The document discusses the limited benefits of intensive glucose control alone for type 2 diabetes patients, as it does not significantly improve life expectancy or quality of life and only provides marginal reductions in cardiovascular risk. While intensified therapy may be beneficial for younger patients with recent diagnoses to reduce microvascular complications, a multifactorial approach targeting all cardiovascular risk factors together is needed later in the disease to make a meaningful impact on outcomes. The greatest benefits occur when intensive treatment is initiated early in the course of the disease.
Caring for all in the last year of life: making a difference.Bruce Mason
Inaugural presentation by Prof. Scott A. Murray, St Columba's Hospice Chair of Primary Palliative Care, Primary Palliative Care Research Group, Centre for Population Health Sciences: General Practice Section, University of Edinburgh. April 21, 2009
HIV treatment has improved and patients can expect life expectancy close to that of HIV negatives. Smoking cessation is therefore an intervention that must be adequately addressed in this population
THERAPEUTIC EFFECT OF SOYA BEAN CHUNKS SUPPLEMENTION DURING HEMODIALYSISNeeleshkumar Maurya
The present study was conducted during the year 2016-17 on 30 ckd-5 patients on hemodialysis admitted in various medical wards of the MLB, Medical College, Jhansi (U.P.) India. The primary data were obtained from all CKD patients 30 days intervals and three times first time proper medication with hemodialysis therapy and second time same condition patients with additional dietary counseling. The data was collected in all the patients, thorough anthropometric measurement, dietary history and blood are collected for analysis of Hb, serum albumin, blood urea, cholesterol and cretonne. The Proper dietary counseling along with high biological protein (20 gm) given during hemodialysis superior the nutritional value of undernourished chronic kidney disease patient. About proper diet counseling of the patients showed significant statistical positive (<0.005) response in a various nutritional factor like BMI, MUAC, Serum Albumin, hemoglobin, total calorie intake while the only medication and dialysis therapy showed an undergoing undernourished in their nutritional value. The patients undergoing hemodialysis often develop protein-energy malnutrition which is related to mortality and morbidity rate increases. Special nutritional care is required for the dialysis patient to improve the net protein anabolism. The nutritional value of soya bean chunks in patients on HD requirements more attention providing one-to-one nutrition psychotherapy could be improvements in the patients. Key words : Dialysis, malnutrition, soybean chunks, high biological protein.
Caring for all in the last year of life: making a difference.Bruce Mason
Inaugural presentation by Prof. Scott A. Murray, St Columba's Hospice Chair of Primary Palliative Care, Primary Palliative Care Research Group, Centre for Population Health Sciences: General Practice Section, University of Edinburgh. April 21, 2009
HIV treatment has improved and patients can expect life expectancy close to that of HIV negatives. Smoking cessation is therefore an intervention that must be adequately addressed in this population
THERAPEUTIC EFFECT OF SOYA BEAN CHUNKS SUPPLEMENTION DURING HEMODIALYSISNeeleshkumar Maurya
The present study was conducted during the year 2016-17 on 30 ckd-5 patients on hemodialysis admitted in various medical wards of the MLB, Medical College, Jhansi (U.P.) India. The primary data were obtained from all CKD patients 30 days intervals and three times first time proper medication with hemodialysis therapy and second time same condition patients with additional dietary counseling. The data was collected in all the patients, thorough anthropometric measurement, dietary history and blood are collected for analysis of Hb, serum albumin, blood urea, cholesterol and cretonne. The Proper dietary counseling along with high biological protein (20 gm) given during hemodialysis superior the nutritional value of undernourished chronic kidney disease patient. About proper diet counseling of the patients showed significant statistical positive (<0.005) response in a various nutritional factor like BMI, MUAC, Serum Albumin, hemoglobin, total calorie intake while the only medication and dialysis therapy showed an undergoing undernourished in their nutritional value. The patients undergoing hemodialysis often develop protein-energy malnutrition which is related to mortality and morbidity rate increases. Special nutritional care is required for the dialysis patient to improve the net protein anabolism. The nutritional value of soya bean chunks in patients on HD requirements more attention providing one-to-one nutrition psychotherapy could be improvements in the patients. Key words : Dialysis, malnutrition, soybean chunks, high biological protein.
