Cardiometabolic risks (CMRs) have rapidly increased to epidemic proportions worldwide in the past three decades. Cardiovascular disease (CVD) remains the number one killer. No country has reduced, reversed, or prevented the increase in the incidence or prevalence of chronic metabolic diseases. Framingham Heart Study group described the modifiable risk factors that promote the development of CVD. They also developed risk calculators, for the prediction of acute vascular events such as heart attacks and stroke. The risk predictor algorithms were fine-tuned, as and when additional risk factors were discovered. However, at the time of this writing, there is no such calculator for assessment, stratification, and management of CMRs. On the other hand, numbers of non-invasive diagnostic devices have been developed for continuous monitoring of blood pressure and glucose profiles. We have described in our earlier articles, non-invasive diagnostic platform developed by LD-Technologies,
A new CDC report finds that hepatitis A infections in the U.S. have risen by 294% since 2015. In nine states and Washington, D.C., the increase in rates was 500% compared to previous years. Hepatitis A, which is the most common cause of viral hepatitis worldwide, is spread fecal-orally after contact with an infected person but is preventable through a vaccine. In the new report, which looked at transmissions between 2016 and 2018, the CDC received 15,000 reports of infections in the U.S.: People who reported drug use or homelessness made up the majority of those who had infections, followed by cases among men who have sex with men and among people who ate contaminated food.
HIMSS 2016 "Predictive Analytics & Genomics in Population Health ManagementDaniel F. Hoemke
Presenting with BaseHealth Founder and Chief Science Officer, Dr. Hossein Fakhrai-Rad at HIMSS 2016. The next generation of total population health integrating genetic data with medical, lifestyle, family history and environmental data.
Δείκτης Ποιότητας και Διαθεσιμότητας της Ιατροφαρμακευτικής Περίθαλψης (Healt...Δρ. Γιώργος K. Κασάπης
Η ποιότητα και διαθεσιμότητα της ιατροφαρμακευτικής περίθαλψης έχει βελτιωθεί στις περισσότερες χώρες του κόσμου μετά το 1990. Όμως, από την άλλη, έχουν αυξηθεί οι ανισότητες τόσο μεταξύ των χωρών, όσο και στο εσωτερικό τους. Η Ελλάδα βρίσκεται στην 20ή θέση της παγκόσμιας κατάταξης, ακριβώς πάνω από τη Γερμανία, σύμφωνα με διεθνή μελέτη που δημοσιεύθηκε στο επιστημονικό έντυπο The Lancet.
Ερευνητές, με επικεφαλής τον καθηγητή Κρίστοφερ Μάρεϊ του Ινστιτούτου Μετρήσεων και Αξιολόγησης της Υγείας του Πανεπιστημίου της Ουάσιγκτον στο Σιάτλ, δημιούργησαν ένα νέο παγκόσμιο δείκτη (Healthcare Access and Quality Index), και βαθμολόγησαν από το 0 έως το 100, 195 χώρες ανάλογα με την ποιότητα της ιατροφαρμακευτικής περίθαλψής τους και του βαθμού στον οποίο έχει ο πληθυσμός έχει πρόσβαση σε αυτήν.
Ο δείκτης έλαβε υπόψη στοιχεία της περιόδου 1990-2015 και βασίστηκε στη θνησιμότητα που υπάρχει σε κάθε χώρα για 32 παθήσεις, η οποία θα μπορούσε να είχε αποφευχθεί με την κατάλληλη ιατρική φροντίδα.
Ουσιαστικά, ο δείκτης αξιολογεί το σύστημα υγείας κάθε χώρας ανάλογα με το βαθμό που οι κάτοικοί της πεθαίνουν με ρυθμό ταχύτερο του αναμενομένου από αιτίες που θα μπορούσαν να είχαν αποφευχθεί με την κατάλληλη ιατροφαρμακευτική παρέμβαση.
Healthcare in future will not be like today. The changes are dramatic and paradigmatic. In this presentation we will see some the mega trends influencing this field. Future Trends, Population Increase, Aging, Urbanization, Individualization and health awareness, Consumerism, Shifting Economy, Technological Progress, Climate Change and Environmental Pollution, Shifting Disease Patterns, lifestyle diseases, high-calorie diet, physical inactivity and higher levels of stress, Decline in muscular, skeletal and infectious diseases, Better-informed Patients, Decline in information asymmetry, Internet, Social Networks, Self care, home care, self-medication, New Health Markets, Pharma, economy, pharmerging countries, Growing Competition, Brand, Generic, Innovative, HighTech, Increasing Cost Pressure, Aging, Better Access, Complex Supply Chains, R&D outsourcing, Complex Products, supply chains, Product Development, Innovation, Pharmacogenomics, Therapeutic Vaccines, Regenerative medicine, 3D Printing, Robot-assisted surgeries, Mobile health,Tele-medical applications, Direct-to-consumer (DTC ) distribution, Direct-to-consumer (DTC ) advertisement, OTC Growth, home delivery, prescription drugs,
A new CDC report finds that hepatitis A infections in the U.S. have risen by 294% since 2015. In nine states and Washington, D.C., the increase in rates was 500% compared to previous years. Hepatitis A, which is the most common cause of viral hepatitis worldwide, is spread fecal-orally after contact with an infected person but is preventable through a vaccine. In the new report, which looked at transmissions between 2016 and 2018, the CDC received 15,000 reports of infections in the U.S.: People who reported drug use or homelessness made up the majority of those who had infections, followed by cases among men who have sex with men and among people who ate contaminated food.
HIMSS 2016 "Predictive Analytics & Genomics in Population Health ManagementDaniel F. Hoemke
Presenting with BaseHealth Founder and Chief Science Officer, Dr. Hossein Fakhrai-Rad at HIMSS 2016. The next generation of total population health integrating genetic data with medical, lifestyle, family history and environmental data.
Δείκτης Ποιότητας και Διαθεσιμότητας της Ιατροφαρμακευτικής Περίθαλψης (Healt...Δρ. Γιώργος K. Κασάπης
Η ποιότητα και διαθεσιμότητα της ιατροφαρμακευτικής περίθαλψης έχει βελτιωθεί στις περισσότερες χώρες του κόσμου μετά το 1990. Όμως, από την άλλη, έχουν αυξηθεί οι ανισότητες τόσο μεταξύ των χωρών, όσο και στο εσωτερικό τους. Η Ελλάδα βρίσκεται στην 20ή θέση της παγκόσμιας κατάταξης, ακριβώς πάνω από τη Γερμανία, σύμφωνα με διεθνή μελέτη που δημοσιεύθηκε στο επιστημονικό έντυπο The Lancet.
Ερευνητές, με επικεφαλής τον καθηγητή Κρίστοφερ Μάρεϊ του Ινστιτούτου Μετρήσεων και Αξιολόγησης της Υγείας του Πανεπιστημίου της Ουάσιγκτον στο Σιάτλ, δημιούργησαν ένα νέο παγκόσμιο δείκτη (Healthcare Access and Quality Index), και βαθμολόγησαν από το 0 έως το 100, 195 χώρες ανάλογα με την ποιότητα της ιατροφαρμακευτικής περίθαλψής τους και του βαθμού στον οποίο έχει ο πληθυσμός έχει πρόσβαση σε αυτήν.
Ο δείκτης έλαβε υπόψη στοιχεία της περιόδου 1990-2015 και βασίστηκε στη θνησιμότητα που υπάρχει σε κάθε χώρα για 32 παθήσεις, η οποία θα μπορούσε να είχε αποφευχθεί με την κατάλληλη ιατρική φροντίδα.
Ουσιαστικά, ο δείκτης αξιολογεί το σύστημα υγείας κάθε χώρας ανάλογα με το βαθμό που οι κάτοικοί της πεθαίνουν με ρυθμό ταχύτερο του αναμενομένου από αιτίες που θα μπορούσαν να είχαν αποφευχθεί με την κατάλληλη ιατροφαρμακευτική παρέμβαση.
Healthcare in future will not be like today. The changes are dramatic and paradigmatic. In this presentation we will see some the mega trends influencing this field. Future Trends, Population Increase, Aging, Urbanization, Individualization and health awareness, Consumerism, Shifting Economy, Technological Progress, Climate Change and Environmental Pollution, Shifting Disease Patterns, lifestyle diseases, high-calorie diet, physical inactivity and higher levels of stress, Decline in muscular, skeletal and infectious diseases, Better-informed Patients, Decline in information asymmetry, Internet, Social Networks, Self care, home care, self-medication, New Health Markets, Pharma, economy, pharmerging countries, Growing Competition, Brand, Generic, Innovative, HighTech, Increasing Cost Pressure, Aging, Better Access, Complex Supply Chains, R&D outsourcing, Complex Products, supply chains, Product Development, Innovation, Pharmacogenomics, Therapeutic Vaccines, Regenerative medicine, 3D Printing, Robot-assisted surgeries, Mobile health,Tele-medical applications, Direct-to-consumer (DTC ) distribution, Direct-to-consumer (DTC ) advertisement, OTC Growth, home delivery, prescription drugs,
Global Medical Cures™ | USA Chartbook on HealthCare for Blacks
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Doctoralia Report on Health and the Internet 2015Doctoralia
How do Internet users behave in the field of online heath? The answer to this and other questions can be found in the first Doctoralia Report on Health and the Internet 2015.
