This document summarizes the INTERACT2 trial which studied the effects of early intensive blood pressure lowering in patients with intracerebral hemorrhage. The trial involved over 2800 patients across 21 countries who were randomized to either receive intensive treatment to lower their blood pressure below 140 mmHg within 1 hour or guideline-recommended treatment with no lower target. The primary outcome was death or major disability at 90 days. While intensive treatment did not significantly reduce the primary outcome, ordinal analysis showed better functional outcomes. Intensive treatment also improved quality of life scores and was not associated with higher death or adverse event rates.
http://www.theheart.org/web_slides/1425587.do
A randomized to placebo or ivabradine study on Systolic Heart Failure Treatment with the If Inhibitor Ivabradine (SHIFT) with patients on standard HF medications according to guidelines
http://www.theheart.org/web_slides/1425587.do
A randomized to placebo or ivabradine study on Systolic Heart Failure Treatment with the If Inhibitor Ivabradine (SHIFT) with patients on standard HF medications according to guidelines
Trial of decompressive craniectomy for traumatic intracranial hypertension1Dr fakhir Raza
The New England Journal of Medicine, Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension, Extended Glasgow Outcome Scale (GOS-E), vegetative state, lower severe disability, traumatic brain injury, RESCUEicp,
PPT on all important trials of traumatic brain injury. - includes design, setting, statistical analysis,outcome, strength, limitations, conclusion#DECRA#RESCUEicp#BEST TRIP#CRASH1#CRASH3#SAFE TBI#EUROTHERM3939#POLAR TRIAL
Also includes trial related BTF guidelines
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.
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.
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
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.
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
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.
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Interact 2 trail
1. INTERACT 2 TRAIL
May 29,
2013 NEJM
GUIDE: DR GURDEEP KAUR
PRESENTED BY: ATUL RANA
2. INTRODUCTION
• Acute intracerebral hemorrhage which is the least treatable
form of stroke ,affects more than 1 million people worldwide
annually with the outcome determined by the volume and
growth of the underlying hematoma.
• Blood pressure often becomes elevated after intracerebral
hemorrhage, frequently reaching very high levels, and is a
predictor of outcome.
• On the basis of the results of the pilot-phase study, Intensive
Blood Pressure Reduction in Acute Cerebral Hemorrhage
Trial 1 (INTERACT1) a main-phase study, INTERACT2 was
conducted to determine the safety and effectiveness of early
intensive lowering of blood pressure in patients with
intracerebral hemorrhage
3. TRAIL DESIGN
• INTERACT2 was an international, multicenter, prospective,
randomized, open-treatment, blinded end-point trial.
• In brief, the effect of a management strategy was compared :-
. targeting a lower systolic blood pressure within 1 hour, with
the current guideline-recommended strategy which targets a
higher systolic blood pressure in patients who had a systolic
blood pressure between 150 and 220 mm Hg and who did not
have a definite indication for or contraindication to blood-
pressure–lowering treatment that could be commenced
within 6 hours after the onset of spontaneous intracranial
hemorrhage
4. • The diagnosis of intracranial hemorrhage was confirmed by
means of computed tomography (CT) or magnetic
resonance imaging (MRI).
• Patients were excluded:-
1. if there was a structural cerebral cause for the
intracerebral hemorrhage,
2 .if they were in a deep coma (defined as a score of 3 to 5
on the Glasgow Coma Scale [GCS], in which scores range
from 3 to 15, with lowerscores indicating reduced levels of
consciousness)
3 .if they had a massive hematoma with a poor prognosis,
4. if early surgery to evacuate the hematoma was
planned
5. STUDY POPULATION
• From October 2008 through August 2012, a
total of 2839 participants (mean age, 63.5
years; 62.9% men) were enrolled at 144
hospitals in 21 countries
• 1403 participants were randomly assigned to
receive early intensive treatment to lower
their blood pressure, and 1436 were assigned
to receive guideline-recommended treatment
6. STUDY DESIGN
• In participants who were assigned to receive intensive
treatment to lower their blood pressure (intensive-
treatment group), intravenous treatment and therapy with
oral agents were to be initiated according to prespecified
treatment protocols that were based on the local
availability of agents, with the goal of achieving a systolic
blood-pressure level of less than 140 mm Hg within 1 hour
after randomization and of maintaining this level for the
next 7 days.