Abstract— Diabetes Mellitus (DM) is a chronic and progressive condition with a hereditary predisposition which is further induced by unhealthy lifestyle. It is a silent killer with cardiovascular complications being most common cause of morbidity and mortality in patients with T2DM.
Objective: To find out association of socio demographic and clinical parameters of diabetes type 2 with hypertension and dyslipidemia among Diabetes Mellitus type 2 cases aged 18 to 70 years. Methodology: A cross sectional hospital based study was conducted on 272 type 2 DM patients attending Department of Medicine in a secondary care referral hospital after taking consent.
Results: Hypertension was present in 192 (70.59%) and dyslipidemia was present in 93 (34.19%) of type 2 diabetes patients. Age, family income, presence of family history, duration of illness, type of treatment, consumption of alcohol , BMI, Hba1c level were found to be associated significantly with both hypertension and dyslipidemia in type 2 DM patients.
Join Doc Andrew to see what's new in health research that supports plant based diet recommendations. Share your questions via @DenverWWAD or email FreemanA@njhealth.org
Andrew Freeman, MD, FACC, FACP is a cardiologist and Director of Clinical Cardiology and Operations at National Jewish Health in Denver, Colorado. He holds leadership roles in the American College of Cardiology at the local and national levels. Dr. Freeman founded Denver's chapter of the Walk with a Doc program and heads Walk with a Doc-Colorado.
Walk with a Doc-Denver is a cost-free empowerment initiative powered by people improving their health, local doctors, and other health professionals who prescribe exercise-as-medicine. The mission? To elevate community health--one walk at a time! The program's Saturday walks include expert talks, health screenings, refreshments, and motivational giveaways. For more info visit: http://walkwithadoc.org/our-locations/denver/
Harnessing the Power of Nutrition to Complement Brain Tumor CareJeanne M Wallace PhD
Presentation by Jeanne M. Wallace, PhD, CNC, at the 1st Annual Brains Matter conference (Sept 2012 in Seattle), sponsored by the Chris Elliott Foundation. Learn how nutrition can play a powerful role to influence the terrain (environment) surrounding cancer cells. Discover foods that can "talk" to your genes, suppressing oncogenes and turning on tumor suppressor genes. Explore simple diet and lifestyle changes you can make to nourish your wellness when facing a brain tumor diagnosis.
PREVALENCE OF DEPRESSION AND ITS ASSOCIATED FACTORS IN ADULTS WITH DIABETES M...pijans
The prevalence of Diabetes Mellitus has been rising steadily owing to several factors such as sedentary
lifestyle, obesity and an aging population. The prevalence of diabetes is predicted to double globally from
171 million in 2000 to 366 million in 2030 with a maximum increase in India with up to 79.4 million
individuals in India. Depression occurs frequently with diabetes but there are not many studies in India to
estimate its prevalence and associated factors. This study was done with the aim of estimating the
prevalence of depression among diabetes patients using the validated Patient Health Questionnaire-9 and
also its associated factors.
Radiation Therapy: Nutritional Strategies to Improve OutcomesJeanne M Wallace PhD
Presentation by Jeanne M. Wallace, PhD, CNC, at "Integrative Cancer Medicine: Clinical Applications of Cancer Strategies" conference April 26-29, 2013, Scottsdale AZ. Explore the mechanisms of tumor resistance to radiation therapy. Review diet, lifestyle, nutritional and botanical strategies for bolstering therapeutic efficacy. Employ selective radioprotectors to lessen injury to healthy tissues. Take into consideration the unfavorable consequences of radiotherapy, which can potentially increase the oncogenic potential of surviving tumor cells, and develop a plan for blocking these pathways. Cases will be presented from 15 yrs experience of the Nutritional Solutions team in counseling clients undergoing radiation therapy for Glioblastoma multiforme brain tumors, colorectal, head-and-neck, breast and gynecologic cancers.
doctors say this is not Chikungunya but an unknown viral fever. Government doctors also repeat the same. One doctor describes it as a cross breeding of denque and Chikungunya.
