A heart transplant is an operation in which a failing, diseased heart is replaced with a healthier, donor heart. Heart transplant is a treatment that's usually reserved for people who have tried medications or other surgeries, but their conditions haven't sufficiently improved
Million Heart, ticking time bomb can we predict or preventasadsoomro1960
There are different stages of HF syndromes , stage B HF is grossly neglected by cardiology community ,which is a ticking bomb to prevent symptomatic HF
Chronic coronary syndrome (CCS) is a term that defines coronary artery disease as a chronic progressive course. It has been introduced to replace the previous term ‘stable coronary artery disease’.
A Mistake that has Hurt No One: Sinus Mistakusasclepiuspdfs
There are times when we, the health care providers make a diagnosis and plan to treat that condition accordingly. In the mean time, because of a second opinion or another specialist consult might change the diagnosis completely and therefore the mode of management could change drastically. Here we present a similar case scenario for work-up of chest pains changing the diagnosis and therefore the mode of treatment. However in this process the patient did not get hurt (“Sinus Mistakus”).
A heart transplant is an operation in which a failing, diseased heart is replaced with a healthier, donor heart. Heart transplant is a treatment that's usually reserved for people who have tried medications or other surgeries, but their conditions haven't sufficiently improved
Million Heart, ticking time bomb can we predict or preventasadsoomro1960
There are different stages of HF syndromes , stage B HF is grossly neglected by cardiology community ,which is a ticking bomb to prevent symptomatic HF
Chronic coronary syndrome (CCS) is a term that defines coronary artery disease as a chronic progressive course. It has been introduced to replace the previous term ‘stable coronary artery disease’.
A Mistake that has Hurt No One: Sinus Mistakusasclepiuspdfs
There are times when we, the health care providers make a diagnosis and plan to treat that condition accordingly. In the mean time, because of a second opinion or another specialist consult might change the diagnosis completely and therefore the mode of management could change drastically. Here we present a similar case scenario for work-up of chest pains changing the diagnosis and therefore the mode of treatment. However in this process the patient did not get hurt (“Sinus Mistakus”).
Heart Failure is common ,complex clinical syndrome,there are different classifications. I have classified in totally different way in graphic form ,with 6 examples of our patients
PHYSIOTHERAPY IN HEART TRANSPLANTATION..AneriPatwari
This power point throws the light on Heart transplantation.
it will inform about the indications and contraindication of heart transplant.
It will tell you about the donor selection & donor-recipient matching for heart transplantation.
It will enhance the knowledge of types and complications of heart transplantation.
It will feed the need of assessment and management of heart transplant pre and post-off
It will give the information about physiotherapy assessment pre and post surgery for heart transplantation.
It will lighten the side of physiotherapy management for heart transplantation.
Similar to New toy in town,non dilated non ischemic HF (20)
Its leftover homework of our physician scientist & health care providers for the last 75 years indeed. Contemporary challenges are numerous , but there is a will there is a way ,today or tomorrow some body some where has to start .
Currently heart failure is being treated by every physician ,any where from community to academic institution ,and is based on old system of payment ( FFP ) fee for service ,we need to switch from FFS to Value based payment ( VBP ) .
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
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.
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.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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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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
How to Give Better Lectures: Some Tips for Doctors
New toy in town,non dilated non ischemic HF
1. Reversible Etiology
Reversible Heart Failure ,is it different ??
Dr Asadullah Khan Soomro & Dr Burai Adlan
Department of Adult Cardiology
King Abdullah Medical City Holy Makkah
Email; hssbasadsoomro@gmail.com
Non Dilated ,non ischemic
Heart Failure Syndromes
With Severe Systolic Dysfunction
“ Benign or Malignant”
2. Non Dilated ,Non Ischemic
De-Novo Heart Failure ,Severe LV Systolic
Dysfunction, moderate MR severe pulm hypertension
.
Journey of simple acute De-Novo
Heart Failure syndromes
Admitted 30.12 2019,discharged
2.1.2020, three post discharge HF face
to face visits.
Two HF Virtual Clinic review 23.6.20 and 19.8.20.
Later regular HF review .Last visit 6.4.2021.
IstPost discharge Heart Failure clinic Visit on 28.1.2021, Stopped Coversyl and after 36 hours wash out
switched to sacubitril 50 mg bid,
2nd Visit 11.2.2021 Clinically compensated, Vitally stable, Labs OK Sacubitril Titrated to 100 mg bid
3rd visit 10.3.20 No ER visit, No readmission, Vitally stable ,Labs OK sacubitril titrated to200 bid.
