The document presents a case study of a 70-year-old male patient admitted with symptoms of giddiness and generalized weakness for 15 days. After examination and investigations, he was diagnosed with acute idiopathic parkinsonism and type 2 diabetes mellitus. He was treated with levodopa, carbodopa, pramipexole, and insulin during his 4-day hospital stay and counselled on lifestyle modifications. His symptoms improved with treatment and he was discharged on medications with follow-up in the neurology outpatient department.
Extrapyramidal symptoms. ... These symptoms include dystonia (continuous spasms and muscle contractions), akathisia (motor restlessness), parkinsonism (characteristic symptoms such as rigidity), bradykinesia (slowness of movement), and tremor, and tardive dyskinesia (irregular, jerky movements).
Extrapyramidal symptoms. ... These symptoms include dystonia (continuous spasms and muscle contractions), akathisia (motor restlessness), parkinsonism (characteristic symptoms such as rigidity), bradykinesia (slowness of movement), and tremor, and tardive dyskinesia (irregular, jerky movements).
Gillian Barrie syndrome An autoimmune disease,
this presentation is a case discussion for actual case includes: demographic data, current history, past history, chief complaint, prognosis, medications, medical treatment, nursing management, disease pathophysiology.
Gillian Barrie syndrome An autoimmune disease,
this presentation is a case discussion for actual case includes: demographic data, current history, past history, chief complaint, prognosis, medications, medical treatment, nursing management, disease pathophysiology.
It may contain a brief intoduction of disease, etiology, types of parkinson disease, clinical findings, dignosis, pathophysiology, treatment, drug classification and their mechanisms of actions.
'Parkinson's Disease Service in Cumbria' - Dr Jim George (Consultant Physician for North Cumbria University Trust) from the Cumbria Neuroscience Conference
parkinson's disease by me ..........prakash mahala p.g. medical surgical nursing at himalayan college of nursing dehradun.......prakashjpmmahala@gmail.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.
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.
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 lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
1. CASE PRESENTATION ON
By
BASIL WILSON
13Q0408
PHARM D IVth yr
ACCUTE IDIOPATHIC
PARKINSONISM &
TYPE 2 DIABETES MELITUS
2. Definition
Parkinsonism is a general term that refers to a group
of neurological disorders that cause movement
problems similar to those seen in Parkinson’s
disease, such as tremors, slow movement and
stiffness.
The defining feature of parkinsonism is
bradykinesia, or slowness with decrement and
degradation of repetitive movements (“fatigue”).
Parkinsonism is a symptom complex, and differs
from Parkinson's disease which is a progressive
neurodegenerative illness.
3. Parkinsonism is an umbrella term, which
means that the person has symptoms similar
to Parkinson’s disease (like tremor, rigidity,
slowness of movements and balance
problems), although a doctor is not sure
whether those symptoms are due to the loss
of dopamine. A number of patients with
Parkinsonism do not have PD. Only 85% of
all Parkinsonism are due to idiopathic
Parkinson’s disease.
4. Atypical Parkinsonism should be
considered particularly in patients with:
•Poor response to dopamine
•Early loss of balance
•Prominent intellectual changes (dementia)
•Rapid onset or progression
•Conspicuous postural hypotension, urinary
and bowel incontinence
•Little or no tremor.
5. Etiology
Parkinson’s disease is the most common
neurodegenerative cause of
parkinsonism. Other causes include multiple
system atrophy, progressive supranuclear
palsy and corticobasal degeneration.
These other neurodegenerative conditions are
sometimes grouped together under term of
“atypical parkinsonism” or “parkinson-plus
syndromes”.
6. Parkinsonism can also be symptomatic,
as a result of various vascular, drug-
related, infectious, toxic, structural and
other known secondary causes. Of
these, drug-induced parkinsonism is
probably the most common and
includes agents that block post-synaptic
dopamine D2 receptors with high
affinity (such as antipsychotic and anti-
emetic medications) and sodium
valproate.
7.
