This is a presentation on ICD Revision current status in Internal Medicine TAG summarizing the latest developments in Beta Phase including the Review Process, Field Trials and next steps
Islamic medicine 1000 years ahead of its times [from www.metacafe.com]Abdrabu Abdallah
Within a century after the death of Prophet Muhammad, Islamic medicine had advanced significantly, establishing hospitals with separate wards, licensing physicians, and advancing practices in various medical fields like surgery and ophthalmology. By the 9th century, the hospital in Baghdad incorporated innovations like treating patients with music and allowing free care, setting standards for modern hospitals. Islamic medicine made major advances in medical education, establishing teaching hospitals and licensing physicians through examinations over 1000 years before similar systems developed in Europe.
What is traditional Japanese Kampo medicineHiroyuki Kanae
The document discusses an international surgical conference held in Yokohama, Japan in August 2011. It then provides an overview of Kampo medicine, which is traditional Japanese herbal medicine that is prescribed by doctors in Japan and covered by national health insurance. In particular, it focuses on Daikenchuto (TU-100), one of the most commonly prescribed Kampo medicines which is used to improve gastrointestinal motility and prevent postoperative complications. The manufacturing process and quality control of TU-100 are then described in detail.
Islamic cultures made many important scientific and medical contributions despite being burned in Europe:
They developed navigational tools like the astrolab and compass which enabled long sea voyages and discovery. Astronomers like Al-Biruni discussed theories of Earth's rotation centuries before Galileo.
Medicine advanced with discoveries in anatomy, use of anesthesia and cauterization in surgery, and linking disease to human contact. Figures like Ibn Sina and Al-Razi wrote influential medical encyclopedias and treatises. Hospitals were also established.
Other fields like optics, sociology, and physics also saw innovations through scholars such as Ibn al-Haytham,
Medicine And Medical Education In Islamic Historyzakir2012
- Islamic medical schools were built following the model of Jundi-Shapur medical school in Persia, which had a teaching hospital and university. Students received clinical and lecture-based training, and were expected to examine patients and record observations.
- Basic sciences like anatomy, pharmacology and herbal medicine were taught through lectures, illustrations and dissections. Students then received clinical training by examining patients under experienced physicians.
- Hospitals established under Islamic rule were the first to provide free care to all citizens, conduct medical research and train students. They had inpatient and outpatient wards, libraries and facilities for various specialties.
- Surgery and clinical practice were advanced through innovations like the use of
Zhejiang University- School of Medicine- PPTSaju Bhaskar
Zhejiang University is one of the oldest universities in China, established in 1897. It has grown significantly over time and now has six campuses across various disciplines like engineering, science, medicine, agriculture and more. It is a comprehensive research university with over 41,000 students and strong academic programs and international partnerships.
Highlights of the History of Medicine Divisionbelgrade18
The document provides an overview of the collections held by the History of Medicine Division, including monographs, serials, manuscripts, prints, photographs, and audiovisual materials covering the history of medicine from the 13th century to before 1970. It notes important early works such as Isagoge Johannitii in Tegni Galeni from the 13th century and Vesalius' De fabrica from 1543. The division also holds collections on East Asian medicine including 3,000 pre-1900 printed books, manuscripts, and ephemera from China, Japan, and Korea. Archives, personal papers, bound manuscripts, and oral histories are accessible to the public during business hours.
Islamic medicine 1000 years ahead of its times [from www.metacafe.com]Abdrabu Abdallah
Within a century after the death of Prophet Muhammad, Islamic medicine had advanced significantly, establishing hospitals with separate wards, licensing physicians, and advancing practices in various medical fields like surgery and ophthalmology. By the 9th century, the hospital in Baghdad incorporated innovations like treating patients with music and allowing free care, setting standards for modern hospitals. Islamic medicine made major advances in medical education, establishing teaching hospitals and licensing physicians through examinations over 1000 years before similar systems developed in Europe.
What is traditional Japanese Kampo medicineHiroyuki Kanae
The document discusses an international surgical conference held in Yokohama, Japan in August 2011. It then provides an overview of Kampo medicine, which is traditional Japanese herbal medicine that is prescribed by doctors in Japan and covered by national health insurance. In particular, it focuses on Daikenchuto (TU-100), one of the most commonly prescribed Kampo medicines which is used to improve gastrointestinal motility and prevent postoperative complications. The manufacturing process and quality control of TU-100 are then described in detail.
Islamic cultures made many important scientific and medical contributions despite being burned in Europe:
They developed navigational tools like the astrolab and compass which enabled long sea voyages and discovery. Astronomers like Al-Biruni discussed theories of Earth's rotation centuries before Galileo.
Medicine advanced with discoveries in anatomy, use of anesthesia and cauterization in surgery, and linking disease to human contact. Figures like Ibn Sina and Al-Razi wrote influential medical encyclopedias and treatises. Hospitals were also established.
Other fields like optics, sociology, and physics also saw innovations through scholars such as Ibn al-Haytham,
Medicine And Medical Education In Islamic Historyzakir2012
- Islamic medical schools were built following the model of Jundi-Shapur medical school in Persia, which had a teaching hospital and university. Students received clinical and lecture-based training, and were expected to examine patients and record observations.
- Basic sciences like anatomy, pharmacology and herbal medicine were taught through lectures, illustrations and dissections. Students then received clinical training by examining patients under experienced physicians.
- Hospitals established under Islamic rule were the first to provide free care to all citizens, conduct medical research and train students. They had inpatient and outpatient wards, libraries and facilities for various specialties.
- Surgery and clinical practice were advanced through innovations like the use of
Zhejiang University- School of Medicine- PPTSaju Bhaskar
Zhejiang University is one of the oldest universities in China, established in 1897. It has grown significantly over time and now has six campuses across various disciplines like engineering, science, medicine, agriculture and more. It is a comprehensive research university with over 41,000 students and strong academic programs and international partnerships.
