Diabetes and hypertension frequently occur together and amplify cardiovascular risk. Aggressive blood pressure control is especially important for diabetics to prevent events like heart disease and stroke. The document discusses the history of diabetes and hypertension, complications, diagnosis criteria, treatment goals, and pharmacological and lifestyle approaches to managing hypertension in diabetes. The key goals are achieving a blood pressure under 130/80 mmHg through lifestyle changes and often multiple drug classes like ACE inhibitors or ARBs to protect the kidneys and reduce cardiovascular risk.
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.
I. Introduction
A. Brief explanation of World Hypertension Day
B. Importance of addressing hypertension as a global health issue
C. Overview of the objectives of the presentation
II. Understanding Hypertension
A. Definition and classification of hypertension
B. Prevalence and global burden of hypertension
C. Risk factors and causes of hypertension
D. Health implications and complications associated with hypertension
III. World Hypertension Day 2023
A. Background and significance of World Hypertension Day
B. Theme and key messages for World Hypertension Day 2023
C. Activities and events organized worldwide to raise awareness
IV. Goals and Objectives
A. Key goals set for World Hypertension Day 2023
B. Promoting prevention and early detection of hypertension
C. Encouraging healthy lifestyle modifications
D. Enhancing public knowledge about hypertension management
V. Initiatives and Campaigns
A. Overview of global initiatives and campaigns
B. Collaborations with international organizations, NGOs, and healthcare professionals
C. Campaign materials and resources available for public use
VI. Strategies for Hypertension Prevention and Control
A. Implementing population-level interventions
B. Screening and diagnosis strategies
C. Lifestyle modifications (diet, physical activity, stress management)
D. Pharmacological management and treatment guidelines
VII. Public Awareness and Education
A. Importance of raising public awareness about hypertension
B. Educational campaigns and resources for the general public
C. Role of healthcare professionals in educating patients
VIII. Impact and Achievements
A. Highlighting the impact of previous World Hypertension Day campaigns
B. Success stories and achievements in hypertension prevention and control
C. Lessons learned and areas for improvement
IX. Conclusion
A. Recap of the key points discussed
B. Call to action for individuals, communities, and policymakers
C. Encouragement to spread awareness and take steps towards hypertension prevention
Calcium channel blockers are useful treatments in the management of hypertension. In this presentation by Dr Vivek Baliga, we look at the added benefits of newer types of CCBs in treating high blood pressure. Read more from Dr Baliga here - http://drvivekbaliga.net
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.
I. Introduction
A. Brief explanation of World Hypertension Day
B. Importance of addressing hypertension as a global health issue
C. Overview of the objectives of the presentation
II. Understanding Hypertension
A. Definition and classification of hypertension
B. Prevalence and global burden of hypertension
C. Risk factors and causes of hypertension
D. Health implications and complications associated with hypertension
III. World Hypertension Day 2023
A. Background and significance of World Hypertension Day
B. Theme and key messages for World Hypertension Day 2023
C. Activities and events organized worldwide to raise awareness
IV. Goals and Objectives
A. Key goals set for World Hypertension Day 2023
B. Promoting prevention and early detection of hypertension
C. Encouraging healthy lifestyle modifications
D. Enhancing public knowledge about hypertension management
V. Initiatives and Campaigns
A. Overview of global initiatives and campaigns
B. Collaborations with international organizations, NGOs, and healthcare professionals
C. Campaign materials and resources available for public use
VI. Strategies for Hypertension Prevention and Control
A. Implementing population-level interventions
B. Screening and diagnosis strategies
C. Lifestyle modifications (diet, physical activity, stress management)
D. Pharmacological management and treatment guidelines
VII. Public Awareness and Education
A. Importance of raising public awareness about hypertension
B. Educational campaigns and resources for the general public
C. Role of healthcare professionals in educating patients
