PrognostiCheck uses impedance plethysmography to measure resistance (R), reactance (Xc), and phase angle (Pa) values. Pa provides a "Vitality Index" that illustrates disease progression, treatment effectiveness, and timing of non-acute death. Studies show Pa is associated with prognosis and survival as an independent variable, and can complement clinical decision making. The technology provides early warnings of physiological changes preceding other diagnostic tests.
Summary of clinical investigations es teck complex systemES-Teck India
Summary of the clinical investigations E.S.Teck Complex March, 20, 2010
Summary of Clinical Investigations ES Teck Complex system EIS System in adjunct to Treatments’ monitoring and to diagnosis with the conventional methods
Sepsis is an emergent medical condition that kills more people annually than prostate cancer, breast cancer, and AIDS combined. For every two heart attack patients cared for by EMS, five patients are hospitalized by sepsis. EMS transports 60% of patients with severe sepsis arriving at the ED and yet EMS providers are often unaware of its presence or what they should do if they find it. This presentation discusses new sepsis criteria along with expert commentary as to how they can be applied in the field. This program includes real-world, practical methods for EMS identification, assessment and field treatment of life-threatening sepsis and looks at the current state of sepsis critical care as well as what we can anticipate in the coming months and years.
Summary of clinical investigations es teck complex systemES-Teck India
Summary of the clinical investigations E.S.Teck Complex March, 20, 2010
Summary of Clinical Investigations ES Teck Complex system EIS System in adjunct to Treatments’ monitoring and to diagnosis with the conventional methods
Sepsis is an emergent medical condition that kills more people annually than prostate cancer, breast cancer, and AIDS combined. For every two heart attack patients cared for by EMS, five patients are hospitalized by sepsis. EMS transports 60% of patients with severe sepsis arriving at the ED and yet EMS providers are often unaware of its presence or what they should do if they find it. This presentation discusses new sepsis criteria along with expert commentary as to how they can be applied in the field. This program includes real-world, practical methods for EMS identification, assessment and field treatment of life-threatening sepsis and looks at the current state of sepsis critical care as well as what we can anticipate in the coming months and years.
Prehospital traumatic cardiac arrest is relatively rare and highly complex event that will challenge even the most skilled providers and resuscitation teams. This is further complicated by a shortfall of clear consensus guidelines to help EMS providers rapidly identify, assess, prioritize and care for underlying life-threats as they simultaneously work to resuscitate the patient. What is the best bal-ance between simple algorithms that focus on core priorities versus critical think-ing recommendations that address issues more specifically? This session looks at the latest research and guidelines from key organizations such as the National Association of EMS Physicians, American College of Surgeons Committee on Trauma, and the American Heart Association as well as similar organizations from around the world to help us make the best decisions and take rapid action to give our patients the best hope of survival. Find more at www.RomDuck.com
Hemocron Elite: A Comparative study of Anticoagulation Monitoring Tests in Tr...Karounka Keita M.S. CCP/LP
Measurement of the activated clotting time (ACT) during procedures guides maintenance of proper anticoagulation, thereby preventing thrombus formation and potential embolization leading to adverse clinical outcomes. Accurate monitoring of the level of anticoagulation can decrease embolic events and improve patient care. Our study compared the ACT results from two modern anticoagulation tests (Hemocron ACT+ and Hemocron ACT-LR) to assess for accuracy by surveying and analyzing activated clotting times in 45 patients undergoing Transcatheter Aortic Valve Replacement (TAVR) procedures utilizing both tests. We found a statistical significance difference existed between the two tests due to a p value less than 0.05 and conclude that there are possible patient benefits using the ACT-LR test in the operative setting.
With the increasing automation of health care information processing, it has become crucial to extract meaningful information from textual notes in electronic medical records. One of the key challenges is to extract and normalize entity mentions. State-of-the-art approaches have focused on the recognition of entities that are explicitly mentioned in a sentence. However, clinical documents often contain phrases that indicate the entities but do not contain their names. We term those implicit entity mentions and introduce the problem of implicit entity recognition (IER) in clinical documents. We propose a solution to IER that leverages entity definitions from a knowledge base to create entity models, projects sentences to the entity models and identifies implicit entity mentions by evaluating semantic similarity between sentences and entity models. The evaluation with 857 sentences selected for 8 different entities shows that our algorithm outperforms the most closely related unsupervised solution. The similarity value calculated by our algorithm proved to be an effective feature in a supervised learning setting, helping it to improve over the baselines, and achieving F1 scores of .81 and .73 for different classes of implicit mentions. Our gold standard annotations are made available to encourage further research in the area of IER.
Cardiologist Sanjiv M. Narayan, MD, PhD, served as a professor of medicine at the University of California, San Diego, where he performed research into ways to treat patients with irregular heartbeats. Today, Dr. Sanjiv Narayan is developing a center for patients with atrial fibrillation at Stanford University.
Several treatments are now available to patients with atrial fibrillation, including electrical cardioversion, in which the patient is shocked with a defibrillator. The electric shock passes through the paddles of a defibrillator and sends a jolt of electricity into the patient's heart.
The doctor may alternately choose to use EKG-style patches on the back and chest to administer the electric shock. The purpose is to reset the rhythm of the patient's heartbeat.
Before the procedure, doctors must confirm that the patient has no blood clots in or around the heart. The patient may be required to take anticoagulants one to two months before the appointment. If a patient is not able to take anticoagulants, doctors will observe the patient's heart with a camera inserted through the mouth with a narrow tube.
Additional risks include heart attack, stroke, fluid in the lungs, and, in rare cases, death. In more than 90 percent of cases, the procedure is effective. Medicine to supplement the procedure increases the chance of success.
The Top 10 Resuscitation Headlines and Controversies: And How To Read Past Th...Rommie Duckworth
We’ve all heard the controversies for cardiac resuscitation. “Use the right medications.”, “Medications don’t matter.”, “Airway first!”, “Don’t worry about the airway!” It is confus-ing for EMS professionals to sort out exactly what they’re supposed to do. Taking a look at the Top Ten Headlines for cardiac resuscitation this program evaluates the strength of the science behind each recommendation as well as how they might be implemented in dif-ferent EMS systems. Getting past the “Headlines”, attendees will return home well-equipped to open up discussions about optimizing EMS cardiac arrest resuscitation in their systems beyond “I read this study once” or “This is what the algorithms say now.”
