More than 20% of participants in low-dose CT screening programs were found on their first scan to have one or more lung nodules that required further investigation.
Presentation by Kenneth Neigut, MD at the Longboat Key Central FL Cancer Institute Annual Seminar. Overview: 1. Review lung cancer screening updates. 2. Management of smal lung nodules detected on CT. 3. The role and limitations of using PET/CT for staging. Key Stats: 160,000 lung cancer deaths occur in the USA every year. 85% of these deaths occur in those with a strong smoking history. Lung CA is the number one cancer killer. Insurance companies will be required to cover the $300-$400 screening under a mandate in the federal health law.
Presentation by Kenneth Neigut, MD at the Longboat Key Central FL Cancer Institute Annual Seminar. Overview: 1. Review lung cancer screening updates. 2. Management of smal lung nodules detected on CT. 3. The role and limitations of using PET/CT for staging. Key Stats: 160,000 lung cancer deaths occur in the USA every year. 85% of these deaths occur in those with a strong smoking history. Lung CA is the number one cancer killer. Insurance companies will be required to cover the $300-$400 screening under a mandate in the federal health law.
Epidemiology./Biostatistics class on lung cancer screening including description of lung cancer, natural history and treatment, lung cancer statistics, lung cancer risk factors, NLST results, NLST follow-on, criteria for a good screening test, USPSTF and CMS lung cancer screening guidelines, and challenges to screening
Lung cancer is the most common cancer in males and second most common in females after breast cancer.
it is the third most commonly diagnosed and leading cause of cancer death in Pakistan, with an estimated 6,800 (4.6%) new cases and 6,013 (5.9%) deaths occurring in 2012
We have compared our data with the international statistics to see where do we stand.
In Pakistan, we do not have a valid central cancer registry at present which can provide a true picture of lung cancer. This calls for an urgent need to formulate a valid central cancer registry in the country in association with the local bodies.
Austin Journal of Vascular Medicine is an open access, peer review journal publishing original research & review articles in all the fields of Vascular Medicine. Austin Journal of Vascular Medicine provides a new platform for all researchers, scientists, scholars, academicians to publish and find latest research information in the field of Vascular Medicine.
Austin Journal of Vascular Medicine is a comprehensive Open Access peer reviewed scientific journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal aims to publish high quality varied article types such as Research, Review, Short Communications, Case Reports, Perspectives (Editorials) and Clinical Images.
Austin Journal of Vascular Medicine supports the scientific modernization and enrichment in Vascular Medicine research community by magnifying access to peer reviewed scientific literary works. Austin also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science
Descriptive Epidemiology of Lung Cancer
Description and Classification
Disease Distribution
Disease Frequency in the US Population
Epidemiological Triad
Prevention ==> Primary, Secondary and Tertiary
Summary
Epidemiology./Biostatistics class on lung cancer screening including description of lung cancer, natural history and treatment, lung cancer statistics, lung cancer risk factors, NLST results, NLST follow-on, criteria for a good screening test, USPSTF and CMS lung cancer screening guidelines, and challenges to screening
Lung cancer is the most common cancer in males and second most common in females after breast cancer.
it is the third most commonly diagnosed and leading cause of cancer death in Pakistan, with an estimated 6,800 (4.6%) new cases and 6,013 (5.9%) deaths occurring in 2012
We have compared our data with the international statistics to see where do we stand.
In Pakistan, we do not have a valid central cancer registry at present which can provide a true picture of lung cancer. This calls for an urgent need to formulate a valid central cancer registry in the country in association with the local bodies.
Austin Journal of Vascular Medicine is an open access, peer review journal publishing original research & review articles in all the fields of Vascular Medicine. Austin Journal of Vascular Medicine provides a new platform for all researchers, scientists, scholars, academicians to publish and find latest research information in the field of Vascular Medicine.
Austin Journal of Vascular Medicine is a comprehensive Open Access peer reviewed scientific journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal aims to publish high quality varied article types such as Research, Review, Short Communications, Case Reports, Perspectives (Editorials) and Clinical Images.