Today it’s critical for providers to devote time to patient education; inform patients about their conditions and how to prevent, treat, and manage them. Proper management of chronic conditions extends well beyond episodic and infrequent visits to a provider’s office. This population health white paper discusses why patients must become responsible for their day-to-day disease management. Patients will frequently be required to self-monitor their health indicators, observe symptoms, and note behavior, but they must also adhere to complex medication regimens
Background; Social Class has shown relation with admissions at Emergency Departments. To assess whether there is a relationship between the level of triage and the social class of patients who attend the emergency department and whether there are other variables that can modulate this association. Methods Observational study with 1000 patients was carried out between May and July 2018 in the Emergency Department of the University Hospital Arnau de Vilanova in Lleida. Sociodemographic variables such as age, gender, country of origin and marital status were analyzed. The triage level and the main explanatory variable was social class. Social class was calculated based on the CSO-SEE 2012 scale. Results 49.4% were male and the average age was 51.7 years. Most of the patients (66.6%) attended the emergency department under their own volition and the most common triage levels were level III or Emergency (45%). There is a significant relationship between age and triage level. The younger patients had a lower triage level (p <0.001). The percentage of patients with lower social class who attended the emergency department for minor reasons was 42% higher compared to the rest of the patients (RR = 1.42; 1.21-1.67 95% CI, p <0.001). Conclusions; Patients with a lower socioeconomic class go to the Emergency Department for less serious pathologies.
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
IHME's Dr. Lozano discusses how the quality of maternal mortality data was improved in Mexico, leading to better estimates to more reliably measure progress.
For more information please visit www.healthmetricsandevaluation.org
More young people in Canada are visiting EDs because of drinking alcoholΔρ. Γιώργος K. Κασάπης
More people are visiting emergency departments after drinking alcohol, a new study finds. Researchers looked at more than 765,000 ED visits in Ontario, Canada’s largest province, and found a 175% increase in such visits between 2003 and 2016 among 25- to 29-year-olds. That spiked to a 240% increase in alcohol-related ED visits for young women, who were also more likely than men to be under Canada’s legal drinking age of 19. For both young men and women, visiting the ED for alcohol-related problems also led to more hospital admissions than other types of ED visits. Other countries, including the U.S., have experienced similar increases in alcohol-related visits to the ED, the authors behind the new study write, urging more research into the reasons behind the growing trend.
Abstract. The Ministry of Health and Social Services in Namibia under the division of epidemiology uses a manual
paper-based approach to capture disease surveillance data through 5 levels of reporting which include the community level, the health facility level, the district level, and the national level. As a result, this method of communicating
and exchanging disease surveillance information is cost and time consuming, which delay disease surveillance information from reaching the head office on time.
Predictive and Preventive Care: Metabolic Diseasesasclepiuspdfs
South Asians have a very high incidence of ischemic heart disease and stroke. In addition, they also have a very high incidence of metabolic diseases such as prehypertension, hypertension, visceral obesity, metabolic syndrome, prediabetes, type-2 diabetes, and its clinical complications. Currently, there are over 75 million diabetic subjects in India and an equal number of prediabetics. Republic of China has taken over India as the diabetes capital of the world, with over 115 million diabetics. Modern medicine is disease focused and has failed to address the prevention of these chronic diseases. According to the reports from the United Nations (Millennium Development Goals [MDGs], the World Health Organization, Global Health Initiatives, and the non-communicable disease risk task force), obesity has increased by 2-fold and type-2 diabetes by 4-fold worldwide. Experts in this field predict that chances of meeting the MDGs set by the UN members of reducing the incidence of these diseases at 2025 to the level of 2020 are very little. Western medicine has failed to reduce or reverse the trend in the incidence of these diseases. We feel that an integrated approach to health care may be a better option, to reduce the disease burden in developing and resource-poor countries. Having said that, one cannot prevent something that one is not aware of, as such it is the need of the hour for us, to develop a robust predictive and preventive health-care platform. In an earlier article, we presented our views on reducing or reversing cardiometabolic diseases. There is great enthusiasm among the health-care providers and professional bodies that integration of emerging technologies will help develop personalized, precision medicine, as well as reduce the cost of health-care worldwide.
Global Medical Cures™ | USA Chartbook on HealthCare for Blacks
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Doctoralia Report on Health and the Internet 2015Doctoralia
How do Internet users behave in the field of online heath? The answer to this and other questions can be found in the first Doctoralia Report on Health and the Internet 2015.
Today it’s critical for providers to devote time to patient education; inform patients about their conditions and how to prevent, treat, and manage them. Proper management of chronic conditions extends well beyond episodic and infrequent visits to a provider’s office. This population health white paper discusses why patients must become responsible for their day-to-day disease management. Patients will frequently be required to self-monitor their health indicators, observe symptoms, and note behavior, but they must also adhere to complex medication regimens
Background; Social Class has shown relation with admissions at Emergency Departments. To assess whether there is a relationship between the level of triage and the social class of patients who attend the emergency department and whether there are other variables that can modulate this association. Methods Observational study with 1000 patients was carried out between May and July 2018 in the Emergency Department of the University Hospital Arnau de Vilanova in Lleida. Sociodemographic variables such as age, gender, country of origin and marital status were analyzed. The triage level and the main explanatory variable was social class. Social class was calculated based on the CSO-SEE 2012 scale. Results 49.4% were male and the average age was 51.7 years. Most of the patients (66.6%) attended the emergency department under their own volition and the most common triage levels were level III or Emergency (45%). There is a significant relationship between age and triage level. The younger patients had a lower triage level (p <0.001). The percentage of patients with lower social class who attended the emergency department for minor reasons was 42% higher compared to the rest of the patients (RR = 1.42; 1.21-1.67 95% CI, p <0.001). Conclusions; Patients with a lower socioeconomic class go to the Emergency Department for less serious pathologies.
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
IHME's Dr. Lozano discusses how the quality of maternal mortality data was improved in Mexico, leading to better estimates to more reliably measure progress.
For more information please visit www.healthmetricsandevaluation.org
More young people in Canada are visiting EDs because of drinking alcoholΔρ. Γιώργος K. Κασάπης
More people are visiting emergency departments after drinking alcohol, a new study finds. Researchers looked at more than 765,000 ED visits in Ontario, Canada’s largest province, and found a 175% increase in such visits between 2003 and 2016 among 25- to 29-year-olds. That spiked to a 240% increase in alcohol-related ED visits for young women, who were also more likely than men to be under Canada’s legal drinking age of 19. For both young men and women, visiting the ED for alcohol-related problems also led to more hospital admissions than other types of ED visits. Other countries, including the U.S., have experienced similar increases in alcohol-related visits to the ED, the authors behind the new study write, urging more research into the reasons behind the growing trend.
Abstract. The Ministry of Health and Social Services in Namibia under the division of epidemiology uses a manual
paper-based approach to capture disease surveillance data through 5 levels of reporting which include the community level, the health facility level, the district level, and the national level. As a result, this method of communicating
and exchanging disease surveillance information is cost and time consuming, which delay disease surveillance information from reaching the head office on time.
Predictive and Preventive Care: Metabolic Diseasesasclepiuspdfs
South Asians have a very high incidence of ischemic heart disease and stroke. In addition, they also have a very high incidence of metabolic diseases such as prehypertension, hypertension, visceral obesity, metabolic syndrome, prediabetes, type-2 diabetes, and its clinical complications. Currently, there are over 75 million diabetic subjects in India and an equal number of prediabetics. Republic of China has taken over India as the diabetes capital of the world, with over 115 million diabetics. Modern medicine is disease focused and has failed to address the prevention of these chronic diseases. According to the reports from the United Nations (Millennium Development Goals [MDGs], the World Health Organization, Global Health Initiatives, and the non-communicable disease risk task force), obesity has increased by 2-fold and type-2 diabetes by 4-fold worldwide. Experts in this field predict that chances of meeting the MDGs set by the UN members of reducing the incidence of these diseases at 2025 to the level of 2020 are very little. Western medicine has failed to reduce or reverse the trend in the incidence of these diseases. We feel that an integrated approach to health care may be a better option, to reduce the disease burden in developing and resource-poor countries. Having said that, one cannot prevent something that one is not aware of, as such it is the need of the hour for us, to develop a robust predictive and preventive health-care platform. In an earlier article, we presented our views on reducing or reversing cardiometabolic diseases. There is great enthusiasm among the health-care providers and professional bodies that integration of emerging technologies will help develop personalized, precision medicine, as well as reduce the cost of health-care worldwide.
Diabetes is a significant cause of mortality and morbidity in different continents of the world. Many diabetes victims are found in developing countries like Sub-Saharan Africa. However, some developed nations like United States and Europe record significant records on diabetes prevalence. Studies project a dramatic increase of the infection spread in the world. Also, it provides visible results on the effects of the infection among the victims and the society at large. Studies of type 2 diabetes prevalence indicate minimal rates in rural population and moderate results in the developed regions of the same country. Such results create an alarm to the unaffected regions. The frequent observation of modestly high prevalence of impaired glucose tolerance in areas with low prevalence of diabetes indicate risk of early stage of diabetes epidemics.
Diabetes is major healthcare concern worldwide with horrific repercussions. The disease can easily be prevented with just some awareness and efforts of people. Many suffer from this horrendous condition because of lack of knowledge about the disease. To end this, creating awareness of the disease and its effects on millions of people in the world is critically important. In this article, we will outline the importance of these efforts, discuss the barriers in way of awareness and education, and highlight some important models in this arena. As an integral part of a diabetes prevention and control program strong awareness-raising and health promotion strategies are needed.