8.
9. Pathophysiology
Parkinson’s disease is primarily associated with the
gradual loss of cells in the substantia nigra of the brain.
This area is responsible for the production of dopamine.
Dopamine is a chemical messenger that transmits signals
between two regions of the brain to coordinate activity.
For example, it connects the substantia nigra and the
corpus striatum to regulate muscle activity.
If there is deficiency of dopamine in the striatum the nerve
cells in this region “fire” out of control. This leaves the
individual unable to direct or control movements..
10. This leads to the initial symptoms of Parkinson’s disease.
As the disease progresses, other areas of the brain and
nervous system degenerate as well causing a more
profound movement disorder.
The exact cause for the loss of cells is unknown. Possible
causes include both genetic and environmental factors
11. Diagnosis
There is no definitive test to detect Parkinson’s disease
or Parkinsonism. For diagnosis, doctors take a
thorough medical history and may request a number of
movement tests. Because of the observational nature of
the diagnosis, Parkinson’s can sometimes be confused
with Parkinsonism, and the diagnosis may need to be
revised over time based on speed of disease
progression, response to medications and other factors.
All the Parkinsonisms have a loss of dopamine, so a
DatScan cannot be used to differentiate between them
and idiopathic Parkinson’s disease.
12. Treatment
There is overlap in treatment for Parkinson’s
and Parkinsonisms. Dopaminergic therapy (the
first line treatment for Parkinson’s) can be
effective in some Parkinsonisms. Other
common treatments for both Parkinson’s and
Parkinsonisms include physical, occupational
and speech therapy; antidepressants and
botulinum toxin (Botox) for dystonia. For all
the conditions, health care providers aim to
treat the symptoms that most affect a person’s
quality of life.
13. Demographic Details
Name : ABC Age : 70 Sex : M
I.P No : 3393 Dept. : Medicine Unit : A
D.O.A : 30/01/2017 D.O.D : 03/02/2017
14. Reason For Admission
C/O Giddiness since 15 days
C/O Generalised weakness since 15 days
Past Medical History
K/C/O Type 2 Diabetes Mellitus
since 20 years
Not a K/C/O HTN/TB/Asthma
15. Patient was apparently alright 15
days back, then developed sudden
giddiness, which is progressive in
nature, aggregate on working,
relieved on rest. C/O generalized
weakness since 15 days.
History Of Present Illness
16. Family History
Diet : Veg
Sleep : Decreased
Appetite : Normal
Habits : Nil
B/B : N & R
No Known Allergies
17. General Physical Examination
Patient is moderately built and nourished
Well oriented to TPP
Conscious & Cooperative
PR : 80 bpm
BP : 120/80 mmHg
PALLOR +ve
18. Systemic Examination
CVS : S1S2 +
No Murmur
RS : B/L Air Entry Equal
CNS : Intact
P/A : Soft, Non tender
23. Urine Routine
PUS cells : 2-3 / hpf
EPITHELIAL cells : 1-2 / hpf
SUGAR : 0.5 %
Echocardiography
Mild Concentric Left Ventricular Hypertrophy
Grade I Diastolic Dysfunction
Good LV systolic Function
Normal Pulmonary Artery pressure
24. TREATMENT CHART
BRAND NAME GENERIC NAME DOSE ROUTE FREQUENCY DAY
1
DAY
2
DAY
3
DAY
4
IVF 1 pint 40ml/hr IV √ √ √ √
Inj. PANTOP PANTOPRAZO
LE
