This document discusses several aspects of managing elderly patients with multiple chronic conditions (multimorbidity). It notes that multimorbidity is highly prevalent in the elderly and impacts physical and cognitive functioning, depression, mortality and hospitalization. It also discusses how multimorbidity affects the management of specific conditions like COPD, diabetes, heart failure, osteoporosis, dementia and hypertension. The document emphasizes that clinical guidelines focused on single diseases do not adequately address the complexity of multimorbid elderly patients.
Planning for the future - when does the future start? Laura-Jane Smith
Presentation at PLAN Network event, on advance care planning in chronic respiratory disease. NB last few slides are resources for the group task, and references. Let me know i I missed any!
Apelin and Sirtuin 1 Dysregulation induce Endocrine and Metabolic Disorders i...CrimsonPublishersGJEM
Apelin and Sirtuin 1 Dysregulation induce
Endocrine and Metabolic Disorders in Chronic Disease by Ian James Martins in Global Journal of Endocrinological Metabolism
Artigo joga dúvidas sobre a necessidade/ ou mesmo contraindicação de insulina em DM2. A hiperinsulinemia que precede a clínica do DM, quando associada à aplicação exógena do hormônio pode trazer efeitos adversos. O artigo põe em dúvida a aplicação de insulina no DM.
Planning for the future - when does the future start? Laura-Jane Smith
Presentation at PLAN Network event, on advance care planning in chronic respiratory disease. NB last few slides are resources for the group task, and references. Let me know i I missed any!
Apelin and Sirtuin 1 Dysregulation induce Endocrine and Metabolic Disorders i...CrimsonPublishersGJEM
Apelin and Sirtuin 1 Dysregulation induce
Endocrine and Metabolic Disorders in Chronic Disease by Ian James Martins in Global Journal of Endocrinological Metabolism
Artigo joga dúvidas sobre a necessidade/ ou mesmo contraindicação de insulina em DM2. A hiperinsulinemia que precede a clínica do DM, quando associada à aplicação exógena do hormônio pode trazer efeitos adversos. O artigo põe em dúvida a aplicação de insulina no DM.
Sleep is a crucial health issue - but it is often ignored by both individuals and the medical community. Sleep has been shown to substantially impact almost every major health condition including Diabetes, Cancer, Obesity, Heart Disease, and Mental Health. It's time for sleep to take it's rightful place in keeping us health. This presentation gives some of the cold, hard facts behind why sleep is such a silent killer.
This Presentation is Briefly Discussing Diabetes in General,
Anti-Diabetic Venomous Animals and the Role of Naja Naja Snake Venom in The Treatment of it.
Triglytza: Counter-Regulation of RAAS and COVID-19 TreatmentRavi Kumar, Ph.D.
TriGlytza is a proprietary dual combination product of ARKAY Therapeutics. It is custom-designed for treatment and mitigation of ARDS and MODS associated with COVID-19.
An introductory talk to Chronic Critical Illness: A state of immune, endocrine, nutritional and metabolic dysfunction leading to significant mortality and morbidity in modern ICUs.
Please feel free to use slides with appropriate attribution/acknowledgement.
*Not medical advice*
*Updated review of evidence advised independently*
Follow on Twitter: @virenkaul
It is time for a paradigm shift in the treatment of type 2 diabetes (2)Ravi Kumar, Ph.D.
"It is now time for a paradigm shift in the treatment of Type 2 diabetes by assessing the individual patient’s risk by determining the inflammatory status and develop drugs that not only sustain the beta cell function but can also be evaluated as a prophylactic therapy."
Sleep is a crucial health issue - but it is often ignored by both individuals and the medical community. Sleep has been shown to substantially impact almost every major health condition including Diabetes, Cancer, Obesity, Heart Disease, and Mental Health. It's time for sleep to take it's rightful place in keeping us health. This presentation gives some of the cold, hard facts behind why sleep is such a silent killer.
This Presentation is Briefly Discussing Diabetes in General,
Anti-Diabetic Venomous Animals and the Role of Naja Naja Snake Venom in The Treatment of it.
Triglytza: Counter-Regulation of RAAS and COVID-19 TreatmentRavi Kumar, Ph.D.
TriGlytza is a proprietary dual combination product of ARKAY Therapeutics. It is custom-designed for treatment and mitigation of ARDS and MODS associated with COVID-19.
