Osteoporosis is a disease of bone that leads to an increased risk of fracture. In osteoporosis the bone mineral density (BMD) is reduced, bone micro architecture is disrupted, and the amount and variety of proteins in bone is altered. Osteoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2.5 standard deviations below peak bone mass (20-year-old healthy female average) as measured by DXA; the term "established osteoporosis" includes the presence of a fragility fracture.
Osteoporosis is a Skeletal disorder characterized by compromised Bone strength. Bone strength primarily reflects the integration of: 1- Bone Density (Mass) 2- Bone Quality 3- Bone Turnover (Recycling). leading to an increased Fragility and risk of fracture.
Osteoporosis is a serious public health concern due to its prevalence worldwide. Currently over 200 million people worldwide suffer from this disease. Approximately 30% of all postmenopausal women have osteoporosis in the USA & Europe. At least 40% of these women and 15-30% of men will sustain one or more fragility fractures in their remaining lifetime. Ageing of populations worldwide will be responsible for a major increase in the incidence of osteoporosis in postmenopausal women. An initial fracture is a major risk factor for a new fracture. An increased risk of 86% for any fracture in people that have already sustained a fracture. Patients with a history of vertebral fracture have a 2.3-fold increased risk of future hip fracture and a 1.4-fold increase in risk of distal forearm fracture.
Prevention and Treatment of Osteoporosis and Fragility fracture:
A- Therapeutic Life style: 1- Good Nutritious Diet. 2- Exercise. 3- Prevention of falls
B- Drug therapy: 1- Anti resorptive agent. 2- Bone forming agents. 3- Other agents
Osteoporosis is a Skeletal disorder characterized by compromised Bone strength. Bone strength primarily reflects the integration of: 1- Bone Density (Mass) 2- Bone Quality 3- Bone Turnover (Recycling). leading to an increased Fragility and risk of fracture.
Osteoporosis is a serious public health concern due to its prevalence worldwide. Currently over 200 million people worldwide suffer from this disease. Approximately 30% of all postmenopausal women have osteoporosis in the USA & Europe. At least 40% of these women and 15-30% of men will sustain one or more fragility fractures in their remaining lifetime. Ageing of populations worldwide will be responsible for a major increase in the incidence of osteoporosis in postmenopausal women. An initial fracture is a major risk factor for a new fracture. An increased risk of 86% for any fracture in people that have already sustained a fracture. Patients with a history of vertebral fracture have a 2.3-fold increased risk of future hip fracture and a 1.4-fold increase in risk of distal forearm fracture.
Prevention and Treatment of Osteoporosis and Fragility fracture:
A- Therapeutic Life style: 1- Good Nutritious Diet. 2- Exercise. 3- Prevention of falls
B- Drug therapy: 1- Anti resorptive agent. 2- Bone forming agents. 3- Other agents
Calcium metabolism disorders
1. CALCIUM METABOLISM DISORDERS
2. OVERVIEW: Calcium definition and requirement . Calcium metabolism regulators : VD , PTH and calcitonin. Functions of calcium. Calcium metabolic bone diseases. Calcium metabolism disorders. CASE !!
3. WHAT IS CALCIUM? Calcium is a mineral that is essential to bone health, cardiovascular health, muscle maintenance, circulatory health, and blood clotting. Calcium also acts as an enzyme activator. While calcium is found in milk and dairy products, it is also available from other food sources, such as green leafy vegetables, seafood (eating salmon with the bones provides an even greater dose), almonds, blackstrap molasses, broccoli, enriched soy and rice milk products, figs, soybeans and tofu.
Orthopedics is a Reconstructive Surgery. Mangled extremity is an injury to at least three out of four systems (soft tissue, bone, nerves, and vessels). A Decision have to be made Amputation + Prosthesis Vs. Limb salvage procedure which includes Irrigation & Debridement, External fixation, Antibiotic bead spacers, Soft tissue coverage and finally Restoring Skeletal Stability by Salvage of Bone Defect
The New Lifestyle diseases is a Puzzle searching for an answer. These diseases emerged as bigger killers than infectious or hereditary diseases. Our view should be global as our body is a one unit containing multiple systems and organs. What is true is that our life style have been changed. We are cornered and surrounded by different kinds of pollutants. The price of our non biological inflammatory life style is
1- A state of chronic low grade inflammation which plays a role in all major diseases including musculoskeletal manifestations
2- Mitochondrial dysfunction, which is root cause of chronic diseases including cancer, nearly all chronic diseases and accelerated aging
The big question is what causes Mitochondrial dysfunction?? The aim of this presentation is to find an answer to this question
Calcium metabolism disorders
1. CALCIUM METABOLISM DISORDERS
2. OVERVIEW: Calcium definition and requirement . Calcium metabolism regulators : VD , PTH and calcitonin. Functions of calcium. Calcium metabolic bone diseases. Calcium metabolism disorders. CASE !!
3. WHAT IS CALCIUM? Calcium is a mineral that is essential to bone health, cardiovascular health, muscle maintenance, circulatory health, and blood clotting. Calcium also acts as an enzyme activator. While calcium is found in milk and dairy products, it is also available from other food sources, such as green leafy vegetables, seafood (eating salmon with the bones provides an even greater dose), almonds, blackstrap molasses, broccoli, enriched soy and rice milk products, figs, soybeans and tofu.