Chapter 3Public Health Data and Communications.docxwalterl4
Chapter 3
Public Health Data and Communications
Learning Objectives
Identify six basic types of public health data
Explain the meaning, use, and limitations of the infant mortality rate and life expectancy measurements
Explain the meanings and uses of HALEs and DALYs
Identify criteria for evaluating the quality of information presented on a website
Explain ways that perceptions affect how people interpret information
Learning Objectives
Explain the roles of probabilities, utilities, and the timing of events in combining public health data
Explain the basic principles for the construction of decision trees and their uses
Explain how attitudes, such as risk-taking attitudes, may affect decision making
Identify three different approaches to clinical decision making and their advantages and disadvantages
Vignette 1
You read that the rate of use of cocaine among teenagers has fallen by 50% in the last decade.
You wonder where that information might come from.
Vignette 2
You hear that life expectancy in the United States is now approximately 80 years.
You wonder what that implies about how long you will live and what that means for your grandmother, who is 82 and in good health.
Vignette 3
You hear on the news the gruesome description of a shark attack on a young boy from another state and decide to keep your son away from the beach.
While playing at a friend’s house, your son nearly drowns after falling into the backyard pool.
You ask why so many people think that drowning in a backyard pool is unusual when it is far more common than shark attacks.
Vignette 4
“Balancing the harms and benefits is essential to making decisions,” your clinician says.
The treatment you are considering has an 80% chance of working, but there is also a 20% chance of side effects.
“What do I need to consider when balancing the harms and the benefits?” you ask.
Vignette 5
You are faced with a decision to have a medical procedure.
One physician tells you there’s no other choice and you must undergo the procedure, another tells you about the harms and benefits and advises you to go ahead and the third lays out the options and tells you it’s your decision.
Why are there such different approaches to making decisions these days?
Questions-to-Ask (1)
What is the scope of health communications?
Where does public health data come from?
How is public health information compiled to measure the health of a population?
How can we evaluate the quality of the presentation of health information?
What factors affect how we perceive public health information?
Questions-to-Ask (2)
What type of information needs to be combined to make health decisions?
What other data needs to be included in decision making?
How do we utilize information to make health decisions?
How can we use health information to make healthcare decisions?
Table 3-1 The 6 Ss of Quantitative Sources of Public Health Data (1/3)Type
ExamplesUsesAdvantages/
DisadvantagesSingle case or small seriesC.
Think of your local community. What health-related issue current.docxirened6
Think of your local community. What health-related issue currently affects a large number of people within your community? How could research help address this issue? How would you go about obtaining more data on the health-related issue you identified?
This is an opportunity for you to explore the practical application of how to create a plan to obtain data on a health-related topic, specifically in your community. Please respond in first person, share personal experiences to further develop your understanding of how evidence-based practice can affect health-related issues at the community level.
Use as references:
National Center for Health Statistics (NCHS)
- National and state data sets as well as statistic reports. Information about ordering data sets that cannot be downloaded.
CDC Data and Statistics page
- much more than NCHS
CDC WONDER
- WONDER provides a single point of access to a wide variety of reports and numeric public health data.
Agency for Healthcare Research and Quality
- Data and Surveys
Statewide Planning and Research Cooperative System (SPARCS)
- Data dictionaries, documentation and request forms. No searchable data online.
U.S. Census Bureau
,
Current census data including information broken down by state, city, and region.
WHOSIS
-- WHO Statistical Information System
In two different paragraph give your personal opinion to Valencia Matilus and Malika Nelson, them do not need a different referents use the same as them.
Valencia Matilus
In the community in Florida many people are infected by the chronic illness hypertension is a common disease cholesterol, fatigues, and stress. Patients are major risks cardiovascular, stokes, and leading causes of death, respectively in the community. In 2016, 80,722 deaths were caused by high blood pressures. In 2014, high blood pressures were five times more deaths than it was in 2016. Hypertension has referred to high blood pressures. Hypertension is a big major cause of premature death worldwide (Benjamin, 2016).
Hypertension very often had no signs or symptoms. Once the primary care doctor has diagnosed the patient had high blood pressures as a medication. Patients can lower their blood pressures by changing their diet, and exercises. In 2015-2016, in the communities 1/3 patients have controlled high blood pressures. 2017, recent revised guidelines more than one patient have unknown or undiagnosed if they have high blood pressures. In 2016, the total costs directed for high blood pressures were $54.8 billion. It’s projected for the year 2035, the total costs will be reach $221.8 billion. I’ll suggest implementing public health to have more programs to help to reduce the hypertension problems. Healthcare providers have provided more information, have classes for the patient, and show them how to eat, have nutrition in the clinic or private doctor offices to reduce mortality. (Benjanmin, 2016).Florida, adults ages 18-39; 45 to 79, nearly half of patients can .
Global death causes & preventive strategyDeepikaHarish
The snapshot approaches to answer the
following problem statement, along with relevant data points, leads & outlining a potential healthcare framework which acts around preventive approach to combat the disease onset & progression
- What are top causes of death worldwide & their impact on
healthcare expenditure
- Is there any insightful characteristic/ common pattern
associated with these indications
- What can be potent lead to develop a strategy plan to
prevent the onset & progression of these disease indications
Global Medical Cures™ | HIV TESTING IN USA
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Diagnosis of Early Risks, Management of Risks, and Reduction of Vascular Dise...asclepiuspdfs
In a recent issue of the Journal of Circulation, American Heart Association has published a scientific statement, related to the excess heart disease and acute vascular events in South Asians living in the USA. The same group of experts, also have published a complementary article in Circulation titled, “call to action: Cardiovascular disease (CVD) in Asian Americans.”I being a South Asian immigrant living in the USA, have always wondered as to why we do not have the same benefits as the other resident Americans in terms of the advantages of living in a highly advanced country? According to a study done in 2013, cardiovascular mortality has declined and diabetes mortality has increased in high-income countries. The study done in 26 industrialized nations, estimated the potential role of trends in population, for body mass index, systolic blood pressure, serum total cholesterol, and smoking, the modifiable risk factors identified as the promoters of CVD, and acute vascular events, by the Framingham Heart Study (FHS) group.
RunningHead: PICOT Question 1
RunningHead: PICOT Question 7
PICOT Question
Avery Bryan
NRS-433V
Professor Christine Vannelli
May 19, 2019
Clinical Problem
A report from the Center for Disease Control and Prevention in 2015 revealed that (9.4%) 30.3 million Americans are diabetic and 84.1 million have prediabetes. This is a total population of over 100 million is at risk of developing type 2 diabetes which is a growing health problem being the seventh leading cause of death in the U.S. An estimated 1.5 million new cases were among 18-year old bracket and the rates of diagnosed diabetes increased proportionally to age. Below 44 years accounted for 4%, below 64 years at 17 % and 25% for those above 65 years across both genders. One-third of adults in America has prediabetes but sadly, they are unaware despite reports released by The National Diabetes Statistics Report every year. These reports elaborate on prevalence and incidence, prediabetes, long-term complications, risk factors, mortality, and cost. Diabetes poses the risk of serious complications like death, blindness, stroke, kidney disorders, cardiac diseases and health problems that lead to amputation of legs. However, the risks can be mitigated through physical body activities, proper dieting and prescribed use of insulin and other related measures to control the blood sugar levels. Diabetes Prevention Program was funded by NIH to research a yearly evidence-based program to improve healthy weight loss through diet and physical activities. There also efforts to determine the effectiveness of public service campaigns in improving the real-life experience in the diagnosis and treatment of diabetes.
PICOT Question.
The population affected by diabetes cuts across all ages, gender, race, and ethnicity. The prevalence is significantly high from 18 years and it increases with age to about 25% above 65 years. In terms of gender, men are at higher risk accounting for 37% while women are at 30% across races and educational levels. On races, the rates were higher among Indians/Alaska natives at 15%, non-Hispanic blacks at 12.7% and Hispanics at 12%. Among Asians, the rates were lower at 8% and 7.4% for non-Hispanic whites.
Intervention indicator for diabetes shows that individuals who do not observe a healthy diet are more exposed to the disease. Some risk behaviors include lack of exercise and excessive intake of junk foods that lead to obesity and increased blood sugar levels. Diabetes prevalence varied according to education levels were those with less than high school education at 12.6% and 7.2% for those higher than high school education.
Comparison and use of a control group from the popularity of Complementary and Alternative Medicine and Traditional Chinese Medicine showed distinct knowledge of diabetes, blood sugar control, and self-care. The experimental group received education through interactive multimedia for three months while the control group received.
What are the differences in publishing diabetes epidemiological manuscripts.pdfPubrica
The scientific and medical research papers produced by Pubrica's team of researchers and writers may be an invaluable tool for authors and practitioners.
MIRA Risk Review: Multivariate metabolic risk calculatorMunich Re
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Convalescent Plasma and COVID-19: Ancient Therapy Re-emergedasclepiuspdfs
Convalescent plasma has again re-emerged as a therapy during coronavirus disease (COVID-19) outbreaks currently use as a prophylactic or an interventional treatment in infected patients. Convalescent plasma has been used in the 20th century confronting different infectious diseases where there was no other therapy available. Conceivably, this convalescent plasma therapy tends to be proving a game-changing treatment in some COVID-19 patients and could support treatment, in addition to the current interventions before other developed therapies are available for the population.