Serum Uric Acid and Outcome after Acute Ischemic Stroke: PREMIER StudyErwin Chiquete, MD, PhD
Background: Current evidence shows that uric acid is a potent
antioxidant whose serum concentration increases rapidly
after acute ischemic stroke (AIS). Nevertheless, the relationship
between serum uric acid (SUA) levels and AIS
outcome remains debatable. We aimed to describe the
prognostic significance of SUA in AIS. Methods: We studied
463 patients (52% men, mean age 68 years, 13% with glomerular
filtration rate <60 />2) at 30 days, or with
any outcome measure at 3, 6 or 12 months poststroke. After
adjustment for age, gender, stroke type and severity (NIHSS
<9),><24 h. Conclusions: A low SUA
concentration is modestly associated with a very good
short-term outcome. Our findings support the hypothesis
that SUA is more a marker of the magnitude of the cerebral
infarction than an independent predictor of stroke outcome.
Understanding of Electronic Medical Records(EMRs) plays a crucial role in improving healthcare outcomes. However, the unstructured nature of EMRs poses several technical challenges for structured information extraction from clinical notes leading to automatic analysis. Natural Language Processing(NLP) techniques developed to process EMRs are effective for variety of tasks, they often fail to preserve the semantics of original information expressed in EMRs, particularly in complex scenarios. This paper illustrates the complexity of the problems involved and deals with conflicts created due to the shortcomings of NLP techniques and demonstrates where domain specific knowledge bases can come to rescue in resolving conflicts that can significantly improve the semantic annotation and structured information extraction. We discuss various insights gained from our study on real world dataset.
Heart Rate Variability (HRV) plays an important role for reporting several cardiological and noncardiological
diseases. Also, the HRV has a prognostic value and is therefore quite important in modelling
the cardiac risk. The nature of the HRV is chaotic, stochastic and it remains highly controversial. Because
the HRV has utmost importance, it needs a sensitive tool to analyze the variability. In previous work,
Rosenstein and Wolf had used the Lyapunov exponent as a quantitative measure for HRV detection
sensitivity. However, the two methods diverge in determining the HRV sensitivity. This paper introduces a
modification to both the Rosenstein and Wolf methods to overcome their drawbacks. The introduced
Mazhar-Eslam algorithm increases the sensitivity to HRV detection with better accuracy.
Interpreting Health Status Of Indian Population Using Phase Angle As Health P...IJRES Journal
Bio Electrical Impedance Analyser is a simple Non-Invasive tool that is used for the Human body composition Analysis. It has been found that the basic principle of Human Body composition Analysis is the measurement of fat vs lean muscle tissue. And it is well known fact that biological tissues the path of least resistance. While Analysing the body composition through Bio Electrical Impedance Analyser body resistance and body reactance are taken into account. Phase Angle is directly calculated from resistance and reactance and Phase Angle is an important indicator of cellular health and integrity. This paper aims at discussing the significance of Phase Angle in Analysis of Human Body Composition and developing and validating prediction equation of Phase Angle at different frequencies.
Prehospital traumatic cardiac arrest is relatively rare and highly complex event that will challenge even the most skilled providers and resuscitation teams. This is further complicated by a shortfall of clear consensus guidelines to help EMS providers rapidly identify, assess, prioritize and care for underlying life-threats as they simultaneously work to resuscitate the patient. What is the best bal-ance between simple algorithms that focus on core priorities versus critical think-ing recommendations that address issues more specifically? This session looks at the latest research and guidelines from key organizations such as the National Association of EMS Physicians, American College of Surgeons Committee on Trauma, and the American Heart Association as well as similar organizations from around the world to help us make the best decisions and take rapid action to give our patients the best hope of survival. Find more at www.RomDuck.com
Hemocron Elite: A Comparative study of Anticoagulation Monitoring Tests in Tr...Karounka Keita M.S. CCP/LP
Measurement of the activated clotting time (ACT) during procedures guides maintenance of proper anticoagulation, thereby preventing thrombus formation and potential embolization leading to adverse clinical outcomes. Accurate monitoring of the level of anticoagulation can decrease embolic events and improve patient care. Our study compared the ACT results from two modern anticoagulation tests (Hemocron ACT+ and Hemocron ACT-LR) to assess for accuracy by surveying and analyzing activated clotting times in 45 patients undergoing Transcatheter Aortic Valve Replacement (TAVR) procedures utilizing both tests. We found a statistical significance difference existed between the two tests due to a p value less than 0.05 and conclude that there are possible patient benefits using the ACT-LR test in the operative setting.
With the increasing automation of health care information processing, it has become crucial to extract meaningful information from textual notes in electronic medical records. One of the key challenges is to extract and normalize entity mentions. State-of-the-art approaches have focused on the recognition of entities that are explicitly mentioned in a sentence. However, clinical documents often contain phrases that indicate the entities but do not contain their names. We term those implicit entity mentions and introduce the problem of implicit entity recognition (IER) in clinical documents. We propose a solution to IER that leverages entity definitions from a knowledge base to create entity models, projects sentences to the entity models and identifies implicit entity mentions by evaluating semantic similarity between sentences and entity models. The evaluation with 857 sentences selected for 8 different entities shows that our algorithm outperforms the most closely related unsupervised solution. The similarity value calculated by our algorithm proved to be an effective feature in a supervised learning setting, helping it to improve over the baselines, and achieving F1 scores of .81 and .73 for different classes of implicit mentions. Our gold standard annotations are made available to encourage further research in the area of IER.
Cardiologist Sanjiv M. Narayan, MD, PhD, served as a professor of medicine at the University of California, San Diego, where he performed research into ways to treat patients with irregular heartbeats. Today, Dr. Sanjiv Narayan is developing a center for patients with atrial fibrillation at Stanford University.
Several treatments are now available to patients with atrial fibrillation, including electrical cardioversion, in which the patient is shocked with a defibrillator. The electric shock passes through the paddles of a defibrillator and sends a jolt of electricity into the patient's heart.
The doctor may alternately choose to use EKG-style patches on the back and chest to administer the electric shock. The purpose is to reset the rhythm of the patient's heartbeat.
Before the procedure, doctors must confirm that the patient has no blood clots in or around the heart. The patient may be required to take anticoagulants one to two months before the appointment. If a patient is not able to take anticoagulants, doctors will observe the patient's heart with a camera inserted through the mouth with a narrow tube.
Additional risks include heart attack, stroke, fluid in the lungs, and, in rare cases, death. In more than 90 percent of cases, the procedure is effective. Medicine to supplement the procedure increases the chance of success.