Orthopedics is a Reconstructive Surgery. Mangled extremity is an injury to at least three out of four systems (soft tissue, bone, nerves, and vessels). A Decision have to be made Amputation + Prosthesis Vs. Limb salvage procedure which includes Irrigation & Debridement, External fixation, Antibiotic bead spacers, Soft tissue coverage and finally Restoring Skeletal Stability by Salvage of Bone Defect
The New Lifestyle diseases is a Puzzle searching for an answer. These diseases emerged as bigger killers than infectious or hereditary diseases. Our view should be global as our body is a one unit containing multiple systems and organs. What is true is that our life style have been changed. We are cornered and surrounded by different kinds of pollutants. The price of our non biological inflammatory life style is
1- A state of chronic low grade inflammation which plays a role in all major diseases including musculoskeletal manifestations
2- Mitochondrial dysfunction, which is root cause of chronic diseases including cancer, nearly all chronic diseases and accelerated aging
The big question is what causes Mitochondrial dysfunction?? The aim of this presentation is to find an answer to this question
Paget’s disease of bone with special reference to dentistry-an insightishita1994
Bone is a dynamic tissue that is constantly renewed. The cell populations that participate in this process; the osteoblasts and osteoclast are derived from different progenitor pools that are under distinct molecular control mechanisms. Together, these cells form temporary anatomical structures, called as basic multicellular units that execute bone remodeling. A number of stimuli affect bone turnover, including hormones, cytokines, and mechanical stimuli. All of these factors affect the amount and quality of the tissue produced. Paget’s disease is a bone disorder characterized by excessive and abnormal remodeling of the bone, resulting in distortion and weakness of affected bones. It is the second‑most common osteo dystrophic condition after osteoporosis.
Osteoporosis is a progressive systemic skeletal disease characterized by low bone mass and microarchitecture deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk.
Bone physiology, OSTEOPOROSIS, Pagets Disease, HyperparathyoidismKaushal Kafle
A brief introduction to bone physiology, with more focus on Osteoporosis and its recent updates. Small tail topics include hyperparathyroidism and pagets disease.
Osteoprogenitor cells: pre-osteoblast, are bone stem cells derived from mesenchymal cells that eventually differentiate into mature osteoblast and osteocyte.
Osteoblast: large metabolically active cell with increased endoplasmic reticulum(ER)
1- Produce high level of alkaline phosphatase.
2- Produce type I collagen which is necessary for calcification.
3- Produce osteocalcine, produce signal to activate osteoclast.
= osteoblast has receptors for hormones such as parathyroid hormone, Vit. D, osteogen, cytokines and growth factors
= after osteoblast have secrete un-mineralized bone they usually become inactive, a few osteoblasts remain in the mineralized osteoid and become osteocyte.
Osteocyte: are osteoblast that have become surrounded by the calcified matrix of bone, these cells acts as mechanoreceptor identifying the loads placed on the individual bones and establishing the nature of such loads.
Osteoclasts: are large multi-nucleated cells, found attached to the surface of active bone formation.
= Found in well-defined pits known as Howships Lacuna.
= Derived from mono-nuclear stem cells in bone marrow and travel through blood vessels to the site of activity. It is activated by: inter-luckin II,I, cytokines.
= decreased endoplasmic reticulum.
Bone lining cells: elongated cells covering bone surface, they are inactive and have a high nucleus to cytoplasmic ratio, these cells has a major impact on calcium metabolism within the body.
Bone development:
Cellular mechanisms:
= skeleton formation begins when mesenchymal cells migrate to the site of skeleton-genesis. The cells then interact with epithelial cells, which in then trigger the mesenchymal cells to cluster together and undergo condensation to form compact mass of cells.
= each step is regulated by special type of genes such as member of home box genes.
= condensed cell then undergo differentiation either chondrocyte or osteoblast.
Core bonding factor-1 (CBFA-1)— (now known as Runx2)
One of the most important bone specified genes in differentiation of mesenchymal cells into – osteoblast.
Core bonding factor -1: CBFA-1 now is known as Runx2.
One of the most important bone specific genes in differentiation of mesenchymal cells into------osteoblast.
Bone morphogenetic protein: BMP:
= Play important role in the developing skeleton.
= BMP has been used ti improving healing and bone defect.
= BMP’s are probably involved in intramembranous bone formation.
= BMP-7 is found in area of brain to induce formation of cranial bones
= BMP’S 2—4 and 5 are expressed in some regions where mesenchymal condensation later give rise to craniofacial bone.
Novel mechanisms of osteoblast and osteoclast interaction:
Osteoblast interact with osteoclast to regulate the osteoclastic action.
Receptor activator of nuclear factor ligand (RANKL) is produced by pre-osteoblast and osteoblast and cell membrane of osteoblastic precursors.
This factor is essential factor for differentiation, fusion into multinucleated
The starting template material is RNA not DNA ( as in PCR assays for the diagnosis of viral infections)
RNA cannot serve as a template for PCR, (RNA is not a substrate for the Taq DNA polymerases commonly utilised in PCR.) Therefore reverse transcription is combined with PCR to convert RNA into a complementary DNA (cDNA)) suitable for PCR
The first step in this procedure is to convert the RNA molecules into single-stranded complementary DNA (cDNA) (Figure 9.20). Once this preliminary step has been carried out, the PCR primers and Taq polymerase are added and the experiment proceeds exactly as in the standard technique
To Restore Your Gut Bacteria and Health rememder the saying of Messenger of Allah Muhammad pbuh ; "No man fills a container worse than his stomach. A few morsels that keep his back upright are sufficient for him. If he has to, then he should keep one-third for food, one-third for drink and one-third for his breathing.“ [At-Tirmidhi] . Also remember the saying of Hippocrates 460 BC - 370 BC : "Let thy food be thy medicine and thy medicine be thy food". And this saying by Moses Maimonides, the great 12th century physician : "No illness which can be treated by diet should be treated by any other means”.
