Pulmonary arterial hypertension (PAH) is abnormally high blood pressure in the arteries of the lungs. It can be caused by genetic factors or other conditions. PAH occurs when pressure in the pulmonary arteries is greater than 25 mmHg at rest or 30 mmHg with exercise. Diagnosis involves assessing medical history and tests like echocardiograms and heart catheterization. Treatment includes medications to dilate blood vessels, diuretics, oxygen therapy, and potentially lung transplantation for severe cases. The document provides details on the types, risk factors, symptoms, diagnosis, and treatment of PAH.
Updated Hypertension Management – ESH 2023.pdfDr. Nayan Ray
Hypertension is the most prevalent CV disorder in the world and according to the WHO, it affects 1.28 billion adults aged 30–79 years worldwide, two-thirds living in low-income and middle-income countries.
In 2019, the global age-standardized average prevalence of hypertension in adults aged 30–79 years was reported to be 34% in men and 32% in women.
At younger ages (<50 years), hypertension is more prevalent in men, whereas a steeper increase of SBP in women from their third decade (and more so following menopause) makes the prevalence of hypertension greater in women in older age categories (>65 years).
Rule of Halves
Half the people with high blood pressure are not known (“rule 1”),
Half of those known are not treated (“rule 2”) and
Half of those treated are not controlled (“rule 3”)'
Definition:
Hypertension is defined based on repeated office SBP values ≥ 140 mmHg and/or DBP ≥ 90 mmHg.
Updated Hypertension Management – ESH 2023.pdfDr. Nayan Ray
Hypertension is the most prevalent CV disorder in the world and according to the WHO, it affects 1.28 billion adults aged 30–79 years worldwide, two-thirds living in low-income and middle-income countries.
In 2019, the global age-standardized average prevalence of hypertension in adults aged 30–79 years was reported to be 34% in men and 32% in women.
At younger ages (<50 years), hypertension is more prevalent in men, whereas a steeper increase of SBP in women from their third decade (and more so following menopause) makes the prevalence of hypertension greater in women in older age categories (>65 years).
Rule of Halves
Half the people with high blood pressure are not known (“rule 1”),
Half of those known are not treated (“rule 2”) and
Half of those treated are not controlled (“rule 3”)'
Definition:
Hypertension is defined based on repeated office SBP values ≥ 140 mmHg and/or DBP ≥ 90 mmHg.
La Dra. Ainara Lozano Bahamonde repasa las novedades incluidas en las últimas guías europeas en insuficiencia cardiaca presentadas en ESC Congress 2021.
The actual prevalence of RH may be lower than what is
perceived in the literature when triple-A (accuracy of BP
measurement, adherence of medications, and adequacy
of anti-HTN medications) are ensured. It is important to
emphasize that the sea of RH starts when the shore of secondary
HTN is over and the island of RfH is still uncharted. RfH is
emerging as a novel phenotype, and growing evidence suggest
that these patients have sympathetic hyperactivity. However,
the role of beta-blockers and interventions such as RDN and
baroreceptor activation techniques is yet to be studied.
La Dra. Ainara Lozano Bahamonde repasa las novedades incluidas en las últimas guías europeas en insuficiencia cardiaca presentadas en ESC Congress 2021.
The actual prevalence of RH may be lower than what is
perceived in the literature when triple-A (accuracy of BP
measurement, adherence of medications, and adequacy
of anti-HTN medications) are ensured. It is important to
emphasize that the sea of RH starts when the shore of secondary
HTN is over and the island of RfH is still uncharted. RfH is
emerging as a novel phenotype, and growing evidence suggest
that these patients have sympathetic hyperactivity. However,
the role of beta-blockers and interventions such as RDN and
baroreceptor activation techniques is yet to be studied.
A presentation by Ulf Thilén at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Pulmonary Arterial Hypertension: The Other High Blood Pressure and its association with scleroderma is presented by
Micheal J. Cuttica MD, MS, Assistant Professor of Medicine, Director; Northwestern Pulmonary Hypertension Program, Northwestern University
Angina also known as angina pectoris is a medical condition characterized by chest pain usually left sided due to inadequate blood supply (ischemia) to the heart muscles due to obstruction (like presence of blood clot), narrowing or contraction (vasospasm) of the supplying coronary arteries.
PowerPoint presentation describing various aspects of Pulmonary Hypertension. Please mail me your feedback on this presentation to following Email ID: tinkujoseph2010@gmail.com.
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.
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
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
2. INTRODUCTION
In the human body, there are two types of circulation that
enable distribution of blood through out the body.
The portion that pumps oxygenated blood from the left
side of the heart via the left ventricle to all parts of the
body is known as the systemic circulation.
On the other hand, the portion that pumps deoxygenated
blood from the right side of the heart via the right
ventricle into the lungs to obtain oxygen is referred to as
the PULMONARY CIRCULATION.
2
3. Pressures in the lung arteries are normally lower than the
pressures in the systemic circulation.
Pulmonary hypertension occurs when the pressure in the
pulmonary circulation becomes abnormally elevated.
Normal pulmonary artery pressure is 8-20 mm Hg at rest.
Pulmonary hypertension is pressure in the pulmonary
artery that is greater than 25 mm Hg at rest or 30
mmHg during physical activity.
3
7. RISK FACTORS
7
Congestive heart failure
Blood clots in the lungs
Family history
Lupus
Scleroderma
Emphysema
Chronic bronchitis
Pulmonary fibrosis
Sleep apnea
Cirrhosis
HIV/AIDs
Sex (young female)
Drug induced
8. PATHOPHYSIOLOGY
8
It is high blood pressure (BP) in the arteries that go
from the heart to the lungs.