First HF
hospitalization
ER Visit Post discharge HF clinic
Transitional care
Vulnerable phase to visit
ER and readmission
BNP Level
6.2.20, 759
8.3.20, 1105
19.8.20, 179
20.10.20, 47
HB%, 14.3, Trop 0.070, HB A1C 8.4
Creat 1.0, Na 139, K,4.3 T bil,0.7
AST 15, ALT 26,Cholest 128,TG 80
LDL 75, HDL 37 ,Uric acid 9.3
Here we are at Get with the Guide Line standard
( AHA) Achieved sacubitril dose titration goal with
in 5-6 weeks . We wish could have even started
early before discharge from hospital.
3. Non Dilated ,Non Ischemic
De-Novo Heart Failure ,Severe LV Systolic
Dysfunction, moderate MR severe pulm hypertension
62 year male DM,HTN non smoker admitted first time at local
hospital in December 2019 with H/O symptoms of heart failure
FC 111 1V for two weeks
Diagnosed to had De-Novo heart failure with severe LV
systolic dysfunction EF 20-25%.No major organ dysfunction
After stablization shifted to our hospital on 30.12.2019 for CAG
to rule out CAD.
Echo revealed Non dilated LV with severe global systolic
dysfunction, & moderate MR
4. Non Dilated ,Non Ischemic
De-Novo Heart Failure ,Severe LV Systolic
Dysfunction, moderate MR severe pulm hypertension
Did CAG and coronaries were essentially normal, evaluated by MRP
and was considered for CRTD after cardiac MRI.
Seen by pulmonology colleague and there was no apparent cause of
severe pulmonary hypertension, may be related to heart failure.
Discharged on 3rd day on Perindopril, Bisoprolol, Spironolactone
,Furosemide, Nitrates ,Statins and ASA .
Follow up after two weaks at HF clinic /MRP 3 months.
Post discharge he was seen in screening clinic on 28.1.20
( First HF Review ).
Subsequently he was seen face to face until sacubitril full dose
titration, stopped Nitrates and furosemide ,Followed twice Virtually
,& Refilled 200 mg sacubitril .
5. Non Dilated ,Non Ischemic
De-Novo Heart Failure ,Severe LV Systolic
Dysfunction, moderate MR severe pulm hypertension
During COVID phase could not turn up for CMRI, neither got opportunity
to repeat echo after 6 months of sacubitril full dose ( standard
practice) .
BNP came down from 1105 to 47 , He maintained dry weight to 75 Kg,
Echo was repeated after one year of sacubitril 200 mg , His EF improved
from 20-25% to 50-55%, MR reduced to mild pulmonary
hypertension stablized RSVP reduced from > 60 to 35.
Last seen on 6.4.21 ,sacubitril changed to candesarten 16 mg
Will see him back after 4 months.
During this one & half year journey on ARNI, 0% Visit to ER,0% Non HF
and HF readmission, Improved quality of life .Fasted whole month of
Ramdan with prayers in Masjid.
( Be Ever green)
6. Non Dilated non Ischemic
Heart Failure
Improved EF ( 15 month Post ARNI )
.
30.12.2019 before ARNI
The left ventricle is grossly normal size.
EF= 20-25 %
There is moderate to severe global hypokinesis of
the left ventricle.
The right ventricle is mild to moderately dilated.
The right ventricular systolic function is mildly
reduced.
There is moderate mitral regurgitation. (vena
contracta = 0.4 cm) No Aortic Valve stenosis No
aortic regurgitation is present. There is moderate
to severe tricuspid regurgitation.
Right ventricular systolic pressure is elevated at
>60mmHg. (assuming RAP =15 mmHg)
There is no pericardial effusion.
4.4.2021 After ARNI
Left ventricular systolic function is low normal.
EF= 50-55 %
There is borderline global hypokinesis of the left
ventricle.
Left ventricular diastolic dysfunction grade II.
The right ventricle is normal in size and function.
The left atrium is mildly dilated.
There is mild mitral regurgitation.
Right ventricular systolic pressure is elevated at 30-
40mmHg.
There has been an improvement of the global LV
systolic function since the last echo 2019.
7. Soomro’s Classification of Heart Failure
Syndromes
.