Aging is the progressive accumulation of damage to an organism over time leading to disease and death. Aging research has been very intensive in the last years aiming at characterizing the Pathophysiology of aging and finding possibilities to fight age-related diseases. Various theories of aging have been proposed. In the last years advanced glycation end products (AGEs) have received particular attention in this context. AGEs are formed in high amounts in diabetes but also in the physiological organism during aging. Higher levels of diabetic complications are due to poor glycemic control. The incidence and prevalence of diabetes mellitus is rising. About 50% of people with diabetes mellitus are unaware of their condition. Pharmacotherapy and Therapeutic lifestyle change (Diet, Regular exercises, Sunshine, Vitamin D and Calcium normal levels) should be the cornerstone of diabetes management.
Epigenetics, the microbiome and the environmentfathi neana
An epigenome consists of a record of the chemical changes to the DNA and histone proteins of an organism. These changes can be passed down to an organism's offspring via transgenerational epigenetic inheritance. Epigenetics, Gut microbiome and the Environment interplay like a vicious triad.
1- The epigenome is highly sensitive to external environment
2- The epigenome is highly sensitive to internal environment (Microbiome)
3- The microbiome (internal environment) is affected by the external environment
Care of the microbiome seems to be a personal issue but as it is affected by the external environment the issue must be global and a worldwide campaign have to be started.
Covid -19 informations you have to knowfathi neana
With Corona worldwide pandemic the people who exposed to the virus show different reactions some did not catch the virus and among those who catch the virus most of them did not show any symptoms or mild unnoticeable symptoms but some of them show sever manifestations and are killed by this virulent virus. Luckily enough this last group are the minority. The question is not why some people is affected by the virus but th question should be why most of the people are not affected or even those who are affected can defeat the virus and escape its fatal outcome?. To answer this question we have to know some basic facts.
A vitamin is an organic molecule (or related set of molecules) that is anessential micronutrient which an organism needs in small quantities for the proper functioning of its metabolism. Essential nutrients cannot besynthesized in the organism, either at all or not in sufficient quantities, and therefore must be obtained through the diet.
Vitamins are classified as either water-soluble or fat-soluble. In humans there are 13 vitamins: 4 fat-soluble (A, D, E, and K) and 9 water-soluble (8 B vitamins and vitamin C). Water-soluble vitamins dissolve easily in water and, in general, are readily excreted from the body, to the degree that urinary output is a strong predictor of vitamin consumption. Because they are not as readily stored, more consistent intake is important. Fat-soluble vitamins are absorbed through the intestinal tractwith the help of lipids (fats). Vitamins A and D can accumulate in the body, which can result in dangerous hypervitaminosis. Fat-soluble vitamin deficiency due to malabsorption is of particular significance in cystic fibrosis.
Free radicals are electron missing atoms or molecules. It is very unstable and react quickly with other compounds, trying to capture the needed electron to gain stability.
Generally, free radicals attack the nearest stable molecule, "stealing" its electron.
When the "attacked" molecule loses its electron, it becomes a free radical itself, beginning a chain reaction like snowball.
Once the process is started, it can cascade, finally resulting in the disruption of a living cell. The rule of antioxidants is to give electrons to free radicals and neutralize its destructive effects especially on the DNA.
Intermittent fasting had a strong anti inflammatory effect beside the many other benefits. Intermittent fasting is an eating pattern and Interventional strategy where in individuals are subjected to varying periods of fasting. It doesn’t specify which foods you should eat but rather when you should eat them. Intermittent fasting (IF) is an eating pattern that cycles between periods of fasting and eating. It’s currently very popular in the health and fitness community. Recently attracted attention because:
1- Its Evidence-Based Health Benefits
2- Its potential for correcting metabolic Abnormalities
3- Better adherence than other methods
Emerging evidence indicates that impaired cellular energy metabolism is the defining characteristic of nearly all cancers regardless of cellular or tissue origin. In contrast to normal cells, which derive most of their usable energy from oxidative phosphorylation, most cancer cells become heavily dependent on substrate level phosphorylation to meet energy demands. Evidence is reviewed supporting a general hypothesis that genomic instability and essentially all hallmarks of cancer, including anaerobic glycolysis (Warburg effect), can be linked to impaired mitochondrial function and energy metabolism. A view of cancer as primarily a metabolic disease and how autophagy process is activated will impact approaches to cancer management and prevention.
Lastly the question is Why some people have no cancer ? the answer is it is the life style and the diet rich in Healthy fat, Antioxidants, Vitamin C, Salvestrols and many natural remedies.
Free radicals are very unstable and react quickly with other compounds, trying to capture the needed electron to gain stability.
Generally, free radicals attack the nearest stable molecule, "stealing" its electron.
When the "attacked" molecule loses its electron, it becomes a free radical itself, beginning a chain reaction.
Once the process is started, it can cascade, finally resulting in the disruption of a living cell.
The drawbacks of climate change are so overt. The Disturbance of Great Ocean Conveyor currents led to the extreme changes in temperature around the globe in the form of a cooler northern, warmer tropical and cooler snowy winter, warmer summer. Many deaths from hypothermia were reported especially in refugee camps as it is not well equipped. Hypothermia is a medical emergency that occurs when the body loses heat faster than it can produce heat, causing a dangerously low body temperature. Normal body temperature is around 98.6 F (37 C). Hypothermia occurs as the body temperature falls below 95 F (35 C). When body temperature drops, heart, nervous system and other organs can't work normally. Left untreated, hypothermia can eventually lead to complete failure of heart and respiratory system and eventually to death.