Can be genetic or caused by another condition.
Platelets, fibroblasts, and circulating cells are involved
in the progression of PAH
The phenotypical change of pulmonary arterial smooth
muscle cells (PASMCs) and pulmonary arterial
endothelial cells (PAECs) results from multiple genetic
and acquired defects and is probably the major cause for
the onset of the disease.
9. Increased PASMC contraction, increased PASMC
proliferation and inhibited PASMC apoptosis,
monoclonal PAEC proliferation, and endothelial injury
all are involved in the development of sustained
pulmonary vasoconstriction, lumen obliteration of small
pulmonary arteries with plexiform lesions, and
pulmonary vascular wall thickening due to medial
hypertrophy.
9
12. FUNCTIONAL CLASSIFICATION
A. Class I - Patients with pulmonary hypertension but
without resulting limitation of physical activity.
Ordinary physical activity does not cause undue
dyspnea or fatigue, chest pain, or near syncope.
B. Class II- Patients with pulmonary hypertension
resulting in slight limitation of physical activity. They
are comfortable at rest. Ordinary physical activity
causes undue dyspnea or fatigue, chest pain, or near
syncope.
12
13. C. Class III - Patients with pulmonary hypertension
resulting in marked limitation of physical activity.
They are comfortable at rest. Less than ordinary
activity causes undue dyspnea, fatigue, and chest pain
or near syncope.
D. Class IV - Patients with pulmonary hypertension with
inability to carry out any physical activity without
symptoms. These patients manifest signs of right heart
failure. Dyspnea and /or fatigue may be present even at
rest. Discomfort is increased by any physical activity
13
15. DIAGNOSIS
Hard to spot/diagnose because it mimics those of other
similar conditions.
Will assess medical history and use one or more tests (ie.
blood test, chest X-ray, CT scan, MRI,
electrocardiogram, echocardiogram, heart
catheterization, pulmonary function test, lung biopsy)
15
17. TREATMENT: NON-PHARMACOLOGIC
Salt and volume management
Supervised exercise (not too strenuous)
Immunization - Specifically, influenza and
pneumococcal
Improving diet
Psycho-social support
17
18. TREATMENT:PHARMACOLOGIC
Fluid restriction
Diuretics to decrease fluid accumulation
Cardiac glycosides (eg, digitalis) in an attempt to
improve cardiac function
Calcium channel blockers for vasodilation
Intravenous prostacyclin helps to decrease pulmonary
hypertension by reducing pulmonary vascular resistance
and pressures and increasing cardiac output
Anticoagulants such as warfarin have been given to
patients because of chronic pulmonary emboli.
Long-term oxygen therapy is suggested to maintain
arterial blood O2 pressure at 60 mmHg
18
19. All: Anticoagulants ± Diuretics ± Digoxin ± Oxygen
Acute vasoreactive testing (IPAH or APAH, ONLY)
Positive: use high dose oral CCB (ie. nifedipine, diltiazem,
or amlodipine)
Negative: depends on risk
• Low/High risk: Endothelin receptor antagonist (ERA) or
Phosphodiesterase Type 5 (PDE5) Inhibitors (oral),
[Prostanoids: epoprostenol (IV) or treprostinil (IV/SC),
Iloprost (inhaled)], Soluble guanylate cyclase (sGC)
stimulators
• Low or intermediate risk: monotherapy or oral combination
therapy
• High risk: combination therapy including IV prostacyclin
analogs
19
21. Prostanoids:
Epoprostenol (Flolan, Veletri): 2 ng/kg/min IV infusion every 15
min (initial)
Treprostinil (Remodulin, Tyvasco):
• Remodulin (IV) = 1.25 ng/kg/min continuous SC or central line
IV infusion (initial)
• Tyvasco: QID inhalation
Iloprost (Ventavis): 2.5 -5 mcg/inhalation 6- 9x/day
• Class AE: D/N/V (dose limiting), flushing, hypotension, anxiety,
chest pain, tachycardia, edema
• Chronic use: anxiety, flu-like symptoms, and jaw pain (lockjaw
with Iloprost)
21
22. ERAs:
Bosentan: 62.5 mg PO bid x 4 wks and then 125 mg bid
• BBW: hepatotoxicity and Cat X
• CI: cyclosporin and glyburide
• AE: HA, decrease Hgb, anemia, increase LFTs, upper
respiratory tract infections, edema, male infertility
• Monitor: LFTs
Ambrisentan: 5 or 10 mg PO qd
• BBW: Cat X
• AE: peripheral edema, HA, decrease Hgb, flushing,
palpitations, congestion
• Monitor: Hgb and haematocrit 22
23. PDE-5 Is:
Sildenafil (Revatio): 10 mg IV tid or 20 mg PO tid (4-6
hr apart)
Tadalafil (Adcirca): 40 mg PO qd or 20 mg PO qd with
mild – moderate renal/hepatic impairment (avoid with
CrCl < 30 mL/min)
• CI: nitrates or sildenafil with PI based regimen, severe
hepatic impairment
• AE: dizziness, sudden drop in BP, HA, flush, dyspepsia,
back pain (Adcirca), and epistaxis
23
24. sGC stimulant:
Riociguat (Adempas): 1 mg PO TID (initial)
• Antacids decrease absorption and should not be taken
within 1 hr of taking medication
• BBW: Cat X
• CI: nitrates or NO donors, PDE inhibitors
• AE: HA, dyspepsia and gastritis, dizziness, N/D/V,
hypotension
• Monitor: BP (baseline and every 2 weeks)
24
25. If fail therapy, add another agent
If fail that, lung transplant or atrial septostomy (Last
option)
25