Steroid use in stroke treatment is controversial. Steroids may reduce brain edema and inflammation but also increase risks. The document discusses several studies on steroid use in different stroke types. It found no clear evidence that steroids improve outcomes in acute ischemic or hemorrhagic stroke. Steroids are only definitively indicated for stroke caused by vasculitis. Evidence is mixed for their use in subarachnoid hemorrhage. In general, the document concludes steroids have limited role in stroke therapy based on available clinical trials.
Pioglitazone Hydrochloride Tablets (P-Glitz) are used along with diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
Pioglitazone Hydrochloride Tablets (P-Glitz) are used along with diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
Sulfonylureas for Diabetes: A deep insightRxVichuZ
This powerpoint presentation solely deals with Sulfonylureas, that come under Insulin secretagogues. Their complete pharmacological profile, with pharmacovigilance parameters, important catchpoints and mnemonics have been explained.
GLP-1 receptor agonists (GLP-1RAs): cardiovascular actions and therapeutic po...OlgaGoryacheva4
My students Babisweta Swain, Abhishek Raj and Piyush Barwal had presented this topic in our 22nd Student Scientific Society Conference in the department of Propaedeutic of Internal Diseases No.2
Controlling blood sugar (glucose) levels is the major goal of diabetes treatment, in order to prevent complications of the disease.
Type 1 diabetes is managed with insulin as well as dietary changes and exercise.
Type 2 diabetes may be managed with non-insulin medications, insulin, weight reduction, or dietary changes.
Medications for type 2 diabetes are designed to
increase insulin output by the pancreas,
decrease the amount of glucose released from the liver,
increase the sensitivity (response) of cells to insulin,
decrease the absorption of carbohydrates from the intestine, and
slow emptying of the stomach, thereby delaying nutrient digestion and absorption in the small intestine.
Diabetes mellitus is a clinical syndrome characterized by an increase in plasma blood glucose (hyperglycemia).
Diabetes has many causes but is most commonly due to type 1 or type 2 diabetes
Sulfonylureas for Diabetes: A deep insightRxVichuZ
This powerpoint presentation solely deals with Sulfonylureas, that come under Insulin secretagogues. Their complete pharmacological profile, with pharmacovigilance parameters, important catchpoints and mnemonics have been explained.
GLP-1 receptor agonists (GLP-1RAs): cardiovascular actions and therapeutic po...OlgaGoryacheva4
My students Babisweta Swain, Abhishek Raj and Piyush Barwal had presented this topic in our 22nd Student Scientific Society Conference in the department of Propaedeutic of Internal Diseases No.2
Controlling blood sugar (glucose) levels is the major goal of diabetes treatment, in order to prevent complications of the disease.
Type 1 diabetes is managed with insulin as well as dietary changes and exercise.
Type 2 diabetes may be managed with non-insulin medications, insulin, weight reduction, or dietary changes.
Medications for type 2 diabetes are designed to
increase insulin output by the pancreas,
decrease the amount of glucose released from the liver,
increase the sensitivity (response) of cells to insulin,
decrease the absorption of carbohydrates from the intestine, and
slow emptying of the stomach, thereby delaying nutrient digestion and absorption in the small intestine.
Diabetes mellitus is a clinical syndrome characterized by an increase in plasma blood glucose (hyperglycemia).
Diabetes has many causes but is most commonly due to type 1 or type 2 diabetes
Efficacy of Dietary Intervention in END STAGE RENAL DISEASEJunaid Nazar
Chronic kidney disease (CKD), a major global public health problem, has been recognized as one of the eleven important causes of death (WHO, 2009). This review explores wide range of barriers related to patients and health systems involved in controlling the prevalence of CKD at the primary health care level.
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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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.