Austin Journal of Vascular Medicine supports the scientific modernization and enrichment in Vascular Medicine research community by magnifying access to peer reviewed scientific literary works. Austin also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science
Descriptive Epidemiology of Lung Cancer
Description and Classification
Disease Distribution
Disease Frequency in the US Population
Epidemiological Triad
Prevention ==> Primary, Secondary and Tertiary
Summary
Clinical diagnosis of MI requires a syndrome indicative of myocardial ischemia with some combination of myocardial necrosis detected by biochemical, ECG, or imaging modalities
Rheumatic fever- a multifactorial disease that follows GAS pharyngitis in a susceptible individual who lives under deprived social conditions, characterized by acute inflammation of the heart, joints, skin, subcutaneous tissue & CNS, that gives rise to typical clinical feature including Arthritis, Carditis, Chorea, Subcutaneous nodules & Erythema marginatum.
Latent period of 2-3 weeks following GAS pharangitis.
Destructive effects on heart valves leads to RHD with serious hemodynamic disturbances causing HF, stroke & infective endocarditis.
PCI is one of the most common procedures in the US, and remain a cornerstone in the management of ischemic heart disease.
Historically, a large proportion of PCI procedures were performed during inpatient hospitalization, allowing for a significant amount of time for monitoring postprocedure to ensure procedural success & identify bleeding or vascular complications, as well as for initiating secondary prevention.
However, technological pharmacological and procedural innovations, as well as payer expectations and cost considerations, have led to a shorter length of stay postprocedure and obviate hospital admission.
Most non-acute MI PCIs performed in the US now are performed under an outpatient designation.
Acute chest pain is one of the most common reason for seeking care in the emergency department (10% of all visits)
Only 10-15% of patients with chest pain actually have ACS.
Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Liver Dis...Shadab Ahmad
Guidelines for the treatment of nonvalvular atrial fibrillation (AF) recommend oral anticoagulation (OAC) for stroke prevention with either warfarin or direct oral anticoagulants (DOACs), with a stronger recommendation for DOACs in the general population.
Advanced liver disease is known to increase the risk for bleeding and affects the hepatic clearance and metabolism of drugs.
Even so, OAC is associated with a lower risk for ischemic stroke and no difference in bleeding, including intracranial hemorrhage (ICH), in patients with AF and liver cirrhosis, and thus OAC should still be considered in this population.
Residual Inflammatory Risk in Patients With Low LDL Cholesterol Levels Underg...Shadab Ahmad
Patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) are at high risk of future adverse ischemic events.
Indeed, increased inflammatory status pre- and post-PCI has also been associated with poor prognosis, and control of the residual inflammatory risk (RIR) in the CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) trial has recently opened new perspectives in the field of secondary prevention.
Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low...Shadab Ahmad
The role of transcatheter aortic valve replacement (TAVR) in the treatment of patients with severe, symptomatic aortic stenosis has evolved on the basis of evidence from clinical trials.
Previous randomized trials of TAVR with both balloon-expandable valves and self-expanding valves showed that, in patients who were at intermediate or high risk for death with surgery, TAVR was either superior or noninferior to standard therapies, including surgical aortic-valve replacement.
However, most patients with severe aortic stenosis are at low surgical risk, and there is insufficient evidence regarding the comparison of TAVR with surgery in such patients.
Infusion Needle Radiofrequency Ablation for Treatment of Refractory Ventricul...Shadab Ahmad
Catheter ablation is an important therapy to prevent and reduce recurrent episodes of ventricular tachycardia (VT) in patients who have implanted defibrillators (ICDs) and premature ventricular beats and nonsustained VT causing significant symptoms or contributing to depressed ventricular function.
Following enhancements to the catheter design, this U.S. Food and Drug Administration investigational device exemption trial was initiated to assess the safety and outcome of RF needle infusion ablation in patients with recurrent ventricular arrhythmias that had failed control with conventional irrigated RF ablation and antiarrhythmic drug therapy.
Percutaneous Transcatheter Mitral Valve ReplacementShadab Ahmad
Symptomatic mitral regurgitation (MR) conveys significant morbidity and mortality. However, many patients with severe MR are not treated with surgery due to advanced age, left ventricular (LV) dysfunction, or other comorbidities. This unmet clinical need has driven the development of safer, catheter-based treatments for mitral valve disease.