Small intestinal bacterial overgrowth (SIBO)fathi neana
Like all healthy ecosystems, Richness of microbiota species characterizes the GI microbiome in healthy individuals. Conversely, a loss in species diversity (Dysbiosis) is a common finding in several disease states. The types of Dysbiosis are: 1- Loss of beneficial bacteria. 2- Overgrowth of potentially pathogenic bacteria. 3- Loss of overall bacterial diversity. 4- Overgrown in an area they’re not supposed to be in like the small intestine (SIBO).
The overgrowth of microbes in the small intestine results in: 1- fermentation of food in the small intestine, producing hydrogen and other gases. 2- They can also degrade the thin mucus layer and come in contact with the gut barrier, causing inflammation and intestinal permeability (Leaky gut). 3- This can lead to a variety of unpleasant symptoms and consequences like food allergies , sensitivities and chronic inflammatory processes. 4- SIBO leads to both maldigestion and malabsorption as the bacteria interfere with normal enzymatic and metabolic activity of the small intestine. 5- Additionally, these bacteria are associated with increased serum endotoxin and bacterial compounds stimulating production of (pro)inflammatory cytokines. 6- Iron is typically absorbed in the duodenum and the jejunum and SIBO can interfere with this absorption resulting in microcytic anemia. 7- Vitamin B12 is absorbed in the ileum and patients with SIBO often have B12 malabsorbtion which leads to megaloblastic anemia and B12 deficiency.
The best treatment for SIBO, like other forms of bacterial imbalance – or DYSBIOSIS is rehabilitating our microbiome.”
Biological diversity, or biodiversity, is the scientific term for the variety and variability of life on Earth. Biodiversity is the key indicator of the health of an ecosystem. Every living thing, including man, is involved in these complex networks of interdependent relationships, which are called ecosystems.
Like all healthy ecosystems, Richness of microbiota species characterizes the GI microbiome in healthy individuals. Conversely, a loss in species diversity is a common finding in several disease states.Microbiota Biodiversity helps us : 1- Combat aggressions from other microorganisms, 2- Maintaining the wholeness of the intestinal mucosa. 3- Plays an important role in the immune system, 4- Performing a barrier effect.5- A healthy and balanced gut microbiota is key to ensuring proper digestive functioning. A gut out of balance means a body out of balance which means illness including Inflammation, Allergies, Infections, Nutrient deficiencies, Weight Gain, Asthma-allergies – Autoimmunity
• Arthritis, Metabolic Bone disease, Skin problems e.g. eczema, Rosacia, Mood disorders - Cognitive decline-Alzheimers and Cancer.
Biological diversity, or biodiversity, is the scientific term for the variety and variability of life on Earth. Biodiversity is the key indicator of the health of an ecosystem. Every living thing, including man, is involved in these complex networks of interdependent relationships, which are called ecosystems.
Like all healthy ecosystems, Richness of microbiota species characterizes the GI microbiome in healthy individuals. Conversely, a loss in species diversity is a common finding in several disease states. Microbiota Biodiversity helps us : 1- Combat aggressions from other microorganisms, 2- Maintaining the wholeness of the intestinal mucosa. 3- Plays an important role in the immune system, 4- Performing a barrier effect.5- A healthy and balanced gut microbiota is key to ensuring proper digestive functioning. A gut out of balance means a body out of balance which means illness including Inflammation, Allergies, Infections, Nutrient deficiencies, Weight Gain, Asthma-allergies – Autoimmunity
• Arthritis, Metabolic Bone disease, Skin problems e.g. eczema, rosacia, Mood disorders - Cognitive decline-Alzheimers and Cancer.
Microbiota, Vitamin D Receptor and Autoimmuityfathi neana
1. Vitamins are substances which usually cannot be made by the body itself.
2. The body synthesizes vitamin D from 7-dehydro-cholesterol. Vitamin D is not a vitamin, it is a Gene-Transcriptional-Activator, a paracrine steroid hormone. It is the primary ligand which activate VDR
3. Deactivated VDR causes down regulation of the innate immunity. The burden on adaptive immunity increases creating a state of chronic inflammation with possible maladaptation and autoimmunity
4. What causes VDR deactivation is mostly a state of chronic inflammation caused by the pathogens associated with dysbiosis or leaky gut
5. VDR deactivation lead to Increased 1,25-dihydroxy vitamin-D (calcitriol) as there is no consumption and no breakdown
6. Sunshine, dietry and Ingested Vitamin D are preparing the precursors of 1,25-dihydroxy vitamin-D (calcitriol)in the presence of good liver and kidney function
7. 1,25-dihydroxy vitamin-D (calcitriol) is the active form which act as the primary ligand for VDR
8. Olmesartan, a VDR agonist, restores innate immune activity, allows (slow) recovery from advanced disease.
9. Treatment on the long term should be directed to reactivation of VDR by the Natural Ways that Increase Calcitrol and Vitamin D Receptor Gene Expression
10. restoring a balanced Microbiota and overcoming the leaky gut play a major rule in VDR reactivation
Successful management of Polytrauma must achieve the following goals, 1- Keep someone alive that would be dead without you 2- Prioritize treatment to prevent killing someone 3- Treat extremity injuries to return the patient to a functional life. The Priorities are 1- Life threatening, 2- Limb threatening, 3- Function threatening. The question about the best strategy in the management Polytrauma and the choice between an Early Total Care (ETC) vs. Damage Control Orthopedics (DCO) will be answered in this presentation.
Microbiota, vitamin D receptor VDR and autoimmuityfathi neana
The big question is what is behind sickness during our life ?. How the pathogens can prevail and what happen to our immune system and microbiota. How the pathogens in a clever way shut down the innate immunity causing persistent chronic illness, chronic inflammation, maladaptive autoimmunity and other chronic diseases. What is the rule of vitamin D and its receptor VDR . What about the current debate regarding the best choice for managing vitamin D deficient function. Hope we can find the answer in this presentation.
