This echocardiography report documents the findings from echocardiograms performed on Mrs. M at various times. The most recent echocardiogram from December 2022 shows dilated left ventricle, reduced left ventricular ejection fraction of 27%, global hypokinesis, and diastolic dysfunction. A prior echocardiogram from August 2021 showed normal left ventricular size and function with an ejection fraction of 60.1%. The echocardiograms document the progression of Mrs. M's condition from normal systolic function to reduced systolic function consistent with cardiomyopathy.
Hurdles and new players in the management of chronic heart failure with reduc...Dhritisdiary
Watch the slideshow for a better understanding: https://youtu.be/CsXvS1hA330
1. Learn the standard therapy in HFrEF
2. Learn its challenges
3. Learn the new drugs for HFrEF.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Hurdles and new players in the management of chronic heart failure with reduc...Dhritisdiary
Watch the slideshow for a better understanding: https://youtu.be/CsXvS1hA330
1. Learn the standard therapy in HFrEF
2. Learn its challenges
3. Learn the new drugs for HFrEF.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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
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.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
2. NO NAME DIAGNOSIS
1. Mr ZM/ 62 yo APS CCS II ec susp IHD pro PAC standby PCI
HHD
DMT2
HBsAg positive
2. Mr NC/ 33 yo CHF FC NYHA II ec IHD (26%) pro PCI
CAD2VD CTO LCX (20/9/22)
HT
dislipidemia
3. Mrs S/ 73 yo ASD II, L to R shunt 19-24 mm, high flow low resistence
paroxysmal tachycardia
supraventricular tachycardia undocumented
TR moderate
High probability for PH
AF NVR
4. Mrs SA/ 47 yo ASD II L to R shunt
High Flow, Low Resistance
5. Mr AS/ 45 yo CHF FC NYHA II ec CAD3VD, CTO di LCx
PCI 4 DES di RCA (26/12/2022) incomplete revasc
DMT2
6. Mr WS/ 81 yo APS CCS II ec IHD pro PAC standby PCI
BPH
Asymptomatic bradycardia
Hiponatremia (Na 132)
VIP WARD
3. NO NAME DIAGNOSIS
1. Mr WE/60 yo CHF FC NYHA II ec IHD
HT stage II
AF NVR
2. Mr BS/79 yo CHF NYHA II ec CAD3VD CTO LCx (incomplete revasc)
Post PCI 1 DES proximal-distal LCX & 1 DES proximal-mid LAD (26/12/22)
HT
DM
3. Mr B/57 yo APS CCS II ec CAD3VD, diffuse disease, CTO di LAD & LCx
4. Mr M/33 yo CHF FC NYHA II ec Severe Mitral Regurgitation
Moderate TR
5. Mrs NF/26 yo ASD II Left to Right Shunt, Normal Flow High Resistance, Reactive Oxygen Test
TR severe
PR moderate
6. Ms HR/27 yo VSD perimembranous 13 – 14 mm , Left to right shunt
PS severe
RPO WARD
4. NO NAME DIAGNOSIS
1. Mr. AK/33 yo Acute STEMI anterior extensive onset 7 jam KILLIP I TIMI 2/14
Post PPCI 2 DES LAD pada CAD1VD (22/12/22) complete revasc
HT
Hiperurisemia (7.3) 23/12/22
6. Mr ZA/49 yo Acute STEMI Anterior onset 2 jam KILLIP 1 TIMI 3/14
Post PPCI 1 DES di LAD berhasil baik pada CAD3VD dengan STO di LAD (trombus type) dan CTO di RCA (imcomplet revasc)
22/12/22
DM tipe II
Hipertensi grade II
5. Mr S/62 yo CHF NYHA III ec DCM dd IHD (EF 20.4% (T))
Hipertensi
Dislipidemia
Dispepsia
Azotemia (Cre 1.9, eGFR 39 ml/min/1.73 m²) -- (1.2) 24/12 perbaikan
Hiperkalemia (5.4) -- (3.0) 24/12 hipokalemia
Hiperurisemia
4. Mr. MH/59 yo CHF NYHA III ec CAD2VD (Complete revas)
Post PCI di RCA dengan 1 DES pada CAD2VD, slow flow di LAD (26/12/22)
Post PPCI 2 DES di proximal-distal LAD pada CAD2VD (5/10/2022)
Dislipidemia
Hiperurisemia
2. Mr. SH/42 yo UAP Killip I TIMI 4/7