Highlights of the History of Medicine Divisionbelgrade18
The document provides an overview of the collections held by the History of Medicine Division, including monographs, serials, manuscripts, prints, photographs, and audiovisual materials covering the history of medicine from the 13th century to before 1970. It notes important early works such as Isagoge Johannitii in Tegni Galeni from the 13th century and Vesalius' De fabrica from 1543. The division also holds collections on East Asian medicine including 3,000 pre-1900 printed books, manuscripts, and ephemera from China, Japan, and Korea. Archives, personal papers, bound manuscripts, and oral histories are accessible to the public during business hours.
This document discusses asymptomatic hyperuricemia and whether or not it should be treated. It covers the physiology of uric acid production and excretion by the kidneys. While acute hyperuricemia nephropathy, uric acid nephrolithiasis, and hyperuricemia after renal transplantation are clear reasons to treat, the evidence for treating asymptomatic hyperuricemia to prevent chronic gouty nephropathy, cardiovascular issues, insulin resistance, hypertension, and inflammation is unclear. Treatment may be warranted if uric acid levels are very high (≥ 8) or if the patient is symptomatic, but otherwise the decision to treat asymptomatic hyperuricemia remains uncertain based on current evidence.
This document provides an overview of Islamic medicine. It discusses the history of Islamic medicine from the 8th to 13th centuries when major Muslim physicians and scholars made significant contributions to the field. Modern medicine, Islamic medicine, homeopathy and traditional medicine do not need to be in conflict. Islamic medicine is flexible, universal, and embraces growth and development. It should be guided by the teachings of the Quran and Hadith and bring people closer to God. The ethical foundations of Islamic medicine are discussed regarding issues like reproduction, contraception, and organ replacement. The conclusion emphasizes that Islamic medical practitioners should focus on teaching and practicing good medicine and substantive research to substantiate Islamic medicine as the right approach.
The document provides an overview of Islamic medicine between the 11th and 15th centuries. It discusses how Islamic ideas influenced the understanding of disease causation and led to advances in hospitals, surgery, anatomy, and chemistry. Key individuals mentioned include Rhazes, who distinguished between smallpox and measles, and Avicenna, whose Canon of Medicine was influential in Europe. Hospitals were established in Baghdad and other cities, and surgeons like Albucasis described various surgical procedures. While dissections were forbidden, observations challenged some of Galen's anatomical theories. Arab scientists also made advances in distillation and developed new drugs.
Japanese encephalitis is a mosquito-borne viral disease that is common in parts of Asia. It is transmitted to humans via bites from infected Culex mosquitoes. While most infections cause mild symptoms or no symptoms, approximately 1 in 250 infections result in encephalitis, which can be fatal in 30% of cases. Survivors often face permanent neurological impairments. Control efforts focus on vaccination programs and reducing mosquito populations in areas like rice paddies where they breed.
Febuxostat for treatment of chronic goutChoying Chen
Febuxostat is a xanthine oxidase inhibitor approved for the treatment of chronic gout. It has been shown in clinical trials to be more effective at lowering uric acid levels compared to allopurinol and is generally well-tolerated. However, febuxostat has been associated with increased rates of liver function abnormalities and cardiovascular events compared to allopurinol. It is recommended that liver function and symptoms of cardiovascular events be monitored in patients taking febuxostat. Febuxostat provides an alternative treatment option for patients who do not achieve target uric acid levels or experience adverse effects with allopurinol.
The document discusses the role of uric acid in the body and debates whether or not hyperuricemia should be treated. It presents evidence that uric acid has both antioxidant and pro-oxidant properties. Higher levels of uric acid may protect against cancer and neurodegenerative diseases but can also lead to gout and kidney problems if levels are too high. The document reviews several studies looking at the relationship between uric acid levels, bone mineral density, and cardiovascular risks.
Dr. Julie Li-Yu presented updated recommendations on how to screen and treat tuberculosis in patients with rheumatic diseases. Dr. Li-Yu and Dr Juan Javier Lichauco were representatives of the Philippine Rheumatology Association to the Task Force developing guidelines for TB management in the country. The slides posted were presented during the Joint Rheumatoid Arthritis - Osteoarthritis Special Interest Symposium held at the F1 Hotel in Taguig City last 28 November 2014.
The document discusses purine and pyrimidine metabolism and their role in genetic material replication, transcription, protein synthesis and cellular metabolism. It then focuses on hyperuricemia and gout, explaining that this results from increased uric acid production or impaired excretion. The key biochemical pathways of purine degradation to uric acid are described, as well as the factors influencing uric acid solubility and excretion by the kidneys through specific transporters. The causes, clinical manifestations and approach to treatment of hyperuricemia are summarized.
I was asked by the organizers to review updates on the management of gout. I compared guideline recommendations from the 2008 Philippine CPG to the 2012 ACR Recommendations and the 2014 3E Initiative.
Muslim Contributions in Medicine-Geography-AstronomyAli Usman
The document summarizes many of the contributions of Muslim scientists to medicine and astronomy throughout history. It shows that Muslim physicians between the 7th-13th centuries established the first hospitals, medical schools, and quarantine practices. Scientists like al-Razi, Ibn Sina, and al-Zahrawi made breakthroughs in surgery, anesthesia, pharmacology, and pathology that influenced Western practices for centuries. Muslim geographers and astronomers also made advances in map-making, navigation, optics, and understanding the motions of celestial bodies before their European counterparts. Their work laid the foundations for modern science.
