This document summarizes the management of pulmonary artery hypertension. It discusses general measures, classes of medical therapy including diuretics, anticoagulants, calcium channel blockers, endothelin receptor antagonists, phosphodiesterase inhibitors, prostacyclins, and guanylate cyclase stimulators. It also discusses surgical therapies like atrial septostomy and indications for lung transplantation. The various medications are described in terms of their effects, dosing, and side effects. Large clinical trials on combination therapy are also summarized.
Guillain Barre’ syndrome(GBS) and Anesthesia considerationTenzin yoezer
Patients with GBS need special care when coming to the surgery. They have a high risk of aspiration, airway compromise, autonomic instability, altered response to NMBs. It is the duty of the anesthesia providers to recognize those problems and minimize the complications.
Guillain Barre’ syndrome(GBS) and Anesthesia considerationTenzin yoezer
Patients with GBS need special care when coming to the surgery. They have a high risk of aspiration, airway compromise, autonomic instability, altered response to NMBs. It is the duty of the anesthesia providers to recognize those problems and minimize the complications.
Pulmonary Arterial Hypertension in Rural Communities: Early Diagnosis and Int...HorizonCME
Pulmonary Arterial Hypertension in Rural Communities: Early Diagnosis and Intervention to Improve Outcomes
Learning Objectives
-Identify the signs, symptoms, and risk factors associated with PAH to facilitate timely referral of patients to specialized pulmonary hypertension centers for early diagnosis and treatment
-Explain the WHO PH Groups and functional status classifications for PAH and their impact on treatment selection
-Outline the diagnostic tests that may be used to identify patients with PAH
-Identify the indications and contraindications for currently available therapies used in the treatment of patients with PAH
-Describe the role of PCPs in managing PAH patients
Michael J. Cuttica MD, Assistant Professor of Medicine at the Northwestern Pulmonary Hypertension Program of Northwestern University discusses Pulmonary Arterial Hypertension in scleroderma patients, including how it is diagnosed and treated.
Pulmonary Arterial Hypertension in Rural Communities: Early Diagnosis and Int...HorizonCME
Pulmonary Arterial Hypertension in Rural Communities: Early Diagnosis and Intervention to Improve Outcomes
Learning Objectives
-Identify the signs, symptoms, and risk factors associated with PAH to facilitate timely referral of patients to specialized pulmonary hypertension centers for early diagnosis and treatment
-Explain the WHO PH Groups and functional status classifications for PAH and their impact on treatment selection
-Outline the diagnostic tests that may be used to identify patients with PAH
-Identify the indications and contraindications for currently available therapies used in the treatment of patients with PAH
-Describe the role of PCPs in managing PAH patients
Michael J. Cuttica MD, Assistant Professor of Medicine at the Northwestern Pulmonary Hypertension Program of Northwestern University discusses Pulmonary Arterial Hypertension in scleroderma patients, including how it is diagnosed and treated.
Anesthetic management in Diabetic mellitusTenzin yoezer
Diabetic is a systemic disease. Preoperative assessment includes blood sugar control, involvement of systems, and types of medication. Intraoperative and postoperative management is also vital.
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
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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.
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
2. Vallerie V. McLaughlin et al. JACC 2015;65:1976-1997American College of Cardiology Foundation
3. General measures
• Low-level graded aerobic exercise, such as walking.
• Avoid heavy physical exertion and isometric exercise, as this may evoke exertional
syncope.
• Oxygen supplementation - SpO2> 90% at rest and with exertion, sleep, or altitude.
• A sodium-restricted diet - manage volume status in those with RV failure.
• Routine immunizations, such as those against influenza and pneumococcal
pneumonia.
4. Classes of therapy
• MEDICAL
• Diuretics
• Anti coagulants
• Digoxin
• Oxygen
• PAH specific therapy
• SURGICAL THERAPY
• Atrial septostomy
• Lung transplantation
5. Diuretics
• To manage RV volume overload
• Serum electrolytes and renal function to be
monitored
• May need to combine Thiazide and loop
diuretics.
6. Anticoagulants
• Studies show improved survival primarily in IPAH.
• INR- 1.5- 2.5
• decreases chances of in-situ thrombosis.
7. Oxygen
• assessment of nocturnal and exertion
oxygenation requirement.
• minimises added insult of hypoxic
vasoconstriction.
• maintain SpO2 > 90%
• rule out concomitant OSA
10. Calcium channel blockers
• Used only when - acute response to vasodilator
testing is demonstrated. (10%)
• Long acting- Diltiazem , nifedipine , amlodipine
• Verapamil avoided- negative inotropic effect
• only 50% maintain response to CCB
• Not in Class IV or patients haveng severe right heart
failure.
• S/E- systemic hypotension
11. ERAs
• Targets relative excess of Endothelin -1
• Blocks ER on endothelium and vascular smooth muscle
• Bosentan, Macitentan (ER-A & B), Ambrisentan (ER-A)
• Improvement in 6 MWD and time to clinical worsening.