The Negative Clinical Consequences Due to the Lack of the Elaboration of a Sc...asclepiuspdfs
Until a few years ago, the immune system was considered as responsible for the only defense against microbial infections and other external agents. On the contrary, the immune cells have been proven to be linked not only through cell-cell contact but also by releasing proteins capable of influencing the immune-inflammatory response, the so-called cytokines or interleukins. Moreover, the cytokines have appeared to play not only immune activities but also metabolic and systemic effects influencing the overall biological systems, including the nervous, the endocrine, and the cardiovascular systems, by representing the main endogenous molecules responsible for the maintenance of the unity of the biological life. Therefore, only the systematic clinical consideration of cytokine effects may allow the generation of real future holistic medicine.
The great benefit of blood/blood constitutes therapy is the ability to provide transfusion support for patients with many unique hematologic conditions. For some patients, such as patients with sickle cell disease, thalassemia major, immune hemolytic anemia, anemia of kidney disease, and aplastic anemia may need for this consolidation extends throughout their life. By knowing the alteration mechanisms of these conditions, we can appreciate the stationary, urgency, and the value of the transfused red blood cell (RBC).
Decreasing or Increasing Role of Autologous Stem Cell Transplantation in Mult...asclepiuspdfs
During the past four decades, autologous stem cell transplantation (ASCT) has been the first choice and the standard option for the treatment of newly diagnosed patients with multiple myeloma. The introduction of new agents such as thalidomide, lenalidomide, and bortezomib has led to a clear improvement in basic approach and those agents became the standard of care in the induction phase; however, they were not able to play the role of ASCT in term of progression-free survival and overall survival. Debate continues about the best induction, consolidation, and maintenance taking into account the toxicities of these new agents. The new monoclonal antibody (anti CD38) starts to take its place in the induction setting and it seems to be a promising agent in the high-risk group. Until recently, ASCT is the standard treatment for newly diagnosed patients.
Comparison of the Hypocalcemic Effects of Erythropoietin and U-74389Gasclepiuspdfs
Aim: This study calculated the effects on serum calcium (Ca) levels, after treatment with either of two drugs: The erythropoietin (Epo) and the antioxidant lazaroid (L) drug U-74389G. The calculation was based on the results of two preliminary studies, each one of which estimated the certain influence, after the respective drug usage in an induced ischemia-reperfusion animal experiment. Materials and Methods: The two main experimental endpoints at which the serum Ca levels were evaluated were the 60th reperfusion min (for the Groups A, C, and E) and the 120th reperfusion min (for the Groups B, D, and F). Especially, the Groups A and B were processed without drugs, Groups C and D after Epo administration, whereas Groups E and F after the L administration. Results: The first preliminary study of Epo presented a non-significant hypocalcemic effect by 0.34% ± 0.68% (P = 0.6095). However, the second preliminary study of U-74389G presented a non-significant hypercalcemic effect by 0.14% ± 0.66% (P = 0.8245). These two studies were coevaluated since they came from the same experimental setting. The outcome of the coevaluation was that L is 2.3623042-fold (2.3482723–2.3764196) more hypercalcemic than Epo (P = 0.0000). Conclusions: The antioxidant capacities of U-74389G ascribe 2.3623042-fold more hypercalcemic effects than Epo (P = 0.0000).
The term refractory anemia (RA) may be confusing to those who are not hematologists. RA should be well defined because it means more than what it says. RA is defined as anemia that is not responsive to therapy except transfusion.[1] The term RA is used to rule out those types of anemia with a known cause such as anemia of systemic diseases (liver and kidney) and anemia of inflammation even though they are considered refractory to therapy.[2] RA with cellular or hypercellular bone marrow was formerly used to exclude aplastic anemia.
Management of Immunogenic Heparin-induced Thrombocytopeniaasclepiuspdfs
Immunogenic heparin-induced thrombocytopenia (HIT) is an immune response to heparin associated with significant morbidity and mortality in hospitalized patients if unidentified as soon as possible, due to thromboembolic complications involving both arterial and venous systems. Early diagnoses based on a comprehensive interpretation of clinical and laboratory information improve clinical outcomes. Management principles of strongly suspected HIT should not be delayed for laboratory result confirmation. Treatment strategies have been introduced including new, safe, and effective agents. This review summarizes the clinical therapeutic options for HIT addressing the use of parenteral direct thrombin inhibitors and indirect factor Xa inhibitors as well as the potential non-Vitamin K antagonist oral anticoagulants.
73-year-old woman without any pertinent history was admitted to the hospital due to remittent fever with erythema. She showed itching and linearly arranged erythema on the chest, back, and abdomen [Figure 1a and b]. As she had been taking daily cefditoren pivoxil for the 4 days before her admission, she was diagnosed as having drug-related scratch dermatitis, and the antibiotic treatment was stopped. Her fever remained. Laboratory data showed elevated levels of white blood cells (14,800/μl, normal range 4000–7000) and liver enzymes such as aspartate aminotransferase (AST) 138 IU/L (normal range 5–40), alanine aminotransferase 97 IU/L (normal range 5–35), and ferritin (17469.5 ng/mL, normal range 5–152).
Bone Marrow Histology is a Pathognomonic Clue to Each of the JAK2V617F, MPL,5...asclepiuspdfs
According to the World Health Organization and Clinical Laboratory Molecular and Pathological criteria bone marrow pathology in JAK2V617F mutated trilinear myeloproliferative neoplasm (MPN) patients essential thrombocythemia (ET) and polycythemia vera are indistinguishably featured by clustered medium to large pleomorphic megakaryocytes and increased cellularity (60–90%) due to increased erythropoiesis and megakaryopoiesis. MPL515 mutated ET is the second distinct clonal MPN characterized by thrombocythemia in a normocellular bone marrow showing clustered increased large to giant mature megakaryocytes with staghorn-like hyperlobulated nuclei. Calreticulin (CALR) mutated hypercellular thrombocythemia associated with prefibrotic megakaryocytic, granulocytic myeloproliferation (MGM) recently became the third distinct MPN featured by dense clusters of immature megakaryocytes with cloud-like nuclei. Bone marrow pathology in newly diagnosed MPN patients appears to be a pathognomonic clue for diagnostic differentiation between JAK2V617F mutated trilinear MPN, MPL515 normocellular thrombocythemia, and CALR thrombocythemia with MGM characteristics followed by secondary reticulin fibrosis. Their natural histories clearly differ featured by an increase of erythro/granulopoiesis and cellularity in JAK2V617F, decrease of erythropoiesis and cellularity in MPL515 and increase of dual megakaryo/granulopoiesis and cellularity in CALR mutated MPN.
Helicobacter pylori Frequency in Polycythemia Vera Patients without Dyspeptic...asclepiuspdfs
Introduction: In polycythemia vera (PV) patients, peptic ulcer and gastroduodenal erosions are more common than the general population, but there are insufficient data on the frequency of Helicobacter pylori (HP) and its role in etiopathogenesis. In this study, we aimed to compare the prevalence of HP infection in PV patients without dyspeptic complaints with a healthy control group without dyspeptic complaints. Materials and Methods: Fifty patients with PV without dyspeptic complaints and 50 controls without dyspeptic complaints were enrolled in this study after informed consent obtained. Stool samples of selected patients were analyzed using HP stool antigen test (True Line®). Results: There was surprisingly striking difference between HP prevalence in PV patients without dyspeptic complaints and asymptomatic healthy controls (64% vs. 2%) (P < 0.05). There was no significant relationship found between HP presence and age, gender, treatment modalities, complete blood count, positivity of JAK2 V617F, serum erythropoietin level, and splenomegaly in PV patients (P > 0.05). Conclusion: As the susceptibility of HP infections in PV patients are higher, it is recommended to have close surveillance of these patients by screening HP presence. In addition, when HP positivity is determined, the eradication of HP is essential to prevent possible future gastrointestinal lesions in patients with PV.
Lymphoma of the Tonsil in a Developing Communityasclepiuspdfs
The lymphoma of the tonsil is a rarity. Single case reports have appeared in countries as disparate as China, Greece, India, Japan, and Turkey. Therefore, this paper presents cases found in Nigeria among the Ibo ethnic group. The epidemiological comparisons are deemed to be worthy of documentation such as age ranges and sides of involvement.
Should Metformin Be Continued after Hospital Admission in Patients with Coron...asclepiuspdfs
Background: In most patients with diabetes, guidelines recommend discontinuation of oral anti-diabetic agents. Preliminary data suggest that pre-admission metformin use may have a mortality benefit in patients with coronavirus disease (COVID)-19 admitted to the hospital. Objective: The objective of the study was to review the impact of metformin on morbidity and mortality among hospitalized patients with COVID-19. Methods: Review of English literature by PUBMED search until November 10, 2020. Search terms included diabetes, COVID-19, metformin, retrospective studies, meta-analyses, pertinent reviews, pre-print articles, and consensus guidelines are reviewed.