Gout is the most common cause of inflammatory arthritis in the US. Treatment of acute gout flares includes nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or colchicine. A randomized controlled trial found that oral prednisolone and naproxen provided equivalent pain relief for acute gout attacks. Colchicine is also effective for treating flares and preventing future attacks by interfering with neutrophil and monocyte activation. Management of gout focuses on both acute flare treatment and long-term urate-lowering therapy to reduce uric acid levels and prevent future attacks.
Hyperuricemia is caused by high levels of uric acid in the blood and can be due to underexcretion of uric acid by the kidneys, overproduction of uric acid, or a combination of both. Underexcretion is the most common cause and can result from reduced kidney function or medications that impact excretion. Overproduction occurs when there is excessive breakdown of purines from foods or the body. Certain genetic disorders, tumors, or diets high in purines can lead to overproduction. Conditions like alcohol use, fructose intake, or rapid weight loss may cause both overproduction and underexcretion of uric acid.
Muslims made many important contributions to the field of geography from the 7th century onwards. Key Muslim geographers and their works included Al-Khwārizmī who wrote one of the earliest books on geography, Al-Masudi who compiled travel observations in his book Meadows of Gold, and Al-Idrisi who created a detailed world map and geographical encyclopedia. Ibn Majid advanced navigation and oceanography through his books on marine science and ship movements. Muslim geographers accumulated knowledge through travel, study, and the needs of pilgrimage and trade, and their works informed both Eastern and Western understanding of geography for centuries.
Gout is a type of inflammatory arthritis caused by deposition of urate crystals in the joints due to persistent hyperuricemia. It manifests as recurrent acute flares typically involving the great toe, as well as chronic tophaceous gout with subcutaneous urate deposits. The pathophysiology involves urate crystal formation triggering inflammation through activation of the NLRP3 inflammasome and recruitment of leukocytes. Acute gout flares are usually self-limiting due to feedback mechanisms that limit inflammation, though chronic tophaceous gout can develop if hyperuricemia is untreated.
This document provides an overview and summary of treatment guidelines for gout. It discusses the different stages of gout including asymptomatic hyperuricemia, acute gout, interval gout, and chronic gout. It reviews guidelines for treating acute gout flares using monotherapy or combination therapies. It also summarizes recommendations for preventing flares and lowering serum uric acid levels through dietary changes and use of urate-lowering therapies such as allopurinol, febuxostat, probenecid, and pegloticase. Head-to-head trials comparing allopurinol and febuxostat are reviewed showing febuxostat is more effective at lowering uric acid levels but has a higher
This document discusses drugs used to treat gout, including colchicine, NSAIDs, corticosteroids, uricosuric agents like probenecid and sulfinpyrazone, and the uric acid synthesis inhibitor allopurinol. It provides details on the pathophysiology of gout, mechanisms of action, pharmacokinetics, indications, dosages and adverse effects of these drugs for both acute gout attacks and long-term treatment of chronic gout and hyperuricemia.
Japanese civilization was shaped by cultural influences from China and the rise of feudalism under military rulers. The Yamato clan took control in the 400s and named emperors to rule, though sometimes in name only. Buddhism spread from China and mixed with existing Shinto practices. In the late 700s, the capital moved to Heian where an refined aristocratic culture developed, illustrated by The Tale of Genji. However, as central power declined in the 1000s, large landowners built private armies and established feudal rule over smaller landowners seeking protection. The Minamoto family established the Kamakura shogunate in 1192, placing a military dictator or shogun in power supported by samur
1. Rheumatoid arthritis is an autoimmune disease that causes inflammation of the joints, most commonly in the hands and feet. It can lead to long-term joint damage and functional disability if not adequately treated.
2. Biologics target specific components of the immune system that drive inflammation in rheumatoid arthritis patients. They are generally reserved for patients who have not responded sufficiently to conventional disease-modifying drugs. Available biologics include TNF inhibitors such as etanercept, infliximab, and adalimumab as well as drugs targeting IL-1, IL-6, CD20, and T-cell co-stimulation.
3. While biologics can significantly reduce
Gout is a common type of arthritis caused by high levels of uric acid in the blood that leads to urate crystal deposits in joints. It affects around 1-2% of adults in developed countries. Diet, genetics, comorbidities like hypertension and diabetes, and medications like diuretics are risk factors. Acute gout attacks are typically treated with NSAIDs, colchicine, or corticosteroids. Long-term management involves lowering uric acid levels through medications like allopurinol, febuxostat, or uricosuric drugs and lifestyle changes like diet modification and weight loss. Proper treatment can help prevent future gout attacks and dissolve urate crystals from joints.
Arastirmaci tarafindan Baslatilan Arastirmalarda larda ortak veri standartlar...Bedirhan Ustun
Araştırmacı tarafından Başlatılan Araştırma (ABA)lar bilimsel bir sistematik içerisinde bir tanı grubundaki deneklere yapılan girişimlerin etkinliklerini değerlendirmek için kullanılabilir: ‘Bu tedavi yöntemi başka yöntemlere göre daha mı iyi’, ‘yan etkileri var mı’ gibi soruları yanıtlamak; ve araştırmalar arasında karşılaştırma yapmak amacıyla yapılabilir. Bu bağlamda, ABAlarda tanı ve girişim etkinliğini ölçmek ve değerlendirmek için bilimsel standartların kullanılması zorunludur. Araştırmacılar genellikle kendi alanlarında daha önce belirlenmiş (1) tanı ve (2) çıktı (outcome) ölçeklerini kullanmaktadırlar.
