La Dra. Ainara Lozano Bahamonde repasa las novedades incluidas en las últimas guías europeas en insuficiencia cardiaca presentadas en ESC Congress 2021.
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.
Antiplatelet agents in acute ischemic strokeYung-Tsai Chu
Review of antiplatelet agents in acute ischemic stroke. Including aspirin, clopidogrel, cilostazol, ticagrelor. Also discussed the indication of DAPT(dual antiplatelet therapy)
Antihypertensive drugs and hypertension managementAnas Indabawa
hypertension can be defined as: A sustained rise in blood pressure.
Blood Pressure is given by two(2) parameters.
Cardiac Output: Given by the rate and stroke volume of the heart.
Total Peripheral Resistance: Given by the blood volume and the level of vasoconstriction
Hypertension is a pathologically increased blood pressure due to an increase in any of these parameters.
La Dra. Ainara Lozano Bahamonde repasa las novedades incluidas en las últimas guías europeas en insuficiencia cardiaca presentadas en ESC Congress 2021.
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.
Antiplatelet agents in acute ischemic strokeYung-Tsai Chu
Review of antiplatelet agents in acute ischemic stroke. Including aspirin, clopidogrel, cilostazol, ticagrelor. Also discussed the indication of DAPT(dual antiplatelet therapy)
Antihypertensive drugs and hypertension managementAnas Indabawa
hypertension can be defined as: A sustained rise in blood pressure.
Blood Pressure is given by two(2) parameters.
Cardiac Output: Given by the rate and stroke volume of the heart.
Total Peripheral Resistance: Given by the blood volume and the level of vasoconstriction
Hypertension is a pathologically increased blood pressure due to an increase in any of these parameters.
Drugs Used in Heart Failure
Drugs without positive inotropic effects used in Heart Failure:
Diuretics
ACE/ARB & Related agents
Vasodilators
β-Adrenergic Blockers
Others
Drugs with positive inotropic effects used in Heart Failure:
Digitalis
Other positive inotropic drugs:
Bipyridines
Beta-Adrenergic agonists
Investigational positive inotropic drugs: Istaroxime, Levosimanden, Omecamtiv mecarbil
hypertension, simplified, jnc 8, treatment and newer modalities to treat. surgical procedures involved for hypertension and jnc 8 versus jnc 7 is compared in this ppt, and also, prevelance and epidemeiology of hypertension is explained. antihypertensives for preffered class and age are explained
Fluid management and Fluid Responsiveness in ICCU / ICU at ASMIHA workshop 2018Isman Firdaus
It is very important for cardiologist or intensivist to determined fluid overload vs loss fluid. Misconception of hypervolemic and hypovolemic state was very important.
Workshop of Low Cardiac Output Management, 2018Isman Firdaus
Low cardiac output or shock or circulatory failure was the terminal state of any disease including cardiovascular problem. It is consist distributive, volume, obstructive and cardiogenic circulatory failure leading multi organ failure and mortality. Hemodynamic monitoring is important evaluation to guide the medication and treatment.
Angiografi koroner perkutan merupakan tindakan kateterisasi dengan menyemprotkan zat kontras ke dalam arteri koroner untuk melihat anatomi arteri koroner sehingga dapat mendeteksi ada atau tidaknya penyempitan (stenosis) yang dimonitor melalui sinar X
Isicam, high bleeding risk pci,2016,ismanIsman Firdaus
Presented by Dr. Isman Firdaus in ISICAM 2016
PCI in high bleeding risk patient was tricky management
Drug Coated Stent vs Bare Meta stent regarding LEADERS FREE trial.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
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
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Hypertensive emergency ina acc 2018, isman
1. Hypertensive Crisis
Isman Firdaus, MD
FIHA, FAPSIC, FAsCC, FESC, FSCAI
Pusat Jantung Nasional, Harapan Kita Hospital
Departement of Cardiology and Vascular Medicine
2. Epidemiology
Hypertensive Emergency
Estimates are that about 1% of those
with hypertension will present with
hypertensive emergency each year
That is >500,000 Americans per year
Correct and quick diagnosis and
management is critical
Mortality rate of up to 90%
3.