So it is undoubtedly the notorius Chikungunya. But even the newspapers and TV channels describe it as unknown viral fever. Government declares that there is an unidentified viral fever and it is not Chikungunya and research is going on to find what it is.
But according to common men who is standing with the knee bending it is Chikungunya and say “I am having Chikungunya for the past three months” when they describe their sufferings.
My doubt is why the media and the Government hesitate to declare that it is Chikungunya.
Whether the World Health Organisation (W.H.O) will declare the country as ugly country if it has Chikungunya?
Or whether the World Bank will refuse to give loans to the country if Chikungunya is there in that country?
Or whether the opposing party members will cry that the Government has failed to control an epidemic decease in Parliament and in Assembly?
God only knows.....
Modulating Oncometabolic Syndrome: Integrative Diet & Nutrition to Complement...Jeanne M Wallace PhD
Presentation by Jeanne M. Wallace, PhD, CNC, at CMBM's Food as Medicine conference, Indianapolis 2013. Oncometabolic Syndrome is a cluster of metabolic factors that influence the growth and progression of cancer. Standard lab testing can be used to assess nutritional factors that may influence cancer outcomes, tailor a protocol to an individual's unique needs, and evaluate the efficacy of the nutrition intervention in modulating these factors.
Dr. Colin Depp, Associate Professor of Psychiatry at the University of California, San Diego and CREST.BD member, describes research on the changes, including positive ones, that occur as people grow older with bipolar disorder. He shares evidence and considerations for treatments for bipolar disorder in older adults, as well as an overview of the lifestyle and behavioral determinants of healthy aging. He also presents new research on the importance of these factors in aging well with bipolar disorder.
Colin Depp, Ph.D. is an Associate Professor of Psychiatry at the University of California, San Diego. He is also Associate Director of Research Education and Training Division of the San Diego Clinical Translational Science Institute and psychologist at the Veterans Administration Healthcare System in San Diego. His research focuses on psychosocial interventions for bipolar disorder, use of technology for behavioral change, and the determinants of successful aging in people with mental illnesses. Dr. Depp is a principal investigator or co-investigator on multiple studies and he on the Editorial Board of Bipolar Disorders.
Abstract— Diabetes Mellitus (DM) is a chronic and progressive condition with a hereditary predisposition which is further induced by unhealthy lifestyle. It is a silent killer with cardiovascular complications being most common cause of morbidity and mortality in patients with T2DM.
Objective: To find out association of socio demographic and clinical parameters of diabetes type 2 with hypertension and dyslipidemia among Diabetes Mellitus type 2 cases aged 18 to 70 years. Methodology: A cross sectional hospital based study was conducted on 272 type 2 DM patients attending Department of Medicine in a secondary care referral hospital after taking consent.
Results: Hypertension was present in 192 (70.59%) and dyslipidemia was present in 93 (34.19%) of type 2 diabetes patients. Age, family income, presence of family history, duration of illness, type of treatment, consumption of alcohol , BMI, Hba1c level were found to be associated significantly with both hypertension and dyslipidemia in type 2 DM patients.
Join Doc Andrew to see what's new in health research that supports plant based diet recommendations. Share your questions via @DenverWWAD or email FreemanA@njhealth.org
Andrew Freeman, MD, FACC, FACP is a cardiologist and Director of Clinical Cardiology and Operations at National Jewish Health in Denver, Colorado. He holds leadership roles in the American College of Cardiology at the local and national levels. Dr. Freeman founded Denver's chapter of the Walk with a Doc program and heads Walk with a Doc-Colorado.