HFrEF
Hypertension
CKD stg V on HD
Anemia NN (Hb 5.8) 21/12/22 -- (8.8) 26/12
MALE WARD
5. NO NAME DIAGNOSIS
1. Ms. MA/ 26 yo Post ASD Closure+ TV repair
2. Mrs. DS/45 yo MASD II 22 mm L to R shunt
Moderate TR, Mild MR, Mild PR
PH
3. Mrs. E/ 33 yo CHF NYHA III e.c IHD (EF 38%)
CKD stg V
Pneumonia
HT, T2DM, dislipidemia
4. Mrs. SW/384yo Efusi perikard massive impending tamponade
Post pericardial window (20/12/22)
Efusi pleura massif post WSD (17/12/22)
G2P1A0 gestational week 8
Klinis SLE
FEMALE WARD
6. NO NAME DIAGNOSIS
1. Mrs. P/ 72 yo Obs Hipotension on HFpEF e.c IHD dd HHD (EF 62%)
AF NVR
AR moderate, MR moderate
Insuff renal
2. Mrs. Mi/ 77 yo ON PPM e.c TAVB with junctional Escape
Recent STEMI Anterior 2 month onset Killip I TIMI 4/14
3. Mrs. PS/ 57 yo Recent STEMI Anteroseptal Killip II TIMI 3/14
AHF on ACS
Dislipidemia
DCM
4. Mr. SU/ 58 yo Acute STEMI anterior extensive KILLIP I TIMI 4/14
Post PPCI 1 DES LAD on CAD2VD
HT
Dislipidemia
CC WARD
7. Case Ilustration
Identity
• Name : Mrs. M
• Age : 30 y.o
• Address : Bonang, Demak
• Marital status : Married
• Occupation : Tailor
• Hospitalized : December 6th ,2022
7
8. Anamnesis December 6th ,2022
Chief complaint : SOB
8
March 2021
On second month of pregnancy (G2P1A0)
Started to feel easily tired, accompanied by
Shortness of breath over a
moderate – heavy Activities
(walking > 1km, lifting heavy objects)
Accompanied by occasional ankle edema
Relieve with rest
October 2021
Hospitalized due to Severe
Preeclampsia (36 weeks GA),
Pregnancy was terminated
by SC.
August 2021
Hospitalized in RSDK due to
HT in pregnancy with
generalized edema.
November 2021
Edema resolved after delivery
But complaint of recurring SOB
on moderate to heavy
activities persisted
9. Anamnesis December 6th ,2022
Chief complaint : SOB
9
December 6th 2022
Complaint of SOB got worsen
Precipitated by mild activities (walking
around house, or doing simple chore)
Accompanied with cough and edema
almost in all body area
DOE(+), PND(+), OP(+)
Couldn’t be relieve with rest or medication
July 2022
Patient already felt better.
Edema resolved with current
medication.
Patient Didn’t control afterward
October 2022
SOB and occasional ankle swelling was
started to occur again with moderate to
heavy activities.
She took her last medication on early
September and didn’t took any
medication after.
10. History of past
illness
10
o No history of uncontrolled movement
o No history of reddish in body area
o No history of migratory joint pain
o No history of weakness half of body or speech
disturbance
Family History
o No family have the same illness with patient
o No history Family with congenital heart disease
Social History
o Was a tailor, stop working after having a
second child
o Had never Consume Alcohol Beverage
11. Recent Medication
• spironolakton tab 100 mg/24 h
• bisoprolol tab 5 mg / 24 h
• furosemid tab 40 mg/ 12 h
• kandesartan tab 16 mg/ 24 h
11
16. Heart
Inspection
• Ictus cordis cannot be seen
Palpation
• Ictus cordis palpated in ICS 5 anterior midaxillar line
• Heave (+)
• Thrill (-)
AUSCULTATION
• S1 S2 single regular murmur (-)
16
17. LUNG
• Inspection :
• Symetric while in static &
dynamic state
• Palpation :
• Vocal fremitus normal on
both side of the lung
• Percussion:
• Sonor on both side of the
lung
• Auscultation:
• Vesicular on all field
• Rales (+/+) 1/3 basal
• Wheezing (-/-)
• Pericardial friction rub (-/-)
ABDOMEN
• Inspection : Ascites (+)
• Auscultation : Normal Bowel