• In Eisenmenger physiology- improvement in PVR, mPAP, 6
MWD.
• Bosentan- Requires LFT monitoring.(rarely - cirrhosis)
• Macitentan- increased tissue penetration & sustained blockade
12. • Oral dosing- Bosentan
• Initiate at 62.5 mg BID X 4 weeks( >12 years,
> 40 kg.)
• increase to maintainance - 125 mg BID
• NO dose adjustment for renal impairment
• No dose adjustment for concomitant
anticoagulation.
13. Ambrisentan
• 5 to 10 mg once daily
• low hepatic toxicity
• No dose adjustment for anticoagulation.
14. PDE 5 I
• Nitric oxide exerts effect through cGMP pathway
and is modulated by PDEs.
• PDE5 is located in walls of blood vessels.
• Pulmonary vasculature has predominantly PDE-
5.
• Sildenafil-Improves 6MWD , but not time to
clinical worsening.
• Tadalafil- improves 6MWD and time to clinical
worsening.
15. • Dose -
• Sildenafil 20 mg TID (0.5 mg/ kg TDS)
• I.V.- Loading 0.4 mg/kg over 3 hours —> 0.07
mg/kg/hr
• Tadalafil 40 mg OD
• Vardenafil 5 mg OD
• S/E- headache, Epistaxis, hypotension, sudden
hearing loss.
17. Epoprostenol
• First FDA approved PAH specific therapy
• improved 6MWD , hammedynamics . QoL and survival
• Very short half life- 2 minutes
• Delivered via continuous I.V. infusion
• 2 ng/kg/min (25to 40 ng/kg/min)
• S/E- jaw pain, flushing, nausea, musculoskeletaletal
pain.
• Catheter complications- dislodgement, embolization,
infection.
18. Treprostinil
• Continuous subcutaneous/ i.v. infusion or
intermittent inhaled treatment.
• t 1/2 - 4 hours
• less risk of rapid fatal deterioration if infusion
stops.
• Lesser catheter related complicateons
• increased gram negative blood stream
infections.
19. Iloprost
• Inhaled prostacyclin
• administered 6-9 times via nebuliser
• S/E : morning syncope, interaction with other
anti hypertensives, increased bleeding with
anticoagulation.
• Nausea vomiting,
• elevated liver enzymes.
20. Soluble Guanylate cyclase
stimulators
• Stimulate nitric oxide receptor
• Dual mode of action
• increases sensitivity of sGC to endogenous
NO
• directly stimulate receptor to mimic NO
• Ricociguat- oral , inoperable CTEPH.
21. COMPASS Program
• Combination of Bosentan and Sildenafil Versus
Sildenafil Monotherapy on Pulmonary Arterial
Hypertension
• Largest RCT for PAH
• morbidity and mortality trial
• assessed safety of bosentan and sildenafil.
• Comprehensive trial to lead the future management of
PAH
• Adding bosentanan to stable silkenafil therapy - no
added advantage.
22.
23. Failure of medical therapy: Atrial
septostomy
• Improved left sided filling
• Decreased right sided pressures
• Bridge to transplant
24. Failure of medical therapy :
indications for lung transplant
• NYHA classs III or IV
• Mean right atrial pressure > 10 mmHg
• Mean pulmonary arterial pressure > 50 mm Hg
• Failure to improve functionally.
• Rapidly progressive disease.
25. Vallerie V. McLaughlin et al. JACC 2015;65:1976-1997American College of Cardiology Foundation
Editor's Notes
Treatment Algorithm for PAH ANA = antinuclear antibody; BAS = balloon atrial septostomy; CCB = calcium-channel blockers; CT = computed tomography; ERA = endothelin receptor antagonist; HIV = human immunodeficiency virus; IPAH = idiopathic pulmonary hypertension; LFT = liver function test; mPAP = mean pulmonary arterial pressure; PAH = pulmonary arterial hypertension; PDE5i = phosphodiesterase type 5 inhibitor; PFT = pulmonary function tests; PH = pulmonary hypertension; sGC = soluble guanylate cyclase stimulator; V/Q = ventilation perfusion scan.
Treatment Algorithm for PAH ANA = antinuclear antibody; BAS = balloon atrial septostomy; CCB = calcium-channel blockers; CT = computed tomography; ERA = endothelin receptor antagonist; HIV = human immunodeficiency virus; IPAH = idiopathic pulmonary hypertension; LFT = liver function test; mPAP = mean pulmonary arterial pressure; PAH = pulmonary arterial hypertension; PDE5i = phosphodiesterase type 5 inhibitor; PFT = pulmonary function tests; PH = pulmonary hypertension; sGC = soluble guanylate cyclase stimulator; V/Q = ventilation perfusion scan.