This document summarizes several studies that examined the effects of targeting different ranges of oxygen saturation levels in extremely preterm infants. The studies found that targeting a lower saturation range of 85-89% resulted in a higher risk of death compared to a range of 91-95%, but also found a lower risk of retinopathy of prematurity. No significant differences were found between groups in rates of disability or other outcomes. A prospective meta-analysis is planned to further evaluate the risks and benefits of different oxygen saturation targets in preterm infants.
CLINICAL TEACHING ON BUBBLE CPAP: Introduction, Definition, History of development, Physiology of Bubble CPAP, Principle, Patient interface, equipments for bubble CPAP, indication and contraindication for bubble CPAP, essential of CPAP, CPAP machine, bubble cpap machine application, setting pressure, FiO2, oxygen flow, Monitoring adequacy and complications of bubble CPAP, Monitoring infant condition, weaning for Bubble CPAP, CPAP Failure, complications related to CPAP, Preventing complications, Nursing Care.
CLINICAL TEACHING ON BUBBLE CPAP: Introduction, Definition, History of development, Physiology of Bubble CPAP, Principle, Patient interface, equipments for bubble CPAP, indication and contraindication for bubble CPAP, essential of CPAP, CPAP machine, bubble cpap machine application, setting pressure, FiO2, oxygen flow, Monitoring adequacy and complications of bubble CPAP, Monitoring infant condition, weaning for Bubble CPAP, CPAP Failure, complications related to CPAP, Preventing complications, Nursing Care.
Effects of souvenaid on plasma micronutrient levels and fatty acid profiles i...Nutricia
A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial
A randomised, double-blind clinical trial was undertaken in order to assess the effectiveness of probiotics in
the prevention of necrotising enterocolitis (NEC) in newborns weighing <1500 g.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. Extreme prematurity of less than 28 weeks'
gestation affects approximately 1% of births
Although 80% of these infants are discharged
home alive , they often sustain severe
morbidity , including BPD, poor growth,
respiratory illness, hospital re-admissions,
visual deficits, cerebral palsy, sensori-neural
disability and cognitive, educational and
behavioural impairment.
3. Oxygen is the most common therapy used in
the care of very preterm infants. It has been
associated with significant improvements in
neonatal survival and disability .
However, preterm infants are highly sensitive
to the harmful biochemical and physiological
effects of supplemental oxygen.
4. So hereby presenting few studies to confirm if
lower target saturation will indeed help in
minimizing complications.
5. Less exposure to oxygen is a simple strategy
that could reduce oxidative stress and tissue
injury and prevent morbidity in very preterm
infants.
In healthy preterm infants breathing air,
arterial oxygen saturation (SpO2) is 85-98%.
However, for infants requiring supplemental
oxygen, the optimum range of arterial oxygen
to minimise organ damage, without causing
hypoxic injury, remains unknown.
6. The COT is a randomized and parallel double-
blind trial that was conducted in 25 hospitals in
Canada, the United States, Argentina, Finland,
Germany, and Israel.
7. Enrollment began in December 2006 and ended
in August 2010. Follow-up assessments were
performed between October 2008 and August
2012.
8. INCLUSION
Infants with gestational ages of 23 weeks 0 days
through 27 weeks 6 days were eligible for
enrollment during the first 24 hours after birth.
9. EXCLUSION
Infant not considered viable
Persistent pulmonary hypertension
Dysmorphic features or congenital
malformations that adversely affect life
expectancy or neurodevelopment
Cyanotic heart disease
Infant was unlikely to be available for long-
term follow-up.
10. PRIMARY OUTCOMES
Death
Gross motor disability: Defined as a level of 2 or higher
according to the Gross Motor Function Classification
System
Cognitive or language delay defined as composite
cognitive or language score of less than 85 (1 SD below
the mean of 100) on the Bayley Scales of Infant and
Toddler Development, Third Edition
Severe hearing loss: Defined as the prescription of
hearing aids or cochlear implants
Bilateral blindness: Defined as a corrected visual acuity
less than 20/200 in the better eye.