VIII. Impact and Achievements
A. Highlighting the impact of previous World Hypertension Day campaigns
B. Success stories and achievements in hypertension prevention and control
C. Lessons learned and areas for improvement
IX. Conclusion
A. Recap of the key points discussed
B. Call to action for individuals, communities, and policymakers
C. Encouragement to spread awareness and take steps towards hypertension prevention
Calcium channel blockers are useful treatments in the management of hypertension. In this presentation by Dr Vivek Baliga, we look at the added benefits of newer types of CCBs in treating high blood pressure. Read more from Dr Baliga here - http://drvivekbaliga.net
Definition of hypertension - prevalence- classification and varieties of hypertension - risk factors - clinical manifestation of hypertension -complication -diagnosis - management - treatment of hypertension and special cases
What is hypertension, Definition of hypertension, Classification of hypertension, pathophysiology of hypertension, Signs and symptoms of hypertension, Risk factors of hypertension, Causes of hypertension, Differential diagnosis of hypertension, Medications of hypertension, Different class of medications for hypertension, Patient education for hypertension
Study material for Doctor of pharmacy and other medical students. Hypertension is a condition in which the force of the blood against the artery walls is too high. Approximately one billion adults or ~22% of the population of the world have hypertension. It is slightly more frequent in men, in those of low socioeconomic status, and prevalence increases with age. So it is more important to manage it as early, this includes Pharmacological as well as Non-pharmacological Management.
Diabetes mellitus (DM) has routinely been described as a metabolic disorder characterized by hyperglycemia that develops as a consequence of defects in insulin secretion, insulin action, or both.
Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves.
1. Microvascular (due to damage to small blood vessels).
2. Macrovascular (due to damage to larger blood vessels).
Definition of hypertension - prevalence- classification and varieties of hypertension - risk factors - clinical manifestation of hypertension -complication -diagnosis - management - treatment of hypertension and special cases
What is hypertension, Definition of hypertension, Classification of hypertension, pathophysiology of hypertension, Signs and symptoms of hypertension, Risk factors of hypertension, Causes of hypertension, Differential diagnosis of hypertension, Medications of hypertension, Different class of medications for hypertension, Patient education for hypertension
Study material for Doctor of pharmacy and other medical students. Hypertension is a condition in which the force of the blood against the artery walls is too high. Approximately one billion adults or ~22% of the population of the world have hypertension. It is slightly more frequent in men, in those of low socioeconomic status, and prevalence increases with age. So it is more important to manage it as early, this includes Pharmacological as well as Non-pharmacological Management.
Diabetes mellitus (DM) has routinely been described as a metabolic disorder characterized by hyperglycemia that develops as a consequence of defects in insulin secretion, insulin action, or both.
Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves.
1. Microvascular (due to damage to small blood vessels).
2. Macrovascular (due to damage to larger blood vessels).
HYPERTENSION- THE LATEST MANAGEMENT
Dr. Awadhesh kumar sharma is a young, diligent and dynamic interventional cardiologist. He did his graduation from GSVM Medical College Kanpur and MD in Internal Medicine from MLB Medical college jhansi. Then he did his superspecilisation degree DM in Cardiology from PGIMER & DR Ram Manoher Lohia Hospital Delhi. He had excellent academic record with Gold medal in MBBS,MD and first class in DM.He was also awarded chief ministers medal in 2009 for his academic excellence by former chief minister of UP Smt Mayawati in 2009.He is also receiver of GEMS international award.He had many national & international publications.He is also in editorial board of international journal- Journal of clinical medicine & research(JCMR).He is also active member of reviewer board of many journals.He is also trainee fellow of American college of cardiology. He is currently working in NABH Approved Gracian Superspeciality Hospital Mohali as Consultant Cardiologist.
