Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to antipsychotic medications characterized by fever, muscle rigidity, and changes in mental status. It occurs in 0.01-0.02% of patients receiving antipsychotics. The classical presentation includes fever, muscle rigidity, altered mental status, and autonomic dysfunction. Diagnosis is based on exposure to antipsychotics, these clinical features, and elevated creatine kinase levels. Treatment involves supportive care, managing symptoms like fever and rigidity, and preventing complications. Outcomes are generally good if treated early, but mortality is around 10%.
A brief overview on Neuroleptic Malignant Syndrome presented for the PGs and the faculty of Dept. of Medicine, Govt. Medical College Kannur, Kerala, India
A brief overview on Neuroleptic Malignant Syndrome presented for the PGs and the faculty of Dept. of Medicine, Govt. Medical College Kannur, Kerala, India
Metabolic encephalopathy diagnosis and managementRobert Robinson
Overview of the diagnosis and management of metabolic encephalopathy for third year medical students in the Personalized Education Program portion of the third year curriculum at SIU Medicine
Metabolic encephalopathy diagnosis and managementRobert Robinson
Overview of the diagnosis and management of metabolic encephalopathy for third year medical students in the Personalized Education Program portion of the third year curriculum at SIU Medicine
Malignant hyperthermia is a potentially fatal hyperdynamic response due to pharmacogenetic abnormalities. This ppt gives a brief description of pathology and pharmacotherapy of malignant hyperthermia.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
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.
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
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.
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
2. Definition
• NMS is an idiosyncratic, life-threatening
complication of treatment with antipsychotic
drugs that is characterized by fever, severe
muscle rigidity, and autonomic and mental
status changes
• ( Strawn et al 2007)
3. • NMS remains a significant source of morbidity
and mortality among patients receiving
antipsychotics. For example, data from the U.S.
Agency for Healthcare Research and Quality
indicate that about 2,000 cases of NMS are
diagnosed annually in hospitals in the United
States, incurring health care costs of $70
million, with a mortality rate of 10%,
4. 1956 - First case reported.
1960 – Current name was introduced in a French
study.
Rare.
• 1960-1997: Incidence 0.2-3.2%
• Current incidence : 0.01 – 0.02%
Mortality rate – 10%.
5. TYPES
• AFEBRILE NMS
Less Malignant, Short Lasting, Good Prognosis
• CLASSICAL NMS
Malignant, long lasting, guarded prognosis
7. High Index Of Suspicion
• Patient on neuroleptics
• Altered sensorium
• With or without rigidity (as it may develop later)
• With or without fever (as it may develop later)
8. • >38 C (100.4 F)Fever
• “Lead pipe” in most severe form
Muscle
rigidity
• Drowsiness, agitation, confusion, delirium,
coma
Altered
mental status
• Fluctuations in BP, tachypnoea, tachycardia,
sialorrhoea, diaphoresis, flushing, skin
pallor, incontinence
Autonomic
instability
Clinical Presentation
Classical tetrad of clinical features
9. Diagnostic Criteria according to DSM 5
• Exposure to Dopamine antagonist or dopamine
agonist withdrawal, within past 72 hours
• Hyperthermia ( >100.4 o F on at least two
occasions, measured orally)
• Rigidity
• Reduced or fluctuating levels of consciousness
• CK elevation (at least 4 times upper limit of
normal)
10. Contd…
• Sympathetic nervous system lability- defined as
any two of the following
a. Blood Pressure elevation (systolic or diastolic
>= 25 % above baseline)
b. Blood pressure fluctuation (>=20 mm Hg
diastolic change or >=25 mm Hg systolic
change within 24 hours)
c. Diaphoresis
d. Urinary incontinence
11. Contd…
• Hyper metabolism, defined as heart rate
increase (>= 25% above baseline) and
respiratory rate increase (>= 50 % above
baseline)
• Negative work up for infectious, toxic, metabolic,
and neurological causes.
12. Levensons Criteria for diagnosis of NMS
Presence of 3 major or 2 major and 4 minor signs indicate
a high probability of NMS
(J Anaes Clin Phar 2012 Oct-Dec: 28(4):517-519)
MAJOR CRITERIA MINOR CRITERIA
Fever Tachycardia
Rigidity Abnormal Blood Pressure
Elevated CPK Altered sensorium
Diaphoresis
Leucocytosis
13. Pathophysiology
• Precise mechanisms are unproven.