(1)Bu tür tanı ölçekleri belirli bir tanı grubunu homojen olarak tanımlamak için yararlıdırlar. Ancak her araştırmacı kendi ölçeğini kullanırsa araştırmaların karşılaştırılması sorun yaratır. Örneğin bir araştırmacı depresif bozukluk tanısını DSMIV diğeri ICD10, bir diğeri başka bir klinik tanı sistemi ile koymuşsa bu çalışmaların aynı hastalık grubuna ait bulguları ortaya koyduğunu söyleyebilmek zordur. Yapılması gereken tıpkı EURO, Dolar vb para birimlerinin birbirine denk eşdeğerlik tablolarını çıkarmak; ya da her tanıyı tek bir sistem üzerinden ele almaktır.
(2) Bu alanda daha önemli olarak ikinci sorun tanıdan çok çıktı (outcome) karşılaştırmalarıdır. Çıktı olarak değişik tanı, belirti sayısı, hastalık şiddeti, yetiyitimi (disability) ve işlevsellik, yaşam kalitesi (quality of life) ve iyilik hali gibi veriler birbiri ile iç içe ve birbiri yerine kullanılmaktadır. Böyle durumlarda tedavi sonuçlarının karşılaştırılması olanaksız olmaktadır. Çözüm çıktı olarak neyin ölçüldüğünün net olarak belirlenmesi ve bunun belirli bir standart ölçek üzerinden derecelendirilmesidir.
Bu sunuda depresyon, alkol bağımlılığı, bel ağrısı, diz ve kalça protezleri üzerinden örnekleri üzerinden tanı ve çıktılar adına standart ölçümlerin nasıl karşılaştırılabileceği anlatılacaktır.
This document discusses asymptomatic hyperuricemia and whether or not it should be treated. It covers the physiology of uric acid production and excretion by the kidneys. While acute hyperuricemia nephropathy, uric acid nephrolithiasis, and hyperuricemia after renal transplantation are clear reasons to treat, the evidence for treating asymptomatic hyperuricemia to prevent chronic gouty nephropathy, cardiovascular issues, insulin resistance, hypertension, and inflammation is unclear. Treatment may be warranted if uric acid levels are very high (≥ 8) or if the patient is symptomatic, but otherwise the decision to treat asymptomatic hyperuricemia remains uncertain based on current evidence.
This document provides an overview of Islamic medicine. It discusses the history of Islamic medicine from the 8th to 13th centuries when major Muslim physicians and scholars made significant contributions to the field. Modern medicine, Islamic medicine, homeopathy and traditional medicine do not need to be in conflict. Islamic medicine is flexible, universal, and embraces growth and development. It should be guided by the teachings of the Quran and Hadith and bring people closer to God. The ethical foundations of Islamic medicine are discussed regarding issues like reproduction, contraception, and organ replacement. The conclusion emphasizes that Islamic medical practitioners should focus on teaching and practicing good medicine and substantive research to substantiate Islamic medicine as the right approach.
The document provides an overview of Islamic medicine between the 11th and 15th centuries. It discusses how Islamic ideas influenced the understanding of disease causation and led to advances in hospitals, surgery, anatomy, and chemistry. Key individuals mentioned include Rhazes, who distinguished between smallpox and measles, and Avicenna, whose Canon of Medicine was influential in Europe. Hospitals were established in Baghdad and other cities, and surgeons like Albucasis described various surgical procedures. While dissections were forbidden, observations challenged some of Galen's anatomical theories. Arab scientists also made advances in distillation and developed new drugs.
Japanese encephalitis is a mosquito-borne viral disease that is common in parts of Asia. It is transmitted to humans via bites from infected Culex mosquitoes. While most infections cause mild symptoms or no symptoms, approximately 1 in 250 infections result in encephalitis, which can be fatal in 30% of cases. Survivors often face permanent neurological impairments. Control efforts focus on vaccination programs and reducing mosquito populations in areas like rice paddies where they breed.
Febuxostat for treatment of chronic goutChoying Chen
Febuxostat is a xanthine oxidase inhibitor approved for the treatment of chronic gout. It has been shown in clinical trials to be more effective at lowering uric acid levels compared to allopurinol and is generally well-tolerated. However, febuxostat has been associated with increased rates of liver function abnormalities and cardiovascular events compared to allopurinol. It is recommended that liver function and symptoms of cardiovascular events be monitored in patients taking febuxostat. Febuxostat provides an alternative treatment option for patients who do not achieve target uric acid levels or experience adverse effects with allopurinol.
The document discusses the role of uric acid in the body and debates whether or not hyperuricemia should be treated. It presents evidence that uric acid has both antioxidant and pro-oxidant properties. Higher levels of uric acid may protect against cancer and neurodegenerative diseases but can also lead to gout and kidney problems if levels are too high. The document reviews several studies looking at the relationship between uric acid levels, bone mineral density, and cardiovascular risks.
Dr. Julie Li-Yu presented updated recommendations on how to screen and treat tuberculosis in patients with rheumatic diseases. Dr. Li-Yu and Dr Juan Javier Lichauco were representatives of the Philippine Rheumatology Association to the Task Force developing guidelines for TB management in the country. The slides posted were presented during the Joint Rheumatoid Arthritis - Osteoarthritis Special Interest Symposium held at the F1 Hotel in Taguig City last 28 November 2014.
The document discusses purine and pyrimidine metabolism and their role in genetic material replication, transcription, protein synthesis and cellular metabolism. It then focuses on hyperuricemia and gout, explaining that this results from increased uric acid production or impaired excretion. The key biochemical pathways of purine degradation to uric acid are described, as well as the factors influencing uric acid solubility and excretion by the kidneys through specific transporters. The causes, clinical manifestations and approach to treatment of hyperuricemia are summarized.
I was asked by the organizers to review updates on the management of gout. I compared guideline recommendations from the 2008 Philippine CPG to the 2012 ACR Recommendations and the 2014 3E Initiative.