DIC is not a disease entity but an event that can accompany various disease processes. It is an “Acquired” Pathological process. Widespread activation of the clotting cascade lead to formation of blood clots in small blood vessels throughout the body causing a compromise of tissue blood flow leading to multiple organ damage MOD. The coagulation process consumes clotting factors and platelets,normal clotting is disrupted and severe bleeding can occur from various sites. Patients with DIC should be treated at hospitals with appropriate critical care units (ICU) with available Subspecialty expertise, such as hematology, blood bank, or surgery. Patients who present to hospitals without those capabilities and who are stable enough for transfer should be referred expeditiously to a hospital that has those resources. Treatment of DIC includes the underlying disorder, supportive treatment and hemostatic Therapy.
Deep vein thrombosis (DVT) & pulmonary embolism (PE). Life-threatening complications following trauma. Incidence of 5 to 63%. Risk factors: Pelvic and lower extremity fractures,Head injury and Prolonged immobilization. DVT prophylaxis is essential in the management of trauma patients.
Sepsis is the systemic inflammatory response syndrome (SIRS) due to severe infection. Sepsis simply is a Race to death between the host immune system and the pathogens. Micro-organisms grow out of control => hyperinflammatory response, With this insidious pathology the body attacks itself (auto immunity) leading to life threatening risk of organ dysfunction, septic shock and death. Micro-organisms can invade the body through wounds, IV lines, catheters etc. Sepsis kills more than 210,000 people in the US /year. It kills about 1,400 people worldwide every day. Significant decrease in Mortality due to increased Recognition and early Treatment.
Fat Embolism Syndrome (FES) is a Syndrome characterized by: Hypoxia, Confusion and Petechiae. Presenting soon after long bone fracture and soft tissue injury. Diagnosed by exclusion of other causes 0f (Hypoxia & Confusion). It occurs in 0.9 – 8.5% of all fracture patients. Up to 35% of the multiply injured. Mortality 2.5 – 15 - 20%. Rare in upper limb injury and children.
Treatment includes prompt stabilization of long bone fractures and supportive measures which includes: 1- Oxygen Therapy to maintain PaO2. 2- Mechanical Ventilation. 3- Adequate Hydration.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
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!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
3. 3
1- Cardiac Dysfunction, Hypertrophy and Failure.
The leading cause of mortality in the developed
world
2- Essential for blood clotting.
3- Stabilizes blood pressure.
4- Contributes to normal brain function.
5- Critical for communicating essential
information among cells.
6- Helps insulin open cells to glucose
6- Chemicals that transmit a signal from a nerve
cell to a target cell
(for example, when a nerve tells a muscle to
move)
7- Facilitates the actual process of contraction of
the muscle cell
8- Assists the movement of sperm to fertilize the
egg
Calcium extra skeletal functions
only 1 percent of the calcium in the body is found outside the bone
This form of calcium is critical for many functions in the body
6. Figure 1.
Signal transduction by voltage-gated
Ca2+
channels. Ca2+
entering cells initiates
numerous intracellular events, including
contraction, secretion, synaptic
transmission, enzyme regulation,
protein phosphorylation /
dephosphorylation, gene transcription.
(Inset) Subunit structure of voltage-
gated Ca2+
channels. The five-subunit
complex that forms high-voltage-
activated Ca2+
channels is illustrated with
a central pore-forming α1 subunit, a
disulfide-linked glycoprotein dimer of α2
and δ subunits, an intracellular β
subunit, and a transmembrane
glycoprotein γ subunit (in some
Ca2+
channel subtypes). As described in
the text, this model is updated from the
original description of the subunit
structure of skeletal muscle
Ca2+
channels. (Adapted from
Takahashi et al. 1987).
Voltage-Gated Calcium Channels
7. Bone is constantly being remodeled.
Remodeling is triggered and controlled by
1- Need for calcium in the extracellular
fluid
2- As a response to mechanical stresses
on the bone tissue
3- Other factors like, (Growth factors –
Hormones - Cytokines)
Bone remodeling is well balanced otherwise
pathological problems may occur
Bone remodeling & metabolism
Bone may seem to be stable and unchanging
But in fact bone metabolism is a dynamic process that balances bone formation and bone
resorption (Bone remodeling)
8. OPG (Osteoprotegerin) RANKL inhibitor
(estrogen - Prolia)
also known as osteoclastogenesis inhibitory factor(OCIF),
or tumor necrosis factor receptor superfamily member
11B (TNFRSF11B), is a protein that in humans is encoded by
theTNFRSF11B gene.[3]
Osteoprotegerin is a cytokine
receptor, and a member of the tumoro necrosis factor (TNF)
receptor superfamily.
RANK (Receptor activator of nuclear
factor Kappa B
RANKL (Receptor activator of nuclear
factor Kappa B ligand.
(PTH in malignancy)
Osteoprotegerin is a decoy receptor for the receptor
activator of nuclear factor Kappa B ligand. By binding
RANKL, OPG prevents RANK-mediated nuclear factor kappa
B (NF-kB) activation which is a central and rapid acting
transcription factor for immune-related genes, and a key
regulator of inflammation, innate immunity, and cell survival
and differentiation
Abbreviations
The ratio of OPG:RANKL produced by
osteoblasts
will determine the extent of bone
resorption.
