New oral anticoagulants
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The document summarizes key details of new oral anticoagulant drugs (NOADs) that are alternatives to warfarin for preventing strokes. It lists 5 NOADs - dabigatran, rivaroxaban, apixaban, edoxaban - along with their brand names, FDA approval dates, dosing information, costs, and reversal agents. It also provides a brief overview of each drug's pharmacokinetic properties including time to peak levels, half-life, drug interactions, and renal clearance compared to warfarin. The document concludes by summarizing findings from major clinical trials on each NOAD's efficacy and safety compared to warfarin in reducing risks of stroke, intracranial
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The document discusses Bacillus anthracis, the bacteria that causes anthrax. It causes three forms of disease - cutaneous, inhalational, and gastrointestinal. B. anthracis is an aerobic, gram-positive spore-forming bacillus. The document outlines diagnostic criteria and laboratory tests used to identify B. anthracis from clinical samples. Treatment protocols are provided for cutaneous and inhalational anthrax in both adults and children. Vaccines available for immunization against anthrax are also mentioned.
cardiologische topics huisartsen
1. The document discusses various topics related to cardiovascular health including oxidative stress, inflammation, endothelial dysfunction, renal-angiotensin-aldosterone system activation, and details on NOAC dosing and contraindications for patients with kidney function impairment.
2. It also provides summaries of clinical trial data on PCSK9 inhibitors like evolocumab, showing consistent and robust LDL-C reductions across different statin types and doses. Evolocumab reduced other atherogenic lipids and modestly increased HDL-C.
3. Safety data indicated evolocumab was generally well tolerated with no significant differences in adverse events compared to control groups. Muscle-related events, neurocognitive events, and diabetes-
Anticoag update sept 2018
This document summarizes guidelines for anticoagulation therapy, including direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, apixaban, and edoxaban. It discusses their indications, dosing, efficacy, safety profiles compared to warfarin, drug interactions, and perioperative management. The key points are that DOACs are generally noninferior or superior to warfarin for stroke prevention with equal or lower risks of bleeding, though drug interactions and the lack of reversal agents for some need to be considered. Perioperative bridging therapy should only be used selectively for high-risk patients, and interruption of anticoagulation should be
Antimicrobial renal-dosing-guidelines kakaa
The document provides renal dosage adjustment guidelines for various antimicrobials. It states that pharmacists will automatically adjust doses of antimicrobials included in the protocol based on estimated creatinine clearance. It notes exceptions for patients under 1 year old where the pharmacist must discuss with the medical team. When a dose change is made, the pharmacist will write a new order indicating it is per protocol without requiring physician signature. Adjustments listed may be overridden if a physician writes "do not adjust" on the order. The most current guidelines can be found online at the antimicrobial stewardship program website.
Diabetes Mellitus A talk for Jas dental employees
Dr. Venkatesh Chittarvu presented information on diabetes mellitus to Jas Dental employees. Diabetes results from high blood glucose levels and symptoms include increased urination, thirst, hunger, and weight loss. It can lead to issues like retinopathy and neuropathy. Dentists must be able to diagnose diabetes, understand its relationship to periodontal disease, and take precautions when treating diabetic patients, like ensuring normal blood glucose levels before surgery. Treatment involves lifestyle changes like nutrition management, exercise, and medications prescribed by physicians. The presentation covered diabetes types, oral manifestations, screening, and prevention.
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Motor system examination
The document describes the examination of the motor system, including inspection of muscle state, tone, power, and reflexes. Inspection assesses muscle size, fasciculations, movements, and deformities. Tone is tested through passive movements and shaking/lifting techniques to identify hypotonia or hypertonia. Muscle power is graded from 0-5 based on strength against resistance. Specific muscles are then tested individually at each major joint.
Management of advanced parkinson’s disease
This document provides information on the management of advanced Parkinson's disease. It discusses the motor and non-motor symptoms that become most prominent in advanced stages, including gait and balance issues, dyskinesias, cognitive and behavioral changes, and autonomic dysfunction. It describes assessment scales used to stage Parkinson's severity and outlines approaches to treating various motor and non-motor complications through medication adjustments, surgical interventions like deep brain stimulation, and management of symptoms like constipation, urinary issues, and drooling.
Higher visual dysfunction
The document discusses higher visual dysfunction and disorders that can result from damage to different parts of the visual pathway and visual processing streams in the brain. It describes how visual information is processed from the eyes to the primary visual cortex and then into two streams - the ventral "what" stream for object recognition and the dorsal "where" stream for spatial processing. It then provides details on four specific disorders: visual agnosia (failure to recognize objects), achromatopsia (loss of color vision), pure alexia (impaired reading ability despite normal writing), and prosopagnosia (inability to recognize faces). Each disorder is caused by damage to different regions of the visual system and results in unique symptoms and challenges for
Facial nerve anatomy, pathology
The document discusses the anatomy, examination, diagnosis, and treatment of facial nerve palsy. It describes the motor, parasympathetic, and sensory parts of the facial nerve and their origins and functions. Examination of the frontal branch and tests for synkinesis, lacrimation, gustation, and sialometry can localize lesions. Bell's palsy is an acute idiopathic peripheral palsy without other cranial nerve involvement. Treatment may include corticosteroids, antivirals, corneal protection, decompression, and physiotherapy. Complications can include incomplete recovery or synkinesis.
Stroke guidelines
The document summarizes current guidelines on the use of tPA and endovascular treatment for acute ischemic stroke based on major clinical trials. It finds that early trials using intra-arterial tPA and first-generation devices showed limited benefit, but more recent trials using stent retrievers demonstrated improved recanalization rates and outcomes when endovascular treatment was initiated within 6 hours of stroke onset. The highest rates of functional independence were seen in patients who achieved near complete or complete recanalization.