An introductory talk to Chronic Critical Illness: A state of immune, endocrine, nutritional and metabolic dysfunction leading to significant mortality and morbidity in modern ICUs.
Please feel free to use slides with appropriate attribution/acknowledgement.
*Not medical advice*
*Updated review of evidence advised independently*
Follow on Twitter: @virenkaul
It is time for a paradigm shift in the treatment of type 2 diabetes (2)Ravi Kumar, Ph.D.
"It is now time for a paradigm shift in the treatment of Type 2 diabetes by assessing the individual patient’s risk by determining the inflammatory status and develop drugs that not only sustain the beta cell function but can also be evaluated as a prophylactic therapy."
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
-To characterize the utilization pattern of preventive care services impacting cardiovascular outcomes in a U.S population using a national database
-To predict the trends in cardiovascular preventive care services in a U.S. population
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
National reports point towards disparities in the utilization of preventive care services but sparse literature exists regarding predicting utilization pattern of preventive care services.
METHODS: The 2007 Medical Expenditure Panel Survey (MEPS), a national probability sample survey of the ambulatory civilian US population, was analyzed to determine demographic patterns of utilization. Recommendations by JNC-VII and NCEP were used to determine guideline adherence to blood pressure and cholesterol checkup respectively. Utilization of blood pressure screening and cholesterol checkup services were used as the dependent variable while age, gender, race, ethnicity, insurance status, perceived health status were used as independent variables. Since guidelines differ for people with elevated blood pressure, respondents with elevated blood pressure were identified in the MEPS database by self-reported diagnosis. Descriptive statistics were used to describe the population, chi-square analysis was used to determine the group differences for the categorical variables. Multivariate logistic regression model was built to predict odds of utilizing appropriate preventive se!
rvices. All analysis was carried out using SAS v9.1.
RESULTS: Total number of adult respondents was 20,434 of which data was available for blood pressure checkup for 20,187 respondents and 15,784 respondents for cholesterol checkup. Overall, respondents were found to adhere to guideline recommendations for getting the blood pressure (n=17,959, 89.0%) and cholesterol (n=14,956, 94.7%) check-up done. A univariate chi-square analysis showed statistically significant differences across all independent variables between people who utilized the preventive care service and those who didn t for blood pressure checkup (p<0><0>65) had much higher odds of using the blood pressure (OR=2.815, CI=2.317-3.420 ) and cholesterol (OR=3.190, CI=2.396-4.!
249 ) preventive services. Males had much lower odds of getting blood pressure (OR=0.350, CI=0.318-0.384) and cholesterol (OR=0.597, CI=0.516-0.692) checks done compared to females. Odds of utilization were nearly similar for all races. Uninsured had lower odds for blood pressure (OR=0.282, CI=0.253-0.315) and cholesterol (OR=0.314, CI=0.262-0.376) use compared to privately insured people.
CONCLUSIONS: Overall MEPS respondents adhered to blood pressure and cholesterol check up guidelines. The study was however successful in identifying existing age, race, income, insurance status related disparities in US population.
Join Doc Andrew to see the research that supports plant based diet recommendations. Address common misconceptions. Ask questions @DenverWWAD or join current discussions at #PlantBased, #PlantBasedRx, or #CulinaryRx.
Also, enjoy bonus learning with these topic-related, 2-minute podcasts by Dr. Andrew:
"The Plant Based Diet and How to Get Started"
https://soundcloud.com/denverwwad/healthcast-23
"Eat Your Way to the Finish Line"
https://soundcloud.com/denverwwad/healthcast-4
Andrew Freeman, MD, FACC, FACP is a cardiologist and Assistant Professor of Medicine at National Jewish Health, Denver, Colorado. He is part of the leadership of both the local and national American College of Cardiology.
Dr. Freeman founded the Denver chapter of the Walk with a Doc program and is the leader of Walk with a Doc-Colorado.