9. What is the Osteoclast
(Calcium - Vit D – PTH – Calcitonin) -> Osteoblast
10. Macrophage of the
universe
Black holes
Black hole of the body
Macrophage
ا اا اا اا اا اا اا اا اا اا اا اا اا ا ا اا اا اا اا اا اا اا اا اا اا اا اا ا ا اا اا اا ا
ا اا اا اا اا اا اا ا ا اا اا اا اا اا اا اا اا اا اا اا اا اا اا اا اا اا اا اا اا اا اا ا ا اا اا اا اا اا اا ا
ا اا اا اا اا اا اا اا اا اا اا اا اا اا ا ا اا اا اا اا اا اا اا اا ا ا اا اا اا اا ا
22 ا اا اا اا اا اا اا اا ا ا اا اا اا ا
(22) If there were, in the heavens
and the earth, other gods besides
Allah, there would have been
confusion in both! but glory to Allah,
the Lord of the Throne: (High is He)
above what they attribute to Him!
11. Cell Name Anatomical Location
Adipose tissue macrophages Adipose tissue
Monocytes Bone marrow/blood
Kupffer cells Liver
Sinus histiocytes Lymph nodes
Alveolar macrophages (dust
cells)
Pulmonary alveoli of lungs
Tissue macrophages
(histiocytes) leading to
giant cells
Connective tissue
Langerhans cells Skin and mucosa
Microglia Central nervous system
Hofbauer cells Placenta
Intraglomerular mesangial
cells
Kidney
Osteoclasts Bone
Epithelioid cells Granulomas
Red pulp
macrophages (Sinusoidallini
ng cells)
Red pulp of spleen
Peritoneal macrophages Peritoneal cavity
LysoMac [33]
Peyer's patch
Each type of macrophage, determined by
its location, has a specific name
fixed macrophages, stay at strategic
locations such as the lungs, liver, neural
tissue, one, spleen and connective tissue,
ingesting foreign materials
and recruiting additional macrophages if
needed
Functions
Phagocytosis
Role in adaptive immunity
Role in muscle regeneration
Role in wound healing
Role in limb regeneration
Role in iron homeostasis
12.
13. Osteoblasts
are related to fibroblasts
and other connective tissue
cells
Osteoclasts
are descended from stem
cells in the bone marrow
that give rise to monocytes
(macrophages).
14.
15. The Osteoblast
is the gait through which most Osteoclastic activity & bone remodeling is
controlled
(The ratio of OPG : RANKL will determine the extent of bone resorption)
Estrogen vs PTH (in diseases as in PT adenoma – bone malignancy)
Bone remodeling is
triggered and controlled
by
1- Need for calcium in the
extracellular fluid
2- As a response to
mechanical stresses on the
bone tissue.
3- Other factors like,
Growth factors
Hormones
Cytokines
17. OPG (Osteoprotegerin) production is
stimulated in vivo by the female sex
hormone estrogen,[7
as well as the osteoporosis
drug, strontium. Denosumab is a
pharmacologic agent that in essence acts like
Osteoprotegerin as a decoy receptor for
osteoblastic RANKL.
Rule of Oestrogen
18. Metabolic Bone Diseases
• Generalized
• Bone turnover
affected
• Not infections
• Not primary bone
neoplastic disease
• Mineralization defect;
Osteomalacia /Rickets
• Low bone mass - mineral content;
Osteoporosis
• High bone mass - mineral content;
Osteopetrosis; Bisphosphonate;
Benign High bone mass, Fluorosis
• High bone turnover;
Pagets; Hyperparathyroidism
• Low bone turnover;
Adynamic disease
21. Osteoporosis
is a disease of bone that leads to an
increased risk of fracture. In
osteoporosis the bone mineral
density (BMD) is reduced, bone micro
architecture is disrupted, and the
amount and variety of proteins in
bone is altered. Osteoporosis is
defined by the World Health
Organization (WHO) in women as a
bone mineral density 2.5 standard
deviations below peak bone mass
(20-year-old healthy female average)
as measured by DXA; the term
"established osteoporosis" includes
the presence of a fragility
fracture.[1]
22. Osteopetrosis
Albers-Sc honberg Disease, Generalized Congenital
Osteosclerosis, Ivory Bones, Marble Bones,
Osteosclerosis Fragilis Generalisata
Osteopetrosis is a congenital defective Osteoclast
function. Osteoclasts are the cells responsible for bone
resorption. They are necessary for the formation of
bone marrow. In people with Osteopetrosis,
Osteoclasts do not function normally and the cavity for
bone marrow does not form.
This causes bones that appear dense on x-ray and
cannot resist average stressors and therefore break
easily.
The condition is quite rare; incidences have been
reported at 1 in 20,000-500,000 for the dominant form
and 1 in 200,000 for the recessive form
23.
24. Bone Remodeling
Rate of Turnover
Bone turnover is a term used
to describe the rate of bone
formation and resorption
Bone resorption is coupled to
bone formation
During growth, turnover
high, formation> resorption,
net bone gain
During adulthood, turnover
moderate, formation<
resorption, net bone loss
25. Diseases of bone turnover
• High bone turnover
Pagets
Hyperparathyroidism
Osteomalacia and rickets
Thyrotoxicosis
Hypogonadism
• Low bone turnover
Adynamic bone disease
Hypophosphatasia
Pagets
26.
27. Diseases of bone turnover
• High bone turnover
Pagets
Hyperparathyroidism
Osteomalacia and rickets
Thyrotoxicosis
Hypogonadism
• Low bone turnover
Adynamic bone disease
Hypophosphatasia
Hyperparathyroidism
28. • High bone turnover
Pagets
Hyperparathyroidism
Osteomalacia and rickets
Thyrotoxicosis
Hypogonadism
• Low bone turnover
Adynamic bone disease
Hypophosphatasia
Osteomalacia and rickets
Diseases of bone turnover
29. • High bone turnover
Pagets
Hyperparathyroidism
Osteomalacia and rickets
Thyrotoxicosis
Hypogonadism
• Low bone turnover
Adynamic bone disease
Hypophosphatasia
Thyrotoxicosis
Diseases of bone turnover
30. Bone Remodeling
Matrix vs mineral
content
Osteogenesis
Imperfecta
(OI)
is a group of genetic
diseases of collagen in
which the bones are
formed improperly,
making them fragile and
prone to breaking.