11. SECONDARY OUTCOMES
ROP, brain injury, patent ductus arteriosus,
necrotizing enterocolitis (NEC),
bronchopulmonary dysplasia (BPD), and the
duration of use of positive airway pressure and
supplemental oxygen.
12. INTERVENTION:
Infants were placed on the modified Massimo
pulse oximeter. The oximeters were modified to
display and store oxygen saturations that were
either 3% higher or lower than the true values.
True values were displayed if the measured values
decreased below 84% or increased above 96%
Caregivers were instructed to adjust the
concentration of oxygen to maintain saturation
values between 88% and 92%, which produced two
treatment groups with true target saturations of
85-89% or 91-95%
13. Alarms were triggered when the displayed
saturations decreased to 86% or increased to 94%
Study oximetry was continued until 36 weeks of
postmenstrual age even if an infant was not
receiving supplemental oxygen. Infants who were
receiving any respiratory support including
oxygen therapy at 35 weeks of postmenstrual age
were monitored with their assigned study
oximeter until a postmenstrual age of 40 weeks.
Study oximetry was stopped earlier if infants were
discharged home
14. RESULTS
The median of the individual study
participants` oxygen saturations on days with
more than 12 hours of oxygen was:
Lower saturation group: 90.9% (IQR 89.6-
92.5%)
Higher saturation group: 93.4% (IQR 92.7-
94.2%)
Targeting lower compared with higher oxygen
saturations had no significant effect on the rate
of death or disability at 18 months.
15. Secondary outcomes:
Targeting lower compared with higher oxygen
saturations reduced the mean postmenstrual
age at the last oxygen therapy from 36.2 to 35.4
weeks (P = 0.03)
There was no significant difference between the
groups in other outcome including ROP and
severe BPD
16. In five randomized, masked trials with similar
protocols conducted in the United States,
Australia, New Zealand, Canada, and the
United Kingdom involving infants born before
28 weeks' gestation, investigators are
evaluating the effects of targeting a range of
oxygen saturation of 85 to 89%, as compared
with a range of 91 to 95%, on survival and
neurodevelopmental outcomes at 18 months to
2 years after the expected delivery date.
17. Halfway through the trials, the oximeter-
calibration algorithm was revised.
Recruitment was stopped early when an
interim analysis showed an increased rate of
death at 36 weeks in the group with a lower
oxygen saturation.
18. RESULTS
1. DEATH:
Those in the lower-target group had a higher rate
of death than those in the higher-target group
before hospital discharge (23.1% vs. 15.9%;
relative risk in the lower-target group, 1.45;
95% confidence interval [CI], 1.15 to 1.84;
P=0.002).
19. 2. ROP: reduced rate in lower saturation group
3. BPD: no change
4. NEC: increased rate in lower saturation group
5. DURATION OF OXYGEN: Decreased in lower
saturation group
20. In conclusion, preterm infants born before 28
weeks' gestation with a target oxygen
saturation of 85 to 89% had a significantly
higher rate of death than did those with a
target of 91 to 95% in a subgroup whose
treatment involved an oximeter-calibration
algorithm similar to that in current use. Our
findings strongly favor the avoidance of
targeting an oxygen saturation of less than 90%
among such infants, according to readings on
current oximeters
21. Surfactant, Positive Pressure, and Oxygenation
Randomized Trial (SUPPORT), a controlled,
multicenter trial with a 2-by-2 factorial design,
to compare two target levels of oxygen
saturation and two ventilation approaches
(continuous positive airway pressure [CPAP]
initiated in the delivery room with a protocol-
driven strategy of limited ventilation vs.
intratracheal administration of surfactant with
a protocol-driven strategy of conventional
ventilation).