The Top 10 Resuscitation Headlines and Controversies: And How To Read Past Th...Rommie Duckworth
We’ve all heard the controversies for cardiac resuscitation. “Use the right medications.”, “Medications don’t matter.”, “Airway first!”, “Don’t worry about the airway!” It is confus-ing for EMS professionals to sort out exactly what they’re supposed to do. Taking a look at the Top Ten Headlines for cardiac resuscitation this program evaluates the strength of the science behind each recommendation as well as how they might be implemented in dif-ferent EMS systems. Getting past the “Headlines”, attendees will return home well-equipped to open up discussions about optimizing EMS cardiac arrest resuscitation in their systems beyond “I read this study once” or “This is what the algorithms say now.”
Serum Uric Acid and Outcome after Acute Ischemic Stroke: PREMIER StudyErwin Chiquete, MD, PhD
Background: Current evidence shows that uric acid is a potent
antioxidant whose serum concentration increases rapidly
after acute ischemic stroke (AIS). Nevertheless, the relationship
between serum uric acid (SUA) levels and AIS
outcome remains debatable. We aimed to describe the
prognostic significance of SUA in AIS. Methods: We studied
463 patients (52% men, mean age 68 years, 13% with glomerular
filtration rate <60 />2) at 30 days, or with
any outcome measure at 3, 6 or 12 months poststroke. After
adjustment for age, gender, stroke type and severity (NIHSS
<9),><24 h. Conclusions: A low SUA
concentration is modestly associated with a very good
short-term outcome. Our findings support the hypothesis
that SUA is more a marker of the magnitude of the cerebral
infarction than an independent predictor of stroke outcome.
Understanding of Electronic Medical Records(EMRs) plays a crucial role in improving healthcare outcomes. However, the unstructured nature of EMRs poses several technical challenges for structured information extraction from clinical notes leading to automatic analysis. Natural Language Processing(NLP) techniques developed to process EMRs are effective for variety of tasks, they often fail to preserve the semantics of original information expressed in EMRs, particularly in complex scenarios. This paper illustrates the complexity of the problems involved and deals with conflicts created due to the shortcomings of NLP techniques and demonstrates where domain specific knowledge bases can come to rescue in resolving conflicts that can significantly improve the semantic annotation and structured information extraction. We discuss various insights gained from our study on real world dataset.
Heart Rate Variability (HRV) plays an important role for reporting several cardiological and noncardiological
diseases. Also, the HRV has a prognostic value and is therefore quite important in modelling
the cardiac risk. The nature of the HRV is chaotic, stochastic and it remains highly controversial. Because
the HRV has utmost importance, it needs a sensitive tool to analyze the variability. In previous work,
Rosenstein and Wolf had used the Lyapunov exponent as a quantitative measure for HRV detection
sensitivity. However, the two methods diverge in determining the HRV sensitivity. This paper introduces a
modification to both the Rosenstein and Wolf methods to overcome their drawbacks. The introduced
Mazhar-Eslam algorithm increases the sensitivity to HRV detection with better accuracy.
Interpreting Health Status Of Indian Population Using Phase Angle As Health P...IJRES Journal
Bio Electrical Impedance Analyser is a simple Non-Invasive tool that is used for the Human body composition Analysis. It has been found that the basic principle of Human Body composition Analysis is the measurement of fat vs lean muscle tissue. And it is well known fact that biological tissues the path of least resistance. While Analysing the body composition through Bio Electrical Impedance Analyser body resistance and body reactance are taken into account. Phase Angle is directly calculated from resistance and reactance and Phase Angle is an important indicator of cellular health and integrity. This paper aims at discussing the significance of Phase Angle in Analysis of Human Body Composition and developing and validating prediction equation of Phase Angle at different frequencies.
PrognostiCheck® device measures prognosis. Reliable, Objective and Noninvasive.IPGDx LLC
Prognostic scoring system objectively and accurately detects the presence and severity of illness, the effectiveness of treatment, the existing burden of illness, the progression of disease and the timing of non-acute death.
ANS Testing Device University of Miami Study PresentationMaxiMedRx
Visit www.maximedrx.com
Sudopath Sudoscan testing device diabetic study by university of miami. Evaluating a New Approach to Detect Type 2 Diabetes Mellitus using the ES Complex-TSS
Risk stratification remains central to implement appropriate therapeutic measures for patients with NSTEMI.
The ECG provides rapid risk assessment for patients presenting with chest pain that permits their allocation to appropriate management algorithms to improve the outcomes
A M ODIFIED M ETHOD F OR P REDICTIVITY OF H EART R ATE V ARIABILITYcsandit
Heart Rate Variability (HRV) plays an important rol
e for reporting several cardiological and
non-cardiological diseases. Also, the HRV has a pro
gnostic value and is therefore quite
important in modelling the cardiac risk. The nature
of the HRV is chaotic, stochastic and it
remains highly controversial. Because the HRV has u
tmost importance, it needs a sensitive tool
to analyze the variability. In previous work, Rosen
stein and Wolf had used the Lyapunov
exponent as a quantitative measure for HRV detectio
n sensitivity. However, the two methods
diverge in determining the HRV sensitivity. This pa
per introduces a modification to both the
Rosenstein and Wolf methods to overcome their drawb
acks. The introduced Mazhar-Eslam
algorithm increases the sensitivity to HRV detectio
n with better accuracy.
Adenocarcinoma is a carcinoma that begins in cells lining glandular types of internal organs (glandular epithelium tissue ) such as the lungs, breasts, colon, prostate, stomach, pancreas, and cervix and has gland-like properties
Mesothelioma is a form of Cancer that most frequently arises from the cells lining the sacs of the chest (the pleura) or the abdomen (the peritoneum) and almost always caused by exposure to asbestos
In breast cancer the severity of the disease can be seen and reported by PrognostiCheck® and guide the patient to the level of care they need sooner and easier
A lung cancer prognosis is an medical opinion about the outcome of the disease in a patient. The score from the PrognostiCheck® test provides a clear illustration of how the individual patient is doing.
Americans count on the safety of their food. There are too many food recalls today. President Barack Obama has created a Food Safety Working Group to coordinate Federal efforts and develop short- and long-term agendas to make food safer.
EFresh(R)-can help make the food supply safer.
EFresh(R) device measures food freshness, juiciness and food quality.IPGDx LLC
Measures the freshness and palatability (tenderness / flavorfulness / juiciness) of foods (meat / fish / poultry / fruits / vegetables) and identifies fresh versus previously frozen.
PrognostiCheck ® - The Biological CompassIPGDx LLC
Prognostic scoring system objectively and accurately detects the presence and severity of illness, the effectiveness of treatment, the existing burden of illness, the progression of disease and the timing of non-acute death.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
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.