2. List of controversial issues
Use of Steroids in Tuberculosis
Pioglitazone in Diabetes
Steroid in stroke
Protein restriction in CKD
Embryonic Stem Cell Transplantation
4. Background
Corticosteroids:
Decrease inflammation, especially in the
subarachnoid space
Reduce cerebral and spinal cord oedema
Reduce inflammation of small blood vessels
and therefore
Reduce damage from decreased blood flow
to the underlying brain tissue
5. Corticosteroids:
It may Suppress the immune response to
mycobacteria, making the systemic effects
worse
May reduce inflammation of the meninges,
reducing drug penetration into the
subarachnoid space
Cause gastrointestinal haemorrhage,
electrolyte imbalance, hyperglycaemia,
infections from fungi or bacteria, and
psychosis
6. Steroids in TB
Although much of the morbidity in
tuberculosis results from an excessive
cellular host response to the bacillus, the
use of steroids in TB management remains
controversial
7. Steroids in TB
Corticosteroids are often used as an adjunct
in the treatment of various forms of TB and
for the prevention of complications, such as
Constrictive pericarditis
Hydrocephalus
Focal neurological deficits
Pleural adhesions
Intestinal stricture
8. Steroids in TB
But they have been proven in clinical trials to
improve the following outcomes only — death
or disability in HIV-seronegative patients with:
Tubercular meningitis and
Tubercular pericarditis
Despite a lack of specific evidence for
efficacy in HIV co-infected patients with
tubercular meningitis or pericarditis,
corticosteroids are generally recommended
in them as well
9. Steroid in Tubercular Meningitis
Tubercular meningitis (TBM) is uniformly
fatal if not treated
An earlier Cochrane systematic review
concluded that corticosteroids significantly
improved the mortality among children with
TBM
But the effect on mortality in adults was
inconclusive
10. Steroid in Tubercular Meningitis
But largest-ever RCT done in Vietnam
revealed corticosteroids to significantly
decrease the risk of death and improve the
disability-free survival in TBM
Central nervous system TB may at times
present as focal space-occupying lesions of
the brain parenchyma or the spinal cord
(TUBERCULOMA) with or without evidence
of meningitis
11. Steroid in Tubercular Meningitis
Corticosteroids may hasten symptomatic
improvement when tuberculoma results in
mass effect or refractory seizures
But eficacy of corticosteroids in this clinical
setting has not been formally evaluated in
clinical trials
Paradoxically,tuberculoma may develop in
patients being treated for TBM despite the
use of adjunctive corticosteroids
12. Steroid in Tubercular Pericarditis
Patients with tubercular pericarditis may
develop
Cardiac tamponade
Constrictive pericarditis
Meta-analysis of different RCTs reveal
corticosteroids decreased the risk of all-cause
mortality by in tubercular pericarditis
• But this reduction failed to achieve statistical
significance
Corticosteroids did not significantly reduce
the need for pericardiectomy also
13. Adrenal TB
Clinically manifest adrenal insufficiency as a
result of TB is an absolute indication for
corticosteroids
Subclinical adrenal insufficiency which is
common among patients with pulmonary as
well as extrapulmonary TB
Adrenal function recovers in most of these
patients with ATT alone
14. Steroid in other extrapulmonary TB
Evidence is inconclusive for use of
corticosteroids in
Genitourinary TB
Laryngeal TB
Peritoneal TB
Miliary TB
Mediastinal TB lymphadenitis
15. Steroid in pulmonary TB
The role of corticosteroids in pulmonary TB
modern-day rifampicin-based regimens is
questionable
Anecdotal reports suggest that
corticosteroids might be beneficial in patients
with endobronchial TB
But in one trial of 34 patients with
endobronchial TB, corticosteroids had no
appreciable effect on bronchoscopic healing
rate, radiological findings, and pulmonary
functions
18. Steroid in Tubercular pleural Effusuion
Most tubercular pleural effusions resolve
spontaneously even without specific ATT.
