This document provides guidance on treating HIV/AIDS, including recommendations on when to initiate treatment based on CD4 count, what antiretroviral regimens to use for treatment-naive patients, the importance of compliance, and potential complications and side effects of treatment. Guidelines recommend treating anyone willing to take medication, with a focus on achieving viral suppression through compliance to improve individual health and reduce community viral load.
learn about excellent case article published in NEJM regarding celiac disease,its rare presentation and approach for the same along with discussion ..we should always think about this rare presentations
learn about excellent case article published in NEJM regarding celiac disease,its rare presentation and approach for the same along with discussion ..we should always think about this rare presentations
Lupus is a chronic autoimmune disease that occurs when a person's immune system attacks their own tissues and organs. Learn about the symptoms of lupus, how it is diagnosed and new treatment options to live well with lupus.
Mood stabilizers is one of the treatment of bipolar disorder. however the effect require more than 2 weeks to action, thus need to adjuct with benzodiazepine for first 2 weeks. Not a choice for aggressive patient. The example of mood stabilizer are lithium, sodium valproate, carbamazepine and lamotrigine. it is suggestible to use mnemonic of "Lisa Very Commitment Lady"
PRN Medications; its justified use: by Dr Prithvi PuwarPrithvi Puwar
The presentation is mentioning the details of PRN medications, its common use, the common problems occured by erroneous medications side effects ...A must to know by duty doctor, registrars and nurses. Most of the presentation slides are in interactive way.
Lupus is a chronic autoimmune disease that occurs when a person's immune system attacks their own tissues and organs. Learn about the symptoms of lupus, how it is diagnosed and new treatment options to live well with lupus.
Mood stabilizers is one of the treatment of bipolar disorder. however the effect require more than 2 weeks to action, thus need to adjuct with benzodiazepine for first 2 weeks. Not a choice for aggressive patient. The example of mood stabilizer are lithium, sodium valproate, carbamazepine and lamotrigine. it is suggestible to use mnemonic of "Lisa Very Commitment Lady"
PRN Medications; its justified use: by Dr Prithvi PuwarPrithvi Puwar
The presentation is mentioning the details of PRN medications, its common use, the common problems occured by erroneous medications side effects ...A must to know by duty doctor, registrars and nurses. Most of the presentation slides are in interactive way.
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
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
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.
- 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
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.
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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!
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.
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.
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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
2. the scoop : :
• Guidelines Rule
• treat anyone who is willing
• compliance is KING
• beware of the drugs
3. DHHS Guidelines for the Use of
Antiretroviral Agents in HIV-1-Infected
Adults and Adolescents
www.aidsinfo.nih.gov
4.
5. who to treat : :
• CD4 < 200, 350, 500, what next?
• treatment is prevention
– serodiscordant couples
– pregnancy
• think of the viral load of the community
6. who to treat::
Clinical Category CD4 Count Recommendation
AIDS defining illness or Any value TREAT
severe symptoms*
Pregnancy, HIVAN, Any value TREAT
tx HBV co-infection
Asymptomatic <350/mm3 TREAT
Asymptomatic 350-500/mm3 55% strongly
45% moderately
Asymptomatic >500/mm3 50% favored
50% optional
*http://www.aegis.com/topics/definition.html
8. who not to treat::
• anyone who is not going to take their medicine
AKA: Non-compliance
It is really more like Why Not to treat
– when you know the details of a situation, the
situation is unchanged. when you don’t know the
details of a situation, it still is unchanged.
Zen proverb
10. how to treat::
• is this person sick?
– CD4 < 200
– CD4 < 50
– Symptoms i.e. opportunistic infection
11. CD4 < 200
• At risk for PCP
• GI symptoms?
• Candidiasis?
• Rash?