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
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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.
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.
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!
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
1. PrognostiCheck ™ is a proprietary noninvasive measurement that depicts prognosis by
illustrating the plasma cell membrane and the exchange between the intra and extracellular
matrices. We use impedance plethysmography, a well-established vascular diagnostic
technique to measure the values of resistance (R) and Reactance (Xc) and calculate phase
angle (Pa). Phase angle is the arc tangent of Xc/R converted to degrees. Without regression
analysis and across disease states and populations phase angle clearly illustrates;
• The presence and progression of disease
• Fluid Balance and Nutrition Status (without regression predictions)
• The effectiveness of a pharmacologic or non-pharmacologic treatment intervention
• Giving an opportunity to modify it to try and optimize a response
• Predicts the timing of non-acute death
• Facilitating the transition from curative-restorative to palliative-hospice care (Transitive
Care™)
We characterize Phase Angle as a ‘Vitality Index™’ which can be positive, neutral or negative
and use it as a qualitative indicator to be added to the existing clinical decision matrix. Since
the Phase Angle illustrates changes that occur prior to those evidenced by cell counts, physical signs,
biochemical assays and imaging techniques its value clearly complements the disease
management process, providing the physician with valuable information sooner. The study is
objective, precise, sensitive and technically feasible. Specific Phase Angle values are
associated with improvement, disease progression and treatment efficacy and the timing of
non-acute death. Phase angle is clearly associated with prognosis and survival as a powerful
independent variable.
While the impedance measuring devices are FDA cleared (510(k)) Class II medical devices the
specific application, PrognostiCheck ™ is investigational and only recently submitted to FDA
under a 513(g) request for classification.
Our interest is in exploring the specific potential of PrognostiCheck ™ as an OTC item targeting
patients with chronic disease states for monitoring disease progression, effectiveness of
treatment and transition from curative-restorative to palliative-hospice care; ‘Transitive
Care™’. This technology and the resulting objective metric obtained from serial measurements
would be the basis for a Health 2.0 application within a social networking medium. A brief
description of the technology and a series of published data are included for your review.
2. What it is:
Impedance Plethysmography (IPG): the gathering of a variety of physiologic data based upon
the measured electrical conductive properties of the body.
The study of electricity is well established, the properties clearly understood and its parameters accurately
measured. When a safe electrical circuit is applied to a biological system or entity the measured electrical
values correspond directly to physiological equivalents and plainly illustrate them. As the nature of the
electrical component is completely defined and does not change the method is particularly effective to
demonstrate the natural changes intrinsic in the biological entity.
IPG has been effectively used for over fifty-years in a variety of clinical medical practice and
research applications. Ranging from the detection of blood clots that may lead to serious
illness (venous thrombosis/pulmonary embolism), estimating the blood pumped by the heart (Left
Ventricular Ejection Fraction) or body composition analysis (estimating body fat); IPG has a
well established history of use.
In addition to its ability to accurately illustrate physiologic (pathophysiologic) parameters in a
noninvasive manner it is the precision (test re-test reliability: 0.98-0.99) of IPG that makes it
a valuable tool; as the changes it documents are the changes inherent in the biological system
as the electrical properties don’t change.
Challenges to the use and validity of IPG are based upon the manipulations of the measured
electrical values by statistical regression analysis. Even when such manipulations are
eloquently composed with the benefit of comparison to sophisticated standards they are
limited by the size and character of the group studied, cannot be accurately applied outside of
it and do not accurately predict findings in all group members equally. This ‘best-fit’ tool is
impractical for general use. No where has this been more evident than in the area of
estimating body composition where these methods are used and based upon the porous
foundation of ‘assumed biological constants’. These ‘assumed constants’ are used to satisfy
and explain variation of the biological system being studied and are used as a ‘bridge’ to
reach another objective or value. These ‘assumed constants’ and their product results are not
sufficiently reliable to base a clinical medical decision upon as they often are neither reliable
nor accurate.
In our applications of IPG we have chosen to provide only the specific measured electrical
values, the understanding of what their physiologic equivalents are and to compare those results in a visible
illustration. This qualitative standard provides the basis for a reliable decision matrix suitable
for clinical practice that is understandable to patient and provider forming the basis of a
practical health-tool.
How it works:
Our body is made of materials that have varying degrees of conductivity based upon water
and cells. In electrical science there is always a balance of forces, a positive and a negative.
Impedance is the opposition to conduction; the voltage-drop or loss measured in the circuit.
To make the measurement the subject becomes the only unknown part of a safe electrical
circuit. The circuit is safe because the electrical signal that is used is at a frequency and
strength (current and voltage) so as not to stimulate or disturb any tissues. The measurement can be
repeated as often as necessary to illustrate and report the information sought. The electrical
circuit’s field is set-up with two stick-on electrodes placed on the subject’s skin with the signal
3. passed between them. These ‘introduction’ electrodes are used to establish and maintain the
electrical circuit through the IPG instrument at a highly-controlled, constant and stable level.
Two more electrodes are placed within that field in relation to anatomical landmarks at the
beginning and end of the area of interest, which may be the whole-body or a region/segment
of the body, depending upon the event to be reported. These ‘detection’ electrodes are used
by the IPG instrument to measure and record the change in the electrical signal. These
changes relate with precision, sensitivity and specificity to cellular level physiology.
The measured impedance is vectored into two parts; Resistance (R) and Reactance (Xc) and
the relationship between them is calculated as the Phase Angle (Pa).
R is inversely proportionate (opposite) to water content so when more water is added to the
body such as in edema the R value decreases and when water is lost from the body such as in dehydration R
increases. When more water is present conduction is improved and resistance is lessened and
conversely when less water is present conduction is reduced and resistance is greater. The R
is a fluid indicator, when higher the subject is dehydrated, when lower the subject has edema
(heart failure, trauma, surgery and critical care) and when the same the subject’s water volume is stable.
Xc is proportionate to cell mass so when you are healthier and better nourished Xc is higher
and when you are less healthy or malnourished Xc is less. The membrane of each cell holds the
electrical signal resulting in the reactance value. When there are more cells and when the
cells are healthier the Xc value is greater as they have a greater capacity to ‘hold’ the
electrical energy. When the cells are not healthy or when there are fewer cells such as in
wasting disorders the Xc value is lower as their capacity to hold the electrical signal is not as good.
The Xc is a nutrition/metabolism indicator, when higher the subject is well-nourished, when lower the
subject is malnourished and when the same over time the subject’s nutrition/metabolism is stable.