Clinical Significance of Hypocalcemia in COVID-19asclepiuspdfs
Background: Preliminary data suggest that hypocalcemia is common among patients with COVID-19 admitted to the hospital. Objective: The objective of the study was to examine the clinical significance of hypocalcemia in the setting of COVID-19. Methods: Literature search (PubMed) until August 5, 2020. Search terms include hypocalcemia, COVID-19, mortality, and complications. Retrospective studies are reviewed due to a lack of randomized trials. Results: Prevalence of hypocalcemia among hospitalized patients with COVID-19 ranges from 62% to 78%, depending on the definition of hypocalcemia and patients’ characteristics. In most cases, hypocalcemia is mild to moderate biochemically. Hypocalcemia is a risk factor for hospitalization of patients with COVID-19. In already hospitalized patients, hypocalcemia is significantly associated with increase severity of COVID-19 and its complications, including multiorgan failure, acute respiratory distress syndrome, and death. Hypocalcemia is significantly correlated with inflammatory markers of COVID-19. Causes of hypocalcemia in COVID-19 patients are unclear, but Vitamin D deficiency may be a contributing factor. Conclusion: Hypocalcemia is common in hospitalized patients with COVID-19 and carries unfavorable outcomes. Further studies are needed to examine the causes of hypocalcemia in COVID-19 and to see whether normalization of circulating calcium levels improves prognosis.
Excess of Maternal Transmission of Type 2 Diabetes: Is there a Role of Bioche...asclepiuspdfs
Objective: An excess of maternal transmission of Type 2 diabetes (T2D) has been reported in some populations but not confirmed in other studies. Mitochondrial inheritance has been proposed to explain such excess. In the present paper, we have considered the presence of T2D in the mother and/or in the father in relation to the risk of T2D and to age at onset of the disease in the offspring. The distribution of two genetic polymorphisms involved in glucose metabolism in relation to the presence of T2D in the mother has been also considered. Materials and Methods: Two hundred and seventy-nine participants with T2D were studied in the population of Penne, a small rural town in the eastern side of central Italy. Adenosine deaminase locus 1 (ADA1) and phosphoglucomutase locus 1 (PGM1) phenotypes were determined by starch gel electrophoresis. Statistical analyses were carried out using commercial software (SPSS). Results: The proportion of patients from T2D mothers is much greater as compared to the proportion of the patients from T2D fathers (P < 0.0001). Age at onset of the disease in patients in whom one or both parents are T2D is lower as compared to other patients. The distribution of ADA1 and PGM1 phenotypes in participants with T2D depends on the presence of diabetes in the mother. Conclusions: About the transmission of T2D, our data confirm the high proportion of maternal T2D and show the role of two common biochemical polymorphisms involved in glucose metabolism.
The Effect of Demographic Data and Hemoglobin A 1c on Treatment Outcomes in P...asclepiuspdfs
Objective: Diabetes mellitus, the most common cause of non-traumatic foot amputations, is a life-threatening condition due to its high mortality and morbidity. In our study, we retrospectively evaluated our patients with diabetic foot syndrome in our clinic. Materials and Methods: The demographic data, duration of diabetes, Wagner classification, haemoglobin A 1c (HbA1c) levels, white blood cell, C-reactive protein sedimentation levels, hospital stay, and treatment results were evaluated retrospectively in 14 patients with diabetic foot between January 2017 and December 2018. Results: The mean age of the patients was 62.43 ± 7.7 years. Of the 14 patients, 3 were females and 11 were males. All 14 patients were type 2 diabetes mellitus. When diabetic foot Wagner classification was performed, 6 patients were evaluated as Wagner 2, five patients were Wagner 3, and three patients were evaluated as Wagner 4. Nine patients had complete amputation and 3 had vascular surgery. Conclusion: Although the level of HbA1c is below the target level, the risk of diabetic foot is increased when there is no adequate diabetes mellitus foot training. Inadequate diabetic patient education and hospitalization of patients after infection progress the amputation rate.
Self-efficacy Impact Adherence in Diabetes Mellitusasclepiuspdfs
The aim of the paper is to explore how self-efficacy (SE) is associated with adherence among adults with diabetes mellitus (DM). Methods: The search of electronic databases identified 564 records from 2007 to 2017 on SE and adherence from different perspectives and its effect on adults with DM. Discussions: SE increases the confidence in adults in their self-care behaviors. Non-adherence continues to be a significant barrier to SE. SE and adherence should be informed by an understanding of theoretical frameworks and the individual characteristics. Conclusion: Adherence is likely among adults with better SE to empower them to make valid decisions about their health. Interventions to improve SE should be tailored based on different types of non-adherence such as intentional and unintentional non-adherence. Implications: An intercollaborative professional practice approach is crucial to improve SE and adherence for sound judgment and valid decision-making.
Uncoiling the Tightening Obesity Spiralasclepiuspdfs
While an underweight prevalence was once more than twice that of obesity, now more people are obese than underweight. Obesity is one of the leading causes of preventable death in the world. There are an estimated 2,100,000,000 obese people worldwide and that number is forecast to grow to 51% of the world’s population by 2030. Escalating obesity-related disease costs threaten to bankrupt the world’s health-care systems.
Prevalence of Chronic Kidney disease in Patients with Metabolic Syndrome in S...asclepiuspdfs
Background and Objective: Chronic kidney disease (CKD) which is an increasingly important clinical and public health issue is associated with cardiovascular disease. Epidemiologic studies have also linked metabolic syndrome (MetS) with an increased risk of incident CKD. Therefore, the present study was designed retrospectively to find the prevalence and potential risk factors of CKD in patients with MetS in Saudi Arabia.
Management Of Hypoglycemia In Patients With Type 2 Diabetesasclepiuspdfs
Hypoglycemia is the rate-limiting step of intensive management in patients with diabetes. Lowering one’s A1C to a prescribed target is expected to mitigate one’s risk of developing long- and short-term diabetes-related complications. Several of the less expensive and commonly prescribed glucose lowering agents favored by practitioners result in weight gain, hypoglycemia, and even an increased risk of cardiovascular (CV) mortality. Although achieving a targeted A1C of <7 % is the standard of care, clinicians often fail to evaluate patients for glycemic variability which can increase oxidative stress driving long-term diabetes-related complications including CV death. The use of concentrated insulins and glucagon-like peptide-1 receptor agonists separately or in combination with each other reduces glycemic variability and one’s risk of hypoglycemia. Pharmaceutical agents which allow patients to safely achieve their targeted A1C without weight gain and hypoglycemia should be preferred in patients with type 2 diabetes.
It is known that the cancer development process is multifactorial nowadays. The relationship between insulin and cancer has recently been gaining in importance. The number of studies between insulin resistance and thyroid cancer is very small, although the association between obesity, type 2 diabetes, and insulin resistance, particularly breast, colon, and pancreatic cancer development, is long. There are studies advocating increased growth factors with insulin resistance as well as triode cancer after thyroid angiogenesis. Insulin and insulin-like growth factors may be the primary causes of pathophysiology in many cancers, especially thyroid cancer, with mitogenic activity.
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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!
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
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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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
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
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.
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
2. Malmefeldt and Rao: Non-invasive diagnostic tools
13 Journal of Clinical Cardiology and Diagnostics • Vol 2 • Issue 1 • 2019
Task Force (USPSTF) recommends, that physicians screen
patients for dyslipidemia (prediabetes or type-2 diabetes),
when they are 40–70 years old and are overweight or obese.
According to a recent article in the Journal of General
Medicine, by the researchers at the Northwestern University
School of Medicine, 53% of patients who had prediabetes
or type-2 diabetes would not be screened.[9]
For instance,
African-American, Latino, and South Asians develop
type-2 diabetes, at a much younger age than the average
Caucasian. Current prevention screening recommendations,
if followed, would leave 70% of Asians, with prediabetes or
undiagnosed diabetes, until their next screening. In an earlier
article, we articulated how a novel approach of screening
the young adults with emerging technologies will provide us
the capabilities for early diagnosis and better management
of the risks, as well as for the reduction and prevention of
cardiometabolic diseases.
According to a recent article by the researchers at the Centers
for Disease Control (USA), after an almost 20-year increase
in the national prevalence and incidence of diabetes, an 8-year
period of stable prevalence and a decrease in the incidence
has been observed.[16]
This decrease in the incidence seems to
be driven by non-Hispanic individuals, suggesting possible
causes for this observation to be ethnic-specific, as well as
due to other demographic disparities. The increasing burden
of diabetes seems to be the result of increases in obesity and
prediabetes. More than 100 million individuals in the USA
have diabetes or prediabetes.[17]
The number of prediabetics
is four-fold higher than that of diabetics in the USA.
Furthermore, a new first of a kind study, by the researchers
at the Imperial College London and the World Health
Organization reports that from 1975 to 2016, the number of
girls with obesity increased from 5 million to 50 million, and
boys from 6 million to 74 million. In other words, childhood
obesity increased 10-fold worldwide since 1975.[18]
If we look
at the global picture, India was considered “diabetes capital”
a few years ago, now China has outranked India but there
are speculations based on trend measurements that India may
take over China again in the near future. Noncommunicable
risk factor collaborator group used data from 751 studies
from 146 counties for their estimate of trends. Based on their
study, they predict, if the post 2000 trends in the increase in
the incidence of diabetes continue, the probability of meeting
the global target of halting the rise in diabetes by 2020 to the
2015 level is 1%.
National Health Service (NHS) of the UK has shifted its focus
on preventive health care. To achieve the set goals, long-term
plan of NHS features digital health prominently. According
to their latest “News Item,” – within the next 5 years,
all patients in England, will be entitled to online digital
consultations with a general practitioner, and women will be
able to access their maternity notes, with their smartphone
or other connected devices. The long-term plan, mentions
of digital tools in connection with all kinds of conditions,
includes non-communicable diseases, such as excess weight,
hypertension, obesity, diabetes, vascular diseases, and cancer.
