#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
Systemic means affects multiple organs.
Lupus is the Latin word for wolf meaning disease affecting skin where the skin lesions look like wolf bite.
Erythematosus means reddening of the skin.
Systemic Lupus Erythematosus or SLE, sometimes also called just lupus is a disease that’s systemic and affects a wide variety of organs, but notably often causes red lesions on the skin.
Systemic Lupus Erythematosus(SLE) is a chronic, nonspecific autoimmune inflammatory disease that typically affects multiple organs and systems, including the skin, joints, muscles, lungs, heart, kidneys, and the CNS and circulatory system.
Individuals with SLE are noted with the production of antibodies and inflammatory responses that are mistakenly directed at their own tissue.
this research is made by a dental student (me) under supervision of our oral medicine specialist dr. muhassad almudhafer and this research is collected from several articles hope u like it
this my email if u would like to contact me - mnmmnz4503.mm@gmail.com
Pathogenesis systemic lupus erythematosus by dr bashir ahmed dar associate pr...Prof Dr Bashir Ahmed Dar
Systemic lupus erythematosus is a chronic, multisystem, inflammatory disorder of autoimmune etiology, occurring predominantly in young women. Common manifestations may include arthralgias and arthritis; malar and other skin rashes; pleuritis or pericarditis; renal or CNS involvement; and hematologic cytopenias.
by Cono Grasso, MD
Jamaica Hospital Medical Center
Presented at the S.L.E. Lupus Foundation's "Get into the Loop!" New York City Lupus Education Series on October 6, 2010.
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.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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 lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Systemic lupus erythematosus is a chronic inflammatory disease
of unknown cause that can affect any organ in the body
including the skin, joints, kidneys, lungs, nervous system, and
the heart.
3. Lupus affects more women than men usually in their 20s and
30s during their child bearing years.
It is characterized by periods of remissions and chronic or acute
relapses or “flares”
Common symptoms are fatigue, fever, weight loss, joint and
muscle pain, sores in the mouth or nose, rashes the most
common of which is the “butterfly” or malar rash after sun
exposure, and Raynauds or microvasospasm of the small blood
vessels especialy in the hands or feet.
Lupus can affect any organ especially the kidneys and heart so
your Rheumatologist is always on the lookout for any signs of
problems in these organ systems.
4. Lupus can be like the game of telephone.
The initial order from
your body’s immune
system may be protective
but somewhere down the
road the order gets
changed and things take
a wrong turn.
http://www.flickr.com/photos/fuffer2005/3006563299/lightbox/
5. Something derails the normal message and the body attacks itself in lupus and
makes antibodies that reacts with itself leading to the symptoms/disease of
lupus. These antibodies seem to only be markers of lupus and an immune
system problem . These antibodies have not been found to cause lupus on their
own and so the cause of lupus is still unknown.
6. These antibodies can then travel throughout the
body and trigger other chemical signals which
leads to inflammation in different parts of the
body and can cause damage in these different
organs including the heart in various ways
7. Valvular disease
The heart has 4 valves that control the flow of blood circulating through
your body
These valves can be injured by bacterial infection or by immune complexes
of antibody/antigen reactions that occur during lupus activity.
More inflammation is then triggered and in the process of healing
, fibrosis, scarring and calcification can occur, which can ultimately
damage the valves
Often this is asymptomatic to the patient but over time valves can become
stiff or floppy and not work as effectively leading to heart failure
8. These damaged valves are also more prone to bacterial infection
or sometimes fragments of deposits on the valves caused by the
lupus inflammatory process can break off and cause emboli
leading to strokes
Patients with antiphospholipid antibodies are also at a higher
risk for endocarditis perhaps from increased deposition of
antibody complexes
9. Antibiotic prophylaxis for lupus patients with valvular lesions
is not an absolute recommendation by the AHA but is suggested
especially when the patient is undergoing procedures that may
cause transient bacteremia which include:
Invasive dental procedures/surgeries
Surgery of the respiratory tract such as tonsillectomy or
bronchoscopy
Invasive surgery/procedure of the GI tract
10. Steroids and other immunosuppressive therapy does not seem
effective for these valve deposits.
Anticoagulation may be helpful for Antiphospholipid antibody
associated valve deposits.
Patients with cardiac symptoms suggestive of valve disease
should undergo echocardiogram testing however screening of
asymptomatic patients is not recommended
11. It is usually asymptomatic and found incidentally but is the most frequent
cause of symptomatic cardiac disease
Pericarditis refers to inflammation of the lining around the heart .
Symptoms include positional substernal chest pain with abnormal heart
sounds on exam.