The Pa is the relationship between R and Xc defined mathematically (arc tangent Xc/R
expressed in degrees). The higher the value of phase angle generally the healthier the subject
indicating the ratio of cells and water is balanced and that the ability of the plasma cell
membrane to hold the electrical signal is good. The Pa is the delay caused by the healthy cell
membrane to hold the electricity as it passes through the circuit. When the Pa is less than
average or in a low range the health of the subject is poor. The Pa may drop during an
episodic illness such as the flu or a cold but then recover quickly thereafter, within a week. If
the Pa does not recover the illness may be more severe. If the Pa continues to drop the illness is
worsening and treatment needs to be adjusted or made more aggressive. When the Pa goes too low
the patient cannot recover. The Pa is a sort of ‘Vitality Index’ which may be considered as ‘Positive’
(healthy), ‘Neutral’, or ‘Negative’ (unhealthy).
Why use it:
Changes in R, Xc and Pa do not explain the reason for the change and they must be taken in
the context of the overall health of the subject and used in addition to the existing clinical
dataset. However their value is that they clearly and reliably illustrate change before changes
are seen through typical methods such as blood chemistries/cell counts, physical signs or
imaging techniques. The basis for this is simply because they ‘see’ and report what is
happening at the cellular level, an earlier level or compartment of physiology before the other
values develop and can be reported. This makes the IPG values very sensitive to changes and
trends of increase or decease can be reported at a time when treatment can be more effective
and before a condition has more rigorously established itself. This ‘early-warning’ can provide
valuable time to act, to detect disease and improve treatment and outcomes or at the end-of-
life to preserve control, comfort and communication. In addition the characterization of the
cell membrane and the exchange it mediates between the intracellular and extracellular
4. environments illustrates the condition of the subject unlike any other methodology providing
valuable information and insight.
The information illustrated by measuring and reporting the R, Xc and Pa add to the subjects
and healthcare providers dataset and decision matrix about prognosis, fluid status,
metabolism and nutrition. Not only is this information helpful to assess and maintain general
health but to detect the presence of disease, characterize its progression and the
effectiveness of treatment. The patient’s compliance with treatment can be improved when they
understand the effects that effort has on their health. The type of treatment can be adjusted to
optimally affect the patient. When treatment is not effective and a cure or restoration of
health is not possible the transition to supportive care can be made based upon objective
values so the patient and their family can understand, accommodate and make the best use of
what time they have available.
When to use it:
The frequency of the measurement is based upon the phenomenon to be captured and
illustrated. For general health concerns measurements are made on an annual or seasonal
basis to assess the condition and effects at hand to adjust health practices. When an illness
occurs the measurements are made more frequently to show what changes are occurring over
time to demonstrate recovery or to support further more definitive investigation. During more
serious illnesses the measurements may be made multiple times throughout the day to
capture and track fluid changes which may occur rapidly. While changes in nutrition and
metabolism are seen in days changes in fluids can occur in hours. Measurements for prognosis
are based upon the dynamics of how aggressive the disease is progressing; the treatment changed
and is followed two or three times weekly.
SELECTED PUBLICATION ABSTRACTS (complete publications available)
Bioelectrical impedance phase angle in clinical practice: implications for prognosis in
advanced colorectal cancer
Gupta D, et al; American Journal Clinical Nutrition, 2004 Dec; 80(6):1634-8
Background: Phase angle, determined by bioelectrical impedance analysis (BIA), detects changes in tissue
electrical properties and has been found to be a prognostic indicator in several chronic
conditions-such as HIV, liver cirrhosis, chronic obstructive pulmonary disease, and lung
cancer-and in patients receiving dialysis. Objective: This study was conducted to investigate the
prognostic role of phase angle in advanced colorectal cancer. Design: We evaluated a case
series of 52 patients with histologically confirmed stage IV colorectal cancer. BIA was
conducted on all patients and phase angle was calculated. The Kaplan-Meier method was used
to calculate survival. Cox proportional hazard models were constructed to evaluate the
prognostic effect of phase angle independent of other clinical and nutritional variables.
Results: Patients with a phase angle ≤5.57 had a median survival of 8.6 mo (95% CI: 4.8,
12.4; n=26), whereas those with a phase angle >5.57 had a median survival of 40.4 mo (95%
CI: 21.9, 58.8; n=26; P=0.0001). Conclusion: Phase angle is a prognostic indicator in patients
with advanced colorectal cancer. Similar studies of other cancer types with larger sample sizes
are needed to further validate the prognostic significance of phase angle in cancer treatment
settings.
5. Bioelectrical impedance analysis in clinical practice: a new perspective on its use beyond
body composition equations
Barbosa-Silva MC, et al; Current Opinion, Clinical Nutrition Metabolic Care, 2005 May; 8(3):311-7
Purpose Of Review: The bioelectrical impedance analysis is not a direct method for estimating
body composition. Its accuracy depends on regression equations, and recent papers have
suggested that this approach should not be used in several clinical situations. Another option is to obtain
information about the electrical properties of tissues by using raw bioelectrical impedance
measurements, resistance and reactance. They can be expressed as a ratio (phase angle) or
as a plot (bioelectrical impedance vector analysis). This review describes their use in clinical
practice. Recent Findings: The phase angle changes with sex and age. It is described as a
prognostic tool in many clinical situations. There are some controversies about considering it as a
nutritional marker. Studies in burn victims and sickle-cell disease corroborate its ability to evaluate
cell membrane function. Bioelectrical impedance vector analysis allows a semi-quantitative
estimation of body composition from information from tissue hydration and soft-tissue mass in
a plot. It can be used in healthy individuals or patients, for a population or individual
evaluation of fluid imbalance or an assessment of soft-tissue mass. It has also been used as a
prognostic tool in dialysis and cancer patients. Summary: The phase angle can be considered a
global marker of health, and future studies are needed to prove its utility in intervention
studies. Bioelectrical impedance vector analysis has increased its utility in clinical practice,
even when the equations may be inaccurate for body composition analysis.
