Osteoporosis is a chronic, progressive skeletal disease characterized by low bone mass, microarchitecture deterioration of bone tissue, bone fragility, and a consequent increase in fracture risk.
Osteoporosis is a disease in which bones become fragile and can easily break. It has no symptoms in its early stages and is a public health threat to more than 44 million Americans. In this community lecture given live on our Berkeley Heights, NJ campus, Dr. Toscano-Zukor, explains how to identify your risk factors for osteoporosis as well as prevent and treat this disease.
This was a lecture in the course "Significant Medical Conditions in Seniors" presented at Peer Learning in Chapel Hill, NC, USA in 2016 by Michael C. Joseph, MD, MPH.
Osteoporosis is a chronic, progressive skeletal disease characterized by low bone mass, microarchitecture deterioration of bone tissue, bone fragility, and a consequent increase in fracture risk.
Osteoporosis is a disease in which bones become fragile and can easily break. It has no symptoms in its early stages and is a public health threat to more than 44 million Americans. In this community lecture given live on our Berkeley Heights, NJ campus, Dr. Toscano-Zukor, explains how to identify your risk factors for osteoporosis as well as prevent and treat this disease.
This was a lecture in the course "Significant Medical Conditions in Seniors" presented at Peer Learning in Chapel Hill, NC, USA in 2016 by Michael C. Joseph, MD, MPH.
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.
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!
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.
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
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
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. What is it?
• Systemic skeletal disease characterised by:
– low bone mass
– microarchitectural deterioration of bone tissue
– resultant increase in fragility and risk of
fracture
3. national osteoporosis society
Why is it important?
• 1 in 3 women and 1 in 12 men over the age of 50
• Every 3 minutes someone has a fracture due to
osteoporosis
• ~2 million people in the Aus have osteoporosis
• 20,000 hip fractures/yr Aus
• 50,000 wrist fractures UK
• 120,000 spinal fractures UK
• Costs $7.4 billion each year
4. Bone Components
• Protein matrix of collagen fibres
• Bone mineral;an inorganic calcium compound
hydroxyapatite
5. • Osteoblasts; synthesise collagen and the control of
mineralisation.
• Osteoclasts; resorb bone by pumping out H+ that dissolves
the hydroxyapatite.
• Osteocytes; direct bone to form in the places where it is
most needed. They may detect mechanical deformation and
mediate the response of the osteoblasts
6. Idiopathic Osteoporosis
• Type 1
– postmenopausal women
– accelerated loss of trabecular bone
– # vertebral bodies, distal forearm
– Oestrogen inhibits osteoclasts; postmenopause bone is
resorbed faster
7. Idiopathic Osteoporosis
• Type 2
– women and men >70yrs
– loss of trabecular and cortical bone
– NOF, prox. Humerus, pelvis, prox tibia
8. Type 2...
• “age related”
• increased breakdown by osteoclasts
• decreased bone formation by osteoblasts
• contribution of:
– decreased oestrogen levels
– Vitamin D deficiency
– secondary Hyperparathyroidism
• Decreased activity
• ?decreased production of insulin-like growth
factors
9. Secondary Osteoporosis
• Hyperparathyroidism
• Hyperthyroidism
• Hypogonadism
• Cushing’s
• Vit D
– helps Ca+ absorbtion in the intestine. Low Vit D results in decreased plasma Ca+..
This increases PTH secretion -> More Ca+ is resorbed from bone
• Ca+ deficiency
• Malabsorption
•IMMOBILITY
11. Other Risk factors
• Female - lower peak bone mass, increased menopausal
bone loss, longer life
• >60years
• FmHx (maternal)
• Caucasian or Asian
• Early menopause
• Prolonged Amenorrhoea at young age
• Low BMI (<19)
• History of fracture
• Smoker
• Sedentary
12. Medications
• Steroids
– increased bone loss by suppressing osteoblasts
– 2.5% pop age>75
• Phenytoin
• Heparin
• Chemotherapy - letrozole
15. Kinds of Fracture
• “Low trauma fractures”
• “fragility fractures”
• WHO: # caused by injury insufficient to
break normal bone - minimal standing
height, or no trauma at all
16.
17. Vertebral crush #
•Acute or Chronic
•Asymptomatic in 2/3rds
•Pain
•Kyphosis
•Instability
•Decreased Height
18. Hip Fracture
•70% mortality at one-year if not fixed
•30% one year mortality
•40% severely disabled at one year
21. Diagnosis without fracture
• Don’t use XR for diagnosis unless reported as “severe
osteopenia” (then get DXA scan)
• Ultrasound of calcaneus - not useful
22. DEXA Scan
• Dual-energy X-Ray absorptiometry
• two beams of single energy pass through bone. The denser the bone the
more the beams are attenuated.
• BMD is then compared to a reference range of young adults with
average bone density, this is expressed in standard deviations:
• T scores:
– 0 and -1 SD - within normal range
– -1 and -2.5 SD - osteopenia
– below -2.5SD - osteoporosis (WHO definition)
• a Z score is also calculated. This compares BMD with a reference
range of those the same age.
23. •only do DXA scan as a “casefinding
strategy, rather than for population
screening”
•it predicts future fracture with high
specificity, but low sensitivity
25. Bisphosphonates.
• Block mineralisation and
osteoclastic bone resorption
• 2nd and 3rd generation
have more anti-resorptive
properties
cyclic Etidronate (1st gen)
- needs to be cyclical to
stop osteomalacia
developing, (2/52
etidronate, 10/52 calcium)
26. Side Effects
not in renal failure!
Jaw osteonecrosis
Upper GI side effects
must be taken upright and stay sitting or standing
without food or drink for 30+ mins
27. Bisphosphonates...
Alendronate (2nd gen) - can cause oesophageal
ulceration. Most data is from daily dosing, but current
recommendations are for weekly
Risedronate. (3rd gen) - cylic side chain
Ibandronate (not yet available here) - iv preparation or
once monthy oral tablet. Evidence not direct
Zolendronic Acid - once yearly infusion. NO evidence for
osteoporosis - high risk of Osteonecrosis
Reduce vertebral and non-vertebral, including hip
28. Strontium
• Sachet drink - daily
• side effects - diarrhoea and headache
Reduce vertebral and non-vertebral, including hip
29. Other treatment
• SERMs
– (selective oestrogen receptor modulators)
– Raloxifene
– decreases risk of ER+ve breast cancer
– Increases risk of DVT/PE
– Used mainly if intolerant of bisphosphonates
– reduces risk of vertebral fractures only
30. • Teriparatide
– recombinant 1-34 parathyroid hormone
– sc daily injection
– Reduce vertebral and non-vertebral, but NOT
hip
– EXPENSIVE!
31. • HRT
– risk outweighs benefits?
– Young women with high risk of fracture and
symtomatic menopause
32. Vitamin D and Calcium
• Contentious preventative treatment
• 2 french nursing home studies demonstrate
decrease in fractures
• primary care randomised study from York
shows no change (BMJ 30th April 05)
• Aberdeen study shows similar results
(Lancet 28th April 05)
• However - ALL other agents were trialled
whilst taking both Calcium and Vit D