The resolution is often incomplete leaving
behind loculated collections and considerable
pleural thickening
It is believed that corticosteroids might
reduce these fibrotic sequelae and hasten
the resolution of pleural effusion as well as
clinical symptoms
19. Steroid in Tubercular pleural Effusuion
Different studies revealed both positive &
negative results regarding improvement of
pleural effusion & prevention of pleural
adhesion by steroid
But no study revealed significant improvement
in pulmonary function (evidenced by forced
vital capacity at the end of treatment)
Thus, the clinical significance of the reduction
in pleural thickening by corticosteroids is
QUESTIONABLE
20. Corticosteroids in HIV-related TB
Paradoxical reactions in TB is defined by a
clinical or radiological worsening of pre-
existing tuberculous lesions or the
development of new lesions, in patients
receiving anti-tuberculous medication who
initially improved on treatment
This phenomenon is also known as Immune
Reconstitution Inflammatory syndrome (IRIS)
This is well-recognised phenomenon,
particularly in HIV-infected individuals where
they are associated with HAART
21. Corticosteroids in HIV-related TB
This phenomenon is also noticed in few
cases of HIV-negative TB
Most cases of paradoxical reactions are
self-limited and respond to NSAID
corticosteroids may be used to treat severe
paradoxical reactions and those
unresponsive to NSAIDs
22. Final Words
The only clinical indication for which
corticosteroids have been demonstrated to be
beneficial beyond reasonable doubt is TBM
Corticosteroids seem to have a potential
benefit in patients with tubercular pericarditis,
But more robust evidence is required
Though corticosteroids reduced the risk of
pleural thickening,clinical significance of this
benefit is unclear
Hence,the use of corticosteroids is not
recommended in tubercular pleural effusion
23. Patients with diabetes were understandably
worried, and their physicians were faced, as
often is the case with such media events,
with the dilemma of determining what should
be the correct advice at a time of limited data
availability
25. Pioglitazone in diabetes
• The type-2 diabetes drug pioglitazone, is at
the center of a great deal of controversy
lately
• Studies have shown that it may carry a
substantial risk of side effects
• Yet experts say it remains one of the most
effective treatments for poorly managed
blood sugar
26. Pioglitazone in diabetes
The European Medicines Agency recently
affirmed that the medication should not be
taken off the market, despite fears that it
may increase the risk of bladder cancer
The agency stated that the studies
indicating increases in bladder cancer risk
only showed a modest correlation, and
pioglitazone is an invaluable medicine for
managing blood sugar
27. Pioglitazone in diabetes
• Piglitazones are usually given when other
medications have proven ineffective
• This may mean that concerns about a
slight increase in bladder cancer risk are
the least of these patients' worries
• They should be primarily concerned about
poorly managed blood sugar
28. Pioglitazone in diabetes
• For these reasons, the agency only
recommended putting warning labels on
the medication and letting medical
professionals determine whether the risk is
worth it
• The U.S. Food and Drug Administration
issued a similar warning about the
medication but declined to pull
pioglitazone.
29. Pioglitazone in diabetes
• Still, some groups are concerned about the
increased risks associated with Actos
• The law firm Williams Kherkher recently
initiated a suit against Takeda
Pharmaceuticals, the company that makes
the medication
• Lawyers said the organization may be
responsible for the pain, suffering and
medical expenses of individuals who have
developed bladder cancer while taking Actos
30. Pioglitazone in diabetes
• Much of the concern over the potential side
effects associated with Actos stems from a
review of the safety and efficacy of the drug
conducted by Takeda five years after it was
approved by the FDA
• The results initially showed little overall
correlation between pioglitazone use and
bladder cancer
31. Pioglitazone in diabetes
• However, when investigators dug deeper
into the numbers, they found that those who
had been taking the drug for extended
periods of time appeared to have slightly
higher rates of cancer
• The FDA now warns physicians to be aware
of this risk and weigh them against potential
benefits
33. Dietary Protein Restriction in CKD: The Debate
Continues
Dietary protein restriction has been one of
the mainstays of nutritional intervention in CKD
patients
The apparent benefits of such dietary
manipulation include :
Diminishing the accumulation of nitrogenous
wastes
Limiting the metabolic disturbances,characteristic
of advanced CKD
34. Proven and Controversial Advantages and Disadvantages of
Dietary Protein Restriction in CKD Patient
Advantage Disadvantage
Proven Dereased toxin load Predisposition to PEM
Slowing progression Complex diet
Better BP control Needs close supervision
Better phosphorus Decreased muscle mass
control
Better H⁺control
Improved insulin
sensitivity
Improved proteinuria*
Controversial Extending time to ESRD Posible weight gain
Increase mortality
35. The role of dietary protein restriction in
slowing progression of CKD is more
controversial, although several meta-
analyses indicate a beneficial effect, albeit
small
36. Concern has been raised by several investigators
that low-protein diets(LPDs) especially very low
quantities of dietary protein (VLPDs), can lead to
Deterioration in the nutritional status
predispose to adverse clinical outcomes,
especially after the initiation long-term of
dialysis
37. These concerns have been mostly defied by
a number of studies showing
well-designed diets planned by skilled
dietitians & followed by motivated & adherent
patients are :
a)Effective
b) and do not have harmful effects on
nutritional condition
38. An article published in American Journal of
Kidney Diseases in 2009 by Menon et el.