Predictive value of APACHE II score is improved by combination with bioelectrical impedance
analysis in multiple trauma patients
PHJ Mueller, et al; Critical Care 1998, 2(Suppl 1):P162
Background: Indication to extensive critical care could be ameliorated by combining APACHE
II (AP II) scores with the Phase-Angle (PA, ~), a global parameter of nutritional status derived
from Bioelectrical Impedance Analysis (BIA). Methods: 40 (30 male/10 female) multiple
trauma patents (age: 16-81 years) with a stay of >5 days on the Intensive Care Unit (ICU)
were studied retrospectively. Routinely obtained daily measurements of nutritional status (BIA
101 Impedance Analyzer, RJL-Systems) included calculations of PA. Results: 10/40 patients
(25%) died during ICU stay (Table). In all patients with AP II scores ~20 (APACHE II-Class
~5) determination of outcome would have been correct by Phase-Angle: all deceased patients had a
PA <3, while surviving patients had a PA >4 (P < 0.05). Discriminate analysis of this data
reveals a probability of 100% for prediction of survival and 94% for lethal outcome
respectively. Conclusion: Even in this small sample of multiple trauma patients there is a clear
cutoff level of PA >4 for prediction of survival. We suggest the routine use of BIA for
observation of ICU patents, but further studies are needed to establish the prognostic relevance of
this method.
Bioelectrical impedance phase angle as a prognostic indicator in advanced pancreatic cancer
Gupta D, et al; British Journal Nutrition, 2004 Dec; 92(6):957-62
Bioelectrical impedance analysis (BIA) is an easy-to-use, non-invasive and reproducible technique to evaluate
changes in body composition and nutritional status. Phase angle, determined by BIA, has been
found to be a prognostic indicator in several chronic conditions, such as HIV, liver cirrhosis,
chronic obstructive pulmonary disease and lung cancer, and in patients undergoing dialysis.
6. The present study investigated the prognostic role of phase angle in advanced pancreatic
cancer. We evaluated a case series of fifty-eight stage IV pancreatic cancer patients treated
at Cancer Treatment Centers of America at Midwestern Regional Medical Center (Zion, IL,
USA) between January 2000 and July 2003. BIA was conducted on all patients using a
bioelectrical impedance analyzer that operated at 50 kHz. The phase angle was calculated as
capacitance (Xc)/resistance (R) and expressed in degrees. The Kaplan-Meier method was used to
calculate survival. Cox proportional hazard models were constructed to evaluate the
prognostic effect of phase angle independent of other clinical and nutritional variables. The
correlations between phase angle and traditional nutritional measures were evaluated using
Pearson and Spearman coefficients. Patients with phase angle <5.0 degrees had a median
survival time of 6.3 (95% CI 3.5, 9.2) months (n 29), while those with phase angle >5.0
degrees had a median survival time of 10.2 (95% CI 9.6, 10.8) months (n 29); this difference
was statistically significant (P=0.02). The present study demonstrates that phase angle is a strong
prognostic indicator in advanced pancreatic cancer. Similar studies in other cancer settings
with larger sample sizes are needed to further validate the prognostic significance of the
phase angle.
Norms and correlates of bioimpedance phase angle in healthy human subjects, hospitalized
patients, and patients with liver cirrhosis
Selberg O, European Journal of Applied Physiology, 2002 Apr; 86(6):509-16
This study investigates whether bioimpedance indexes rather than derived body compartments
would be adequate for nutritional assessment. Evidence is provided that the phase angle as determined
by conventional tetrapolar whole body bioelectrical impedance analysis at 50 kHz (1) was
largely determined by the arms and legs and not the trunk, (2) was higher in control subjects
than in hospitalized patients [mean (SD) 6.6 degrees (0.6) degrees vs 4.9 degrees (1.2)
degrees, P<0.001], (3) discriminated poorly between cirrhotic patients of different Child-Pugh
class, and (4) was positively correlated with muscle mass ( r=0.53) and muscle strength
(r=0.53) in these patients (each P<0.01). In a prospective study of patients with liver
cirrhosis Kaplan-Meier and log rank analyses of survival curves demonstrated that patients
with phase angles equal to or less than 5.4 degrees had shorter survival times than patients
with higher phase angles [6.6 degrees (1.4) degrees] and that phase angles less than 4.4
degrees were associated with even shorter survival times (P<0.01). The prognostic roles of
the phase angle and standard nutritional parameters such as total body potassium,
anthropometric measurements, and impedance derived fat free mass, body cell mass and fat
mass were evaluated separately by Cox regression which eliminated all variables except the
phase angle as predictors of patient survival time ( P<0.01). We concluded that for the clinical
assessment of patients the phase angle may be superior to commonly used body composition information.
Relationship of bioelectrical impedance parameters to nutrition and survival in peritoneal
dialysis patients
Mushnick R, et al; Kidney International Supplement, 2003 Nov ;( 87):S53-6
Background: Malnutrition is highly prevalent in peritoneal dialysis (PD) patients and is
associated with higher mortality in these patients. In this study, we have prospectively
examined the relationship of bioimpedance indexes to the nutritional status and survival in PD
patients. Methods: We enrolled 48 PD patients beginning in November 2000. On enrollment,
bioelectrical impedance analysis (BIA) (BIA-101; RJL/Akern, Clinton Township, MI, USA) was
performed and monthly blood was analyzed for biochemical markers, including pre-albumin.
7. Patients were followed until April 2003. Results: The mean age of PD patients was 51 +/- 15
(SD) years. Fifty-eight percent of the patients were female and 23% of the patients were
diabetic. Mean body mass index (BMI) was 25.7 +/- 5.0 kg/m2. Mean resistance, reactance, and
phase angle were 521 +/- 104 ohms, 57 +/- 19 ohms, and 6.16 +/- 1.6 degrees, respectively.
During the study period, 8 patients (17%) expired. The Kaplan-Meier method was used to
compute observed survival. The cumulative observed survival of PD patients with enrollment
phase angle greater than or equal to 6 degrees was significantly higher (P = 0.008) than that
of patients with phase angle less than 6. Using Cox's multivariate regression analysis, phase
angle was an independent predictor (relative risk = 0.39, P = 0.027) of more than two years'
survival in PD patients. Serum pre-albumin was directly correlated with phase angle (r = 0.54,
P < 0.0001), reactance (r = 0.55, P < 0.0001), and resistance (r = 0.29, P = 0.06).
Conclusion: BIA indexes reflect nutritional status and may be useful in monitoring nutritional
status in PD patients. Phase angle is a strong prognostic index in PD patients. It is useful to
incorporate pre-albumin and BIA parameters in the regular assessment of PD patients, whose
survival may be improved by better management of malnutrition and overall health status.
The validity of bioelectrical impedance phase angle for nutritional assessment in children
Nagano M, et al; J Pediatric Surgery, 2000 Jul; 35(7):1035-9
Background/Purpose: Bioelectrical impedance analysis (BIA) is a quick and noninvasive
method for estimating body composition. Many prediction equations have been reported
recently using bioelectrical impedance to calculate fat free mass (FFM) and fat mass (FM).