Osteogenesis Imperfecta
31. Type I Collagen, Osteogenesis Imperfecta and the Genetics of Osteoporosis
collagen
“blue” eyes in OI
fractures in OI
Collagen is the major protein of bone
• Proteins encoded by COLIA1 and
COLIA2 genes
• Collagen genes produce alpha 1 and
alpha 2 chains
• Chains assemble to form collagen fibres
Mutations in collagen coding regions
cause extreme bone fragility and severe
Osteoporosis
•“Brittle bone disease”
• Osteogenesis Imperfecta (OI)
Osteogenesis Imperfecta
Blue sclera
33. Osteoporosis
Low (mineralized bone) mass (Resorption > Formation)
Decreased volume of mineralized bone tissue per unit
of bone
Cortical thinning and increased porosity
Decreased number and thickness of trabeculae
Decreased bone strength Increased risk of fracture
Osteoporosis is one of the most devastating disorders associated with aging.
Osteoporosis-related fractures result in significant morbidity and mortality.
Characterized by qualitatively normal but quantitatively deficient bone.
Generalized decrease in bone mass is seen.
Bone is normal structurally as determined by histological and chemical analysis
Radiographs in patients with osteoporosis reveal increased radiolucency of bone
(Osteopenia)
Osteopenia occurs when bone resorption exceeds bone formation.
35. Osteoporosis Risk
factors
• Age-related
• Hypogonadism: estrogen
&testosterone
• Calcium deficiency and
insufficiency
• Vitamin D deficiency and
insufficiency
• Corticosteroid Treatment and
Cushing’s Disease
• Immobilization
• Antiepileptic Drugs
• Myeloma
• Thyrotoxicosis
• Idiopathic
• Osteogenesis Imperfecta:
COLA1,A2
• Phosphate Deficiency
• Homocystinuria: cystathionine
synthase
• Heparin
• Pseudoganglioma syndrome:
LRP 5
Major risk factors
-Age > 65 years
-Systemic glucocorticoid therapy of >3
months duration
-Mal-absorption syndrome
-Primary hyper parathyroidism
-Propensity to fall
-Osteopenia apparent on X-ray film
-Hypo-gonadism
-Early menopause (before age 45)
-Family history of osteoporotic fracture
(especially maternal hip fracture)
Minor risk factors
Rheumatoid arthritis
- Past history of clinical hyperthyroidism
- Chronic anticonvulsant therapy
- Low dietary calcium intake
- Smoker
- Excessive alcohol intake
- Excessive caffeine intake
- Weight <57 kg
- Weight loss >10% of weight at age 25
- Chronic heparin therapy
36. 1. Primary osteoporosis
Involutional (most common)
- osteoporosis in which no
underlying cause can be
identified.
oType I
(postmenopausal)
oType II (aging related)
oIdiopathic
oJuvenile
oAdult
2. Secondary osteoporosis -
osteoporosis in which there is
an underlying cause.
CLASSIFICATIONS OF OSTEOPOROSIS
• Generalized
Cortical
Trabecular
. . Regional
(involving one segment of the
skeleton)
• Localized
rheumatoid arthritis
• Bone marrow disease
(single multiple focal areas of
osteoporosis)
myeloma
secondary cancer
lymphoma and leukemia
Mastocytosis histiocytosis
37. 0.4
0.6
0.8
1.0
1.2
1.4
0 10 20 30 40 50 60 70 80
0.4
0.6
0.8
1.0
1.2
1.4
0 10 20 30 40 50 60 70 80
BMD, g/cm2
0.4
0.6
0.8
1.0
1.2
1.4
0 10 20 30 40 50 60 70 80
Age
TOTAL BODY FEMORAL NECK LUMBAR SPINE
Change in BMD (mean ± 1SD) with age in
healthy male (--) and female (--)(DPX, Lunar)
38. 0.50
0.60
0.70
0.80
0.90
1.00
1.10
1.20
55-59 60-64 65-69 70-74 75-79 80-84 85-89
Female
Male
0
500
1000
1500
2000
2500
65-69 70- 74 75-79 80- 84 85- 89
250
0
0
500
1000
1500
2000
Femoral Neck BMD and Hip Fracture
Age (years)
BMD, g/cm2
Fractures/100,000/year
Kellie et al, AM J Pub Health 1990; 80:326
43. )()(
4(
(4) Praying: "O my Lord! infirm indeed are my bones, and the hair of my head doth glisten
with grey: but never am I unblest, O my Lord, in my prayer to Thee!
