During my 1st &2nd year of residency period , i used to teach Anatomy and Orthopaedics for foreign undergraduate medical students. At last year i taught Neurology for one batch. so i posted some of my collections for competely educational purpose coz i believe in knowledge ...inseted of deleting these ppts , they may me useful for others so i shared it ....
Parkinson’s disease (PD):It is a progressive disorder of the central nervous system (CNS) with both motor and non-motor symptoms.
PD is a common disease that affects an estimated 1million American and an estimated 7 to 10 million people worldwide.
The prevalence of the disease is expected to increase substantially in the coming years due to the aging of the population.
The average age of onset is 50-60 years.
PATHOPHYSIOLOGY:
Parkinsonism is a generic term used to describe a group of disorders with primary disturbance in the dopamine system of basal ganglia (BG).
BG is a network of sub cortical nuclei consisting of caudate nucleus, putamen ,globus pallidus, and subthalamic nucleus with along with substantia nigra.
The BG engage in number of parallel circuit or loops ,only few of which are motor .
Vertigo is a subtype of dizziness in which a patient inappropriately experiences the perception of motion (usually a spinning motion) due to dysfunction of the vestibular system.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
During my 1st &2nd year of residency period , i used to teach Anatomy and Orthopaedics for foreign undergraduate medical students. At last year i taught Neurology for one batch. so i posted some of my collections for competely educational purpose coz i believe in knowledge ...inseted of deleting these ppts , they may me useful for others so i shared it ....
Parkinson’s disease (PD):It is a progressive disorder of the central nervous system (CNS) with both motor and non-motor symptoms.
PD is a common disease that affects an estimated 1million American and an estimated 7 to 10 million people worldwide.
The prevalence of the disease is expected to increase substantially in the coming years due to the aging of the population.
The average age of onset is 50-60 years.
PATHOPHYSIOLOGY:
Parkinsonism is a generic term used to describe a group of disorders with primary disturbance in the dopamine system of basal ganglia (BG).
BG is a network of sub cortical nuclei consisting of caudate nucleus, putamen ,globus pallidus, and subthalamic nucleus with along with substantia nigra.
The BG engage in number of parallel circuit or loops ,only few of which are motor .
Vertigo is a subtype of dizziness in which a patient inappropriately experiences the perception of motion (usually a spinning motion) due to dysfunction of the vestibular system.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
2. History & epidemiology
- Introduction and Conclusion
Anatomy & physiology
Pathology of Parkinsonism
Clinical features & diagnosis of Parkinsonism
Management of Parkinsonism
Pathology of Alzheimer’s disease
Clinical Feature & Diagnosis of Alzheimer’s
Management Of Alzheimer’s Disease
3. Parkinsonism is a generic term that is used to define a syndrome manifest
as bradykinesia with rigidity and/or tremor. It has a differential
diagnosis (Table 449-2) that reflects damage to different components
of the basal ganglia. Among the different forms of parkinsonism, PD is the
most common (approximately 75% of cases).
4. Parkinsonism is a clinical syndrome characterized by motor
symptoms like bradykinesia,tremor and rigidity.
Classification of theParkinsonism
Primary parkinsonism (Parkinson’s disease)
• Sporadic/Idiopathic
• Genetic
Parkinsonism-plus syndromes (Atypical parkinsonism)
• Progressive supranuclear palsy (PSP)
• Multiple system atrophy(MSA)
• Cerebellar type (MSA-c)
• Parkinsons type(MSA-p)
• Cortical-basal ganglionic degeneration(CBGD)
• Frontotemporal dementia(FTD)
12. Began to experience tremors and stiffness of his left
arm while he walked
Changes in his posture and unusual movements of
his left arm.
Sleep disturbances
Gait problems- stooped posture
Symptoms gradually worsened with time
Case 1
Mr Anil chaudhry, 65 years old man, a retired
university professor……
13. Case 2
Mrs Meena devi, 76 years old woman
Lived alone for several years
Brought to the neurological department, by
her daughter, memory impairment
General and neurological examinations-
normal
Speech – highly anomic , paraphasic
Unable to provide birth month, year, current
year
Cognitive domain – below average
15. History of Parkinson’s
Disease
First clear medical description: James
Parkinson in An Essay on the Shaking Palsy
(1817)
Jean-Martin Charcot-
Influential in refining and expanding this
early description & in disseminating
information internationally
Named the disorder as Parkinson’s disease
16. William Gowers- Slight male predominance of
the disorder, joint deformities typical of the
disease.