Chronic Stable Angina- Diagnosis & management
By Dr Awadhesh Kumar Sharma
Dr. Awadhesh kumar sharma is a young, diligent and dynamic interventional cardiologist. He did his graduation from GSVM Medical College Kanpur and MD in Internal Medicine from MLB Medical college jhansi. Then he did his superspecilisation degree DM in Cardiology from PGIMER & DR Ram Manoher Lohia Hospital Delhi. He had excellent academic record with Gold medal in MBBS,MD and first class in DM.He was also awarded chief ministers medal in 2009 for his academic excellence by former chief minister of UP Smt Mayawati in 2009.He is also receiver of GEMS international award.He had many national & international publications.He is also in editorial board of international journal- Journal of clinical medicine & research(JCMR).He is also active member of reviewer board of many journals.He is also trainee fellow of American college of cardiology. He is currently working in NABH Approved Gracian Superspeciality Hospital Mohali as Consultant Cardiologist.
Perioperative management of diabetes mellitusSourav Mondal
A detailed stepwise approach for the perioperative management of diabetes mellitus.
Sources taken from latest edition of Harrison, Millers, Stoeltings and ADA Guidelines.
By a anaesthetist, for a anaesthesist
Essential Hypertension By Raheef Alatassi
Definition & classifications
Prevention & detection & importance
Causes
HTN in pregnancy
Management
Goals of treatment
Classes of drugs & side effects
Specific management in e.g. IHD,DM
HTN emergency & urgency with management
Gluteal abscess with diabetes mellitus and diabetic ketoacidosis (2)Goutham Kondeti
About the patient with Diabetes mellitus and ketoacidosis with abscess, his treatment plan, goals of treatment, monitoring parameters, drug interactions, patient counseling, precautions
Pediatric Type 2 Diabetes Mellitus. BY DR SAYED ISMAILSayed Ahmed
diabetes mellitus type 2 in children
pathophysiology of type 2 DM
manifestations of DM
Complications , investigation and management of type2 DM in children
Vitamin D is an important prohormone for optimal intestinal calcium absorption for mineralization of bone. Because the vitamin D receptor is present in multiple tissues, there has been interest in evaluating other potential functions of vitamin D, particularly, in cardiovascular diseases (CVD). Cross-sectional studies have reported that vitamin D deficiency is associated with increased risk of CVD, including hypertension, heart failure, and ischemic heart disease. Initial prospective studies have also demonstrated that vitamin D deficiency increases the risk of developing incident hypertension or sudden cardiac death in individuals with preexisting CVD. Very few prospective clinical studies have been conducted to examine the effect of vitamin D supplementation on cardiovascular outcomes. The mechanism for how vitamin D may improve CVD outcomes remains obscure; however, potential hypotheses include the downregulation of the renin-angiotensin-aldosterone system, direct effects on the heart, and vasculature or improvement of glycemic control. This review will examine the epidemiologic and clinical evidence for vitamin D deficiency as a cardiovascular risk factor and explore potential mechanisms for the cardioprotective effect of vitamin D.
How to deal with CALCIFIED CORONARY ARTERY LESIONS .Coronary artery calcification (CAC) is highly prevalent in patients with coronary heart disease (CHD) and is associated with major adverse cardiovascular events. There are two recognized type of CAC—intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary intervention have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD patients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.
Hypertension is a common medical and social problem leading to cardiovascular diseases worldwide. Antihypertensive drugs are clinically applied to decrease the morbidity and mortality induced by hypertension itself and its complications. The 2014 hypertension guideline of the Eighth Joint National Committee (JNC8) for hypertension therapy in the United States has made several significant changes with respect to the clinical management of hypertension and the initiative medications, as compared with the previous guidelines. In addition to the instructions that pharmacologic treatment should be initiated when blood pressure (BP) is 150/90 mmHg or higher in adults over 60 years, 140/90 mmHg in adults younger than 60 years, or 140/90 mmHg or higher (regardless of age) in patients with hypertension and diabetes, a thiazide-type diuretic, calcium (Ca2+) channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB) should be considered to start an initial antihypertensive medication in non-black population. In black population with or without diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or CCB. Thus, CCB has become one of the most important initial agents for antihypertensive monotherapy. Furthermore, since CCBs have been proved not to increase the risk of coronary events and stroke,CCBs appear to be a favorable choice for monotherapy as well as for combination with other agent classes in the treatment of hypertension and may provide specific benefits beyond BP lowering.Nowadays, dihydropyridine (DHP) CCBs are one group of most frequently prescribed antihypertensive medications in China and other Eastern Asian countries.