• In participants who were assigned to receive guideline-
recommended treatment (standard- treatment group),
blood-pressure–lowering treatment was to be
administered if their systolic blood pressure was higher
than 180 mm Hg
• no lower level was stipulated
7. RANDOMIZATION
• Investigators entered baseline data into a database
associated with a secure Web-based randomization
system.
• The data were checked to confirm the eligibility of the
patient, and several key clinical variables were
recorded before the system assigned a participant to
intensive or guideline-recommended management of
blood pressure with the use of a minimization
algorithm to ensure that the groups were balanced
with respect to country, hospital, and time (≤4 hours
vs. >4 hours) since the onset of the
intracerebralhemorrhage
8.
9.
10. ASSESSMENTS
• Demographic and clinical characteristics were
recorded at the time of enrollment.
• The severity of the stroke was assessed with the
use of the GCS and the National Institutes of
Health Stroke Scale21 (NIHSS, on which scores
range from 0 to 42, with higher scores indicating
a more severe neurologic deficit) at baseline, at
24 hours, and at 7 days (or at the time of
discharge, if that occurred before 7 days)
11. ASSESSMENTS
• Participants were followed up in person or by
telephone at 28 days and at 90 days by trained
local staff who were unaware of the group
assignments.
• Participants who did not receive the assigned
treatment or who did not adhere to the protocol
were followed up in full, and their data were
included in the analyses according to the
intention-to-treat principle.
12.
13.
14. Outcome Measures
• The primary outcome measure was the
proportion of participants with a poor
outcome, defined as:-
. death
.or major disability.
• Major disability was defined as a score of 3 to
5 on the modified Rankin scale at 90 days
after randomization.
15. OUTCOME MEASURES
• Other secondary outcomes were:-
1 . all-cause mortality and cause-specific
mortality.
2 .five dimensions of health-related quality of
life (mobility, selfcare, usual activities, pain or
discomfort, and anxiety or depression), as
assessed with the use of the European Quality of
Life–5 Dimensions (EQ-5D) questionnaire,23 with
each dimension graded according to one of three
levels of severity (no problems, moderate
problems, or extreme problems)
16. OUTCOME MEASURES
3.the duration of the initial hospitalization;
4.residence in a residential care facility at 90
days;
5.poor outcomes at 7 days and at 28 days;
6. serious adverse events
17. OUTCOME MEASURES
• The safety outcomes of primary interest were:-
• 1. early neurologic deterioration (defined as an
increase from baseline to 24 hours of 4 or more points
on the NIHSS or a decrease of 2 or more points on the
GCS)
• 2. Episodes of severe hypotension with clinical
consequences that required corrective therapy with
intravenous fluids or vasopressor agents.
• 3. The difference in the volume of the hematoma from
baseline to 24 hours was assessed in a prespecified
subgroup of participants who underwent repeat brain
imaging.
18.
19.
20.
21.
22.
23.
24. DISCUSSION
• In this trial involving patients with intracranial hemorrhage,
early intensive lowering of blood pressure, as compared
with the more conservative level of blood-pressure control
currently recommended in guidelines, did not result in a
significant reduction in the rate of the primary outcome of
death or major disability.
• However, in an ordinal analysis of the primary outcome, in
which the statistical power for assessing physical
functioning was enhanced, there were significantly better
functional outcomes among patients assigned to intensive
treatment to lower their blood pressure than among
patients assigned to guideline-recommended treatment
25. • Furthermore, there was significantly better
physical and psychological well-being among
patients who received intensive treatment.
• These results are consistent with observational
epidemiologic findings associating high blood-
pressure levels with poor outcomes among
patients with intracerebral hemorrhage and
indicate that early intensive lowering of blood
pressure in this patient population is safe.
26. • Moreover, there was no evidence of a
significant effect modification according to a
history or no history of hypertension — a
finding that is relevant because it has been
postulated that patients with hypertension
have an upward shift in cerebral
autoregulation and possibly an increased risk
of cerebral ischemia related to intensive
lowering of blood pressure
27. SUMMARY
• In summary, early intensive lowering of blood
pressure did not result in a significant reduction in
the rate of the primary outcome of death or major
disability, but an ordinal analysis of scores on the
modified Rankin scale did suggest that intensive
treatment improved functional outcomes.
• Intensive lowering of blood pressure was not
associated with an increase in the ratesof death or
serious adverse events.