This month (July 1, 2019) marks a milestone in the journey
of digitization; its scheduled completion date for the roll-out
of the “NHS App,” described as the “digital front door” to
the NHS services. The app itself is unlikely to expand any
further. Instead, the intention seems to be to plug in additional
digital products, through open application programming
interfaces.[19]
Maurice Smith, a member of the governing
body of NHS concludes, “what it does is, to demonstrate the
direction of the digital travel. Society, in general, is moving
toward digitally-enabled ways of working and interacting
with services, and this inevitable transition to ‘digital health’
has to be reflected in all aspects of healthcare.
What we are proposing through a series of articles on the
topic of our interest, “integration of emerging diagnostic
technologies for better health care,” is to describe a similar
direction of travel. Currently, there is a great interest, and
tremendous efforts to develop simple, cost effective, non-
invasive diagnostic tools and technologies. All of these
technologies, use simple, sophisticated sensors, to elicit
expected physiological responses from human body, gather
the data, compute, use proprietary software and trained
algorithms, to provide expected results, interpretations,
and conclusions. Because they do not directly measure any
biomarkers as the blood chemistry does, the values expressed
are not “real values” but algorithm-based derivatives. In
view of this fact, they need to be thoroughly validated by
independent clinical studies, and appropriate corrections
made in their interpretations. Furthermore, all of the devices
on the market although are capable of developing diagnostic
data on a variety of biomarkers, do not have the capability of
integrating such data to develop a meaningful interpretation.
We will use time-tested cardiovascular risk calculator as an
example, describe some non-invasive diagnostic tools and
platforms to illustrate our concept of “integration of things”
for better diagnosis, risk assessment, risk prediction, and risk
management.
As mentioned in our introduction, metabolic diseases have
increased in the incidence and prevalence worldwide,
to epidemic proportions. All of these metabolic diseases
contribute significantly, to the cardiovascular (CVD) and
cerebrovasculardiseasemorbidityandmortality.Framingham
Heart Studies (FHS) initiated by the National Institutes of
Health (NIH), USA some seven decades ago, developed the
concept of “risk factors” for coronary artery disease (CAD)
and published its findings in 1957.[20]
FHS demonstrated
the epidemiological relations of cigarette smoking, blood
pressure, and cholesterol, to the incidence of CAD. FHS
researchers have developed a general CAD risk profile for
use in primary care settings for calculating 10-year risk for
developing CVD.[21]
Several studies have explored currently
3. Malmefeldt and Rao: Non-invasive diagnostic tools
Journal of Clinical Cardiology and Diagnostics • Vol 2 • Issue 1 • 2019 14
available and widely used CVD risk assessment models,
to examine the evidence available on new biomarkers and
the nonclinical measures in improving the risk prediction in
the population level. Adding C-reactive protein, lipoprotein
little-A (Lpa) levels, and to conventional cardiovascular risk
models, have been shown to improve risk prediction for
cardiovascular events.[22-24]
Similarly, there are suggestions that adding Lpa to the known
cluster of risks will improve risk prediction for certain
ethnic populations (South Asians). Risk stratification for
CVD remains suboptimal, even after the introduction of
global risk assessment by various scores. Researchers from
the University Medical Center, Germany, have emphasized
potential use of biomarkers for risk stratification, in initially
healthy subjects and patients, with manifest chronic
atherosclerosis, particularly focusing on the integrated value
of the combination of these markers. In an earlier article on
this topic, we proposed using healthy cohorts from a pool
of fitness and wellness enthusiasts, to follow early risk
assessment, risk stratification, and robust management of the
diagnosed risks. In this overview, we will describe the use
of non-invasive diagnostic tools; discuss how some of the
diagnostic platforms have achieved computing, integration,
analysis, and interpretation capabilities. In addition, we
advocate the development of a modular portal that can take
such diagnostic data, which are relevant for risk assessment
and stratification of cardiometabolic risks (CMRs) from
multiple devices, and fine-tune the risk prediction for CVD
development and acute events associated with this disease.
DISCUSSION
Of the three metabolic diseases, detection of hypertension
and excess weight or obesity is easy. Blood pressure monitors
are in use for over 100 years. Having said that, we would like
to see the use of 24-h ambulatory blood pressure monitoring
for the management of hypertension. These devices can be
programmed and continuously used for over a 24-h period.
They can also monitor heart rate, compute average readings,
and help in predicting the likelihood of cardiovascular
and cerebrovascular disease-linked hypertension. If need
be, these devices could be improved to detect endothelial
dysfunction, the earliest manifestation of vascular disease.As
far as the excess weight, and obesity, measurements, height/
weight, as well as waist/hip ratio, will provide the needed
measurements. When it comes to diabetes, current guidelines
prefer the use of fasting glucose and hemoglobin A1c
(HBA1c) measurements from the same sample, preferably.[25]
In our efforts to develop and promote the use of non-invasive
diagnostic devices, senior author of this article, Dr. Rao
secured a grant from the Indian Council of Medical Research,
India, and developed a prototype, of a non-invasive
glucometer using near infrared (IR) sensors.[26]
The IR emitter
was a 940 nm IR-light-emitting diode, and the detector was a
photodiode chip, with 1100 nm wavelength. The idea was to
develop a device that will compute both blood glucose values
and HBA1c values from the same reading. We also have
validated the use of Abbott FreeStyle Libre [Figure 1] for its
usefulness in continuous glucose profiling in the interstitial
tissues. As shown in Figure 1, the glucose profile provides
data on median glucose level, expected goal to achieve, and
calculates HBA1c values. Figure 2 shows a glucose profile of
a diabetic patient, who is on medication for over 20 years. In
addition to the median glucose level (154), and low threshold
(70), the data also provide color-coded indexing of low
(green), moderate (yellow), and high (orange) values. Ability
to monitor glucose every 15 min noninvasively empowers
the patient to self-monitor the effect of medication, diet, and
physical activity on glucose levels at the touch of a button.
Figure 3 shows average glucose values computed for the 24-h
reading. Having such data accessible make the patient aware
of the daily variations in the glucose level and provide a
unique opportunity, to contemplate on the effect of daily diet
and physical activity on the glucose levels. Again, this kind
of information empowers the patient, to make adjustments
in lifestyle so that elevated mean level of glucose can be
brought down to expected levels. The data analysis shown
in Figure 4 also provide information on average glucose for
the 24-h period, percent of time the glucose was in target
level (20%), percent of time below target (2%), percent of
time above target (78%). Having such information, helps the
Figure 1: Glucose profile of a diabetic not under any
medication (hemoglobin A1c – 9.8%) (Courtesy: Abbott
Diabetes Care; Bengaluru, India)
Figure 2: Glucose profile of a diabetic under medication
(hemoglobin A1c – 7.2%) (Personal data: Karnataka Institute
of Endocrinology and Research, Bengaluru, India)
4. Malmefeldt and Rao: Non-invasive diagnostic tools
15 Journal of Clinical Cardiology and Diagnostics • Vol 2 • Issue 1 • 2019
patient to pay attention to the time the level of glucose was
higher than the target level and thus provides an opportunity
to the patient to try various interventions to lower the glucose
level to the targeted goal. This is the closest to personalized/
precision medicine at the time of this writing.
In addition to our efforts toward the development of
diagnostic devices, we also work with inventors, innovators,
and entrepreneurs, to validate various diagnostic tools
and platforms. We work closely with Dr. Albert Maarek
of Miami, Florida, who is the innovator of LD-products,
a unique non-invasive diagnostic platform, for diagnosis
of CMRs. Figure 5 shows the three basic devices used to
do various diagnostic tests. The FDA approved devices
used are oximeter, blood pressure monitor, and a galvanic
skin response monitor. The combination of these devices
on a single platform is described by the innovator as “data
systems,” with different names, as indicated in Figure 5. The
Sudo Path System is used to monitor early stages of peripheral
neuropathy and changes in microcirculation. TM-Oxi System
is used for monitoring diabetic autonomic neuropathy and
endothelial function. EX-ComplexTSS is used for monitoring
diabetes-related clinical complications and management of
risk factors. Gandhi and Rao have validated TM-Oxi and
Sudo Path systems.[27-29]
In their collaborative studies, using
plethysmography to compute the risks, CVD risk score had
a sensitivity of 82.5% and specificity of 96.8% for detecting
CAD. In a separate study, we compared two different groups
of diabetes patients and found their Sudo-motor score had
a sensitivity of 91.4% and a specificity of 79.1% to detect
diabetes-mediated peripheral neuropathy.[29]
As mentioned earlier, ES complex data system focuses
on diabetes treatment management and early detection of
clinical complications. Figure 6 shows bar graphs for relative
risk, for various biomarkers. Risks are color-coded from
green (low-risk), yellow (medium risk), orange (moderate
risk), and red (high risk). In this patient profile, body mass
as represented as fat mass, impaired glucose tolerance, and
blood pressure are colored red and in view of this finding
their CMR score is 15 and their autonomous nervous system
score (ANR) is 8. We have used this system to evaluate
treatment success. Figure 7 shows data from studies where
we followed the effect of treatment on various risk factors.
These patients were prediabetics, or they were in the early
stages of diabetes. Most of their risk could be managed by
simple lifestyle changes, including diet, physical activity, and
antiglycemic treatment. In collaboration with Dr. Pratiksha
Gandhi, Chairwoman, IPC Heart Care, Mumbai, India, we
have validated, early diagnosis of CMRs, and management
of success or otherwise, of various complementary therapies
using the three “test systems” of LD-technologies.[27-29]
In 2018, LD-Technologies developed their revised version of
LD products [Figure 8], ANS-1/TM flow, peripheral arterial
disease (PAD) series, and life probes, a “health kiosk.”