Sound
• Percussion : Shifting dullness (+)
• Palpation :
Liver cannot be palpated
Hepatojugular reflux (-)
Ekstremitas
Edema on upper and lower
extrimites (+/+/+/+)
17
EXTRIMITIES
18. EKG December 6th 2022
Interpretation
•Rhythm : Sinus
•Rate : 76 bpm
•Axis : normoaxis
•P wave(s): P mitrale lead II
•PR Interval: 140 ms
•QRS : Poor R
wave progression
•ST segmen: No Changes
•T wave(s): T inverted V4-
V6; II AVF; I AVL
•Conclusion
Sinur Ryhthm 76 bpm,
normoaxis, LAE, PRWP
19. THORAX X-RAY 6/12/22
Posteroanterior Description:
o Cardio Thoracic Ratio : 75%
o Apex shifting to laterocaudal
aspect
o Cephalization (+)
o Flat cardiac left waist border
o Double Contour
o Right heart border >1/3 right
heart diameter
o Sharp Costophrenic (+/-)
Lateral Description:
o Retrosternal and retrocardiac
space narrowing
Conclusion:
Cardiomegaly (LV, LA, RV,
RA), pulmonary edema, left
pleural effusion
19
28. 31/8/21
LVH konsentrik
fungsi sistolik LV normal (LVEF 60%)
disfungsi diastolik grade II dengan
peningkatan LAP
mild MR, mild TR, mild PR
15/11/21
Efusi Pericardial loculated (+) mild 4-6mm
Efusi Pleura (+) sinistra
LVH konsentrik, RWMA(+)
Fungsi sistolik LV turun LVEF 37.1% (Biplane)
Disfungsi diastolik LV grade II
Fungsi sistolik RV normal
MR mild, TR mild
Echocardiografi
9/11/21
Efusi perikardial loculated (+) mild to
moderate10-15mm
Efusi pleura (+) sinistra
Dimensi ruang jantung dalam batas normal,
LVH konsentrik
Fungsi sistolik LV turun dengan LVEF 37.0%
(Biplane)
Fungsi sistolik RV normal
MR trivial, TR mild
Low probability for PH
29. 29
19/12/21
Dilatasi LV, LVH konsentrik
Global hipokinetik
Fungsi sistolik LV turun dengan
LVEF : 32% (B)
Fungsi sistolik RV nomal
Disfungsi diastolik LV grade II
MR Mild, AR Mild, TR Mild
Low probability for PH
12/6/22
Dilatasi LA, LV
LVH konsentrik
LV sec (+)
Global hipokinetik
Fungsi sistolik LV turun dengan LVEF 25% (B)
Fungsi RV normal dengan TAPSE 21 mm
Disfungsi diastolik LV Grade III
AR mild, TR mild
Intermediate probability for PH
70. Bersifat kronis Waxing and Waning
Flare dapat muncul saat remisi
Morbiditas dini karena penyakit. | morbiditas lanjut karena lama penyakit dan terapi
70
Perjalanan Penyakit
Bertsias, et al. Systemic Lupus Erythematosus: Pathogenesis and Clinical Features. EULAR Textbook on Rheumatic Diseases: ch 20, pg 476- 505.
Levy, et al. Systemic Lupus Erythematosus in Children and Adolescents. Pediatr Clin North Am. Author manuscript; available in PMC 2013 April 01.
71. 71
Patogenesis
Bertsias, et al. Systemic Lupus Erythematosus: Pathogenesis and Clinical Features. EULAR Textbook on Rheumatic Diseases: ch 20, pg 476- 505.
Levy, et al. Systemic Lupus Erythematosus in Children and Adolescents. Pediatr Clin North Am. Author manuscript; available in PMC 2013 April 01.
72. 72
Diagnosis
Charras, et al. Systemic Lupus Erythematosus in Children and Young People. Current Rheumatology Reports (2021) 23: 20.
Levy, et al. Systemic Lupus Erythematosus in Children and Adolescents. Pediatr Clin North Am. Author manuscript; available in PMC 2013 April 01.
73. 73
Diagnosis
Charras, et al. Systemic Lupus Erythematosus in Children and Young People. Current Rheumatology Reports (2021) 23: 20.
Levy, et al. Systemic Lupus Erythematosus in Children and Adolescents. Pediatr Clin North Am. Author manuscript; available in PMC 2013 April 01.
74. 74
Diagnosis
Charras, et al. Systemic Lupus Erythematosus in Children and Young People. Current Rheumatology Reports (2021) 23: 20.