Richer and Meige
Babinski - Babinski sign
Brissaud
Greenfield and Bosanquet- Clear delineation of
the brain stem lesions
17. Epidemiology of Parkinson’s
disease
Prevalence
Crude prevalence –India - 328 per 100,00
Incidence
Crude annual incidence rates- 1.5 per 100,000
population (China) in 1986 to 14.8 (Finland)
through 1968 to 1970.
18. Gender differences
Slightly more common in men than in women
Male to female ratio- 1.2:1 to 1.5:1
Geographic distribution
Crude prevalence
• China - 15 per 100,000
• India - 328 per 100,000
• Mississippi, USA - 131 per 100,000
• Argentina - 657 per 100,000
19. Ethnic distribution
White people in Europe and North America have a
higher prevalence, around 100 to 350 per 100,000
population.
Asians in Japan & China and Africans have lower rates,
around one-fifth to one-tenth of those in whites.
20. Age Distribution
Less common before 50 years of age & increases steadily
with age thereafter up to the ninth decade.
~1 in every 200 persons aged 60–69 had PD in the United
States (US) and Western Europe.
For people in their 70’s, this increased to ~1 person with
PD in every 100 people,
For people in their 80’s, ~1 in every 35 had PD
21.
22. Incidence
“Every four seconds, a new case of
dementia occurs somewhere in the world.”
Cohort longitudinal studies provide rates
between 10 and 15 per thousand.
Advancing age -primary risk factor
Women- higher risk of developing AD
particularly in the population older than 85
38. Cognition(caudate circuit)
eg:A person seeing a lion approach ????
FUNCTIONS
Executes Learned Patterns of Motor Activity
eg:writing of letters of the alphabet.
hammering nails,
shooting a basketball through a hoop,
50. Idiopathic
Ageing
Usual occurrence in late middle age, and
increases in its prevalence at older ages
Loss of striatal dopamine and dopamine of
cells in the SN with age
51. Genetic factors
PD may be multifactorial in etiology with genetic contributions
The younger the age of symptom onset, the more likely genetic
factors play a dominant role
At least ten single gene mutations identified
52. Mutations in gene coding Alpha synuclein and
LRRK2 (leucine rich repeat kinase 2) - Autosomal
dominant PD
Mutations in gene coding Parkin,DJ-1and PINK1-
Autosomal recessive PD
53. Pathogenesis
Three major mechanisms in dopaminergic neuron
loss
Mitochondrial dysfunction
Oxidative and nitrosative stress
Ubiquitin proteosome system dysfunction
57. Microscopic
Loss of pigmented ,catecholaminergic neurons
Intraneuronal Lewy bodies within t
h
e
pigmented neurons of the substantia nigra.
Lewy bodies are cytoplasmic eosinophilic round
to elongated inclusions that often have a dense
core sourrounded by halo.
Lewy bodies are composed of Alpha –synuclein
62. Motor symptoms
Characterized by Four cardinal features :
Bradykinesia (or Hypokinesia)
Tremor atrest
Rigidity
Posturalinstability
63. Bradykinesia
Slowness of movements with a progressive loss of
amplitude or speed.
Difficulty with planning, initiation and
execution of movements.
64. Clinical Manifestations of Bradykinesia
Difficulties with tasks requiring fine motor
control:
Loss of spontaneous movements andgesturing
Hypomimia (decreased facial expression)
MASK LIKE FACE
Decreased spontaneousblinking
Hypophonia
Micrographia
Sialorrhoea
69. Rest Tremor
Tremor : Rhythmical & involuntary shaking,
trembling or quivering movements of the muscles.
Rest tremor ( 4 - 6 Hertz) :
Maximal when the limb is at rest
Disappears with voluntary movement and sleep
Alternating contraction of agonist and antagonist
muscles at a rapid pace
Usually Unilateral at onset
71. Rigidity
Increased muscle tone felt during examination by
passive movement
Both the agonist and antagonist muscles are
involved
Rigidity :
Cogwheelrigidity
Lead-piperigidity
74. Festinating / Shuffling Gait:
i) Difficulty to initiate walking
ii) Shortened stride
iii) Reduced arm swing
iv) Rapid small steps (shuffling)
RUNNING AFTER THE CENTRE OF GRAVITY
Freezing phenomenon
76. Sleep disturbances
REM behavior disorder
excessive day timedrowsiness
Cognitive impairment
Dementia : In >80% of patients after 20 years of
disease
77.