Transcatheter mitral valve repair can be safe and effective in patients with suitable anatomy.
Long-Term Durability of Transcatheter Aortic Valve ProsthesesShadab Ahmad
Assessments of valve function in the early randomized trial cohorts and registries have consistently shown preserved valve function up to 5 years after TAVR. However, it is well recognized that structural valve degeneration (SVD) with surgical aortic valve bioprostheses is usually not seen until 5 to 10 years post-procedure, and data in this time frame following TAVR are very sparse
Cardiac Troponin Elevation in Patients Without a Specific DiagnosisShadab Ahmad
Measurement of cardiac troponin (cTn) levels is a cornerstone in the assessment of patients with acute chest pain.
An elevation in the cTn level together with a significant change in the setting of coronary ischemia indicates myocardial infarction (MI).
However, even other cardiac and noncardiac conditions may result in acute cTn increases (e.g., arrhythmias, severe hyper- or hypotension, pulmonary embolism, neurologic events, or endurance efforts).
Acute but subtle increases in cTn levels may also be difficult to distinguish from chronic cTn elevation which is a common finding in the elderly, patients with renal failure, or patients with chronic cardiac conditions.
His Resynchronization Versus Biventricular Pacing in Patients With Heart Fail...Shadab Ahmad
This study tested the ability of HBP to deliver resynchronization and then compared the electromechanical effects of His resynchronization against conventional BVP, using high-precision hemodynamic assessment and noninvasive epicardial ventricular activation mapping
Alirocumab and Cardiovascular Outcomes after Acute Coronary SyndromeShadab Ahmad
Studies have shown that mutations conveying gain or loss of function of PCSK9 result in a higher or lower level of LDL cholesterol, respectively, which in turn is associated with a corresponding higher or lower risk of incident coronary heart disease. These findings have led to the development of monoclonal antibodies to PCSK9 that produce substantial reductions in LDL cholesterol when administered alone or with a statin
Angiotensin neprilysin inhibition in acute decompensated heart failureShadab Ahmad
Sacubitril–valsartan is an angiotensin receptor– neprilysin inhibitor that is indicated for the treatment of patients with symptomatic heart failure with reduced ejection fraction
Rivaroxaban for thromboprophylaxis after Hospitalization for Medical IllnessShadab Ahmad
Anticoagulant prophylaxis reduces the risk of in-hospital venous thromboembolism by 50 to 60% but is rarely continued after discharge in accordance with current guidelines
A Study of Chest X-Ray PA View & Lateral ViewsShadab Ahmad
X-ray is a form of electromagnetic radiation.
Frequencies in the range 30 petahertz to 30 exahertz (3×10^16 Hz to 3×10^19 Hz)
Energies in the range 100 eV to 100 keV.
It a type of ionizing radiation, and therefore harmful to living tissue.
A No-Prophylaxis Platelet-Transfusion Strategy for Hematologic CancersShadab Ahmad
The effectiveness of platelet transfusions to prevent bleeding in
patients with hematologic cancers remains unclear.
This trial assessed whether a policy of not giving prophylactic platelet
transfusions was as effective and safe as a policy of providing prophylaxis.
In patients with hematologic cancers, severe thrombocytopenia
frequently develops as a consequence of the disease or its treatment.
Recent advances in diagnosis & management of SLEShadab Ahmad
Systemic lupus erythematosus (SLE) is an autoimmune disease in which organs and cells undergo damage mediated by tissue binding autoantibodies and immune complexes.
90 % of patients at diagnosis are women of childbearing age groups.
Highest prevalence is in black women and lowest is in white men.
Influence of the Timing of Malaria Infection during pregnancy on birth weight...Shadab Ahmad
Malaria infection during pregnancy is a significant cause of maternal, fetal, and infant mortality and morbidity.
Malaria in pregnancy is associated with maternal anemia, premature delivery, and intrauterine growth retardation.
The period of malaria infection during pregnancy, which has the highest impact for the mother and the baby, is still an open question.
Endocarditis in adults with bacterial meningitisShadab Ahmad
Bacterial meningitis is a life-threatening disease that is associated with considerable mortality and morbidity.