ignite the controversy by providing evidence
that
Compared with an LPD, ssignment to a very
low-protein diet increased the risk of death
in long-term follow-up of the MDRD study
• But had no impact on delaying the
progression to kidney failure & no
relatioship with a composite outcome of
kidney failure & death
39. • These result emphasize the importance of
follow-up when evaluating the impact of
Interventions designed to slow the chronic
disease
41. Steroid in Stroke
Theoretically, steroids are
immunosuppressive agents that
Lessen Cerebral edema
Decrease intracranial pressure
Strengthen the blood-brain barrier
42. Steroid in Stroke
These possible benefits have to be weighed
against potentially serious steroid-related
side effects, such as
Immunosuppression and infection
Diabetic exacerbation
Gastrointestinal hemorrhage
Compromised wound healing
The place of steroids in the management of
stroke is still controversial
43. Steroid in Stroke
Perhaps the only general agreement on the
use of steroids in stroke is where vasculitis
is suspected or proven
As a cause of stroke, vasculitis is very rare
(<1% of all strokes), but treatment with
steroids should be started whenever it is
suspected
44. Steroid in Stroke
The effectiveness of steroids as one of the
options for the treatment of acute stroke,
either hemorrhagic or infarction, has never
been shown
So far only 2 randomized, controlled trials
concerning the use of dexamethasone in
primary supratentorial intracerebral
hemorrhage have been reported
45. Steroid in Stroke
In 2001, Ogun and Odusote performed a
prospective double-blind, placebo-controlled,
randomized clinical trial to determine
The effectiveness of a short course of high-
dose dexamethasone on mortality and
neurological recovery in acute stroke patient
Forty patients were eligible for the study
27 were presumed to have hemorrhagic
stroke and 13 patients had cerebral infarction
46. Steroid in Stroke
• Of the 27 hemorrhagic stroke patients, 15
were treated with 100 mg dexamethasone
immediately and 16 mg every 6 hours for 2
days, and 12 patients were given placebo
• Of the 13 patients with cerebral infarction, 5
were in the steroid group and 8 in the
placebo group
• At 1 month, 16 patients (80%) in the
dexamethasone group and 17 (85%) in the
placebo group had died
47. Steroid in Stroke
• This study failed to demonstrate any
benefit of a short-term course of high-dose
steroids in improving the mortality of acute
stroke patients, and the use of these
steroids should be discouraged
48. SAH
• Subarachnoid hemorrhage (SAH) accounts
for 7% to 8% of all strokes and leads to early
death (1 month) in about 30% to 35%
• Important contributing factors to the
development of delayed cerebral ischemia
after aneurysmal SAH
Decreasing plasma volume
Hyponatremia
Impaired autoregulation of cerebral blood
flow
Reactive inflammation
49. Steroid in Stroke
Mineralocorticoid treatment with
fludrocortisone acetate prevents plasma
volume depletion
Glucocorticoid treatment
anti-inflammatory effect
cerebral vasodilation and
Improvement of cerebral blood flow after SAH
50. Steroid in Stroke
• However, a beneficial effect of steroids on
the clinical outcome in patients with SAH
has not been proven by any well-conducted
clinical trial
51. Summary
• Steroids have a very limited role in stroke
therapy
• The only definite proven indication of steroids
in stroke is in patients with vasculitis
• Steroid use in acute stroke (either cerebral
infarction or hemorrhage) has been
confirmed by several well-controlled clinical
trials to be of no benefit
• With regard to SAH, it is still debatable whether
steroids are beneficial and further studies are
necessary to document their benefit.