22. The oxygen-saturation component of the trial
tested the hypothesis that a lower target range
of oxygen saturation (85 to 89%), as compared
with a higher target range (91 to 95%), would
reduce the incidence of the composite outcome
of severe retinopathy of prematurity or death
among infants who were born between 24
weeks 0 days of gestation and 27 weeks 6 days
of gestation.
23. Patients
Infants who were born between 24 weeks 0
days of gestation and 27 weeks 6 days of
gestation for whom a decision had been made
to provide full resuscitation were eligible for
enrollment at birth. Infants born in other
hospitals and those known to have major
congenital anomalies were excluded.
24. PRIMARY OUTCOME:
Death before discharge occurred in 130 of 654
infants in the lower-oxygen-saturation group
(19.9%) as compared with 107 of 662 infants in
the higher-oxygen-saturation group (16.2%)
(relative risk with lower oxygen saturation,
1.27; 95% CI, 1.01 to 1.60; P=0.04; number
needed to harm, 27). The distribution of the
major causes of death did not differ
significantly between the two groups
25. The rate of severe retinopathy among survivors
who were discharged or transferred to another
facility or who reached the age of 1 year was
lower in the lower-oxygen-saturation group
(8.6% vs. 17.9%; relative risk, 0.52; 95% CI, 0.37
to 0.73; P<0.001; number needed to treat, 11).
27. A prospective meta-analysis (PMA) is one where
studies are identified, evaluated, and
determined to be eligible before the results of
any included studies are known or published,
thereby avoiding some of the potential biases
inherent in standard, retrospective meta-
analyses. This methodology provides the same
strengths as a single large-scale multicentre
randomised study whilst allowing greater
pragmatic flexibility.
28. The NeOProM Collaboration protocol
(NCT01124331) has been agreed prior to the
results of individual trials being available. This
includes pre-specifying the hypotheses,
inclusion criteria and outcome measures to be
used.
29. Participants:
Participants in the eligible trials will be infants
born before 28 weeks' gestation and enrolled
within 24 hours of birth.
30. The primary outcome to be assessed is a
composite outcome of death or major disability
at 18 months - 2 years corrected age.
31. Additional outcomes
ROP treatment by laser photocoagulation or
cryotherapy (performed if Type I ROP or
threshold ROP occurs)
measures of respiratory support, defined as (a)
supplemental oxygen requirement at 36 weeks'
postmenstrual age , (b) days of endotracheal
intubation (c) days of continuous positive
airway pressure (CPAP), (d) days of
supplemental oxygen, (e) days on home
oxygen
32. patent ductus arteriosus diagnosed by
ultrasound and requiring medical treatment
patent ductus arteriosus requiring surgical
treatment
necrotising enterocolitis requiring surgery
weight at birth, 36 weeks' postmenstrual age,
discharge home and 18-24 months corrected
age
33. re-admissions to hospital up to 18-24 months
corrected age
cerebral palsy with GMFCS level 2 or higher or
MACS level 2 or higher at 18-24 months
corrected age
blindness (<6/60 vision, 1.3 logMAR in both
eyes)
deafness requiring hearing aids
quantitative Bayley III score
34. The lower SpO2 range was associated with a
significant increase in the risk of death. There
was no significant difference between the two
target ranges in the rate of disability at 18-24
months, including blindness. A significant
difference between groups in the risk of the
composite primary outcome of death or
disability in favour of the higher SpO2 range
was mainly attributable to the difference
between groups in the risk of death.
35. The lower target range did not reduce
bronchopulmonary dysplasia or severe visual
impairment, but it did increase the risk of
necrotizing enterocolitis requiring surgery or
causing death.
36. The trials provide no reason to prefer SpO2
targets below 90% and indicate the importance
of more trials to see if a further survival
advantage can be identified. The safety of
targets above 95% has not been evaluated. The
five trials were designed to be similar to
facilitate an individual patient data meta-
analysis, and this Neonatal Oxygen Prospective
Meta-Analysis (NeOProM) may provide
further insights.