Levy, et al. Systemic Lupus Erythematosus in Children and Adolescents. Pediatr Clin North Am. Author manuscript; available in PMC 2013 April 01.
75. 75
Diagnosis
Charras, et al. Systemic Lupus Erythematosus in Children and Young People. Current Rheumatology Reports (2021) 23: 20.
Levy, et al. Systemic Lupus Erythematosus in Children and Adolescents. Pediatr Clin North Am. Author manuscript; available in PMC 2013 April 01.
76. 76
Diagnosis
Charras, et al. Systemic Lupus Erythematosus in Children and Young People. Current Rheumatology Reports (2021) 23: 20.
Levy, et al. Systemic Lupus Erythematosus in Children and Adolescents. Pediatr Clin North Am. Author manuscript; available in PMC 2013 April 01.
94. 94
Preeclampsia is defined as the presence of
(1) a systolic blood pressure (SBP) greater than or equal to 140 mm Hg or a
diastolic blood pressure (DBP) greater than or equal to 90 mm Hg or higher,
on two occasions at least 4 hours apart in a previously normotensive
patient, OR
(2) an SBP greater than or equal to 160 mm Hg or a DBP greater than or equal to
110 mm Hg or higher. (In this case, hypertension can be confirmed within
minutes to facilitate timely antihypertensive therapy.)
proteinuria of greater than or equal to 0.3 grams in a 24-hour urine specimen, a
protein (mg/dL)/creatinine (mg/dL) ratio of 0.3 or higher, or a urine dipstick
protein of 1+ (if a quantitative measurement is unavailable) is required to
diagnose preeclampsia.
Good morning Dr. Sodiqur Rifqi cardiologist consultant, and good morning all fellow residents. This morning we will deliver grand round case report presentation
Zaenal mutaqin SAF
Nur chalim YH
Sumarni PPN
Sri Astuti AY
Aris S YH
W Sukiman SR
Iswantoro PPN
Slamet Raharjo AAF
Angga Kurniawan SAF
Mega Handoyo AAF
Safrudin PPN
Zaenal Abidin SSH
Mita Aulia
Diah Santi
Eni
Sri WAhyuni
Pardjini
Sri Kurnia
Pursinasih
Suprapto
Formerly work in the field
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Indeks Massa Tubuh : 24.22/m2 normoweight dalam kriteria WHO
Over weight kalau Asia Pacific
Asia-Pacific (BMI)
Underweight <18.5
Normal 18.5–22.9
Overweight 23–24.9
Obese ≥25
In mouth we found…
(1) a long or holodiastolic murmur, indicating a persistent LA-LV
gradient;
(2) a short A2-OS
interval, consistent with higher LA pressure;
(3) a loud P2 (or single S2) and/or an RV lift, suggestive of pulmonary
hypertension
Thorax x-ray in semierect AP position
6 anterior costae can be seen
Leu 12.1
UR 79
Cr 3.0
Ca 2.1
Trop 0.91
Leu 12.1
UR 79
Cr 3.0
Ca 2.1
Trop 0.91
Leu 12.1
UR 79
Cr 3.0
Ca 2.1
Trop 0.91
Leu 12.1
UR 79
Cr 3.0
Ca 2.1
Trop 0.91
Leu 12.1
UR 79
Cr 3.0
Ca 2.1
Trop 0.91
PLAX
No LA, LV dilation
LA dilation, LVH eccentric
AR , MR mild
Normal aortic valve with 3 cusps
AR PR TR
LV global hipokinetik
LV dilation
LV SEC
MR TR AR Mild
E/A : 1.73
E/e’ : 15.13
EDT : 115 ms
Grade II DD
No RA , LA dilation
TAPSE 23 mm
IVC Collapse : 17% ( 11mm / 0.9mm)
Biplane : 32%
GLS : -7.7%
PLAX
LA dilation, LVH eccentric
AR , MR mild
Normal aortic valve with 3 cusps
AR PR TR
LV global hipokinetik
LV dilation
LV SEC
MR TR AR Mild
E/A : 1.15
E/e’ : 15.8
EDT : 162 ms
Grade II DD
TAPSE 25 mm
NO GOLD STANDARD FOR SLE DIAGNOSIS
SLICC memiliki sensitifitas yang lebih baik dalam mendiagnosis jSLE dibanding dengan ACR 97, namun ternyata memiliki spesifisitas yang lebih rendah