4.
5. Definitions:
• Hypertension:
– Stage I: 140-159/90-99
– Stage II: >160/100
• Hypertensive Urgency:
– Systolic BP >180 or Diastolic BP >120 in the
absence of end-organ damage
6. Definitions Continued:
• Hypertensive Emergencies:
– SBP >180 OR DBP>120 in the presence of end-
organ damage
• Malignant Hypertension: End-organ damage--
eyes, kidneys, brain (hemorrhage/infarct)
affected
• Hypertensive encephalopathy: Cerebral edema
leading to neurological symptoms
7. Treatment Options
• Hypertensive Urgency:
– Goal: Reduce BP to <160/100 over several hours
to day
• Elderly at high risk of ischemia from rapid
reduction of BP, therefore slower reduction in
BP in this patient population
– Previously treated hypertension:
• Increase dose of existing med or add another
med
• Reinstitution of med in non-compliant patients
8. Treatment Continued
• Hypertensive Emergency:
– Goal: Lower Diastolic BP to approximately 100-105
over 2-6 hours; max initial fall not to exceed 20 -
25%
• More aggressive decrease can lead to ischemic
stroke and myocardial ischemia
– If focal neurological sx presentobtain MRI to r/o
acute stroke (rapid BP correction contraindicated)
– Parenteral antihypertensives (IV Drip)
recommended over oral agents in hypertensive
emergency
9.
10.
11.
12.
13. Heart failure—TH, BB, ACEI, ARB, ALDO
Post MI—BB, ACEI, ALDO
High CVD risk—TH, BB, ACEI, CCB
Diabetes—TH, BB, ACEI, ARB, CCB
Chronic Renal Failure—ACEI, ARB
Recurrent stroke prevention—TH, ACEI
KEY: ACEI, angiotensin converting enzyme inhibitor; ALDO, aldosterone antagonist; ARB,
angiotensin receptor blocker; BB, b blocker; CCB, calcium channel blocker; TH, thiazide.
Oral Drug Choices often Based on
Comorbid Conditions
17. Diltiazem Multiple Effects
-
ANTI-
ANGINAL
ANTI-
ARRHYTHMIC DILTIAZEM
• Anti-arrhythmic
• Arterial dilator
• Negative inotropic
• Regression of LVH
• Post-infarct protection
if no LVF
SYSTEM
CIRCULATION
ARTERIOLAR
DILATION
AFTERLOAD
BP
ATRIAL FIB
(with digoxin)
PSVT
Opie, 2001
18. Parenteral Drugs for Treatment of Hypertensive
Emergencies ( Vasodilators )
Drugs Onset of action Duration of action
Nicardipine * 5 min 1 hr
Sodium Nitropruside immediate 1-2 min
Fenoldopam < 5 min 30 min
Nitroglycerin * 2-5 min 2-3 min
Enalaprilat 15-30 min 6 hr
Hydralazine 10-20 min 4-6 hr
Diltiazem * 5 min 30 min
Trimetaphan 5-10 min 10 min
* Available in Indonesia
19. Pathophysiologic Effects Diltiazem
• Potent vasodilator
– Inhibits vascular smooth muscle contractility and decreases
peripheral vascular resistance
• Reduce Coronary resistance
– Dilates coronary arteries and increases coronary blood flow
• Decrease Heart rate
– Rate-Pressure Product (HR x SBP) reduce myocardial oxygen
demand
– Absence of reflex tachycardia
• No adverse effects on glucose or carbohydrate metabolism
Drugs. 1990;39:757.