Walk with a Doc-Denver is a cost-free empowerment initiative powered by people improving their health, local doctors, and other health professionals who prescribe exercise-as-medicine. The mission? To elevate community health--one walk at a time! The program's Saturday walks include expert talks, health screenings, refreshments, and motivational giveaways. For more info visit: http://walkwithadoc.org/our-locations/denver/
Harnessing the Power of Nutrition to Complement Brain Tumor CareJeanne M Wallace PhD
Presentation by Jeanne M. Wallace, PhD, CNC, at the 1st Annual Brains Matter conference (Sept 2012 in Seattle), sponsored by the Chris Elliott Foundation. Learn how nutrition can play a powerful role to influence the terrain (environment) surrounding cancer cells. Discover foods that can "talk" to your genes, suppressing oncogenes and turning on tumor suppressor genes. Explore simple diet and lifestyle changes you can make to nourish your wellness when facing a brain tumor diagnosis.
PREVALENCE OF DEPRESSION AND ITS ASSOCIATED FACTORS IN ADULTS WITH DIABETES M...pijans
The prevalence of Diabetes Mellitus has been rising steadily owing to several factors such as sedentary
lifestyle, obesity and an aging population. The prevalence of diabetes is predicted to double globally from
171 million in 2000 to 366 million in 2030 with a maximum increase in India with up to 79.4 million
individuals in India. Depression occurs frequently with diabetes but there are not many studies in India to
estimate its prevalence and associated factors. This study was done with the aim of estimating the
prevalence of depression among diabetes patients using the validated Patient Health Questionnaire-9 and
also its associated factors.
Radiation Therapy: Nutritional Strategies to Improve OutcomesJeanne M Wallace PhD
Presentation by Jeanne M. Wallace, PhD, CNC, at "Integrative Cancer Medicine: Clinical Applications of Cancer Strategies" conference April 26-29, 2013, Scottsdale AZ. Explore the mechanisms of tumor resistance to radiation therapy. Review diet, lifestyle, nutritional and botanical strategies for bolstering therapeutic efficacy. Employ selective radioprotectors to lessen injury to healthy tissues. Take into consideration the unfavorable consequences of radiotherapy, which can potentially increase the oncogenic potential of surviving tumor cells, and develop a plan for blocking these pathways. Cases will be presented from 15 yrs experience of the Nutritional Solutions team in counseling clients undergoing radiation therapy for Glioblastoma multiforme brain tumors, colorectal, head-and-neck, breast and gynecologic cancers.
doctors say this is not Chikungunya but an unknown viral fever. Government doctors also repeat the same. One doctor describes it as a cross breeding of denque and Chikungunya.
So it is undoubtedly the notorius Chikungunya. But even the newspapers and TV channels describe it as unknown viral fever. Government declares that there is an unidentified viral fever and it is not Chikungunya and research is going on to find what it is.
But according to common men who is standing with the knee bending it is Chikungunya and say “I am having Chikungunya for the past three months” when they describe their sufferings.
My doubt is why the media and the Government hesitate to declare that it is Chikungunya.
Whether the World Health Organisation (W.H.O) will declare the country as ugly country if it has Chikungunya?
Or whether the World Bank will refuse to give loans to the country if Chikungunya is there in that country?
Or whether the opposing party members will cry that the Government has failed to control an epidemic decease in Parliament and in Assembly?
God only knows.....
Modulating Oncometabolic Syndrome: Integrative Diet & Nutrition to Complement...Jeanne M Wallace PhD
Presentation by Jeanne M. Wallace, PhD, CNC, at CMBM's Food as Medicine conference, Indianapolis 2013. Oncometabolic Syndrome is a cluster of metabolic factors that influence the growth and progression of cancer. Standard lab testing can be used to assess nutritional factors that may influence cancer outcomes, tailor a protocol to an individual's unique needs, and evaluate the efficacy of the nutrition intervention in modulating these factors.
Dr. Colin Depp, Associate Professor of Psychiatry at the University of California, San Diego and CREST.BD member, describes research on the changes, including positive ones, that occur as people grow older with bipolar disorder. He shares evidence and considerations for treatments for bipolar disorder in older adults, as well as an overview of the lifestyle and behavioral determinants of healthy aging. He also presents new research on the importance of these factors in aging well with bipolar disorder.