• Antipsychotic-induced dopamine blockade
• Sudden drop in CNS dopaminergic activity
•
Nigro striatal pathway – Muscle Rigidity
Hypothalamus --- Impaired heat regulation
Mesolimbic / mesocortical pathways– altered mental status
14. DIFFERENTIAL DIAGNOSIS
• Infectious
• Meningitis or encephalitis
• Post infectious encephalomyelitis
syndrome
• Brain abscess
• Sepsis
• Psychiatric or neurological
• Idiopathic malignant catatonia
• Agitated delirium
• Benign extrapyramidal side effects
• No convulsive status epilepticus
• Structural lesions, particularly
involving the midbrain
• Toxic or pharmacological
• Anticholinergic delirium
• Salicylate poisoning
• Malignant hyperthermia
(inhalational anaesthetics,
• succinylcholine)
• Serotonin syndrome (monoamine
oxidase inhibitors, triptans,
• linezolid)
• Substances of abuse
(amphetamines, hallucinogens)
• Withdrawal from dopamine
agonists, baclofen, sedative
hypnotics,
• and alcohol
• Endocrine
• Thyrotoxicosis
• Pheochromocytoma
• Environmental
• Heatstroke
16. Challenges in Classical NMS
• Management of hyperthermia
• Management of hypotension and dehydration
• Management of severe rigidity
• Management of complications – ARDS and
Cardiac arrest
• Management of other complications arising due
to prolon ICU/ Ward stay like bed sores, hospital
acquired pneumonias, septicemia, etc.
18. Management of Hyperthermia
• Cold sponging, ice packs, ice water enema
• Antipyretics:
a. Combination of Mephenemic acid (450 mg) +
paracetamol (500 mg)
b. Intra Venous Diclofenac
c. Intravenous Paracetamol
• It may take 2 to 3 days for the temperature to
normalize
19. Management of Hypotension and
Dehydration
• I V central line placement
• I V fluids
• Injection Mephentine 15 mg
• Dopamine / Dobutamine / Noradrenaline
20. Management of Severe Rigidity
• Tablet Bromocriptine 2.5 mg 1 – 1 – 1
gradually increase to 4 – 4 – 4
• Tablet Amantadine 100 mg 1 – 1 – 1
• Dantrolene Sod. Is not available in India
• Consider using Tablet Baclofen 30 mg 1 – 1 – 1
21. Management of Myoglobinuria leading
to acute renal shutdown
• Vigorous hydration – plenty of IV fluids to flush
the kidney
• Isotonic saline boluses of 20 ml / kg should be
initially administered with repeat boluses
depending on the hydration status of the patient
• This should be followed by continuous hydration
with IV fluids
• Maintain blood pressure to an optimum level
• Achievement of urine output goal of 2-3 ml
/kg/hr is recommended
22. • Follow up with mannitol to induce diuresis
supported by administration of IV fluids has
been advocated
• Mannitol causes diuresis, which minimizes
intratubular myoglobin deposition, acts as a free
radical scavanger and reduces tubule cell
damage and may act as direct renal vasodilator
• Raising the pH of the urine to 6.5 or more can be
facilitated by adding sodium bicarbonate
23. Management of complications
• The patient may have to be on assisted
ventilation and may require cardiorespiratory
resuscitation
• A good nursing care, prophylactic use of
antibiotics may be used to prevent some
complications.
• Ondensetron is used to manage vomiting
24. ECT IN NMS
Strawn, J.R., Keck, p., Jr.,Stanley N. Caroff, M.D. Neuroleptic Malignant Syndrome Am J Psychiatry 164:6,
June 2007
• A review found that ECT was
consistently effective even
after failed pharmacotherapy
and that clinical response
often occurred over the course
of the first several treatments.
Treatment response to ECT
was not predicted by age, sex,
psychiatric diagnosis, or any
particular features of NMS. A
typical ECT regimen for acute
NMS would include six to 10
treatments with bilateral
electrode placement.
25. Antipsychotic use after NMS
Estimated risk of 30% of developing NMS again
with re-introduction of antipsychotics.
Precautions:
▫ At least 2 weeks should be allowed from recovery
before rechallenge.
▫ Low potency conventional antipsychotics/ atypical
antipsychotics.
▫ Start with a low dose and titrate gradually.
▫ Careful monitoring for early signs of NMS.
26. Prognosis
• Most episodes resolve in 2 weeks (>70%)
• Mortality rates 10-20%
▫ Decreased if associated with higher potency agents
compared to lower potency agents
▫ Cause of Death
Cardiac arrhythmias
Myocardial infarction
Seizures
Pulmonary edema
Bronchopneumonia
Renal failure