This document discusses hypertension, including definitions, types, causes, diagnosis, treatment and goals. It defines hypertension as a blood pressure over 140/90 mmHg based on multiple readings. Types include primary (essential) hypertension which is most common, and secondary hypertension which has an identifiable underlying cause. Causes of secondary hypertension include renal, endocrine and vascular diseases. Treatment involves lifestyle changes and may include diuretics, ACE inhibitors, calcium channel blockers, and other classes of medications. Goals are under 140/90 mmHg for most patients, though higher for some groups. Combination drug therapy is often needed to achieve blood pressure control.
Dr Abdullah Ansari
PG-2 (Medicine)
AMU ALIGARH
A general approach to periodic paralysis....
(including hypokalemic periodic paralysis and thyrotoxic periodic paralysis, and other “Channelopathies” or “Membranopathies)
Pathophysiology
Epidemiology
Primary or familial periodic paralysis
Secondary periodic paralysis
Conventional classification of periodic paralysis
Classification of primary periodic paralysis based on ion-channel abnormalities
Clinical approach to a case of periodic paralysis
History of muscle weakness
Age of onset
Family history
Timing
Intensity
History of administration of certain drugs
Clinical examination
Differential Diagnosis
Laboratory investigations
Serum K+
CPK and serum myoglobin
ECG
EMG
Nerve conduction studies
Provocative Testing
Muscle biopsy
Treatment
Prognosis
Management of hypertensive condition in 2020 according to AHA/ASA guidelines. We will discuss the presentation, clinical assessment, investigations, and management of hypertension along with major randomized controlled trials and guidelines.
Dr Abdullah Ansari
PG-2 (Medicine)
AMU ALIGARH
A general approach to periodic paralysis....
(including hypokalemic periodic paralysis and thyrotoxic periodic paralysis, and other “Channelopathies” or “Membranopathies)
Pathophysiology
Epidemiology
Primary or familial periodic paralysis
Secondary periodic paralysis
Conventional classification of periodic paralysis
Classification of primary periodic paralysis based on ion-channel abnormalities
Clinical approach to a case of periodic paralysis
History of muscle weakness
Age of onset
Family history
Timing
Intensity
History of administration of certain drugs
Clinical examination
Differential Diagnosis
Laboratory investigations
Serum K+
CPK and serum myoglobin
ECG
EMG
Nerve conduction studies
Provocative Testing
Muscle biopsy
Treatment
Prognosis
Management of hypertensive condition in 2020 according to AHA/ASA guidelines. We will discuss the presentation, clinical assessment, investigations, and management of hypertension along with major randomized controlled trials and guidelines.
Approach to a case of Fever with altered sensoriumRoy Shilanjan
A brief description about the possible d/d of fever with alteration of sensorium and how to approach the diagnosis through systematic yet focused history taking , physical examination and lab and radiological investigations.
Management of hypertension in acute strokeSudhir Kumar
Hypertension is an important and common risk factor for brain stroke- both ischemia and hemorrhagic subtypes. Appropriate management of blood pressure is crucial for good recovery rom acute stroke, and prevent recurrence of stroke. This presentation looks at the role played by hypertension in causing first ever and recurrent strokes. The current guidelines are also discussed.
This PPT focuses on the diagnosis and treatment of the primary headache disorders, with special emphasis on migraine, the headache most likely to bring patients to physicians and pharmacists. warning signs of the ominous headache, which, although rare, can herald a life-threatening condition. Clinical characteristics of the primary headache types, migraine, tension-type headache, and cluster headache, are described
JNC 8 guideline to Management of HypertensionPranav Sopory
JNC - 8 guidelines to management of Hypertension.
Rencent developments in CKD (Chronic Kidney Disease) and DM (Daibetes Mellitus) management.
Drugs discussed along with doses and side effects.
Compelling indiactions.
2017 AHA/ACC criteria for Hypertension management in brief.
>> Contains animation. Download and view.
Approach to a case of Fever with altered sensoriumRoy Shilanjan
A brief description about the possible d/d of fever with alteration of sensorium and how to approach the diagnosis through systematic yet focused history taking , physical examination and lab and radiological investigations.
Management of hypertension in acute strokeSudhir Kumar
Hypertension is an important and common risk factor for brain stroke- both ischemia and hemorrhagic subtypes. Appropriate management of blood pressure is crucial for good recovery rom acute stroke, and prevent recurrence of stroke. This presentation looks at the role played by hypertension in causing first ever and recurrent strokes. The current guidelines are also discussed.
This PPT focuses on the diagnosis and treatment of the primary headache disorders, with special emphasis on migraine, the headache most likely to bring patients to physicians and pharmacists. warning signs of the ominous headache, which, although rare, can herald a life-threatening condition. Clinical characteristics of the primary headache types, migraine, tension-type headache, and cluster headache, are described
JNC 8 guideline to Management of HypertensionPranav Sopory
JNC - 8 guidelines to management of Hypertension.