Muslim Contributions in Medicine-Geography-AstronomyAli Usman
The document summarizes many of the contributions of Muslim scientists to medicine and astronomy throughout history. It shows that Muslim physicians between the 7th-13th centuries established the first hospitals, medical schools, and quarantine practices. Scientists like al-Razi, Ibn Sina, and al-Zahrawi made breakthroughs in surgery, anesthesia, pharmacology, and pathology that influenced Western practices for centuries. Muslim geographers and astronomers also made advances in map-making, navigation, optics, and understanding the motions of celestial bodies before their European counterparts. Their work laid the foundations for modern science.
Gout is the most common cause of inflammatory arthritis in the US. Treatment of acute gout flares includes nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or colchicine. A randomized controlled trial found that oral prednisolone and naproxen provided equivalent pain relief for acute gout attacks. Colchicine is also effective for treating flares and preventing future attacks by interfering with neutrophil and monocyte activation. Management of gout focuses on both acute flare treatment and long-term urate-lowering therapy to reduce uric acid levels and prevent future attacks.
Hyperuricemia is caused by high levels of uric acid in the blood and can be due to underexcretion of uric acid by the kidneys, overproduction of uric acid, or a combination of both. Underexcretion is the most common cause and can result from reduced kidney function or medications that impact excretion. Overproduction occurs when there is excessive breakdown of purines from foods or the body. Certain genetic disorders, tumors, or diets high in purines can lead to overproduction. Conditions like alcohol use, fructose intake, or rapid weight loss may cause both overproduction and underexcretion of uric acid.
Muslims made many important contributions to the field of geography from the 7th century onwards. Key Muslim geographers and their works included Al-Khwārizmī who wrote one of the earliest books on geography, Al-Masudi who compiled travel observations in his book Meadows of Gold, and Al-Idrisi who created a detailed world map and geographical encyclopedia. Ibn Majid advanced navigation and oceanography through his books on marine science and ship movements. Muslim geographers accumulated knowledge through travel, study, and the needs of pilgrimage and trade, and their works informed both Eastern and Western understanding of geography for centuries.
Gout is a type of inflammatory arthritis caused by deposition of urate crystals in the joints due to persistent hyperuricemia. It manifests as recurrent acute flares typically involving the great toe, as well as chronic tophaceous gout with subcutaneous urate deposits. The pathophysiology involves urate crystal formation triggering inflammation through activation of the NLRP3 inflammasome and recruitment of leukocytes. Acute gout flares are usually self-limiting due to feedback mechanisms that limit inflammation, though chronic tophaceous gout can develop if hyperuricemia is untreated.
This document provides an overview and summary of treatment guidelines for gout. It discusses the different stages of gout including asymptomatic hyperuricemia, acute gout, interval gout, and chronic gout. It reviews guidelines for treating acute gout flares using monotherapy or combination therapies. It also summarizes recommendations for preventing flares and lowering serum uric acid levels through dietary changes and use of urate-lowering therapies such as allopurinol, febuxostat, probenecid, and pegloticase. Head-to-head trials comparing allopurinol and febuxostat are reviewed showing febuxostat is more effective at lowering uric acid levels but has a higher
This document discusses drugs used to treat gout, including colchicine, NSAIDs, corticosteroids, uricosuric agents like probenecid and sulfinpyrazone, and the uric acid synthesis inhibitor allopurinol. It provides details on the pathophysiology of gout, mechanisms of action, pharmacokinetics, indications, dosages and adverse effects of these drugs for both acute gout attacks and long-term treatment of chronic gout and hyperuricemia.
Japanese civilization was shaped by cultural influences from China and the rise of feudalism under military rulers. The Yamato clan took control in the 400s and named emperors to rule, though sometimes in name only. Buddhism spread from China and mixed with existing Shinto practices. In the late 700s, the capital moved to Heian where an refined aristocratic culture developed, illustrated by The Tale of Genji. However, as central power declined in the 1000s, large landowners built private armies and established feudal rule over smaller landowners seeking protection. The Minamoto family established the Kamakura shogunate in 1192, placing a military dictator or shogun in power supported by samur
1. Rheumatoid arthritis is an autoimmune disease that causes inflammation of the joints, most commonly in the hands and feet. It can lead to long-term joint damage and functional disability if not adequately treated.
2. Biologics target specific components of the immune system that drive inflammation in rheumatoid arthritis patients. They are generally reserved for patients who have not responded sufficiently to conventional disease-modifying drugs. Available biologics include TNF inhibitors such as etanercept, infliximab, and adalimumab as well as drugs targeting IL-1, IL-6, CD20, and T-cell co-stimulation.
3. While biologics can significantly reduce
Gout is a common type of arthritis caused by high levels of uric acid in the blood that leads to urate crystal deposits in joints. It affects around 1-2% of adults in developed countries. Diet, genetics, comorbidities like hypertension and diabetes, and medications like diuretics are risk factors. Acute gout attacks are typically treated with NSAIDs, colchicine, or corticosteroids. Long-term management involves lowering uric acid levels through medications like allopurinol, febuxostat, or uricosuric drugs and lifestyle changes like diet modification and weight loss. Proper treatment can help prevent future gout attacks and dissolve urate crystals from joints.
Arastirmaci tarafindan Baslatilan Arastirmalarda larda ortak veri standartlar...Bedirhan Ustun
Araştırmacı tarafından Başlatılan Araştırma (ABA)lar bilimsel bir sistematik içerisinde bir tanı grubundaki deneklere yapılan girişimlerin etkinliklerini değerlendirmek için kullanılabilir: ‘Bu tedavi yöntemi başka yöntemlere göre daha mı iyi’, ‘yan etkileri var mı’ gibi soruları yanıtlamak; ve araştırmalar arasında karşılaştırma yapmak amacıyla yapılabilir. Bu bağlamda, ABAlarda tanı ve girişim etkinliğini ölçmek ve değerlendirmek için bilimsel standartların kullanılması zorunludur. Araştırmacılar genellikle kendi alanlarında daha önce belirlenmiş (1) tanı ve (2) çıktı (outcome) ölçeklerini kullanmaktadırlar.