Acute De-Novo
Heart Failure syndromes
Chronic Heart Failure
Syndromes
Chronic
Compensated
Stage C Acute
Decompensation
of Chronic HF
Stage C
Chronic
Advanced HF
Syndromes
Stage D
Acute
De-Novo
Simple Acute
De-Novo
Complex
Acute
De-Novo
Malignant
“Benign or Malignant ?”
We have following 6 common heart failure syndromes , always classify your patients
80 to 90% job is clinical . Use your wisdom before decisions.
8. Heart Failure clinic Dispose Criteria
“ Dispose to where ,if greens are rising“
Low risk HF patient ,can be discharged if established co-ordinated follow
up at community heart failure services are available at primary /
secondary care HF Clinics attended by combination of nurses and
experienced physicians. Minimum of at least two of the following patient
characteristics should be present to justify discharge from HF clinic.
1) Stable NYHA class 1 or 11 for 6-12 months.
2) Using optimal devices and pharmacological therapies.
3) Stable adherence to optimal HF therapy.
4) No hospitalization for > one year.
5) LVEF > 35% ( Consisitently shown if > 1 recent EF measurement).
6) Reversible causes of heart failure controlled.
7) Follow up by physician interested in management of HF.
8) Establish a new permanent KAMC Virtual Heart failure clinic
9. Alternatives after disposal
from HF clinic
Establish a Net work of
Community
Heart Failure
Services
Under supervision of
Makkah Heart Failure
cluster.
Establish
KAMC
Permanent Virtual Heart
Failure Clinic
Under umbrella of
Nurse led multi disciplinary
Heart Failure
Clinic
Reduce your burden of Heart Failure ER Visits and re admissions through these alternatives
Other wise, we can not break vicious cycle of disposal and re appearance as new cases,
will cost more ??
10. King Abdullah Medical City Holy Makkah
From the desk of Heart failure Clinic
“Feed back letter to referring hospital/community physician ”
Dear Doctors,
I had the pleasure of meeting your patient Mr./ Miss / Mrs.__________________________________ in Rapid Access Heart Failure clinic today. I
have reviewed the records that you have kindly forwarded to me, although you are familiar with patients history. I will briefly review it for your
record and ours.
Above named Patient is a _______ year old man/woman who gives thorough history including concomitant medical problems. A social history,
family, occupational history and current medications __________________
__________________________________________________________________________________________
He/she now complaining of
____________________________________________________________________________________________with past medical history of
_________________________________________________________ he/she does/ does not smoke or drink alcohol, he /she lives with
____________________________ and worked as _________ but unable to work for
________________________________________________________________________
Overall Patient is suffering from heart failure Stage ________________ due to an____________ ____________. Precipitated by
___________________ there is / is no evidence of fluid overload at this time. Other pertinent diagnosis and problems include,
____________________________________________________________________________________________
I would suggest the following further diagnostic tests to assess present status and prognosis. I have taken the liberty to adjust her current
medications as follows __________________________________________________
____________________________________________________________________________________________
I have also suggested the initiation of Beta blocks / ACE inhibitors / others _______________________________.
I have also introduced her to Dr. / Nurse _________________________ members of the team for follow-up care.
Once the above testing is completed and medications adjusted. I will plan on seeing him/her to discuss results and plans. At that time I will
communicate my findings to you.
I appreciate the opportunity to participate in patient care with you.
Sincerely,
Physician Name & Signature
Note ( Modify your description according to patient and type of clinic)
11. Summary
Heart Failure is a science and a art ,guide line are to guide
us ,but decision is your. Devices are revolutionary but at
the cost of complications especially infections.
Do not treat only ejection fraction, treat heart failure and
patient as a whole. Things keep changing beyond our
expectations .
Devices are life changing and saving indeed but
effectiveness of drugs and idiopathic dynamic etiology
must be considered and, review your patient from time to
time for devices.
12. Summary
HF clinic is a old and tiny part of multidisciplinary
heart failure programe.
Non Dilated non ischemic cardiomyopathy is new
entity in heart failure world ,especially idiopathic.
Improved HF & ejection fraction was because of drugs
or underlying idiopathic etiology is a mysterious
question ,credit goes to physician scientist or industry
?? 50-50% or 70-30% ? You are the best judge.
( Be Ever green)
13. Thanks to all colleagues for giving us opportunity to take care
of this Pleasant gentleman,& to learn some thing new in heart
failure world of tigers and elephants .