Rencent developments in CKD (Chronic Kidney Disease) and DM (Daibetes Mellitus) management.
Drugs discussed along with doses and side effects.
Compelling indiactions.
2017 AHA/ACC criteria for Hypertension management in brief.
>> Contains animation. Download and view.
Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.
Several distinct types of DM are caused by a complex interaction of genetics and environmental factors.
Depending on the etiology of the DM, factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production.
The metabolic dysregulation associated with DM causes secondary pathophysiologic changes in multiple organ systems that impose a tremendous burden on the individual with diabetes and on the health care system.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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!
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
2. According to the Joint National Committee
based on the averagethe average of two or more properly measured BP
readings.
On each of two or more office visits.
DEFINITION
3. The patient must be properly prepared and positioned and
seated quietly for at least 5 minutes in a chair.
The auscultatory method should be used.
Caffeine, exercise, and smoking should be
avoided for at least 30 minutes before BP measurement.
An appropriately sized cuff should be used.
ACCURATE BLOOD PRESSURE MEASUREMENT
4. Isolated systolic hypertension is considered to be present when
the blood pressure is ≥140/<90 mmHg
isolated diastolic hypertension is considered to be present
when the blood pressure is <140/≥90 mmHg
ISOLATED HYPERTENSION
5. White coat hypertension defined as blood pressure that is
consistently elevated by office readings but does not meet diagnostic
criteria for hypertension based upon out-of-office readings.
Masked hypertension — Masked hypertension is defined as
blood pressure that is consistently elevated by out-of-office measurements
but does not meet the criteria for hypertension based upon office readings
0
0.5
1
1.5
2
2.5
Normal BP White coat
hypertension
Masked
Hypertension
Hypertension
prognosis
OddsRatioofa
CardiovascularEvent
7. MALIGNANT HYPERTENSION
Moderate to severe hypertensive retinopathy (formerly
called "malignant hypertension")
The absolute level of blood pressure is not as important as its rate of rise.
usually associated with diastolic pressures above 120 mmHg. However, it
can occur at diastolic pressures as low as 100 mmHg in previously
normotensive patients.
Clinically;
-progressive retinopathy (arteriolar spasm, hemorrhages, exudates,papilledema),
-deteriorating renal function with proteinuria,
-microangiopathic hemolytic anemia
-encephalopathy.
8. Hypertensive Urgencies: severe hypertension (diastolic pressure
usually >120 mmHg) in asymptomatic patients with no acute target-
organ damage
Hypertensive Emergencies: severe hypertension (diastolic
pressure usually >120 mmHg) in patients with acute ongoing target-organ
damage
HYPERTENSIVE CRISES
9. FOLLOW-UP BASED ON INITIAL BP
MEASUREMENTS FOR ADULTS*
*Without acute end-organ damagewww.nhlbi.nih.gov
10. Ibrahim: I think systolic pressure is much more important that the
diastolic.
Naisam: no my friend, you are so wrong! they are both important but the
diastolic pressure is more important as a CVD risk factor
QUESTION
11. Systolic BP is more important cardiovascular risk factor after age 50.
Diastolic BP is more important before age 50.
ANSWER
12. BENEFITS OF TREATING HYPERTENSION
Younger than 60 (reducing BP 10/5-6 mmHg)
reduces the risk of stroke by 42%
reduces the risk of coronary event by 14%
Older than 60 (reducing BP 15/6 mmHg)
reduces overall mortality by 15%
reduces cardiovascular mortality by 36%
reduces incidence of stroke by 35%
reduces coronary artery disease by 18%
Lancet 1990;335:827-38
Arch Fam Med 1995;4:943-50
27. for the general hypertensive population under the age of 60 years
<140/90
patients of all ages with diabetes or chronic kidney disease who do not
have proteinuria<140/90
for the general hypertensive population aged 80 years and older.Goal
blood pressure is <150/90 mmHg
The choice between these two goal blood pressures depends upon the
patient's general health, comorbid conditions, postural blood pressure
changes, the number of medications needed to reach the goal, and upon
individual values and preferences.
GOAL BLOOD PRESSURE
28. hypertensive patients who are less than 20/10 mmHg above goal can
initially be treated with monotherapy.
the major classes of drugs that have been used for monotherapy are a
low-dose thiazide diuretic, long-acting angiotensin-converting enzyme
(ACE) inhibitor/angiotensin II receptor blocker (ARB), or a long-acting
dihydropyridine calcium channel blocker.
MONOTHERAPY
29. recommended therapy with the combination of a long-acting ACE
inhibitor/ARB plus a long-acting dihydropyridine calcium channel blocker
Among nonobese patients who are already being treated with an ACE
inhibitor/ARB plus a thiazide diuretic and have attained goal blood
pressure, we suggest stopping the thiazide and switching to a long-acting
dihydropyridine calcium channel blocker
COMBINATION THERAPY
31. Primary HTN:
also known as
essential HTN.
accounts for 95%
cases of HTN.
no universally
established cause
known.