(1)Bu tür tanı ölçekleri belirli bir tanı grubunu homojen olarak tanımlamak için yararlıdırlar. Ancak her araştırmacı kendi ölçeğini kullanırsa araştırmaların karşılaştırılması sorun yaratır. Örneğin bir araştırmacı depresif bozukluk tanısını DSMIV diğeri ICD10, bir diğeri başka bir klinik tanı sistemi ile koymuşsa bu çalışmaların aynı hastalık grubuna ait bulguları ortaya koyduğunu söyleyebilmek zordur. Yapılması gereken tıpkı EURO, Dolar vb para birimlerinin birbirine denk eşdeğerlik tablolarını çıkarmak; ya da her tanıyı tek bir sistem üzerinden ele almaktır.
(2) Bu alanda daha önemli olarak ikinci sorun tanıdan çok çıktı (outcome) karşılaştırmalarıdır. Çıktı olarak değişik tanı, belirti sayısı, hastalık şiddeti, yetiyitimi (disability) ve işlevsellik, yaşam kalitesi (quality of life) ve iyilik hali gibi veriler birbiri ile iç içe ve birbiri yerine kullanılmaktadır. Böyle durumlarda tedavi sonuçlarının karşılaştırılması olanaksız olmaktadır. Çözüm çıktı olarak neyin ölçüldüğünün net olarak belirlenmesi ve bunun belirli bir standart ölçek üzerinden derecelendirilmesidir.
Bu sunuda depresyon, alkol bağımlılığı, bel ağrısı, diz ve kalça protezleri üzerinden örnekleri üzerinden tanı ve çıktılar adına standart ölçümlerin nasıl karşılaştırılabileceği anlatılacaktır.
Elektronik Sağlık Kayıtlarında Hasta Mahremiyeti ve Etik SorunlarBedirhan Ustun
Issues about privacy, security and confidentiality of electronic health records in Turkey discussed in legal frameworks of Turkish Constitution and European Court of Human Rights
2017 Depression and Culture: Etic or Emic ? Can Memetics help?Bedirhan Ustun
This is a review of 40 years of research on Depression on how cultures may affect the manifestation of depression symptoms in different cultures. Key findings are: "depression is a brain disease" "its manifestations are shaped by culture" "new research opportunities on big data and Memetics can help us understand better gene-environment interaction"
Big Data: Impact on Global Health and Clinical Decision MakingBedirhan Ustun
A primer on Big Data and some warnings:
Big Data is not a FAD
YOU are already using it…
It is here to stay
Big Data has Minimal Structure
Big Data Is usually Raw Data
It is NOT like a typical Relational Database
Big Data is available - and Less Expensive
Big Data is not collected for a purpose - has no map
It is your business – your time and money is at work
Kisisel Saglik Verileri: Elektronik Saglik Kayitlarinda GuvenlikBedirhan Ustun
Kisisel Saglik Verileri; Electronic Health Records; Personal Health Records; EHR; PHR; Security; Privacy; Turkish Law; Turkish Constitution; European Court on Human Rights;
Ustun 2017 ethical legal issues in psychiatryBedirhan Ustun
This document outlines key concepts in medical ethics and legal issues in psychiatry. It discusses objectives of teaching ethics, including respecting patient autonomy, acting within legal and professional boundaries, and being responsible to society. Key concepts covered include informed consent, confidentiality, voluntary vs involuntary treatment, and competence. Several ethical scenarios are presented, such as a patient asking the doctor not to disclose a terminal cancer diagnosis or HIV status. Throughout, the document emphasizes that psychiatric practice requires upholding patient rights and welfare above all other considerations.
This document discusses the importance of the doctor-patient relationship and key aspects of building a good relationship. It outlines patients' bill of rights and perspectives from medical, personal, and social views. Good doctors are good listeners, show interest and concern for patients, respect them, and have knowledge of both medical issues and interpersonal skills. Research shows doctors often interrupt patients and disagree on key problems. Doctors should aim to understand patients' situations, not judge them, and use empathy, emotion awareness, and effective communication in interactions. Personality types and social factors may influence relationships.
Personality and Personality Disorders: Medical Lecture on fundamentalsBedirhan Ustun
A lecture on personality and personality disorders for Medical Students ( Class III) . Explains "Big Five" Myers-Brigs; DSM5 and IPDE; TCI; temperament;
Making health data work for Patients and PopulationsBedirhan Ustun
This presentation contains the slide deck that Professor Iain Buchan - of Manchester University delivered in Koc University about what can be achieved if clinical health information were captured in a digital format.
Çatışma ve Travma ne zaman yararlıdır ?: Psikiyatride travma sonrası ne yapab...Bedirhan Ustun
Bu sunu travma ile başa çıkma ve bu süreçle ilgili savunma mekanizmaları, adaptasyon ve büyüme kavramlarını ele almaktadır
'Fort-da' oyunu ele alınıp ayrılık kaygısı (separation anxiety) ndan kurtulma mekanizması üzerinden gidilerek, yitirilen nesnenin yerine bir başka nesne koyabilme ve bunun zihinsel representasyonu ve söze dökülmesi örnek alınarak bunun yaşam boyunca başka travmalarda kullanımı ve dayanıklılık (resilience) geliştirilmesine ilişkin etmenler tartışılmaktadır.