52. Controversies in Stroke
Steroids Have No Role in Stroke Therapy
Niphon Poungvarin, MD, FRCP, FRCP(E), FRCP(Glasg)
+ Author Affiliations
From the Division of Medicine, Department of Neurology,
Siriraj Hospital Medical School, Mahidol University,
Bangkok, Thailand.
Correspondence to Prof Niphon Poungvarin, Mahidol
University - Thailand, Siriraj Hospital Medical School,
Dept of Medicine/Division of Neurology, Bangkok, 1070
Thailand. E-mail sinpg@mucc.mahidol.ac.th
54. Definition of Stem cell
• A stem cell is a generic cell that can make
exact copies of itself indefinitely
• stem cell has the ability to produce
specialized cells for various tissues in the
body, such as heart muscle, brain tissue, and
liver tissue
55. Types of stem cells
• Embryonic stem cells : these are taken
from aborted fetuses or fertilized eggs that
are left over from from in vitro fertilization
(IVF)
• They are useful for medical and research
purposes because they can produce cells for
almost every tissue in the body
56. • Adult stem cells - these are not as
versatile for research purposes because
they are specific to certain cell types, such
as blood, intestines, skin, and muscle
• The term "adult stem cell" may be
misleading because both children and
adults have them
57. Excitement and Controversy
• Doctors have been performing bone
marrow stem cell transplants for decades
• But when scientists learned how to
remove stem cells from human embryos in
1998, both excitement and controversy
ensued
• The excitement was due to the huge
potential these cells have in curing human
disease
58. Excitement and Controversy
• The controversy centered on the moral
implications of destroying human embryos
• Political leaders began to debate over how
to regulate and fund research involving
human embryonic stem (hES) cells
59. New Possibilities
• But Scientists have learned how to
stimulate a patient's own cells to behave
like embryonic stem cells
• These so-called induced pluripotent stem
(iPS) cells are reducing the need for
human embryos in research and opening
up exciting new possibilities for stem cell
therapies.
60. The Ethical Questions
• Until recently, the only way to get pluripotent
stem cells for research was to remove the
inner cell mass of an embryo and put it in a
dish
• The thought of destroying a human embryo
can be unsettling, even if it is only five days
old
61. The Ethical Questions
• Stem cell research thus raised difficult
questions:
Does life begin at fertilization, in the womb,
or at birth?
Is a human embryo equivalent to a human
child?
Does a human embryo have any rights?
Is it justified to destroy a single embryo to
cure a countless number of patients?
62. IPS Cells: Problem Solved?
With iPS cells now available as an
alternative to hES cells, the debate over
stem cell research is becoming
increasingly irrelevant
But ethical questions regarding hES cells
may not entirely go away
Inevitably, some human embryos will still
be needed for research
iPS cells are not exactly the same as hES
cells, and hES cells still provide important
controls
63. IPS Cells: Problem Solved?
• hES cells are a gold standard against
which the "stemness" of iPS cells is
measured
• Some experts believe it's wise to continue
the study of all stem cell types, since we're
not sure yet which one will be the most
useful for cell replacement therapies
64. IPS Cells: Problem Solved?
• An additional ethical consideration is that
iPS cells have the potential to develop into
a human embryo, in effect producing a
clone of the donor
• Many nations are already prepared for
this, having legislation in place that bans
human cloning
65.
66. Stem Cell Research Legislation
• The U.S. government released new stem
cell guidelines in 2009
• The new guidelines cover issues such as
informed consent of donors and the
wording of consent, as well as the issue of
financial gain
• The National Institutes of Health (NIH)
maintains a register of stem cells,
including human embryonic lines, that are
eligible for government funding.