Colin Depp, Ph.D. is an Associate Professor of Psychiatry at the University of California, San Diego. He is also Associate Director of Research Education and Training Division of the San Diego Clinical Translational Science Institute and psychologist at the Veterans Administration Healthcare System in San Diego. His research focuses on psychosocial interventions for bipolar disorder, use of technology for behavioral change, and the determinants of successful aging in people with mental illnesses. Dr. Depp is a principal investigator or co-investigator on multiple studies and he on the Editorial Board of Bipolar Disorders.
Mr. AH is a 70-year-old man who was diagnosed with T2DM 10 years ago. He was initially treated with lifestyle management and metformin.
3 years later, his doctors advised him to add long acting basal insulin analogue to metformin, reached to 40U/day .
Other current medical conditions include: hypertension, hypothyroidism, and mild osteoporosis without fracture history.
Current medications; Metformin 1000 mg bid, long acting basal insulin analogue 40U/day , Candesartan 16 mg qd, Alendronate 70 mg once weekly, Levothyroxine 100 mg qd.
Physical exam: BMI 26 kg/m2, BP 140/80 mmHg, otherwise unremarkable.
His current FPG 140 mg/dL and HbA1c 8.5%. Kidney and liver functions are normal.
Slides to Guide Reducing Cardiovascular Risk in Type 2 Diabetes: What I Do an...hivlifeinfo
Slides to Guide Reducing Cardiovascular Risk in Type 2 Diabetes: What I Do and Why.2018
Zachary T. Bloomgarden, MD, MACE
Program Director
Mikhail N. Kosiborod, MD
Pamela Kushner, MD, FAAFP
Format: Microsoft PowerPoint (.ppt)
File Size: 923 KB
Released: June 29, 2018
Slides on Diabetes in the South Focus on Prevention.2018hivlifeinfo
Learn how to overcome common barriers to diabetes prevention with this downloadable slideset.
Richard E. Pratley, MD
Format: Microsoft PowerPoint (.ppt)
File Size: 3.16 MB
Released: October 23, 2018
Weight diabetes and metabolic problems in patients taking atypical antipsycho...Alex J Mitchell
Free slide show on weight gain, diabetes and metabolic problems in those taking atypical antipsychotic medication in schizophrenia, bipolar disorder and related conditions. Image credits retained by original authors. Please give correct acknolwedgements if you present any material from here.
Deciding When Hospice Care is Needed | VITAS HealthcareVITAS Healthcare
The goal of this webinar is to help healthcare professionals address the specific challenges of end-of-life care when determining a terminal prognosis, so they can provide the optimum care for the patient and family during the final stages of life.
DIABETES AND CARDIOVASCULAR DISEASE - THE CONTINUUMPraveen Nagula
DIABETES IS ONE OF THE MOST COMMON NONCOMMUNICABLE DISEASES WORLD WIDE.
EVERY 6 SECONDS ONE PERSON IS AFFECTED BY DIABETES..
THEME FOR 2014-2016
LETS UNITE FOR DIABETES
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
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.
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
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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
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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.
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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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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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!
3. Effective and Cost-Effective Treatment
The scope of the problem
What are we trying to achieve?
Choosing the right treatment
4. Most of the medical
textbooks are based upon
experience gained
in Western populations.
The culture, phenotype and
genotype of diabetes differs
between major population
groups
Egyptian people should
rewrite the textbooks for
use in Egypt!
5. A Century of Economic Growth
High employment, increasing disposable
income, cheap food and energy (and
everything that goes with these things)
are changing the phenotype of the
human species
The changing phenotype of the human species (affluent variety)
Diabetologia 2004;47:1339-1342
6. Health Correlates of Economic Growth:
A Changing Human Phenotype
Increasing height: 1 cm/decade
Changing body proportions
Increasing weight-to-height ratio
Increasing longevity: 3-4 months for
every calendar year
7. Estimated Numbers with Diabetes
(in millions) in 2000 and 2030
Western Countries Growing economies
15. Calorie restriction is the only form of therapy
that strikes at the root cause of diabetes
Pharmacotherapy largely represents the
attempt to compensate for a failure of
Edwin Gale
calorie restriction
16. Summary: The Human Phenotype
Affluent humans are developing a new and
distinctive phenotype
Diseases of relative overnutrition have
emerged as the leading causes of death
Increasing longevity is a major factor in
the diabetes epidemic
17. Effective and Cost-Effective Treatment
The scope of the problem
What are we trying to achieve?