Walk with a Doc-Denver is a free health improvement and community empowerment initiative. Local doctors and a team of healthcare professionals--all volunteers--host Saturday walks that include expert talks, health screenings, refreshments, and motivational giveaways. For more info visit: Denver.WalkWithADoc.org
Debra K. Katzman, MD ABSTRACT The purpose of the current article .docxedwardmarivel
Debra K. Katzman, MD* ABSTRACT The purpose of the current article is to summarize the evidence-based medical complications and treatments that are both common and unique to adolescents with anorexia nervosa (AN). Recent literature relating to the cardiovascular complications,refeedingsyndrome, alterations in linear growth, impaired bone mineralaccretion,and structuralandfunctional brain changes was reviewed. The literature suggests that the medical complications in adolescents with AN are different from those reported in adults. The unique clinical presentation, the early onset, and the unknown impact of these
complications underscore the need for early identification and treatment of AN in adolescents. AN is a serious disorder with significant and often life-threatening medical complications. The increasing growth of evidence highlights the importance of early identification and treatment by an interdisciplinary team of health care providers who have expertise in managing adolescents with AN and their medical sequelae. ª 2005 by Wiley Periodicals, Inc.
Keywords: medical complications; adolescents; anorexia nervosa
(Int J Eat Disord 2005; 37:S52–S59
Introduction
Anorexia nervosa (AN) in adolescents can cause significant medical complications in every organ system in the growing and developing body.1 Critical to the ongoing advancement of our understanding of AN in adolescents is the steady growth of evidence on the identification and management of the multitude of medical complications. Although many of these medical complications improve with nutritional rehabilitation and recovery from the eating disorder, some are potentially irreversible. As such, the long-term implications of these medical complications that typically begin in the formative years of adolescence are unknown. The current article summarizes the evidence-based literature on common medical complications that have been specifically studied in adolescent populations with AN over the past 20 years. We will focus on the cardiovascular and metabolic complications with a particular emphasis on refeeding syndrome, alterations in linear growth, impaired bone mineral accretion, and reference to structural and functional brain
changes, all of which have been studied in adolescents with AN.
Cardiovascular Complications
AN is a life-threatening condition, with significant risk of death due to cardiac complications. One third of the deaths in adults with eating disorders are due to cardiac complications.2 There are no such data regarding adolescents with AN. Cardiac involvement is present in the early stages of the disorder in adolescents with AN.3,4 In fact, even with a short duration of illness, there are both functional and structural cardiac abnormalities that appear to be reversible with early identification and treatment.3 Upon reviewing the adolescent eating disorder literature, the most common reported cardiovascular complications include electrocardiographic abnormalities such as.
correspondencen engl j med 371;12 nejm.org september 18, 2.docxfaithxdunce63732
correspondence
n engl j med 371;12 nejm.org september 18, 2014 1167
We concur that preventing of a cryptococcal
disease with targeted pre-ART cryptococcal an-
tigen screening in patients with CD4 cell counts
lower than 100 per cubic millimeter is preferable
to treating meningitis.3 Cryptococcal antigen
screening is probably cost-saving.4,5 Our ran-
domized clinical trial (ClinicalTrials.gov num-
ber, NCT01535469) in Uganda is testing broad
implementation of World Health Organization
recommendations for cryptococcal screening.
David R. Boulware, M.D., M.P.H.
University of Minnesota
Minneapolis, MN
[email protected]
David B. Meya, M.Med.
Infectious Disease Institute
Kampala, Uganda
Since publication of their article, the authors report no fur-
ther potential conflict of interest.
1. Rolfes MA, Hullsiek KH, Rhein J, et al. The effect of thera-
peutic lumbar punctures on acute mortality from cryptococcal
meningitis. Clin Infect Dis 2014 July 23 (Epub ahead of print).
2. Boulware DR, Stauffer WM, Hendel-Paterson BR, et al. Mal-
treatment of Strongyloides infection: case series and worldwide
physicians-in-training survey. Am J Med 2007;120:545.e1-545.e8.
3. Meya DB, Manabe YC, Castelnuovo B, et al. Cost-effective-
ness of serum cryptococcal antigen screening to prevent deaths
among HIV-infected persons with a CD4+ cell count ≤100 cells/
μL who start HIV therapy in resource-limited settings. Clin In-
fect Dis 2010;51:448-55.
4. Rajasingham R, Meya DB, Boulware DR. Integrating crypto-
coccal antigen screening and pre-emptive treatment into routine
HIV care. J Acquir Immune Defic Syndr 2012;59(5):e85-e91.
5. Jarvis JN, Harrison TS, Lawn SD, Meintjes G, Wood R, Cleary
S. Cost effectiveness of cryptococcal antigen screening as a
strategy to prevent HIV-associated cryptococcal meningitis in
South Africa. PLoS One 2013;8(7):e69288.