Currently, Streptococcus pneumoniae is responsible for 70% of the cases in Europe and the United States.
Bacterial meningitis is often related to other foci of infection outside the central nervous system such as pneumonia, sinusitis, or otitis.
An uncommon focus of bacterial meningitis is infective endocarditis.
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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.
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.
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
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Probability of cancer in pulmonary nodules detected on first screening CT scan
1. Probability of Cancer in
Pulmonary Nodules
Detected on First Screening CT
N Engl J Med 2013;369:910-9.
DOI: 10.1056/NEJMoa1214726
Published on september 5, 2013
Speaker: Dr. Shadab Ahmad
2. Background
• Major clinical issues in the implementation of low-dose CT
screening at the population level include the definition of a
positive screening result and the appropriate management of
lung nodules detected on a scan.
• The U.S. National Lung Screening trial showed that screening
with the use of low-dose thoracic computed tomography (CT)
reduces mortality from lung cancer by 20%.
• More than 20% of participants in low-dose CT screening
programs were found on their first scan to have one or more
lung nodules that required further investigation.
3. • An accurate and practical model that can predict the probability
that a lung nodule is malignant and that can be used to guide
clinical decision making will reduce costs and the risk of
morbidity and mortality in screening programs.
4. Study Design
• Prospective study of two high-risk screening cohorts.
• Pan-Canadian Early Detection of Lung Cancer Study
(PanCan)
• British Columbia Cancer Agency (BCCA).
5. Methods
Study Oversight
• The development data set included participants enrolled in the
multicenter Pan-Canadian Early Detection of Lung Cancer
Study (PanCan).
• The validation data set included participants enrolled in several
chemoprevention trials sponsored by the U.S. National Cancer
Institute and conducted by the British Columbia Cancer Agency
(BCCA).
6. Incluaion Criteria
PanCan Studies
• Current and former smoker
• Age 50-70 years
• Without history of lung cancer
BCCA studies
• Current and former smokers
• Age 50-74 years
• Without history of lung cancer
• Smoking history of at least 30 pack-years
At least one noncalcified lung nodule on the baseline low-dose CT scan
7. Exclusion Criteria
• Hilar or mediastinal lymphadenopathy, for whom further
investigations are warranted irrespective of the nodule size.
8. Thoracic CT Scans
PanCan
• A multidetector-row CT scanner with maximum section
collimation of 1.25 mm and four or more data-acquisition
channels was used at each participating site.
• The CT scans were obtained at 120 kVp, 40 to 50 mA, and a
tuberotation time of less than 1 second.
• Contiguous images were reconstructed in the transaxial plane
at up to 1.25-mm thickness.
9. BCCA studies
• low-dose CT scanning was initially performed on a single-slice
CT scanner and subsequently on 4-, 8-, or 16-detector CT
scanners.
• The CT scans were obtained at 120 kVp, 40 to 80 mA, and
rotation times of up to 1 second.
• Images were reconstructed at a 1.25-mm and 1-mm slice width.
10. Diagnosis of Lung Cancer
• Histopathological examination of resection specimens
• Cytopathological examination of needle-aspiration biopsy
samples
11. Results
Study Participants
Pan-Can
• A total of 2537 persons were enrolled, the median overall
follow-up was 3.1 years.
• 187 participants (7.4%) were lost to follow-up.
• 1871 of the 2537 participants (73.7%) had a total of 7008 lung
nodules.
• 102 had nodules that were malignant (5.5%).
12. BCCA Study
• 1090 participants had 5021 nodules.
• 40 of the 1090 persons with nodules (3.7%) were found to have
42 lung cancers during a median follow-up of 8.6 years
The PanCan and BCCA study populations were similar with
respect to age, sex, body-mass index, percentage of patients
with emphysema, and percent of predicted forced expiratory
volume in 1 second (FEV1).
15. Conclusion
• Prospective study
• Two high-risk screening cohorts determined the probability that
pulmonary nodules detected by screening low-dose CT would
be cancerous.
• The relationship between nodule size and cancer is nonlinear.
• Nodule location in the upper lobes increased the probability of
cancer.
• Perifissural nodules represent a minimal risk of lung cancer and
probably do not require longitudinal follow-up with CT.