Description of Mind-Body dichotomy; error of Descartes, new paradigms of Mental Illness; RDOC; mind-body interaction; human evolution; evolutionary basis of human illness
ICF provides domains of functioning as body functions, personal activities and societal participation to classifiy what a person can do in a certain environment. It provides a common language for communication and meaningful exchange of data.
DSM5 has changed the requirements for describing the clinical significance of a DSM category. Now there it is required that "impairment" criteria is specified in accordance with the ICF ( International Classification of Functioning Disability and Health ) and operationally measured with the WHODAS 2.0;
State of the WHO Family of International Classifications -2015Bedirhan Ustun
The document discusses the history and development of the International Classification of Diseases (ICD) over 150 years from its origins in William Farr's work in the mid-19th century to the current revision process for ICD-11. It notes that ICD-11 aims to evolve as a multi-purpose classification that can serve various uses in an electronic environment and be linked to other clinical terminologies and ontologies. The development includes creating a foundation component with detailed disease descriptions and linearizations tailored for specific uses such as mortality statistics and primary care.
How can ICD-11 possibly help you enhancing your casemix ?
What Can ICD11 offer systematically?
A systematic meaningful integrated system of clinical conditions - (not only for DRGs … )
Better clinical description
Better severity grading
Better coding of co-morbidity
Inherent functional information (key ICF classes)
Integrated information system between ICD, ICF, ICHI
Deconstructing Diagnosis into subgroups
Computerized information processing
ICD Revision: Current Status Internal Medicine workgroupBedirhan Ustun
ICD Revision has entered into the final phase. It will be submitted to the World Health Organization's governing bodies in 2018. What is the current situation? Peer Review - Field Test. Do we need additional detail for Internal Medicine?
The presentation multiple code sets ( aka linearizations) that are used in ICD11 and its different use cases: Primary Care, Mortality statistics, Morbidity Statistics. Use for Primary Care should be simple short and user friendly. It should have incentives for the providers and compatible with ICD11 Joint Linearizations.
1. ICD Revision Overview
Tevfik Bedirhan Üstün
Classifications, Terminologies, Standards Team
World Health Organization
2. Tokyo 2007 April 2013 February
ICD - Revision Journey
Thanks to:
• WHOFIC Network
• Japanese MHLW
• Japan Hospital Association
Table 1: Major Japanese academic societies
• Japanesesupporting Organizations
Medical ICD revision project
The Japanese Society of Internal Medicine
The Japanese Society of Gastroenterology
The Japanese Respiratory Society
Japanese Society of Nephrology
The Japan Endocrine Society
Japan Diabetes Society
Japanese Society of Hematology
The Japanese Circulation Society
Japanese Society of Neurology
Japan College of Rhumatology
Japan Association for Medical Informatics
The Japanese Society of Medical Record Administra
3. IM TAG Brazil Poster
Conclusions - Request
• Japanese government and academic societies have heavily involved
in the IM-TAG activities.
• As ICD is used in many countries with various ways it should be
supported financially by WHO and a number of governments.
• Also, it is essential to provide concrete and logical leadership by WHO
for conducting such a large international project effectively.
9. Age-adjusted death rates for
nephritis, nephrotic syndrome, and nephrosis:
United States, 1968-2005
10.
11.
12.
13. ICD-11 Revision Goals
1. Evolve a multi-purpose and coherent classification
– Mortality, morbidity, primary care, clinical care, research, public
health…
– Consistency & interoperability across different uses
2. Serve as an international and multilingual reference standard
for scientific comparability and communication purposes
3. Ensure that ICD-11 will function in an electronic environment.
• ICD-11 will be a digital product
• Support electronic health records and information systems
• Link ICD logically to underpinning terminologies and ontologies (e.g. SNOMED, GO, …)
• ICD Categories “defined” by "logical operational rules" on their associations and details
14. ICD-11 Timeline
• 2012 : Beta version & Field Trials Version
– +2 YR : Field trials
• 2015 : Final version for WHA Approval
– 2015+ implementation
– Continuous Annual Cycles
• ICD 2015
• ICD 2016
• ICD 2017
16. • Open and Collaborative Platform
– Web based
– Like WIKIPEDIA
• But
– by the Content Model
• with
– by the TAGs , and scientific peers
17. ICD11 βeta
• http://www.who.int/classifications/icd/revision
• Beta – Browser & Print
10 look & feel + descriptions – code structure !
βeta
• ICD-11 Beta draft is NOT FINAL
• updated on a daily basis
•NOT TO BE USED for CODING
except for agreed FIELD TRIALS
18. The ICD Foundation Component
• is a collection of ALL
ICD entities like
diseases, disorders...
• It represents the whole
ICD universe.
• In a simple way, the foundation component is similar to a
“store” of books or songs.
• From these elements we build a selection as a
linearization.
• This analogy may however be misleading because there
are many links between the ICD entities (like parent-child
relations and other).
• The ICD entities in the Foundation Component:
• are not necessarily mutually exclusive
• allow multiple parenting ( i. e. an entity may be
in more than one branch, for example
tuberculosis meningitis is both an infection and
a brain disease)
19. The ICD Linearizations
• A linearization is a subset of the
foundation component, that is:
• Fit for a particular purpose: reporting
mortality, morbidity, or other uses
• Jointly Exhaustive of ICD Universe (Foundation
Component)
• Composed of entities that are Mutually Exclusive
of each other
• Each entity is given a single parent
20. Primary Care
Foundation: ICD
categories with Linearizations
- Definitions, synonyms
- Clinical descriptions Morbidity
- Diagnostic criteria
- Causal mechanism
- Functional Properties
Find Term Mortality
SNOMED-CT,
International Classification of
23
Functioning, Disability and Health (ICF)…
21. Linerization requirements
• Classical ICD
– Mutually Exclusive
MEJE priniciple
– Jointly Exhaustive
No double counting
All categories will be in
Residuals:
Other (*.8)
Unspecified (*.9)
should be generated for each linearization
22. Building Linearizations
• Multiple Parenting Allowed
– Pneumonia
• Lung Disease
• Sometimes Infectious Disease
• Permanence of meaning across different
linearizations
– Telescopic principle
• Zoom in – zoom out
24. PC – Low 1
PC – Low 2
PC – Low 3
PRIMARY CARE Low Resource
(Verbal Autopsy ?)
