physicians, hospital administrators, and
ancillary healthcare personnel.
The goal for the acute management of patients with stroke
is to stabilize the patient and to complete initial evaluation and
assessment, including imaging and laboratory studies, within
a definitive time period of patient arrival to the hospital.
The reasons for the success depend on multidisciplinary
approach of improved prevention and improved care within
the early hours of acute stroke. To continue encouraging
trends, the public and healthcare professionals must remain
vigilant and committed to improving overall stroke care.2
4.
Goals for early management of acute
stroke
The goals for early management of patients with acute stroke
are to stabilize the patient and to complete initial evaluation
and assessment, including imaging and laboratory studies,
5. a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 3 2 8 e3 3 6
331
Fig. 4 e Stroke activation system e process mapping.
within a definitive time period of patient arrival to the hospital
(Fig. 1).2,3 Critical decisions focus on the need for intubation,
blood pressure control, and determination of risk/benefit for
thrombolytic intervention.
The goal of these guidelines is to limit the morbidity and
mortality associated with stroke. The guidelines support the
overarching concept of stroke systems of care and detail
aspects of stroke care from patient recognition; emergency
medical services activation, transport, and triage; through the
initial hours in the emergency department and stroke unit.
The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general
physiological optimization for cerebral resuscitation.4,5
6. 332
a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 3 2 8 e3 3 6
Fig. 5 e Golden hour clock: started upon patient arrival & suspected stroke.7
Fig. 6 e Stroke operational unit.
7. a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 3 2 8 e3 3 6
Fig. 7 e Paradigm shift: early management of acute stroke over the years.
333
8. 334
a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 3 2 8 e3 3 6
Fig. 7 e (continued).
5.
Acute stroke program: a multidisciplinary
team approach for early management of acute
stroke cases at Apollo Hospitals, Hyderabad
Being an “Acute Stroke e JCI Clinical Care Program Certified
Centre”, Apollo Hospitals, Hyderabad had an amplified need in
timely management of acute stroke cases efficiently & effectively and thus reducing the morbidity & mortality rates,
focusing on better patient outcomes.
While Time plays a chief role from arrival of the patient till
discharge, and in every step starting from identification of
symptoms, availability of Neuro-physician & Radiologist,
emergent diagnostics & investigations (CT & MRI scan, Blood
samples and swallow tests on time), Early specific treatments
(thrombolisation, others), availability of healthcare providers
(Physiatrist, Physiotherapy, Dietician, Medical Social Worker
and Occupational therapist), following initiatives were put in
place for a timely & efficient management.
Fig. 8 e Graphical representation of the timelines of a sample case study.
9. a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 3 2 8 e3 3 6
Identified formed a multidisciplinary acute stroke team
consisting of
Emergency Physicians.
EMS Paramedics.
Neuro-Physicians.
Radiologists.
Laboratory Doctors Technicians.
Stroke Doctor.
Stroke Nurse.
Stroke Unit Doctor.
Dietician.
Rehabilitation Team e Physiatrist, Physiotherapist,
Occupational therapist Speech therapist.
Medical Social Worker.
Quality Coordinators (Clinical Non Clinical).
Acute stroke algorithm developed (Fig. 2).
Acute stroke clinical pathway developed based on evidence-based guidelines taken from the Brain Attack
Coalition Thomas Jefferson University Hospital: Acute
ischemic stroke critical pathway card.6 Modified and
tailored to meet the needs of the Indian population
(Fig. 3).
Acute stroke pathway mapping developed (Fig. 4).
Acute Stroke Activation System/Acute Stroke SMS Alert
system: SMS alert to acute stroke team on patient arrival
with patient details, to all the stroke team members upon
patient’s arrival.
Golden hour clock in the ER (Fig. 5) e Patient suspected with
stroke, the clock is started and the timings are recorded.
Operational stroke unit (Fig. 6).
Timelines with benchmarks (Fig. 7) (Fig. 8).
Acute stroke clubs for stroke survivors.
Performance improvement measures.
In hospital training programs.
335
Stroke campaigns for community awareness.
Apollo stroke clubs for stroke survivors.
Learning from the misses/hitches e Continuous CMEs
stroke committee meets.
There is no question that time is brain. The faster someone
calls EMS, arrives to the hospital and receives treatment, the
greater the likelihood of survival and reduced disability.
The stroke team at Apollo Hospitals, Hyderabad is aware of
this fact and is constantly striving for quality improvement.
The idea of bringing in a platform where everyone could
come together as a team at the very point of patient arrival into
the hospital and coordinate in the entire care process till
discharge and follow ups.
The objective was to streamline the entire process for
timely management, addressable of issues on time at the
point of care, “Acute Stroke SMS Alert System”.
Concern was to bring in quality care measurable for acute
stroke protocols, made more effective and efficient in delivering
quality patient care at the earliest. Full proof mechanism to be
in place to check and correct errors instantaneously.
A lot can be done to prevent and treat stroke, rehabilitate
those who suffer stroke, while professional and public awareness are the first steps to act on time.
6.
Conclusion
All of the above treatment advances are based on immediate
intervention, underlining the urgency of stroke recognition
and early treatment. A systematic multidisciplinary protocol
based acute stroke care management system, can reduce the
mortality morbidity of the patients affected with acute
stroke.
Conflicts of interest
Best practices for stroke management at Apollo Hospitals, Hyderabad.
Acute stroke protocols.
Adherence to timelines.
Acute stroke activation system/stroke alerts e SMS system.
Dedicated neuro team.
Dedicated stroke unit tracheotomy ward e Operational
stroke unit.
Controlled supervision.
Medical social worker counseling.
Post stroke follow Up e Walk-in, Telephonic.
Stroke clubs for stroke survivors: talks, activities, sharing
experiences etc.
Stroke campaigns for community awareness.
Acute stroke tracers for tracking the cases e team based
approach with focus on quality.
Focused stroke rounds with Interdisciplinary team neurophysicians.
All authors have none to declare.
references
1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448697/.
2. http://stroke.ahajournals.org/content/suppl/2013/01/29/STR.
0b013e318284056a.DC1/Executive_Summary.pdf.
3. Adams Jr HP, del Zoppo G, Alberts MJ, et al. Guidelines for the
early management of adults with ischemic stroke: a guideline
from the American Heart Association/American Stroke
Association Stroke Council, Clinical Cardiology Council,
Cardiovascular Radiology and Intervention Council, and the
Atherosclerotic Peripheral Vascular Disease and Quality of
Care Outcomes in Research Interdisciplinary Working Groups:
the American Academy of Neurology affirms the value of this
guideline as an educational tool for neurologists. Stroke. May
2007;38(5):1655e1711.
4. Guidelines for the early management of patients with acute
ischemic stroke: a guideline for healthcare professionals from
the American Heart Association/American Stroke Association.
10. 336
a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 3 2 8 e3 3 6
Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ,
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5. http://stroke.ahajournals.org/content/44/3/870.
6. http://www.stroke-site.org/pathways/tjuh_pathways.html.
7. http://www.activase.com/resource-center/image-librarygolden-hour-images.jsp.
8. http://emedicine.medscape.com/article/1159752overview#aw2aab6b2.
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