Among patients with or at high risk of CVD, use of an FDC strategy for blood pressure, cholesterol, and platelet control vs usual care resulted in significantly improved medication adherence.Polypill therapy significantly improved adherence, SBP and LDL-cholesterol in high risk patients compared with usual care, especially among those who were under-treated at baseline.
A transesophageal echocardiogram (TEE) uses echocardiography to assess the structure and function of the heart. During the procedure, a transducer (like a microphone) sends out ultrasonic sound waves. When the transducer is placed at certain locations and angles, the ultrasonic sound waves move through the skin and other body tissues to the heart tissues, where the waves bounce or "echo" off of the heart structures. The transducer picks up the reflected waves and sends them to a computer. The computer displays the echoes as images of the heart walls and valves.
A traditional echocardiogram is done by putting the transducer on the surface of the chest. This is called a transthoracic echocardiogram. A transesophageal echocardiogram is done by inserting a probe with a transducer down the esophagus. This provides a clearer image of the heart because the sound waves do not have to pass through skin, muscle, or bone tissue. The TEE probe is much closer to the heart since the esophagus and heart are right next to each other.
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.
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
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
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!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
3. Diabetes: The Problem
INDIA, the diabetes capital of world in next
thirty years can also be the hypertension
capital of world. (JAPI 2007)(:55:323-24).
4. Diabetes: History
1500 B.C.-Earliest known
record of diabetes
mentioned on 3rd Dynasty
Egyptian papyrus by
physician Hesy-Ra;
mentions polyuria as a
symptom.
400 B.C.-Indian surgeon
Susruta describes ‘honeyed
urines’ produced by ‘big
eaters of rice and sugar’.
5. Diabetes: History
250 A.D.-Apollinius of Memphis
coins the name ‘diabetes’
1674-Thomas Willis publishes ‘The
Diabetes or Pissing Evil’. Writes
‘those laboring with this Disease,
piss a great deal more than they
drink’ asserting that all diabetic
urine ‘was wonderfully sweet as if it
were imbued with Honey or Sugar’
6. Diabetes: History
1798- John Rollo documents excess sugar in blood
and urine
1813- Claude Bernard links diabetes with glycogen
metabolism
1869- Paul Langerhans (German medical student)
finds islets in the pancreas, but is unable to explain
function
1889- von Mehring and Minkowski prove that
diabetes develops when they remove the pancreas
of dogs
7. Diabetes: History
1910- English physiologist, Sir
Edward Albert Sharpey-Schafer,
suggested that a single chemical
component was missing from the
pancreas of diabetics and called it
“insulin”.
1922- Banting and Best (a medical
student) isolate insulin (‘ilsetin’ or
‘iletin’) and inject the ‘thick brown
muck’ into a 14 year old boy (7.5
ml into each buttock) producing
some fall in glucose complicated
by abscesses
8.
Diabetes: History
1922- Collip refines the extract and reinjects it in the boy with glucose falling
from 520 to 120 mg/dl in 24 hours
10. Hypertension and insulin resistance frequently occur
together as part of the dysmetabolic syndrome.
The addition of hypertension to the clinical picture of
diabetes amplifies the already high cardiovascular
disease risk in these patients.
Aggressive blood pressure control prevents more
cardiovascular events in diabetics than non-diabetics.
11. Diagnosis Criteria
Normal
Pre diabetes
Diabetes
Fasting Blood Glucose Test
(FBG)*
Less than
100
Between
100 - 125
More than or equal
to 126
Glucose Tolerance Test
(GTT) **
Less than
140
Equal to or more than
140 but
less than 200
More than or equal
to 200
* FBG
blood test is done after fasting 8 hours.
** GTT results are repeated after 2 hours. A person drinks a 75 mg
glucose solution before test. 100 mg for Pregnant women.