Choosing the right treatment
18. What are we trying to achieve?
1. Near-normal glucose control?
2. Near-normal life expectancy?
3. Near-normal life quality?
19. Near-normal glucose control
Offers strong protection against
microvascular complications
- but the benefit diminishes with
increasing age
But weak protection against
cardiovascular outcomes
Has not been shown to improve life
expectancy in type 2 diabetes
Intensified glucose control can reduce
20. Lifetime Risk of Blindness by Age at
Diagnosis and HbA1c
n/1000
Age at diagnosis
Ann Int Med 1997;127:788
21. Lifetime Risk of ESRF by Age at Diagnosis
and HbA1c
n/1000
Age at diagnosis
Ann Int Med 1997;127:788
22. Microvascular Disease
Risk diminishes with age and/or limited life
expectancy.
The full benefits seen in young patients with type 1
diabetes are not achieved in older people with
type 2 diabetes
23. Near-normal glucose control
Offers strong protection against
microvascular complications
But weak protection against
cardiovascular outcomes
Has not been shown to improve life
expectancy in type 2 diabetes
Intensified glucose control can reduce
quality of life
24. HRs for CV outcomes, DM vs non-diabetes
Emerging Risk Factors Collaboration (EFRC), Lancet 2010;375:2215-22
26. A 50-year-old man with diabetes loses
6 years of life expectancy
60% of the excess mortality is due
to vascular deaths
Emerging Risk Factors Collaboration (EFRC), NEJM 2011;364:829-41
28. Near-normal glucose control
Offers strong protection against
microvascular complications
But weak protection against
cardiovascular outcomes
Has not been shown to improve life
expectancy in type 2 diabetes
Intensified glucose control can reduce
quality of life
29. Mortality – intensive versus standard
Meta-Analysis: 13 studies, 34533 patients
All cause mortality
OR: 1.04 (0.91 – 1.19)
Cardiovascular death
OR: 1.11 (0.96 – 1.43)
Boussageon R et al. BMJ 2011
30. Relationship Between Glycated Haemoglobin and
Mortality in 47,970 Patients
Oral therapy Insulin
UK General Practice Research Database,
Currie et al, Lancet 2010
31. Near-normal glucose control
Offers strong protection against
microvascular complications
But weak protection against
cardiovascular outcomes
Has not been shown to improve life
expectancy in type 2 diabetes
Intensified glucose control can reduce
quality of life
32. Patient perceptions of intensive
glucose lowering
701 pts with T2DM asked re QOL utilities;
a score of 1.0 = perfect health, 0 = death
Intensive glucose control scored 0.67, or 1/3 of a
year‟s quality of life
Huang et al, Diabetes Care (2007) 30:2478
33. Check Point
Intensified glucose lowering therapy ALONE
offers limited benefits in type 2 diabetes
BUT
Combined attention to all cardiovascular risk
factors can make a dramatic difference to
outcomes
34. STENO-2
Randomized 160 NEJM 2008;358:580
80 80
Trial Ends 67 63 Mean 7.8 yr
55 38
Study Ends Mean 5.5 yr
Died 24 (9 CVD) 40 (19 CVD)
Intensified Conventional
(1 dropped out) (2 dropped out)
35. Effective and Cost-Effective Treatment
The scope of the problem
What are we trying to achieve?
Choosing the right treatment
38. When?
Does intensified
Why?
therapy benefit?
Life Quality
CV Risk
Other risks
Longevity
Hemmingsen B et al: Cochrane Database Syst Rev. 2011 Jun 15;6:CD008143
Yudkin et al, Diabetologia 2010;53:2079-85
39. When?
Does intensified
Why?
therapy benefit?