These equations are based on the assumption that the composition and density of FFM are
stable. In children, the composition and density of FFM vary according to age and clinical state, so the
use of these equations is limited. However, phase angle is directly determined from resistance (Rz) and
reactance (Xc) without equations and reflects body cell mass. The authors, therefore,
investigated the validity of phase angle for nutritional assessment in children. Methods:
Bioelectrical impedance analysis and anthropometric measurements were performed in 81
patients, including 71 well-nourished and 10 malnourished children. Results: Phase angle
correlated with body weight (R = 0.818) and arm muscle circumference (r = 0.901) in well-
nourished children. Malnourished patients showed lower phase angle than that of well-
nourished children. Conclusion: Bioelectrical impedance phase angle is a useful parameter for
nutritional assessment in children.
Uremic malnutrition is a predictor of death independent of inflammatory status
Pupim LB, et al, Kidney Int. 2004 Nov; 66(5):2054-60
Background: Several studies have pointed out the influence of nutritional parameters and/or
indices of inflammation on morbidity and mortality. Often, these conditions coexist, and the
relative importance of poor nutritional status and chronic inflammation in terms of predicting
clinical outcomes in chronic hemodialysis (CHD) patients has not been clarified. Methods: We
undertook a prospective cohort study analyzing time-dependent changes in several established
nutritional and inflammatory markers, and their influence on mortality in 194 CHD patients
(53% male, 36% white, 30% with diabetes mellitus, mean age 55.7 +/- 15.4 years)
throughout a 57-month period. Serial measurements of serum concentrations of albumin, pre-
albumin, creatinine, transferrin, cholesterol, and C-reactive protein (CRP), as well as
normalized protein catabolic rate, post-dialysis weight, and phase angle and reactance by
bioelectrical impedance analysis were performed every 3 months. Clinical outcomes were
simultaneously assessed using indicators of mortality. Results: Serum albumin, serum pre-
albumin, serum creatinine, and phase angle were significant predictors of all cause mortality,
8. even after adjustment for serum CRP concentrations. Serum CRP concentrations were not
significantly associated with mortality. Serum albumin concentrations and phase angle were
also independent predictors of cardiovascular deaths in the multivariate model. Conclusion:
The nutritional status of CHD patients predicts mortality independent of concomitant presence
or absence of inflammatory response. Prevention of, and timely intervention to treat uremic
malnutrition by suitable means are necessary independent of the presence and/or therapy of
inflammation in terms of improving clinical outcomes in CHD patients.
Altered tissue electric properties in lung cancer patients as detected by bioelectric impedance
vector analysis
Toso S, et al; Nutrition, 2000 Feb; 16(2):120-4
Modifications of body composition are frequent in cancer patients. Bioelectric impedance
analysis can specifically detect changes in tissue electric properties, which may be associated
with outcome. We evaluated the distribution of the impedance vectors from 63 adult male patients with
lung cancer, stages IIIB (33 patients) and IV (30 patients), in supportive therapy. Body weight
change over the previous 6 mo. was the same in both groups (stable/increased 36% and
decreased in 62%). Patients were compared with 56 healthy subjects matched for gender, age, and
body mass index (25 kg/m2).
Impedance measurements (standard tetrapolar electrode placement on the hand and foot)
were made with 50-kHz alternating currents. The resistance and reactance of the vector
components were standardized by the height of the subjects and were plotted as
resistance/reactance graphs. The impedance vector distribution was the same in patients with
either stage IIIB or IV cancer. The mean vector position differed significantly between cancer
patients and control subjects (Hotelling T2 test, P < 0.01) because of a reduced reactance
component (i.e., a smaller phase angle) with preserved resistance component in both cancer
groups. Patients with a phase angle smaller than 4.5 degrees had a significantly shorter, i.e.,
18 mo., survival. Body weight loss was not significantly associated with survival. In
conclusion, impedance vectors from lung cancer patients were characterized by a reduced
reactance component. The altered tissue electric properties were more predictive than weight
loss of prognosis.
Bioelectrical Impedance Analysis as a Predictor of Survival in Patients with Human
Immunodeficiency Virus Infection
Michael Ott, Harold Fischer; et al; Journal of Acquired Immune Deficiency Syndromes and Human
Retrovirology 9:20-25 1995
Summary: In patients with AIDS, short-term survival has been related to body weight, body
composition, and serum nutritional parameters, but their prognostic impact at earlier stages of
the HIV infection is not known. With an individual follow-up period of 1,000 days, we
investigated the prognostic relevance of electrical tissue conductivity (resistance R, reactance
Xc, phase angle Ø, extracellular mass (ECM), body cell mass (BCM) measured by bioelectrical
impedance analysis), of the CD4 + cell count, and of serum parameters indicating malnutrition
in 75 HIV-infected male patients at Walter Reed stages 3-5. After initial recording, 29 patients (38.7%)
died from AIDS during this period. Among 12 parameters estimated with a semi parametric Cox
regression model adjusted for therapy (pentamidine, azidothymidine), the phase angle Ø
(parameter estimate: 1.043, 95% confidence interval of 0.61 to 1.47) P < 0.0001 the
ECM/BCM ratio, Xc, BCM, serum cholesterol, number of CD4 + cells, and serum albumin had
9. significant prognostic influence on survival, whereas age, body weight, body mass index,
resistance, serum protein, and serum triglycerides did not. In a model with four covariates
CD4 + cells, phase angle, pentamidine, azidothymidine, the prognostic impact of the CD4 + cell
count (parameter estimate: - 0.549) was lower compared with the phase angle Ø parameter
estimate: - 0.799); (P < 0.0001) and did not gain statistical significance (P = 0.0626). The
phase angle Ø was the best single predictive factor for survival among all 12 parameters
(comparison of the respective Cox models with the likelihood ratio test). Body composition as reflected
by the phase angle Ø is a major determinant of long term survival in HIV infection, thereby
representing an important parameter for monitoring disease progression.