One test is not enough!
The diagnosis must be done by a physician.
13. The Appropriate Blood pressure Control in Diabetes
(ABCD) trial investigated the effect of aggressive blood
pressure control in type 2 diabetic patients with peripheral
arterial disease.
The intensively treated group (125/75 mm Hg) had no
increased risk of cardiovascular events over 4 years of
follow up.
Achieving American diabetes association target blood
pressure (130/80 mm Hg) almost always requires more
then one agent.
14. Hypertension and diabetes being two important risk
factors for cardiovascular disease, stroke and chronic
kidney disease deserve prime importance in strategy for
control of non-communicable diseases.
In the united kingdom prospective diabetes study
(UKPDS), each 10 mmHg decrease in mean systolic blood
pressure was associated with ----reduction in risk of 12% for any complication related to
diabetes.
15% for deaths related to diabetes.
11% for myocardial infarction.
13% for micro vascular complications.
15. But treatment of hypertension in diabetes mellitus is not
always easy and much confusion prevail regarding -----Definition
Target blood pressure
Use of specific agents like ACE inhibitors, ARB,
thiazide diuretics and beta-blockers and their adverse
effects.
16. Definition, screening and diagnosis
According to Joint National Committee – 7 (JNC-7)
Staging
Normal
Prehypertensive
Stage 1 hypertension
Stage 2 hypertension
SBP
<120
120-139
140-159
>160
DBP
<80
80-89
90-99
>100
17. In
Prehypertensive------Life style modification
Stage 1 & 2
Should be treated
But Prehypertensive + diabetes mellitus /CKD
Life style modification,if it fails to redude BP to <130/80
mm Hg then--Start drug therapy
18. According to ADA
BP should be measured at every routine diabetes
visit.
BP should be less than 130/80 mm Hg.
Orthostatic measurement of blood pressure should
be performed to assess for the presence of autonomic
neuropathy.
20. Nocturnal hypertension in diabetes mellitus –
Lack of nocturnal dipping in arterial blood pressure
has been demonstrated both in type 1 and type 2
diabetes.
The lack of nocturnal dipping is associated with
increased risk of stroke and myocardial infarction.
Night time BP control becomes especially
important in diabetics.
21. Excessive salt sensitivity and increased extracellular
volume:
BP of diabetic patients is more sensitive to salt intake
and this sodium sensitivity is found even in absence
of nephropathy.
A decreased salt intake is important for diabetic
patients with hypertension.
22. Diabetes ,hypertension and nephropathy--Increased systolic BP is a significant risk factor for
micro albuminuria and rapid progression of
nephropathy.
Isolated systolic hypertension----ISH is strongly related to development of micro and
macrovascular diseases in patients with DM.
23. Goals of therapy--- American Diabetes Association recommends
target blood pressure levels of <130/80 mm Hg.
In pregnant patients with diabetes and chronic
hypertension, blood pressure target goals of 110129/65-79mm Hg are suggested in the interest of
long term maternal health and minimizing impaired
fetal growth.
25. Weight loss
Loss of weight by 1kg decreases BP by approx 1mm hg.
Sodium restriction
Decrease in sodium intake from 4.6 gm to 2.3 gm/day
results in reduction of 5mm Hg is SBP and 2-3 mm Hg in
DBP.
Exercise
Diabetic patients who are 35 yrs of age or older and are
planning to begin a vigorous exercise programme should
have exercise stress testing or other appropriate noninvasive testing.
At least 150 min of moderate intensity aerobic physical
activity is recommended per week.
Smoking cessation
Moderation of alcohol intake.
28. Health
The first part of our
equation is activity
Get moving, find something you
enjoy
29.
30. Health
The second part of the
equation is nutrition
Your body needs the right fuel to help it
work well.
31. The ADA Pyramid
SIX FOOD GROUPS:
•Group 1: Bread, grains
and other starches
•Group 2: Vegetables
•Group 3: Fruits
•Group 4: Milk
•Group 5: Meats, meat
substitutes and other
proteins(like cheese,
eggs, tofu).