Life Quality No
CV Risk
Other risks
Longevity
Hemmingsen B et al: Cochrane Database Syst Rev. 2011 Jun 15;6:CD008143
Yudkin et al, Diabetologia 2010;53:2079-85
40. When?
Does intensified
Why?
therapy benefit?
Life Quality No
CV Risk Marginal
Other risks
Longevity
Hemmingsen B et al: Cochrane Database Syst Rev. 2011 Jun 15;6:CD008143
Yudkin et al, Diabetologia 2010;53:2079-85
41. When?
Does intensified
Why?
therapy benefit?
Life Quality No
CV Risk Marginal
Other risks Minor
Longevity
Hemmingsen B et al: Cochrane Database Syst Rev. 2011 Jun 15;6:CD008143
Yudkin et al, Diabetologia 2010;53:2079-85
42. When?
Does intensified
Why?
therapy benefit?
Life Quality No
CV Risk Marginal
Other risks Minor
Longevity No
Hemmingsen B et al: Cochrane Database Syst Rev. 2011 Jun 15;6:CD008143
Yudkin et al, Diabetologia 2010;53:2079-85
43. When?
Does intensified
Why?
therapy benefit?
Life Quality No
CV Risk Marginal But early
intervention
Other risks Minor is beneficial!
Longevity No
Hemmingsen B et al: Cochrane Database Syst Rev. 2011 Jun 15;6:CD008143
Yudkin et al, Diabetologia 2010;53:2079-85
44. VADT - HR for Primary Outcome in
Intensive Arm
1.4
1.2
Hazard Ratio
1
0.8
0.6
0.4
0.2
0
0 3 6 9 12 15 18 21 24
Duration of Diabetes (yrs)
46. Comorbidity and Glucose Control, New
onset patients aged 60-64 yrs
Comorb. Life Exp Days added
Case 1 0 14.6 yrs +106
Case 2 3 9.7 yrs + 44
Case 3 7 4.8 yrs + 8
Huang et al, Ann Int Med (2008) 149:11-19
47. When?
Why? Who?
Life Quality Life Quality
CV Risk CV Risk
Other risks Other risks
Longevity Longevity
48. When?
Why? Who?
Life Quality Life Quality Prognosis,
patient choice
CV Risk CV Risk
Other risks Other risks
Longevity Longevity
49. When?
Why? Who?
Life Quality Life Quality Prognosis,
patient choice
CV Risk CV Risk
Other risks Other risks Established
vascular disease?
Longevity Longevity
51. When?
Why? Who? How?
Life Quality Life Quality Life Quality
CV Risk CV Risk CV Risk
Other risks Other risks Other risks
Longevity Longevity Longevity
52. When?
Why? Who? How?
Life Quality
Diabetes therapies previously
considered solely in terms of CV Risk
HbA1c reduction ...
Other risks
Longevity
53. Spot Quiz
• Treatment A lowers HbA1c from
10.5% to 9%
• Treatment B lowers HbA1c from 7.6%
to 7%
• Which treatment is more potent?
55. When?
Why? Who? How?
Diabetes therapies previously Life Quality
considered solely in terms of
CV Risk
HbA1c reduction ...
Other risks
But global profile now
seen as more important Longevity
56. Check Point
Most patients have been exposed to multiple
treatments
RCT evidence does not (with some exceptions)
allow us to assess the global impact of specific
therapies upon cardiovascular risk
60. Lifestyle …
Is the starting point for any treatment
No treatment for diabetes can work effectively
without adjustment of lifestyle
Diabetes conferences are 90% about
pharmacology and 10% about human behaviour
Real world therapy is the other way round
62. Myocardial Infarction Hazard Ratio
(fatal or non-fatal myocardial infarction or sudden death)
Intensive (metformin) vs. Conventional glucose control
HR (95%CI)
UKPDS 80
63. Metformin in Patients with
Established Atherosclerosis
Method:
Comparison of 2 year mortality in 19,691
patients with diabetes and known vascular
disease, treated with or without metformin,
in the REACH registry.