Bioelectrical Impedance Analysis Predicts Survival in Hemodialysis Patients
G.M Chertow, et al; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
**Published as quot;BLUE RIBBON AWARDquot; Abstract # T164, A0969, page 1442, journal of the American Society
of Nephrology, September 1996, Volume 7, #9
Abstract: We performed a cross-sectional study of BIA (Bioelectrical impedance analysis, BIA
101-Q, RJL Systems, Clinton Township, MI) in 3009 HD (hemodialysis) patients with follow-up
to 12 (median 8) months to evaluate the relation between impedance and survival. 296 deaths
were documented over the study period; patients were censored at transplantation or if lost
to follow-up. Mean (± SD) age was 60.5 ± 15.5 years, 47% were females, 47% African-
American, and 36% diabetic. Dialysis vintage was 3.8 ± 3.7 years. Mean reactance (Xc) was
40.9 ± 13.8 ohms; mean resistance (R) was 497.7 ± 99.0 ohms. The mean Xc/R ratio 0.084 ±
0.030; Xc/R was directly correlated with albumin (r=0.24), pre-albumin (r=0.27), and
creatinine (r=0.40), and inversely correlated with age (r= -0.33) and Quartile’s index (r= -
0.15). Xc/R was significantly higher in men Africa Americans, and non-diabetics (P< 0.0001
compared with women, Caucasians, and diabetics, respectively). To obviate linearity
assumptions, Xc/R was ranked into quintiles, and the relative risks of death (RR) and 95%
confidence intervals (95% CI) within each quintile were estimated from proportional hazards
regression, with and without covariate adjustment. Survival in patients within the upper three
quintiles of Xc/R; The RR in the two lowest quintiles was 2.7 (95% CI 1.1 to 2.2, P=0.009), respectively.
After adjustment for age, sex, race, diabetes, albumin, creatinine, and urea reduction ratio, the
RR in the lowest quintile was 1.5 (95% CI 1.2 to 2.1, P=0.003). Results were similar when Xc
and R were adjusted for body stature. Conclusion: Xc/R is correlated with biochemical
surrogates of nutritional status in hemodialysis patients, and provides prognostic power even
after adjustment for case mix and laboratory variables. Longer-term follow-up and longitudinal
assessment of Xc/R will be required to determine the optimal role for BIA in HD patient assessment.
Phase angle from bioelectrical impedance analysis remains an independent predictive
marker in HIV-infected patients in the era of highly active antiretroviral treatment
Schwenk A, et al; American Journal of Clinical Nutrition, 2000 Aug; 72(2):496-501
Abstract: Background: Highly active antiretroviral treatment (HAART) reduces the risk of
wasting in HIV infection and may alter the prognostic weight of wasting. The phase angle from
bioelectrical impedance analysis (BIA) can be interpreted as a surrogate marker for the
catabolic reaction to chronic HIV infection and opportunistic disease. Objective: Our objective
was to assess the prognostic ability of the phase angle in HIV-infected patients in the era of HAART.
Design: Two cross-sectional observation studies were conducted in 1996 and 1997 at a German
10. university outpatient HIV clinic. In the 1996 and 1997 cohorts, HAART was prescribed to 17 of
212 and 168 of 257 patients at baseline and to 179 of 212 and 234 of 257 patients during
observation, respectively. Whole-body BIA was assessed at 50 KHz. Time to clinical progression
and survival were calculated by using Cox proportional hazard models with time-dependent
covariates. Median observation times were 1000 and 515 d for the 1996 and 1997 cohorts,
respectively. Results: Higher phase angle was associated with a lower relative mortality risk,
adjusted for viral load and CD4 + cell count, of 0.49 (95% CI: 0.30, 0.81) per degree in 1996
and of 0.33 (95% CI: 0.18, 0.61) in 1997. The influence of phase angle on time to clinical
progression, adjusted for viral load and CD4 + cell count, was not significant in 1996 but the
relative risk was 0.58 (0.36, 0.83) in 1997. Conclusion: Despite the favorable effects of HAART
on the nutritional status of HIV-infected persons, low phase angle remains an independent
adverse prognostic marker of clinical progression and survival.
Bioelectrical impedance analysis for assessment of severity of illness in pediatric patients
after heart surgery
Shime N, et al; Critical Care Medicine 2002 Mar; 30(3):518-20
Objective: To investigate whether perioperative changes in bioelectrical impedance reflect the
severity of illness in pediatric patients after heart surgery. Design: Prospective, controlled
study. Setting: University-affiliated children's hospital. Patients: A total of 107 patients admitted
to a pediatric intensive care unit after congenital heart surgery. Interventions: None.
Measurements And Main Results: Single frequency (50 kHz) bioelectrical impedance was
measured in the lower extremities before surgery and immediately, 16 hrs, and 40 hrs after
admission (D0, D1, D2) to the pediatric intensive care unit. Postoperative changes in
bioelectrical impedance were assessed by calculating values relative to the preoperative data
(bioelectrical impedance ratio). These bioelectrical impedance ratios at D0 in both the non-
surviving and surviving patients were 0.84 +/0.06 and 0.85 +/- 0.01 (mean +/- SE),
respectively, indicating that the initial decrease caused by surgical stress itself was not directly
related to the prognosis. The bioelectrical impedance ratio showed an increase toward
preoperative values in surviving patients (0.94 +/- 0.02) at D1, and they showed a sustained
decrease (0.70 +/- 0.06) in non-surviving patients. Patients with a bioelectrical impedance ratio
at D1 of < 0.8 showed a higher mortality (25%) compared with those patients with a day-1
bioelectrical impedance ratio of > or = 1.0 (0%). The duration of the stay in the pediatric
intensive care unit, mechanical ventilation, and inotropic support were all significantly longer
in the patients with the lower bioelectrical impedance ratio. Conclusions: Measurement of the
relative changes in postoperative bioelectrical impedance, which reflects perioperative
alterations in body composition, provides a quantitative estimation of the critical illness in
pediatric patients after heart surgery.
Localized bioimpedance analysis in the evaluation of neuromuscular disease
Rutkove SB, Muscle Nerve 2002 Mar; 25(3):390-7
Localized bioimpedance analysis is a novel, noninvasive technique with potential application to
neuromuscular disease. In this procedure, high-frequency alternating current is passed
through muscle, and parameters related to the consequent voltage pattern are evaluated.
Currents flowing perpendicular to muscle fibers encounter many more cell membranes than do
currents flowing parallel to them, producing surface voltage patterns that are altered by disease. Using
this technique, 45 normal subjects and 25 patients with various neuromuscular diseases were
11. studied, including 4 with amyotrophic lateral sclerosis, 4 with inflammatory myopathy, and 11
with inclusionbody myositis. Two parameters, the spatially averaged phase and the effective longitudinal
resistivity, were altered in patients with neuromuscular disease. Reductions in phase
correlated to disease progression, whereas normalization of phase correlated with disease
remission. In patients with inclusion-body myositis, a unique pattern of reduced phase and
elevated resistivity was identified. These findings suggest that localized bioimpedance analysis has the
potential of playing a substantial role in the diagnostic and therapeutic evaluation of neuromuscular disease.