Pericardial effusion will occur at some point at least half of lupus patients
Pericarditis/pericardial effusion usually occurs when lupus is active
12. Usually it is a benign condition and is treated with
NSAIDS/anti-inflammatories and sometimes steroids with
success
If fluid has built up significantly around the heart surgical
drainage would be required
Myocarditis occurs when the heart muscle is inflamed and is a
much more serious condition but fortunately occurs rarely but
can be treated with immunosupressant medications and would
need be treated aggressively to prevent irreversible heart
damage
13. Conduction defects where the electrical system of the heart is
disrupted sometimes occurs as a result of myocarditis episode.
Usually it is a result of inflammation and fibrosis of the
conduction system of the heart and can lead to arrythmias such
as heart block.
Most often it is a first degree heart block and often short term
and reverses with time. Higher degree heart block are not
usually seen in adult lupus patients.
14. Neonatal lupus is observed in 1-2 % of babies born to mothers with
autoimmune disease. There seems to be an association with Ro and La
antibodies carried by the mother being transferred the the fetus
There is an increased incidence up to 17% in mothers with Ro and La
antibodies who already had a previous child with heart block. Still this is
a minority of births.
Symptoms include a facial/body rash that can occur up to 4 months old
Cardiac manifestations such has heart block usually occurs in utero or in
the neonatal period. It is less common after birth ( a Toronto based study
reported an incidence after birth of only 5%) This heart block is
irreversible and life threatening and requires aggressive fetal monitoring
during pregnancy.
15. Patients with SLE have been found to have an increased risk of
accelerated atherosclerosis leading to coronary heart disease
and heart attack
Several studies have given reports of up to double the risk of
heart disease in young women with SLE in their 30s and 40s as
opposed to other women at that age without SLE
16. With improvements in treatments of other life-threatening
organ disease caused by lupus such as kidney failure coronary
artery disease is emerging as the leading cause of morbidity and
premature death in patients with SLE
Reasons for this are likely multifactorial:
Traditional risk factors such as diabetes, high
cholesterol, hypertension, family history, obesity, sedentary
lifestyle, cigarette smoking are still important modifiable risk
factors
Other factors special to lupus include steroid use and lupus
itself are factors as well
17. We know now that atherosclerosis itself is an inflammatory
process with activation of the immue system and inflammation
driven processes that lead to the plaques that causes blockages
in the arteries of the heart
Image from medscape.org
18. We also know that Lupus specific factors likely play a role here.
Certain antibodies associated with lupus stimulates the production
and storage of cholesterol
Lupus also affects your blood vessels and how they respond to stress
and injury and affect their inherent repair mechanisms
SLE-Related Risk Factors
Standard Risk Factors
Systemic inflammation
Age
Autoantibodies to endothelium,
Hypertension
HDL, phospholipids
Hyperlipidemia
Circulating immune complexes
Hyperglycemia
Activated complement products
Smoking
Nephritis
Genetic factors
Dyslipidemia
Image from
Hahn, B. n engl j
med
349;25, december
Macrophage Monocyte
18, 2003
Calcium
Foam cell
Endothelium
Oxidized
LDL
HDL
Smooth-muscle cells
19. Numerous studies have shown an increased prevalence in Lupus
patients of certain risk factors for heart disease including
Hypertension
Diabetes
Premature menopause
Sedentary lifestyle
At risk body habitus
Metabolic syndrome (central obesity, high cholesterol, diabetes)
20. Steroid use- can cause or worsen traditional risk factors like
high cholesterol, diabetes, and obesity
- dose and duration of steroid use may be an important
factor with higher dose and longer use may also be a
maker of more active SLE
Active SLE which indicates an active inflammatory state may
also in itself be a risk factor for accelerated atherosclerosis and
heart disease
21. Cholesterol screening
Stress test and echocardiograms
CT of the heart looking for calcification
Carotid artery ultrasound
Cardiac mri
22. Check your cholesterol levels regularly
Current recommendations suggest treating SLE patients as having a
cardiac equivalent which means treating to goals of a LDL cholesterol
less than 100 with cholesterol lowering drugs
Certain trials have shown statins which are effective cholesterol
lowering drugs also have an anti-inflammatory effect
Plaquenil which is a useful medication in the treatment of several
manifestations of lupus has also been shown to have lipid lowering
effects – C. Tang, T. Gofrey, et. al, Int Med Journal, July 2012; 968-978.
23. Diabetes – control glucose with medications and diet and lifestyle changes
Hypertension control with medications, diet and lifestyle changes
IF possible reduce steroid dose as much as possible
Stop smoking
Weight control and reducing obesity
Healthy well balanced diet – low fat, high fiber diet incorporating fresh fruits
and vegetables and lean proteins is the way to go. there is no proven “anti-
inflammatory diet”
Exercise regularly – improves blood pressure, lowers cholesterol, improves
fatigue, aids weight loss