• Needs meds as soon as ready
12. CD4 < 50
• This group of patients is TROUBLE
• Must look for OI’s, frequently more than 1
• IRIS is common
• TB is bad in this group, skin test not reliable
• 1/3 mortality in first year after diagnosis
15. how it works::
1. Fusion
2. Reverse transcription
3. Integration
4. Transcription
5. Assembly of virus particles
6. Budding of virus particles
16. efavirenz
• Category D, neural tube defects
– Recommend 2 birth control methods, negative HCG
prior to initiation
• Caution with use in prior psychiatric disease
• False + cannabinoid & benzos on screening
• AEs: Drowsiness, dizziness, insomnia, abnormal
dreaming, agitation
• Take at bedtime on an empty stomach to ↓CNS SE
• If need to eat, avoid taking with fatty food
• Rash is possible, as long as no other symptoms keep
taking meds but need medical eval ASAP
19. tenofovir/emtricitabine ::
• Generally well tolerated: gas, headaches
• Fanconi’s syndrome and renal insufficiency
• Check urinalysis every 6 months; PO4 suggested
• Hyperpigmentation possible
• Osteopenia
• Active against HBV
• Know pt’s status and counsel accordingly
• Once daily with or without food
• Both agents need renal adjustment when <50ml/min
20. Fanconi’s Syndrome::
• The Fanconi syndrome refers to a generalized
impairment in proximal tubular function
leading to urinary wasting of compounds
normally reabsorbed in the proximal tubule.
The consequences are hypophosphatemia
(which can lead to osteomalacia), renal
glucosuria, hypouricemia, aminoaciduria, and
proximal renal tubular acidosis due to
bicarbonate loss in the urine (Up To Date).
22. atazanavir/ritonavir
• Interacts with PPIs, antacids, & H2A
• All available OTC
• Increased unconjugated bili
• Scleral icterus or jaundice
• Take with food
• Less impact on lipids
• Prolonged PR interval, asymptomatic 1st degree
AV block
• 3 total: 1 atazanavir, 1 ritonavir, 1
tenofovir/emtricitabine
23. darunavir/ritonavir
• CAUTION with sulfa allergy (not contraindicated)
• Take with food
• Rash 10%
• Abdominal pain
• Headache
• Hepatotoxicity
• Diarrhea (usually less than Kaletra)
• 4 tablets total: 1 ritonavir, 2 darunavir, 1
tenofovir/emtricitabine
25. raltegravir::
• Taken BID
• Minimal drug interactions
• PPI increases raltegravir
• AEs: diarrhea, nausea, headache, and pyrexia
• Increased ALT, AST, CPK possible
• Myopathy and rhabdomyolysis reported
• 3 tablets total: 1 raltegravir BID, 1
tenofovir/emtricitabine
26. compliance ::
• The tendency to yield to others especially in a
weak or subservient way
• The strain of an elastic body expressed as a
function of the force applied to it
• How many doses have you missed in the last
month?
• How many have you taken late?
27. compliance ::
• How many doses have you missed in the last
month?
• How many have you taken late?
• WHY?
• How can we improve this?
28. compliance ::
• 95% compliance is MINIMUM required to
receive maximal drug benefit
• 19/20 days or once per month for a once daily
drug
• compare self-report to pill counts
• works great with diabetes too
35. Fanconi’s Syndrome::
• The Fanconi syndrome refers to a generalized
impairment in proximal tubular function
leading to urinary wasting of compounds
normally reabsorbed in the proximal tubule.
The consequences are hypophosphatemia
(which can lead to osteomalacia), renal
glucosuria, hypouricemia, aminoaciduria, and
proximal renal tubular acidosis due to
bicarbonate loss in the urine (Up To Date).
37. resources::
• consult with US – AFCAHN, phone, email
• Guidelines
• Warmline is AWESOME
• Community providers
Editor's Notes
HIV transmission between sero-discordant partners. Dash line is with + partner delaying treatment, solid line is with partner treated early. Clinical events were TB, candidiasis, pneumocysitits. The composite group was #C plus transmission to seronegative partner