Secondary HTN:
less common cause of
HTN ( 5%).
secondary to other
potentially rectifiable
causes.
TYPES OF HYPERTENSION
35. Onset: at age < 30 yrs ( Fibromuscular dysplasia) or >
55 (atherosclerotic renal artery stenosis), sudden onset
(thrombus or cholesterol embolism).
Episodic, headache and chest pain/palpitation
(pheochromocytoma, thyroid dysfunction).
Morbid obesity with history of snoring and daytime
sleepiness (sleep disorders)
Abdominal bruit especially with a diastolic component
(renovascular)
Truncal obesity, purple striae, buffalo hump
(hypercortisolism
SECONDARY HTN-CLUES IN MEDICAL
HISTORY
38. PRIMARY
HYPERALDOSTERONISM
• Idiopathic – 60%,
hyperplasia.
• Neoplasm – adenoma
(rarely carcinoma) –
35%. Conn syn. F:M-2:1
• Glucocorticoid
suppressible
–Fusion between CYP11B1
and aldosterone synthase
–Aldosterone secretion
under regulation of ACTH
39. Plasma aldosterone to renin ratio — An elevated plasma
aldosterone concentration to PRA ratio (PAC/PRA) and an increased PAC
are both required for the diagnosis of primary aldosteronism.
41. Common cause of secondary HTN (2-5%)
HTN is both cause and consequence of renal disease
Multifactorial cause for HTN including disturbances in Na/water balance,
vasodepressors/ prostaglandins imbalance
Renal disease from multiple etiologies.
RENAL PARENCHYMAL DISEASE
מסר חשוב
מספיק ירידות קטנות בל&quot;ד בכדי להגיע לירידה משמעותית בסיבוכים.
מצד שני, מספיק אפילו עליה קטנה בנורמה כדי להקפיץ את כמות הסיבוכים.
באנשים צעירים (מתחת גיל 60) :
אם מורידים להם ל&quot;ד סיסטולי ב10 ממ&quot;כ , או דיאסטולי ב5 ממ&quot;כ תהיה ירידה של 40% בשבץ (לא לזכור אחוזים, רק להבין רעיון).
באנשים מבוגרים
מספיקה ירידה ב15 ממ&quot;כ סיסטולי – תהיה להם ירידה בשבץ, ובמחלת CV ב35%.
even modest weight loss can lead to a reduction of blood pressure and an increase in insulin sensitivity
Regular physical activ- ity facilitates weight loss, decreases blood pressure, and reduces the overall risk of cardiovascular disease
Dietary NaCl reduction also has been shown to reduce the long-term risk of cardiovascular events in adults with “prehypertension.
אנשים עם אוסטאופרוזיס ניתן טיאזיד ולא פוסיד כי פוסיד מסייע לאיבוד סידן בשתן, לעומת טיאזיד שמונע איבוד סידן.
באנשים עם אבני כליה לעומת זאת נותנים טיאזיד כי אנו רוצים להוריד את ההפרשה של סידן בשתן .
potassium-sparing diuretics, amiloride
These agents are weak antihypertensive agents but may be used in combination with a thiazide to protect against hypokalemia
ACEIs attenuate the development of left ventricular hypertro- phy, improve symptomatology and risk of death from CHF, and reduce morbidity and mortality rates in post-myocardial infarc- tion patients
ARBs provide selective blockade of AT1 receptors, and the effect of angiotensin II on unblocked AT2 receptors may augment their hypotensive effect
AT2 receptor microvascular dilator action through NO
ACEI/ARB combinations are less effective in lowering blood pressure than is the case when either class of these agents is used in combination with other classes of agents
patients with vascular disease or a high risk of diabetes, combination ACEI/ARB therapy has been associated with more adverse events
Hypertrichosis שיעור יתר
NSAIDS
שכבת הגלומרולוזה- מפרישה אלדוסטרון
יתר אלדוסטרון (גורם ליל&quot;ד):
ראשוני- הפרשה מוגברת של אלדוסטרון
שניוני – רמות גבוהות של רנין שמעלות אלדוסטרון
סיבות:
1. הסיבה הנפוצה- היפרפלסיה (60% מהמקרים)
2. אדנומה שמפרישה אלדוסטרון- Conn syn , שכיח יותר בנשים.
3. Glucocorticoid suppressible - יש חיבור בין גן שמגיב ACTH(CYP11B1 ) לבין אלדוסטרון סינתאז . זה אומר שהפרשת האלדוסטרון תחת הבקרה של קורטיזול (הוא נמצא ברמה גבוהה בפלסמה ואין לו משוב שלילי מרמות של מלחים). אפשר לטפל בזה אם מעכבים אלדוסטרון (כמו באחרים).
Liquorice consumption may also cause a temporary form of AME due to its ability to block 11β-hydroxysteroid dehydrogenase type 2, in turn causing increased levels of cortisol
l, this isozyme inactivates circulating cortisol to the less-active metabolite cortisone