Chapter 30 The Romans ةةةة
ةةةةة - Ar-Room: Verse 54
فففففففففف فففففففففف ففففففف ففففففف
ففففففففففففف فففففف فففف فففففف ففففف
فففففففففففففف فففففف فففف فففففف ففففف
ففففففففففف فففففففف ففففففففففف
فففففففففف فففففففففف فففففف
It is Allah Who created you in a state
of (helpless) weakness, then gave
(you) strength after weakness, then,
after strength, gave (you weakness
and a hoary head: He creates as He
wills, and it is He Who has all
knowledge and power
(Senility - Flamed head - Bone weakness -
General weakness)
44. ‘Menopause” VS ”Andropause”
Hormonal changes ( Sex Hormones – Growth hormone etc)
Bone weakness is not alone
Senility
Flamed head
(Grey hair)
Bone weakness
The strongest tissue weakened
General weakness
(All systems – skin -
Musculoskeletal –
Neuromuscular – CV - Renal –
Respiratory – Psychological -
Coordination – Balance -
Vision – Hearing – Reactions
etc)
Special care is needed
Slippery stairs & floor
Illumination
Obstacles & furniture
Exercises (Power + ROM)
Healthy diet – Sunshine
Psychological
23
45. Hype about hip fractures?
Not a myth but exaggeration of a fact to pay attention
Published in The New York Times, May 10, 2010,
Company With Osteoporosis Treatment Wins the ‘Super Bowl’ By LORA KOLODNY
Courtesy of McCombs School of Business, Texas Venture Labs
Biologics MD team competing at Global Moot Corp.
56. Treatment
Life style
Nutrition
Calcium, Vitamin D
Exercises
It acts like parathyroid hormone small doses by
stimulating Osteoblasts
(Ratio of OPG > RANKL)
Exercise with its anabolic effect, may at the
same time stop or reverse osteoporosis.
57. Osteoblasts
Respond well to increased stresses on bones
Weight bearing activities stimulate
Osteoblasts
Walk vs. Brisk Walk 4-6 hours a week
1- Cardiovascular function
2- D.M. Reduce insulin resistance
3- Fracture incidence less by 65%
4- Even reduce cancer by 18%
5- Metabolic Syndrome if combined
with intermittent fasting (IF)
WT bearing is the best
Antiresorptive bone forming agent
58. Bone Mass and Activity
80
85
90
95
100
105
110
115
%SedentaryControl
Row Volleyball Basketball Swim Run Weights
Sports
59. 1- Anti resorptive agents
Bisphosphonate, Estrogen analogs, Raloxifene SERMs, Calcitonin
2- Bone anabolic agents
Teriparatide (Forteo, recombinant PTH)
Calcium salts, Sodium fluoride
3- Other agents (RANKL inhibitors)
1- Denosumab (marketed as Prolia®) was approved for the treatment
of osteoporosis in June 2010 fully human monoclonal antobody that
mimics the activity of OPG (osyeoprotegerin).
2- Strontium ranelate (Protelos) Oral strontium ranelate is an
alternative oral treatment, belonging to a class of drugs called "dual
action bone agents" (DABAs)
Treatment
Medicines
60. The Citric acid cycle - Krebs cycle - TCA cycle
Bisphosphonate and Statin block Mevalonic acid pathway
The citric acid cycle is a key metabolic pathway that unifies
carbohydrate, fat, and protein metabolism. The reactions of the
cycle are carried out by 8 enzymes that completely oxidize acetate,
in the form of Acetyl CoA
BISPHOSPHANATE
61. Bisphosphonates (drugs such as Fosamax, Actonel, and Boniva) .
Like statins
They block very important metabolic pathways (Mevalonate pathway)
Nitrogenous Bisphosphonates begin their action on bone metabolism by blocking the enzyme farnesyl
diphosphate synthase (FPPS) which is involved in the mevalonate pathway (also called the HMG-CoA reductase
pathway). Statins disrupt the mevalonate pathway to stop cholesterol synthesis, they do not bind to bone
surfaces.
Bisphosphonates inhibited steps of the mevalonate pathway result
in Osteoclasts that lack a ruffled border and are therefore unable
to resorb bone.
They are “potent inhibitors of FPPS” which catalyzes the synthesis
of farnesyl disphosphate (FPP), an important precursor of sterols,
dolichols, ubiquinones, and prenylated proteins
Benefits of CoQ10 ranging from positive results on cardiac health and endurance training, cancer, diabetes,
periodontal disease, and neurological conditions
A higher risk of developing atrial fibrillation (irregular and rapid heartbeat) is a possible side effect of
Bisphosphonates – and low levels of CoQ10 caused by the drugs.
The highest concentrations of CoQ10 in the body are found in organs that require the most energy to function
properly such as the heart, the lungs, the kidneys, and the liver. Unfortunately, normal ubiquinone production
decreases with age.
Foods rich in ubiquinone – mainly fish, fish oils, organ meats and whole grains
62. 1-Bisphosphonate Interactions
interact with several common medications. Some make the drug less effective, while others can
increase the risk of side effects. These include:
•Aspirin and NSAIDs drugs (ibuprofen, naproxen and anaprox): causes increased stomach
irritation.
•Iron supplements and magnesium products: prevents absorption.
•Antacids: makes it less effective.
2- FDA Recalls and Warnings
Warning letter for “overstating the benefits while minimizing the risks
Femur Fractures
Osteonecrosis of the Jaw
Barrett’s esophagus, dysphagia and gastritis esophageal cancer
Incapacitating bone, joint and muscle pains
Irregular heartbeat
Painful eye disorders that cause inflammation and distorted vision.
3-Cases Against Fosamax Increase
Court cases against Merck began in 2004 once research proved that Fosamax causes Osteonecrosis
of the jaw. Patients with side effects such as femur fractures, Dead Jaw Syndrome, esophagus
problems and musculoskeletal pain have filed lawsuits against Merck. Thousands of patients have
filed in a multidistrict litigation (MDL) in New York and New Jersey. With MDL cases, pre-trial
proceedings are heard together; however, each case has a separate trial
Bisphosphonate side effects
One of the most widely studied candidate genes is COLIA1 which is known to be mutated in Osteogenesis Imperfecta, a disease characterised by low BMD and extreme bone fragility. In this disease, mutations occur which affect the protein coding regions of the COLIA1 or COLIA2 gene, resulting in under production of collagen or in the production of abnormal collagen which is rapidly degraded.