Roussel et al, Arch Int Med 2010;170:1892-99
64. Metformin in Patients with
Established Atherosclerosis
+Metformin -Metformin
% Mortality 6.3 (5.2-7.4) 9.8 (8.4-11.2%)
Hazard Ratio 0.76 (0.65-0.89)
(adjusted)
Roussel et al, Arch Int Med 2010;170:1892-99
65. Benefits of Metformin
(Hazard Ratios)
Age 65-80 0.77 (0.62-0.95)
Heart failure 0.69 (0.54-0.90)
GFR 30-60 0.64 (0.48-0.86)
MF + INS 0.64 (0.46-0.89)
Roussel et al, Arch Int Med 2010;170:1892-99
66. Metformin: Summary
Mechanism of cardiovascular protection
unclear – related to mechanism of
cancer protection?
Observational studies to date show
consistent reductions in overall and
cardiovascular mortality
68. Closure of the K+ channel leads
to membrane depolarization
69. KATP channels
Transducers between intracellular energy metabolism
and electrical excitability
Found in many tissues including heart and brain
Mostly closed in tissues outside the beta cell; open in
response to ischaemia, hormones or neurotransmitters
In cardiac muscle and neurones the reduction in
electrical activity protects against damage
Frances Ashcroft, J Clin Invest 2005;115;2047-58
70. Variant forms of the channel
Kir 6.2 SUR1 beta cells
Kir 6.2 SUR2A cardiomyocytes
Kir 6.2 SUR2B arterial smooth muscle
All sulfonylureas show
some cross-reactivity
71. Potential cardiovascular consequences
of failure to open KATP channels
The default setting for cardiovascular KATP
channels is closure. Opening results in -
• Limitation of myocardial damage during ischaemia
• Loss of preconditioning
• Masking of ST segment elevation
• Loss of smooth muscle relaxation in coronary
arteries
Bell, CMAJ 2006;174:185-6
72. Myocardial Infarction Hazard Ratio
(fatal or non-fatal myocardial infarction or sudden death)
Intensive (SU/Ins) vs. Conventional glucose control
HR (95%CI)
UKPDS 80
73. Sulfonylureas: Summary
No clear evidence that theoretical risk
translates into actual risk
No clear evidence that prognosis worse
after myocardial infarction
Best avoided in interventional cardiology
Gliclazide probably safer than glibenclamide
74. Disadvantages of Newer Therapies
Benefits overstated
Unsupported claims
“Newer” may not mean „better”
Evidence base not yet established
Long term safety unknown
Much more expensive!
75.
76. A Situation of Diminishing Returns
Analogs DPP4s
SUs
TZDs
Metformin
Insulin
1920 1960 2010
77. And Escalating Costs
1500
Rosiglitazone
Pioglitazone
Sitagliptin
1000 Euros/yr
Analog +
Lantus
Metformin 500
Gliclazide
Human
Pork
UK Formulary, 2006
78. Costs as % total
Costs of glucose-
lowering medication
in England
Currie et al, Diabet Med 2010;27:744-52
79. Costs as % total Total Costs (£m)
Adjusted to 2008
Currie et al, Diabet Med 2010;27:744-52
80. Costs as % total Total Costs (£m)
Adjusted to 2008
Costs (in England)
2000 = £289.9 million
2008 = £590.4 million
Currie et al, Diabet Med 2010;27:744-52
83. Insulin costs (£) per 1000 units
Cumulative excess cost of analogues to
the NHS is ~£650 million
Currie et al, BMJ in press
84.
85. Overall Summary
Metformin emerges as “best buy”
The disadvantages of the sulfonylureas
have been over-stated
Analogue insulins have marginal benefits only
in type 2 diabetes
Newer therapies should be reserved for
second line use
86. Where Next?
Future clinical trials will need to evaluate
global risks and benefits of individual
therapies (and combinations) rather than
focusing on glucose-lowering efficacy
87. The Physician’s Prayer
From inability to let well alone,
From too much zeal for the new and contempt for
what is old,
From putting knowledge before wisdom,
Science before art and cleverness before common sense,
From treating patients as cases
And from making the cure of the disease more grievous
than the endurance of the same,
Good Lord deliver us.
Sir Robert Hutchison (1871-1960)