They improved their earlier concept of testing and eliciting
biological/physiological responses from human body, fine-
tunedtheirproprietarysoftware,andtrainedtheiralgorithmsto
Figure 3: Daily mean glucose values, computed from approximately 96 data points per day (Personal data: Karnataka Institute
of Endocrinology, Bengaluru, India)
Figure 4: Daily glucose summary (average, time in target, below target, above target) (Personal data: Karnataka Institute of
Endocrinology, Bengaluru, India)
Figure 5: (Courtesy: Dr
Albert Maarek, LD-Technologies,
Miami, Florida)
5. Malmefeldt and Rao: Non-invasive diagnostic tools
Journal of Clinical Cardiology and Diagnostics • Vol 2 • Issue 1 • 2019 16
provide a host of functional responses and biomarkers. In this
newly developed system, technologies used are: SWEATC,
galvanic skin response monitor capable of monitoring small
fiber neuropathy; ES-BC, a bioimpedance analyzer to monitor
body composition; LD-Oxy, a photoplethysmography (PTG)
monitor to measure endothelial dysfunction, fitness, cardiac
autonomic dysfunction, and cardiac autonomic neuropathy;
andTBL-ABI,avolumeplethysmographymonitortomeasure
PAD and blood pressure analysis (CASP). These various tests
seem to help in the diagnosis of clinical symptoms and causes
that underlie such dysfunctions.
Some examples include ANS dysfunction, indicative of
exercise intolerance, mental stress, fatigue, and weakness;
baroreceptor dysfunction, indicative of headache, excessive
sweating, and high blood pressure; cardiac autonomic
neuropathy, indicative of dizziness and fainting, urinary
problems, sexual difficulties, altered digestion, and inability
to recognize low blood sugar; sinus node dysfunction,
indicative of fatigue, dizziness, chest pain, confusion, and
palpitations; endothelial dysfunction, pain in leg, shortness
of breath, and muscle weakness; high blood pressure,
headache, fatigue, vision problems, chest pain, difficulty in
breathing, and irregular heartbeat; peripheral artery disease,
lower extremity pain, muscle cramping of thighs or calves
when walking, and climbing stairs or exercising; small fiber
neuropathy, chronic pain, pins and needles, pricks, and
tingling numbness. In spite of the fact that the developers
claim the capabilities of these tests to diagnose a variety
of symptoms and causes associated with the development
of CMRs, these systems need a robust independent clinical
validation to establish the specificity and efficiency of their
ability to diagnose these symptoms and relate it to one or
more of the related causes.
Similar to our earlier collaborative studies on the various data
systems (TM-Oxi, Sudo Path), we have started validating
the new version of LD-products. We have briefly discussed
some cases and flow charts, to explain the importance of
such tests in fitness management, risk assessment, risk
stratification, and treatment management. Figure 9 shows
clinical symptoms of a patient. Clinical symptoms of a patient
Male 80 years old, height 168 cm. weight 67 kg. Not under
any medication. Symptoms: Dizziness, weakness, numbness
(legs), tremors, mood swings, anxiety, short of breath. The
data presented summarizes biomarker tests for each of the
visits, color-coded to indicate low, moderate, and high risk.
Some risks have remained unchanged whereas; others have
either improved or progressed to a higher risk. Just a glance
at such a finding, baffles the scientist or clinicians in turns of
making sense out of results of such elaborate tests. However,
proprietary software and algorithms are used to collect such
results, compute, analyze, and develop scores for a cluster of
risks. Figure 10 shows Wellness Index, which is derived from
the collective data from three test scores, vascular risk score,
autonomic risk score, and lifestyle risk score. Test results for
Figure 6: Risk factors for cardiometabolic diseases (Courtesy:
Dr. Albert Maarek, LD-Technologies, Miami, Florida)
Figure 7: Risk factors for cardiometabolic diseases: Before
and after treatment (Courtesy: LD-Technologies, Miami,
Florida)
Figure 8: LD-products for TM-flow data systems (Courtesy:
Dr. Albert Maarek, LD-Technologies, Miami, Florida)
Figure 9: Risk profiling using LD-flow data systems (Personal
data: Wellness Screening Concept and Health Knowledge
AB, Sweden)
6. Malmefeldt and Rao: Non-invasive diagnostic tools
17 Journal of Clinical Cardiology and Diagnostics • Vol 2 • Issue 1 • 2019
each of these risk scores, vascular, autonomic, and lifestyle,
are color-coded, as shown in Figure 10. Overall, wellness of
this patient as computed by the collective data is 66%. The
goal of the trainer/clinician is to correct the observed risks
under each category and demonstrate the improvements in
fitness, wellness index, and post-intervention.
In the case of this patient, there is a lot of room for intervention
and improvement of risk scores as the vascular score (19%),
autonomic score (19%), and lifestyle score (28%) are
relatively low. By appropriate interventions of biomarkers
responsible for these low scores, one can improve the overall
Wellness Index. Results of such studies, demonstrating how
one can develop interventions, and improve various risk
scores, will be the subject of our next article in this series.
Figure 11 shows the summary data from another patient, with
excellent Wellness Index [Figure 11, left side]. However,
what one can appreciate from this study is that even in a
case where the Wellness Index is 92%, there is still room to
improve [Figure 11, right side] the Wellness Index from 92
to 97%. The optimal value for Wellness Index is 100%, for
lifestyle score is 40%, autonomic score 30%, and for vascular
score 30%, together these scores add up to 100%. CMR score
includes biomarkers such as insulin resistance, hypertension,
lipid profile, diabetes-neuropathy, endothelial dysfunction,
and other symptoms of CVDs; whereas vascular risk score
includes inflammation, immune responses, lipid profile,
vascular tone, blood pressure, CASP, coagulation, and
arterial brachial index; autonomic score, on the other hand,
provides information on microcirculation, C-fiber activity,
cardiac innervation, adrenergic response, nor-adrenergic
response, parasympathetic responses, and baroreceptor
function associated data, as shown in Figure 12.
The purpose of this overview was not to describe all the
available noninvasive tools for monitoring metabolic risks,
but to explain the future directions; we want to pursue in the
field of clinical and diagnostic cardiology, for early detection,
risk assessment, risk prediction, and therapeutic management
of CMRs. Having said that, we want to inform the readers that
the future of clinical diagnosis and management of diseases
will heavily depend on the integration of available emerging
technologies. Therefore, we will have to start thinking as
to how, we can use this wealth of information coming from
a variety of independent tools, to develop a state-of-the-
art health-portal or an app that can capture these data and
generate appropriate risk assessment, and data interpretation
charts for empowering the patients. Such an app or a portal
should have the built-in capability, to share the information
with the clinicians as well as health-care professional. For
instance, the new Apple watch-4 can share the data with
clinicians, if they have already set-up patient health portals. If
we just take cardiometabolic disease as cluster of metabolic
disease; currently, we have the ability to diagnose all the
major metabolic risks, including oxidative stress, chronic
inflammation, excess weight, visceral obesity, body-mass
index, altered micro- and macro-circulation, endothelial
dysfunction, hardening of the arteries, clinical complications
associated with obesity, diabetes, and cardiovascular and
cerebrovascular diseases. The system may not be perfect, but
it is a good start, and there is plenty of room for improvement,
based on clinical validation.
Researchers have come a long way at the LD-technologies,
in improving their products for non-invasive diagnosis
Figure 10: Computing wellness index based on biomarkers (Personal data: Wellness Screening Concept and Health Knowledge
AB, Sweden)
Figure 11: Computing wellness index based on biomarkers
(Personal data: Wellness Screening Concept and Health
Knowledge AB, Sweden)
7. Malmefeldt and Rao: Non-invasive diagnostic tools
Journal of Clinical Cardiology and Diagnostics • Vol 2 • Issue 1 • 2019 18
of CMRs and cluster of risks. In addition, by developing
proprietary software, analytics, and algorithms, they have
been able to generate information on a variety of risks,
cluster of risks and risk scores for vascular dysfunctions, and
autonomic dysfunctions. It is worth discussing how these
researchers have been able to take individual test results
(as electrical outputs) obtained by a variety of sensors,
using well-tested devices such as oximeter, blood pressure
monitor, and galvanic skin monitor, compute values for
biomarkers and train their algorithms to provide information
on symptoms and causes. If you just carefully examine the
results presented in Figure 12, you will realize the power of
sensors, computing software analytics, and algorithms. In
view of the fact that majority of these biomarkers are not
assayed directly, we feel the need to validate these results
with appropriate clinical studies. One other indirect way to
validate, the data are using appropriate interventions to see
if such interventions change the risk scores. We are currently
in the process of developing such investigational studies in
Sweden, India, and the USA.
Another area that we are very much interested is, how we
can improve this diagnostic platform further. Since these
are patented technologies, we will not be able to directly
alter the functioning of any of the components of this
platform. However, we can use this information as well as
data from other sources on a separate “smart platform” to
compute, integrate, and fine-tune the risk prediction, and
risk management capabilities. Let us briefly discuss a novel
approach to build such a health portal or an app. We will
limit here to those devices that will provide complementary
information for improving early diagnosis and better
management of cardiometabolic diseases. Diabetes is a
major contributor to the morbidity and mortality of CVDs.