20. • Ischemic cardiac muscle is improved by
① Increasing insufficient coronary blood volume (O2 supply)
② Decreasing cardiac performance(HER two-sided effect)
Two-sided effect for myocardial ischemia
Thick coronary vasodilating effect
Collateral vasodilating effect
BP lowering effect
HR decreasing effect
①Increasing vascular flow in
ischemic cardiac muscle
②Decreasing cardiac performance
Improvement of O2 supply and demand in
ischemic cardiac muscle
Cardioprotective Efficacy
23. NICARDIPINE and DILTIAZEM
NICARDIPINE DILTIAZEM
Target organ Arteriole (ca
Channel)
Arteriole (ca
Channel)
Clinical effect Vasodilatation :
BP decreased
Vasodilatation :
BP decreased
Heart Rate
24. Diltiazem Injection can use for patients who have Normally HR until High
Nicardipine I.V Diltiazem I.V
< 60 60 - 80 > 80
Heart Rate
(beat/minute)
Differentiation between Diltiazem and Nicardipine on Heart Rate
25.
26. Subject : 11 patients with hypertension
emergency
Design : Open study
Diltiazem injection Drip infusion: 5~40
μg/kg/min
Average BP reduced
224/119 mmHg to 170/95 mmHg (mean
change 27.3 +9.0 %, P<0.001)
HR controlled
Current Therapeutic Research.1987: 42:1223.
Antihypertensive drugs and Heart Rate
28. Nicardipine i.v.
Hirayama A, Katayama Y, et al:Neurological Research 16; 97-99, 1994
35 patients who had surgical evacuation of spontaneous intracerebral haematomas after cerebral hemorrhage
Herbesser i.v.: 12, Nitroglycerin i.v.: 13, Nicardipine i.v.:10
Compare the intracranial pressure when the same blood pressure reduction level is achieved in each group.
①CPP index=△CPP/△SBP
②CPP index coming close to 1 indicates less
increase of intracranial pressure.
Comparison of intracranial pressure
change by different antihypertensives.
Changeofintracranialpressure
Comparison of Cerebral perfusion pressure
index (CPP index) by different antihypertensives.
CPPindex
Herbesser i.v. Nitroglycerin i.v. Nicardipine i.v.Herbesser i.v. Nitroglycerin i.v.
20
10
0
2.0
1.5
0.0
1.0
6.7
14.2
17.0
1.33±0.07
1.80±0.11
1.63±0.13
p<0.05
p<0.05
(mmHg)
Target
Medication
Methods
Antihypertensive drugs cause increase of ICP
29. Diltiazem i.v. reduced cardiac event rate
in patients with unstable angina.
Target
Gobel E, et al. Lancet 346:1653-1657, 1995
Nitroglycerin i.v. group (n=61)
Herbesser i.v. group (n=60)
Incidenceduringi.v.(%)
40
30
20
10
0
Myocardial infarction refractory angina Myocardial infarction
+
refractory angina
10
5
28
10
38
15
p=0.02*
p=0.007**
Methods
129 patients with unstable angina
Randomized, double blind comparative trial
Diltiazem i.v. group (n=60) :25mg i.v.+5mg/h continuous i.v. (increase dose to 25mg/h)
Nitroglycerin i.v. group (n=61) : Physiologic saline i.v.+1mg/h continuous i.v. (increase dose to 5mg)
30. Intravenous bolus injection
0.2 mg / kgBW
Intravenous drip infusion
( 5-15 µg / kgBW / minute )
10-20 % MBP reduction
from baseline
Switch to oral HERBESSER® CD 200
Diltiazem (Herbesser) Chart Injection
Dose Flow Chart
Stable BP until 1 hr
Observe every 10-20 minutes
Dose
calculation
31. Intravenous bolus injection
10-15 mg IV (0,2-03 mg/KgBB) 1-2 min
20-30 mg/hr (15 menit)
>20 % MAP reduction
from baseline
Switch to oral drugs
Diltiazem (Herbesser) Chart Injectio
For Hypertensive Crisis
Dose
calculation
MAP > 15% Tidak
Intravenous drip infusion 50 mg/hr (20 min)
Observe every 10 minutes
10mg/hr ( 1-4 hr)
Observe every 10 minutes