25. Mort/PCHigh 11
PC – Low 1 Mort/PCHigh 12
Mort/PCHigh 13
Mort/PCHigh 21
PC – Low 2
Mort/PCHigh 22
Mort/PCHigh 31
PC – Low 3
Mort/PCHigh 32
Mort/PCHigh 33
Mort/PCHigh 34
Mort/PCHigh 35
PRIMARY CARE Low Resource PRIMARY CARE High Resource
(Verbal Autopsy ?) MORTALITY
26. Morbidity111
Mort/PCHigh 11
Morbidity112
PC – Low 1 Mort/PCHigh 12 Morbidity121
Morbidity131
Mort/PCHigh 13
Morbidity132
Morbidity133
Mort/PCHigh 21 Morbidity211
PC – Low 2
Morbidity221
Mort/PCHigh 22
Morbidity222
Morbidity311
Mort/PCHigh 31
PC – Low 3 Morbidity312
Mort/PCHigh 32
Morbidity321
Mort/PCHigh 33
Morbidity341
Mort/PCHigh 34
Morbidity342
Mort/PCHigh 35 Morbidity351
PRIMARY CARE Low Resource PRIMARY CARE High Resource MORBIDITY
(Verbal Autopsy ?) MORTALITY International
27. Morbidity111
Mort/PCHigh 11
Morbidity112
PC – Low 1 Mort/PCHigh 12 Morbidity121
Morbidity131
Mort/PCHigh 13
Morbidity132
Morbidity133
Mort/PCHigh 21 Morbidity211
PC – Low 2
Morbidity221
Mort/PCHigh 22
Morbidity222
Morbidity311
Mort/PCHigh 31
PC – Low 3 Morbidity312
Mort/PCHigh 32
Morbidity321
Mort/PCHigh 33
Morbidity341
Mort/PCHigh 34
Morbidity342
Mort/PCHigh 35 Morbidity351
PRIMARY CARE Low Resource PRIMARY CARE High Resource MORBIDITY Extensions
(Verbal Autopsy ?) MORTALITY International National Linearizations
Specialty - Research
28. X – Chapter:
Extension Codes
Type 1 Type 2 Type 3
Severity Main Condition (types) History of
Temporality Reason for Family History of
(course of the condition) encounter/admission
Temporality Main Resource Condition Screening/Evaluation
(Time in Life)
Etiology Present on Admission
Anatomic detail Provisional diagnosis
Topology
Specific Anatomic
Location
Histopathology Diagnosis confirmed by
Biological Indicators Rule out / Differential
Consciousness
External Causes (detail)
Injury Specific (detail)
30. Why a Review Process
• The review process will help WHO assure
the quality of the Beta Content
• Review focus:
– Scientific accuracy
– Completeness of each unit
– Internal consistency
– Utility / Relevance of each unit
31. Review Process
• The review process :
– the content
• Definitions
• Content model parameters
– The structure - of the linearization (s)
• Mortality
• Morbidity
• Primary Care
• The reviewers:
– scientific peers
32. Initial Review
• Initial Review of the current Beta draft:
– Linearization Structure(s) (e.g. Mortality and Morbidity or Primary
Care)
– Content
• Review Units: may include individual entities or groups of entities
at any level, such as:
Structure Review Units Content Review Units
– Entire Linearization – Chapter
– Chapter – Subchapter
– Subchapter – Clusters
– Clusters – Individual entities
– Use Cases – Other groups of entities, as selected
– Other structure groupings, as selected
33. Reviewers
• Content Reviewers: Pool of specialist
experts to review in their area of
expertise, similar to quality assessment in
peer-reviewed journals.
• Structure Reviewers: Morbidity TAG and
Mortality TAG
• TAG and WG members :
– will act as a scientific journal editorial board.
– should NOT be nominated as reviewers.
34. Call for Reviewers
• WHO Requests all TAGs and WGs to provide
nominations of reviewers for the next step in the Beta
Phase.
• Please send the following information to WHO
(robinsonm@who.int) and copy the message to Bedirhan
(ustunb@who.int) :
– Name of the nominee
– Email address
– Area(s) of expertise (content they are qualified to review)
– CV of the nominee (preferred)
– Linked-In or other professional profile link (if available)
Dr. Kenji Fujiwara passed away at age 74, on November 4, 2012. Dr. Fujiwara was clearly one of the originators of the development of ICD-11 in Japan and a great leader who contributed significantly to the development of ICD not only in Japa...n but also within WHO.For those of us involved in the revision of ICD, we can overcome his loss by successfully completing the 11th revision of ICD. We will carry on his aspirations and fulfill our responsibility to the world by further improving on ICD through its 11th revision. May Dr. Kenji Fujiwara rest in peace
The linearization is similar tothe classical print version of ICD Tabular Lists (e.g. volume I of ICD-10 or other previous editions). Various linearizations could be built at different granularity, use case or other purposes such as for Primary Care, Clinical Care or Research. The linkage from the foundation component to a particular linearization will ensure consistent use of the ICD. The ICD Entities are represented in a content model which has 13 predefined parameters. The information filled in by ICD authors is visible in the alpha browser.
There is currently great diversity in the level of work completed in the Beta draft