In view of this fact, the addition of values for glucose or
HBA1c in computing early risk for diabetes will add value
for risk prediction. We can import the data on glucose profile
of a patient directly onto our “health portal” from devices
such as Abbott FreeStyle Libre or Dexcom-G6 continuous
glucose monitor (CGM). If we want to make these emerging
tools popular and useful, we will have to make them
user-friendly for patients, clinicians, as well as health-care
providers. Currently, available diagnostic tools generate
useful data, compute, and generate a wealth of information
on their findings (charts, graphs, alerts, etc.). However, what
we are suggesting in our novel approach for integration is
that these individual values obtained on biomarkers from
various diagnostic devices, be collected on a smart app, and
appropriate software analysis and algorithm be developed,
to process this information along with any other biomarker
or risk associated with the CMRs, to fine-tune the risk
prediction equations or scores.
Scripps Translational Science Institute funded by the NIH
has been working with Fitbit, an activity tracker to deploy
one million participants in the “All of Us,” research program.
According to the researchers, “the goal of this research
is to gain insight into how wearable devices might impact
compliance and engagement in a large national cohort study
of this scale.” In this large study, they will be collecting a
variety of data with this tracking device, such as physical
activity, exercise, sleep data, heart rate, and cardiorespiratory
fitness. Such data are very useful to monitor the development
of metabolic diseases. All of Us project, envisages to build
one of the world’s largest data sets, with the specific goal
of improving the ability to prevent and treat disease, based
on individual differences in lifestyles. In a press release
on January 2019, NIH launched the “Fitbit Bring-Your-
Own-Device (BYOD)” project, the First Digital Health
Technology Initiative’ in the USA. Researchers of this one
of a kind project, express that data sharing is a high priority
to both researchers and participants. In an earlier article, we
articulated the use of “fitness and wellness” participants to
build a dataset for developing early diagnosis and effective
management of metabolic risks. In building such a platform
for population-based studies, one can create programs that
can take into account all the known risk factors so that data
analysis and risk prediction for the development of disease-
specific risks could be fine-tuned. For instance, tracking
devices could add additional features to the analytical
capabilities of the existing devices to meet such requirements.
We have already described the capabilities of LD-technology
products, to measure various risks associated with CMRs,
Figure 12: Factors used for computing risk scores and wellness index (Personal data: Wellness Screening Concept and Health
Knowledge AB, Sweden)
8. Malmefeldt and Rao: Non-invasive diagnostic tools
19 Journal of Clinical Cardiology and Diagnostics • Vol 2 • Issue 1 • 2019
including diabetes-related clinical complications such
as endothelial dysfunction, peripheral neuropathy, and
PAD. Greatest potential to reduce the burden of stroke, for
instance, is by primary prevention of the first-ever stroke.[30]
Researchers at AUT University Auckland, New Zealand,
have developed a new app, the “stroke riskometer.” They
used data from 752 stroke outcomes from a sample of 9501
individuals, across three countries (New Zealand, Russia,
and Netherlands), to investigate the performance of a novel
stroke risk prediction tool algorithm, compared to a standard
stroke risk prediction algorithm (Framingham stroke risk
score [FSRS]). The stroke riskometer performed well against
the FSRS. Other related complications including, diabetes
retinopathy (DR) and diabetic maculopathy, are the leading
causes of blindness worldwide. Changes in tiny blood vessels
of the eye may predict a higher risk of later narrowing in
the large blood vessels in the legs, according to a study
presented at the American Heart Association’s epidemiology
and prevention/Lifestyle and Cardiometabolic Health 2017
Scientific Sessions. Mobile fundus cameras are available,
for routine screening of eyes at the population level. In
addition, automated screening algorithms have begun to be
incorporated into the national DR screening programs in
Scotland and the UK.[31]
LD-technology devices measure
altered flow dynamics in micro as well as macrocirculation
and have been shown to predict diabetic neuropathy as
well as diabetes-mediated peripheral artery disease. We
are interested in developing wearables capable of “pulse
waveform” analysis, at various pulse points so that one can
monitor altered flow velocity of regional vascular beds.[32]
In a short overview on such an important topic, it is rather
difficult to discuss all aspects of this novel approach. Readers
are urged to refer to articles, comprehensive reviews, and
monographs on this subject.[33-41]
CONCLUSIONS
Metabolic diseases such as hypertension, excess weight,
obesity, type-2 diabetes, and vascular disease have increased
rapidly to epidemic proportions worldwide. These chronic
diseases contribute significantly, to the increased morbidity
and mortality related to vascular disease. FHS group
has defined the modifiable risk factors that promote the
development of CVDs. Vascular disease has remained the
number one killer, for over a century. FHS group based on
their findings developed Framingham Risk Score calculator
for both CVD and Stroke events. As and when additional
biomarkers were discovered, the risk prediction has been
fine-tuned by adding the newly discovered biomarkers and
retraining the risk prediction algorithms. Several studies
have demonstrated that robust management of modifiable
risk factors, significantly reduces premature mortality due
to ischemic heart disease. In spite of these observations,
the trends in the increased incidence of metabolic diseases
have not slowed down. Modern medicine has failed to
reduce, or prevent, these chronic metabolic diseases. In
an earlier article, we articulated some novel approaches to
diagnose early risks and effectively manage the observed
risks. In our efforts to develop novel preventive strategies,
we are working on the development of cost-effective non-
invasive diagnostic platforms as well as validating the
existing devices and platforms. Advances in medical device
technologies, availability of inexpensive sensors, and the
newer applications of software analytics and improved
algorithms have accelerated the integration of emerging
diagnostic technologies, for the development of improved
platforms for monitoring biomarkers, computing the risk
assessment, risk stratification, and risk management.
In this overview, we have described some of the diagnostic
tools and platforms available with special emphasis on
biomarkers, related to cardiometabolic diseases. We have
emphasized, the importance of integration of emerging
diagnostic technologies, to fine-tune risk assessment, risk
stratification, and risk management. When we review the
available emerging technologies, it becomes evident that
unlike classical blood chemistry, the newer diagnostic tests
rely heavily on software analytics and proprietary algorithms.
We have discussed how LD-technology products, obtain their
data for biological and physiological functions with a variety
non-invasive technologies, compute, integrate and interpret
these data, to match the clinical symptoms and possible
causes, that underlie these clinical conditions. Using such
non-invasive technology largest population-based studies
are under progress to track physical activities, biological and
physiological functions, to validate cardiorespiratory fitness.
The road ahead will bring in a host of diagnostic tools, big
data computing, artificial intelligence, and machine learning
algorithms, to improve risk assessment, risk stratification,
and risk prediction. What we have documented in this
article is the immediate need to validate all the new non-
invasive diagnostic tools in terms of specificity, accuracy,
and improved prediction capabilities. We also have stressed
the need, to develop an app or a health portal that can
collect data from a variety of non-invasive diagnostic tools,
integrate seamlessly to any existing dataset, and provide
improved prediction capabilities. We have used Abbott CGM
and LD-technology products as examples for integration
of technologies for monitoring CMR, cluster of risks, and
interpretation of such integrated data.
We have just discussed two major non-invasive devices
in this overview, CGM, and LD technology products, for
monitoring CMR. The two commercially available CGMs
are measure of interstitial glucose instead of blood glucose.
The HBA1c values are obtained using software analytics
and specific algorithms. Similarly, the LD-products obtain
most of their test data using three devices, oximetry, blood
pressure monitor, and skin response monitor. Much of the
data reported as clinical symptoms and causes or derived
9. Malmefeldt and Rao: Non-invasive diagnostic tools
Journal of Clinical Cardiology and Diagnostics • Vol 2 • Issue 1 • 2019 20
using proprietary software and algorithms. Even from big
data users such as IBM-Watson, algorithm-based results,
and interpretation present some limitations. Developers of
these emerging technologies do not provide any information
as to how various biomarkers are estimated. In view of this
fact, it is difficult to completely rely on these interpretations,
when working with large cohorts, or patients. The solution
we have suggested in our overview is to use these techniques
and develop extensive clinical data, suggest appropriate
interventions for the observed risks and see if the suggested
interventions improve individual risk scores or collective risk
scores. As mentioned earlier in this overview, we are trying
to validate noninvasive diagnostic tools and platforms in the
USA, Sweden, and India. We will report our findings as and
when we have sufficient data.
ACKNOWLEDGMENTS
Senior author, Gundu H.R. Rao, Emeritus Professor, University
of Minnesota, thanks, Mr.Aneel J.Antony for his collaboration
on the Noninvasive Glucometer Development Studies.
He thanks Indian Council of Medical Research (ICMR),
for funding glucometer-related studies. He also thanks, Dr
PratikshaGandhi,Chairwoman,IPCHeartcare,Mumbai,India,
Dr Albert Maarek of LD Technologies, Miami, Florida and
Ms. Elena Malmefeldt, Wellness Concepts, Sweden, for their
collaboration in device development and clinical validation
studies. He thanks, National Design Research Forum (NDRF)
of Defence Research and Development Organization (DRDO),
Government of India, for sponsoring our research proposal to
the ICMR, as well as honoring Dr. Rao with membership on
the Board of advisors, Medical Device Development, NDRF.
Finally, he expresses his appreciation to the Institutions of
Engineers, Bengaluru, India, for electing him as their first
Fellow of Institutions of Engineers.
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How to cite this article: Malmefeldt E, Rao GHR.
Noninvasive Diagnostic Tools: Cardiometabolic Risk
Assessment and Prediction. J Clin Cardiol Diagn
2019;2(1):12-21.