Storage disease
This document summarizes several glycogen storage diseases and lysosomal storage diseases. For glycogen storage diseases, it lists the enzyme deficiency, symptoms such as hypoglycemia and hepatomegaly, and mnemonics to remember each disease. For lysosomal storage diseases, it provides the deficient enzyme, accumulated substrate, inheritance pattern, and key findings for each condition. It concludes by highlighting some distinguishing features between similar diseases, such as neurological symptoms in Niemann-Pick versus Gaucher's, and differences between Hunter's and Hurler's syndromes.
Leukodystrophies
This document summarizes several genetic leukodystrophies, including their inheritance pattern, affected enzyme or gene, clinical features, and MRI appearance. It describes adrenoleukodystrophy as an X-linked disorder caused by ABCD1 gene defects that leads to failure of peroxisomal fatty acid oxidation and can present as childhood cerebral adrenoleukodystrophy, adrenomyeloneuropathy, or Addison's disease. On MRI, it shows a characteristic pattern of different intensities in the central white matter. Zellweger syndrome is an autosomal recessive peroxisomal disorder caused by PEX1 defects that results in facial features, hepatomegaly, renal cysts, and diffuse
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This document provides an overview of neuro-opthalmology, including:
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Congenital malformations of the skull
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All what you need to know about medications used to treat Parkinson's disease patients. Doses, mechanism and side effects.
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A summary for all AED anti-epileptic medications, doses, mechanism of action, side effects and dosage for pediatrics.
Emperical antibiotics in ICU
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Multiple sclerosis disease modifying therapies
This document summarizes disease-modifying therapies for multiple sclerosis including self-injectable drugs like interferon beta-1a and glatiramer acetate, oral drugs like fingolimod and teriflunomide, intravenous drugs like natalizumab and ocrelizumab, and comparison of their effects on annualized relapse rate, EDSS progression, new MRI lesions, and percentage achieving relapse-free status over 2 years based on clinical trials. It also discusses risk factors for progressive multifocal leukoencephalopathy (PML) with natalizumab treatment and acute relapse treatment options.
Child Development Milestones
This document outlines typical developmental milestones in gross motor skills, fine motor skills, language, and social/cognitive abilities for children from 2 months to 5 years of age. Gross motor skills progress from lifting the head and rolling to walking, running, jumping and climbing stairs. Fine motor skills start with grasping toys and tracking objects and advance to using utensils, tying shoes, and printing letters. Language develops from cooing and babbling to using words and sentences of increasing length and complexity. Social and cognitive skills grow from recognizing caregivers and responding to sounds to following commands, pretend play, and basic academic concepts like colors and numbers.
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Sensation is the neurological process by which we become aware of surrounding environment.
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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chemistry investigatory project
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Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
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Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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This quiz was conducted as a promotional event for the 2024 Annual Meet of Kerala Chapter of API.
More than 20 participants took part everyday !
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Dr. ZANAB FARHEEN FAYAZ ,MDS(ORTHODONTICS & DENTOFACIAL ORTHOPEDICS ).
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Cell Therapy Expansion and Challenges in Autoimmune Disease
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Ageing, the Elderly, Gerontology and Public Health
Challenges associated with ageing from a public health perspective
Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Pollen and Fungal allergy: aeroallergy.pdf
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New oral anticoagulants
- 1. Koriesh, Oct 2015 The new oral anticoagulant drugs (NOADs) Warfarin Dabigatran Rivaroxaban Apixaban Edoxaban Brand name Coumadin Pradaxa Xarelto Eliquis Savaysa FDA approval for stroke Before Christ Oct 2010 Nov 2011 Dec 2012 Jan 2015 Dose Normal individual Hepatic disease Kidney disease Variable Avoid in Child-P B & C* No adjustment 150mg BID Avoid in Child-P B & C* CrCl 15:30: 75mg BID 20mg Daily(with evening meal) Avoid in Child-P B & C* CrCl 15:50: 15mg Daily 5mg BID Avoid in Child-P B & C* 2.5 BID if 2 of the following (age>80, Cr >1.5, Wt <60Kg) 60mg Daily Avoid in Child-P B & C* CrCl 15:50: 30mg Daily Costs (monthly) 8$ (5mg) 357$ 357$ 357$ 300$ Reversal Vitamin K Praxiband None None None Detailed information Target Vit K factors Factor II Factor Xa Factor Xa Factor Xa Time to peak 3-5 days 1h 3h 3h 1h Half life 40h 12h 7-11h 12h 9-11h Withholding before procedures 5 days 24h for minor surgery 48h for major surgery 24h for minor surgery 48h for major surgery 24h for minor surgery 48h for major surgery Interaction Multiple P-glycoprotein inhibitors** CYP 3A4 inhibitors & P- glycoprotein inhibitors** CYP 3A4 inhibitors & P- glycoprotein inhibitors** CYP 3A4 inhibitors & P- glycoprotein inhibitors** Renal clearance 0 80% 35% 25% 40% Compared to warfarin: Risk of Stroke (RRR) Risk of ICH (RR) Risk of GI bleed (RR) ↓ (34%) ↓ (0.4) ↑ (1.5) Non-inferior ↓ ↓ ↓ (20%) ↓ ↓ Involved Trials RE-LY RELY-ABLE ROCKET-AF Japanese AF AVERROES ARISTOTLE ENGAGE AF-TIMI * avoid in Child Pugh B & C due to increased risk of hemorrhage ** P-glycoprotein inhibitors: include verapamil – Amiodarone – Clarithromycin - Costs based on prices on 10/30/15 with no coupons or discounts.