78.
79.
80.
81. Diagnosis of Parkinsonism
Diagnosis is primarily clinical, based on history
and examination
Confirmatory diagnosis : Histological
demonstration of the intraneuronal Lewy
bodies on autopsy.
CT scan & MRI exclude other causes.
82. Examination of signs
Bradykinesia :
Ask patient to do repetitive movements as
quickly and as possible
• opening and closing the hand
• tapping thumb and index fingers
• or tapping the foot on the ground
Rest tremor:
Differentiate from the intentional tremor seen in
cerebellar disease
Best observed while the patient is focused on a
particular mental task.
83. Rigidity:
Increased resistance to passive movements
Postural stability
The “Pull test” is performed in order to assess
postural stability
84. UK Parkinson’s Disease Society Brain Bank’s
clinical criteria for the diagnosis of probable
Parkinson’s disease
Step 1
Bradykinesia
At least one of the following criteria:
• Rigidity
• Rest tremor (4–6 Hz )
• Postural instability (not caused by primary
visual, vestibular, cerebellar or
proprioceptive dysfunction)
Step 2
Exclude other causes of parkinsonism
85. Step 3
At least three of the following supportive
(prospective) criteria:
• Unilateral onset
• Rest tremor
• Progressive disorder
• Persistent asymmetry
• Severe levodopa induced chorea (dyskinesia)
• Clinical course of 10 years or more
89. No definitecure
Relief of cardinal signs- rigidity, tremor , &
akinesia
Correction of mood changes
Treatment of other symptoms such a
s
depression,sleep disturbance .
Treatment of cause when possible
100. Levodopa
‘Gold-standard' treatment for Parkinson's..
Therapautic benefit is nearly complete in early stages
but declines as disease advances(“Wearing-off effect”)
1-2% cross BBB
Improves cardinal signs- tremor, rigidity and akinesia.
101. Side Effects
At the initiation of therapy
Nausea, vomiting, hypotension, cardiac arrhythmias,
angina, taste alteration.
Avoided by gradual titration
Long-term complications
Dyskinesias
Behavioural effects: hallucination, psychosis
On–off effect
Wearing-off effect
(“on” episodes when the drug is working and “off” episodes when parkinsonian
features return)
103. Ergot derivatives:
(e.g., bromocriptine, pergolide, cabergoline) and were associated with
ergot-related side effects, including cardiac valvular damage.
Second generation of nonergot dopamine agonists :
(e.g., pramipexole, ropinirole, rotigotine)
Dopamine agonist
Side effect:
oNausea,vomiting, and orthostatic hypotension.
o Hallucinations and cognitive impairment are more than levodopa so use
cautiosly in age more than 70
oSedation with sudden unintended episodes of falling asleep while driving a
motor vehicle have been reported.
104. MAO-B INHIBITORS
Monotherapy in early disease.
Reduced “off” time when used as an adjunct to levodopa in patients with
motor fluctuations.
105. COMT INHIBITORS:
Levodopa with a COMT inhibitor reduces “off” time and prolongs “on” time.
Two COMT inhibitors have been approved, tolcapone and entacapone.
106. Anticholinergic drugs:
Their major clinical effect is on tremor, although it is not certain that this benefit is
superior to what can be obtained with agents such as levodopa
and dopamine agonists. Still, they can be helpful in individual
patients with severe tremor.
Their use is limited particularly in the elderly, due to their propensity to induce a
variety of side effects including urinary dysfunction, glaucoma, and particularly
cognitive impairment.
110. PARKINSONISM
CASE 1
Mr Poudel, 65 years old
man
Difficulty in walking and
speaking , tremor in left
hand and leg
Sleep disturbances
111. Rx:
Levodopa 250 mg+ carbidopa25mg
Medication reduced his symptoms but did not stop
the disease from getting worst.
His loss of mobility and speech impairment
limited his social interactions.
He and his wife also have had to give up many of
their retirement travel plans.