40 MG IV 1-0-0 √ √
Inj. ACTRAPID HUMAN
INSULIN
SC 1-0-1 √ √ √ √
Tab. RAMIPRIL RAMIPRIL 2.5 MG P/O 0-0-1 √ √ √ √
Tab. SYNDOPA LEVODOPA
CARBIDOPA
110 MG P/O ½-0- ½ √ √ √ √
Tab. PRAMIPEX PRAMIPEXOL
E
0.125MG P/O 1-0-1 √ √ √ √
25. Daily Assessment
Day 2
No Fresh Complaints
PR : 90 bpm
B.P : 110/70 mmHg
S/E
RS : B/L AEE
NVBS +
CVS : S1S2 +
No Murmur
CNS : Intact
P/A : Soft non tender
Treatment Advice
As Per Chart
Patient not willing for MRI Brain & further investigations
26. Day 3
No Fresh Complaints
PR : 80 bpm
B.P : 110/70 mmHg
S/E
RS : B/L AEE
NVBS +
CVS : S1S2 +
No Murmur
CNS : Intact
P/A : Soft, Non tender
Treatment Advice
As Per Chart
27. Day 4
No Fresh complaints
PR : 76 bpm
B.P : 112/80 mmHg
S/E
RS : B/L AEE
NVBS +
CVS : S1S2 +
No Murmur
CNS : Intact
P/A : Soft, Non tender
Treatment Advice
As Per Chart
28. DAYS TIM
E
GRBS(mg/dL) Insulin dose given
DAY 1 2 PM 360
8 PM 245 10 UNITS
DAY 2 7.30
AM
269 14 UNITS
2 PM 132 2 UNITS
8 PM 343 14 UNITS
DAY 3 8 AM 207 10 UNITS
8 PM 379 18 UNITS
DAY 4 8 AM 188 6 UNITS
INSUIN DOSAGE CHART
SLIDING SCALE
<100 Stop
100-150 2 Units
150-200 6 Units
200-250 10 Units
250-300 14 Units
30. Discharge Medication
BRAND NAME GENERIC NAME DOSE ROUT
E
FREQUENCY DURATIO
N
Tab. RAMIPRIL RAMIPRIL 2.5 MG P/O 0-0-1 14 Days
Tab. SYNDOPA LEVODOPA
CARBIDOPA
110 MG P/O ½-0- ½(7 days)
½-½- ½ (7 days)
14 Days
Tab.
PRAMIPEX
PRAMIPEXOLE 0.125
MG
P/O 1-0-1(7 days)
2-0-2(cont.)
14 Days
Review after 14 days in Neuro OPD
31. PHARMACEUTICAL CARE PLAN
Subjective Evidence
Objective Evidence
C/O Giddiness since 15 days
C/O Generalised Weakness since 15 days
RBC : 425 mg/dl (60-140)
32. Assessment
Based on the Subjective and Objective evidences ,
it is assessed that the patient is suffering from
ACUTE IDIOPATHIC PARKINSONISM
With
TYPE 2 DIABETES MELLITUS
34. Standard Recommendations
Dopaminergic therapy (the first line
treatment for Parkinson’s) can be effective in
some Parkinsonism's. Other common
treatments for both Parkinson’s and
Parkinsonism include physical, occupational
and speech therapy; antidepressants and
botulinum toxin (Botox) for dystonia. For all
the conditions, health care providers aim to
treat the symptoms that most affect a
person’s quality of life.
35. Patient Counselling
About disease
Diabetes mellitus type 2 (also known as type 2
diabetes) is a long term metabolic disorder that
is characterized by high blood sugar, insulin
resistance, and relative lack of insulin.
Parkinsonism is a clinical syndrome
characterized by tremor, bradykinesia, rigidity,
and postural instability.
36. About Drugs
LEVODOPA & CARBIDOPA is given in
combination
LEVODOPA is an anti parkinsonism agent which is a
dopamine receptor antagonist
CARBIDOPA is given to increase the amount of
levodopa in brain
ACTRAPID is a fast acting insulin which is produced
by Recombinant Technology
37. Life Style Modification
Healthy eating
Try not to move too quickly.
Aim for your heel to strike the floor first when
you're walking.
If you notice yourself shuffling, stop and check
your posture. It's best to stand up straight.
Look in front of you, not directly down, while
walking.
Distribute your weight evenly between both feet,
and don't lean.
Avoid carrying things while you walk.
Avoid walking backward.