DOI: 10.1056/NEJMc1409052
Antidepressant Use in Pregnancy and the Risk
of Cardiac Defects
To the Editor: Congenital heart disease can
have devastating consequences, even in patients
with simple defects.1-3 Huybrechts et al. (June 19
issue)4 suggest that the risk of cardiac malforma-
tions in children of mothers receiving antide-
pressants is low. It is interesting that in the un-
adjusted analysis, the relative risk of cardiac
malformations is increased by 25% among in-
fants exposed to antidepressants. However, after
adjustment for multiple factors, this association
was lost. Thus, the key to applying these results
to clinical practice is to understand the methods
that were used. Such factors as misclassification
resulting from the low adherence to antidepres-
sant use and the lack of data on spontaneous or
medical terminations have the potential to bias
the results. Information on missing data is lack-
ing, especially in measurements that were used
to construct the propensity scores, and such
missing data would automatically exclude pa-
tients from the analysis, introducing bias. Al-
th.
Anti ulcer drugs and their Advance pharmacology ||
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
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.
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
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
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.
8. COMPLEJIDAD: Impacto global de las diferentes enfermedades en individuo; gravedad de enfermedades – otros aspectos relacionados con la saludNo todos los Ancianos son PluripatológicosLa mayoría de Pluripatológicos son Ancianos
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30. FRAGILIDAD / COMORBILIDAD COGNICIÓN SARCOPENIA DETERIORO FUNCIONAL INFLAMACIÓN COMPLEJIDAD DE LAS INTERACCIONES ANEMIA
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49. DEMENCIA J Am Med Dir Assoc. 2011 Oct;12(8):565-72. Associations between the anticholinergic risk scale score and physical function: potential implications for adverse outcomes in older hospitalized patients. J Am Geriatr Soc. 2011 Aug;59(8):1477-83. doi: 10.1111/j.1532-5415.2011.03491.x. Epub 2011 Jun 24. Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study. J Clin Pharmacol. 2011 Feb;51(2):256-63. Anticholinergic drug use and mortality among residents of long-term care facilities: a prospective cohort study. Arch Intern Med. 2011 Jul 25;171(14):1244-50. Physical activity and cognition in women with vascular conditions. Arch Intern Med. 2011 Jul 25;171(14):1251-7 Activity energy expenditure and incident cognitive impairment in older adults. Ann Intern Med. 2011 Sep 6;155(5):300-8.Cognitive impairment: an independent predictor of excess mortality: a cohort study
50. NEUROLÉPTICOS J Clin Psychiatry. 2004 Jan;65(1):114-9. A 3-month, randomized, placebo-controlled, neuroleptic discontinuation study in 100 people with dementia: the neuropsychiatric inventory median cutoff is a predictor of clinical outcome. Ballard CG, Thomas A, Fossey J, Lee L, Jacoby R, Lana MM, Bannister C, McShane R, Swann A, Juszczak E, O'Brien JT. PLoS Med. 2008 Apr 1;5(4):e76. A randomised, blinded, placebo-controlled trial in dementia patients continuing or stopping neuroleptics (the DART-AD trial). Ballard C, Lana MM, Theodoulou M, Douglas S, McShane R, Jacoby R, Kossakowski K, Yu LM, Juszczak E; Investigators DART AD. JAMA. 2011 Sep 28;306(12):1359-69. Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis.
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54. Diabetes Care. 2011 Jun;34(6):1369-71. Epub 2011 Apr 22.Assessing theassociation of pioglitazone use and bladdercancerthroughdrug adverse eventreporting.
55. Gut. 2011 Oct 13. Primaryprevention of colorectalcancerwithlow-doseaspirin in combinationwithendoscopy: a cost-effectivenessanalysis.
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57. EPOC Respir Med. 2011 Mar;105(3):461-9. Falls in people with chronic obstructive pulmonary disease: an observational cohort study. Patients with COPD have a high susceptibility to falls, which is associated with a worsening of dyspnea perception as related to HRQoL. Fall prevention programs in COPD are recommended. Respir Med. 2011 Feb;105(2):236-42. Chronic respiratory disease and multimorbidity: prevalence and impact in a general practice setting. The majority of patients with chronic respiratory disease have multimorbidity. Clinical guidelines based on single disease entities and outcomes are not as easy to implement and may not be as effective in this group. Eur J Clin Invest. 2011 May;41(5):507-12. doi: 10.1111/j.1365-2362.2010.02434.x. Statin use in patients with asthma: a nationwide population-based study.
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