•Group 6: Fats, oils and
sweets
34. General principles of treatment --It has been recommended that all patients should
receive either an ACE inhibitor or ARB.
Multiple drug therapy is generally required to
achieve target blood pressure.
Aspirin therapy is recommended in patients of
diabetes with hypertension.
(ADA position statement diabetes care 30:54541, 2007)
Statin therapy should be given to achieve LDL
cholesterol level <100 mg/dl.
35. Pharmacological therapy
Thiazide diuretic and Beta Blockers
- There have been concerns among physicians as many
studies have shown thiazides and beta blockers
promote glucose intolerance.
Inspite of this both agents have been recommended for
treatment of hypertension in DM, lower doses of shorter
acting thiazides- hydrochlorthiazide instead of
chlorethalidone are generally well tolerated and not
associated with adverse metabolic effects.
Recommendations for beta blockers are-- combined
alpha and beta blocker should be preferable agents.
Carvedilol is the potential agent of choice as it
effectively control blood pressure and improves insulin
sensitivity and decreases HbA1C.
36. ACE inhibitors
Reduce cardiovascular mortality and progression of
renal disease.
Increases upto 30-35% from baseline serum creatinine
level (creatinine of 3mg/dl or less) that stablize with in the
first 2 months of ACE inhibitors therapy should not deter
use of these agents.(Arch Intern Med 2000).
combination of ACE inhibitors and ARBs causes dual
blockade of RAS and provides superior renoprotection but
serum potassium level should be monitored causitiously.
37. The UKPDS and systolic hypertension in Europe trial
(Syst-Eur) have shown beneficial effects for both ACE
inhibitors and calcium channel blockers in patients with
diabetes.
Modulation of the renin angiotensin system has
particular importance in diabetic patients.
ACE inhibitors reduces nephropathy and end stage
renal disease in patients with type 1 diabetes, and
angiotensin receptor blockers reduce the risk of these
microvascular disorders in patient with type 2
diabetes.
38. In the Heart Outcomes and Prevention Evaluation
(HOPE) study, ramipril significantly decreased the
rates of myocardial infarction ,stroke and death in
patients with diabetes and a mean blood pressure of
140/80 mm Hg.
The Losartan Intervention For End point (LIFE)
study enrolled 1195 diabetic subjects as part of the
cohort. Participants had hypertension and evidence of
left ventricular hypertrophy, subjects were randomized
to losartan or atenolol. Despite equivalent blood
pressure lowering, the subjects randomized to
losartan experienced a 39 percent reduction in all
cause mortality, a 37 percent reduction in
cardiovascular mortality, and a 21 percent reduction in
stroke.
41. How Can You Help Reduce Your Risk of
Hypertension in Diabetes?
Limit alcohol to
1-2 drinks
per day.
Take your
medications
regularly.
Stop sm
oking!
If
ove
r we
igh
l os e
w e i t,
ght
.
Phy
sical
activ
ity
ow
ds l
foo
Eat
s.
lorie
in
ca
t &
fa
42. What are goals to healthy
living?
Be SMART
Specific
Measurable
Achievable
Relevant
Time
43. Summary
Diabetes is a growing problem
Hypertension is a growing problem
Hypertension and diabetes are dying
problems
Hypertension is preventable
Editor's Notes
The basic idea concerning good health is:
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Physical Activity, such as running
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Plus Sound Nutrition, such as fruits and grains
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Equal Good Health
Now that you know why being healthy is a good idea, lets discuss what you can do to get that way.
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The first part of our equation, activity, is key. This includes active play and sports. Just get moving with something you enjoy!
Ask students
What do you like to do?
Facilitate responses
Do you always make time for activities?
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Adopting a healthy lifestyle is essential in helping reduce your overall risk of heart disease.
If you currently take medications for preventing heart disease, their effectiveness will be enhanced by making these healthy lifestyle changes.