Resistant hypertension is defined as uncontrolled blood pressure despite treatment with three or more antihypertensive medications, including a diuretic. Pseudo-resistant hypertension accounts for around 50% of cases due to issues like inaccurate measurements, poor medication adherence, and inadequate treatment regimens. Ambulatory blood pressure monitoring is important for accurately diagnosing and managing resistant hypertension. Treatment involves optimizing medication regimens with medications like chlorthalidone, spiranolactone, and amiloride-hydrochlorothiazide combinations, and considering interventions for refractory cases involving more than five medications.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Javed Butler, MD, MPH, MBA, discusses heart failure in this CME activity titled, "New Frontiers in Managing Heart Failure: Are SGLT2 Inhibitors the Next Leap Forward in Optimizing Patient Care?" For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2JG2v9l. CME credit will be available until May 29, 2020.
Javed Butler, MD, MPH, MBA, discusses heart failure in this CME activity titled, "New Frontiers in Managing Heart Failure: Are SGLT2 Inhibitors the Next Leap Forward in Optimizing Patient Care?" For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2JG2v9l. CME credit will be available until May 29, 2020.
Recent Advancements in the treatment of Hypertension.Akshata Darandale
Uncontrolled blood pressure had become most common cause of death accounting for more than 7 million deaths per year worldwide. Despite the availability of potent lifestyle and pharmacologic approaches, rates of control of blood pressure are unsatisfactory and additional strategies to curb the burden of hypertension are warranted. Several novel pharmacological and device-based approaches have recently been tested and may prove helpful to achieve better blood pressure control rates and thereby improve cardiovascular outcomes in patients with hypertension.
This session will help pharmacists enhance their expertise in managing patients with hypertension through updates on the latest hypertension guidelines, discussion on the role that pharmacists can and should play in the detection and ongoing management of hypertension and hands-on experience with blood pressure measurement devices.
Longitudinal hemodynamics in acute phase of treatment with labetalol in hypertensive pregnant women to predict need for vasodilatory therapy
D. Stott, M. Bolten, D. Paraschiv, I. Papastefanou, J.B. Chambers and N.A. Kametas
Volume 49, Issue 1, Date: January (pages 85–94)
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.17335/full
Serial hemodynamic monitoring to guide treatment of maternal hypertension leads to reduction in severe hypertension
D. Stott, I. Papastefanou, D. Paraschiv, K. Clark and N.A. Kametas
Volume 49, Issue 1, Date: January (pages 95–103)
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.17341/full
Slides prepared by Dr Katherine Goetzinger (UOG Editor for Trainees)
In this overview, we draw inspiration from the article titled "Managing Hypertension in Primary Care“, published in the Canadian Family Physician journal (Vol 65: October 2019).
The article, edited by Khrystine Waked PharmD, Jeff Nagge PharmD, and Kelly Grindrod PharmD MSc,.
It provides valuable insights and evidence-based approaches to tackle Hypertension Management In Primary Care.
By incorporating the recommendations discussed in this article, we can enhance our ability to manage hypertension and ultimately improving patient outcomes and quality of life.
Effect of hydrocortisone on development of shock amongDr fakhir Raza
effects of hydrocortisone on development of shock among patients with severe sepsis the HYPRESS Randomized Clinical Trial American Medical Association caring for the critically ill patients Surviving sepsis campaign, to determine weather hydrocortisone therapy in patients with severe sepsis prevents the development of septic shock
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
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
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.
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.
4. RESISTANT HYPERTENSION
• Uncontrolled (>140/90 mm Hg)
• office BP
• Despite three antihypertensive drugs
• In adequate doses and combinations
• OR Controlled with 4 drugs
• Including one diuretic
• Long acting: Chlorthalidone/ spiranolactone
• After 3 months follow up
Calhoun et al. AHA/ACC. J Hypertension 2008
6. CAVEATS OF DEFINITION
• Secondary causes?
• What is ‘controlled’ BP?
• OBP/ ABP/ HBP?
• Accurate Measurements?
• Which Anti-hypertensives?
• what doses?
• Which diuretics?
• Adherence?
12. Resistant HTN 12.2% True Resistant HTN 7.5%
Sierra et al. Hypertension. 2011
WHO ARE GOING TO HAVE
TRULY RESISTANT HYPERTENSION?
13. Muxfeldt et al. Hypertension Research 2013
RRESISTANT HTN
473
OFFICE BP<140/90
94 (20%)
OFFICE BP>140/90
379 (80%)
SUSTAINED CONTROLLED BP
58 (62%)
MASKED HTN
36 (38%)
TRUE RHTN
226 (60%)
WHITE COAT HTN
153 (40%)
5 years of follow-up
ABPM
LONG TERM FOLLOW UP
14. ABPM: NEW TOOL IN BOX
Muxfeldt et al. Hypertension Research 2013
15. ABPM
• ABPM is a very important tool not only for
diagnosis but also for treatment and follow
up.
• Office BP has a poor prognostic value than
ABPM
Muxfeldt et al. Hypertension Research 2013
18. Inaccuracy of BP measurement
Triage BP technique overestimated the prevalence of
uncontrolled RHTN in approximately 33% of the patients
Bhatt et al. J Am Soc Hypertens 2016
19. Adherence Factor
Durand et al. Journal of Hypertension 2017
Adherence method Prevalence
Prescription refill 31%
Serum drug level 86%
Pill counts 3%
24 studies. 68000 patients
20. Inadequate Therapy
44684 patients of resistant HTN
on 3 or more antihypertensive agents
Egan et al. Hypertension 2012
Inadequate Therapy Prevalence
Optimal diuretic 15%
Recommended
optimal dose
50%
Optimal BP therapy in
-Black
-CKD
-DM
-CAD
22. One antihypertensive at night-time
Harmida et al. Hypertension 2010. (n=250)
Group of single morning dose:
-nondipping pattern twofold higher
-lower nocturnal fall of SBP and DBP
1306 true resistant hypertensives,
those using at least one drug at bedtime:
Better contol of ABP
Better metabolic profile
Less subclinical organ damage
Muxfeldt et al. J Hypertens 2008.
27. PATHWAY 2
Home monitoring to exclude white coat HTN
Directly observed therapy to ensure adherence
Patients with eGFR <45 mL/min were excluded
Included predominantly white Caucasians
Williams et al, PATHWAY 2, Lancet 2015
28. Spironolactone was the most effective blood pressure-lowering agent
throughout the distribution of baseline plasma renin
but it was particularly effective in patients with lower renin
Williams et al, PATHWAY 2, Lancet 2015
32. White Coat
HTN 15%
Masked
HTN 25%
True Resistant
HTN 45%
Controlled
HTN 15%
Outcome
Daughtery et al. Circulation 2012
White coat HTN not so benign
33. ‘’Refractory’’ hypertension
Refractory hypertension was defined as failure to
achieve blood pressure control with treatment
prescribed by hypertension experts at minimum of 3
follow-up visits during at least 6 months of care,
receiving an 5 or more different antihypertensive
medications.
Acelajado et al. J Clin Hypertens 2012. University of Alabama at Birmingham Hypertension Clinic
34. Study Population
(Resistant HTN)
Definition of RfH % of RfH
Acelajado et al,
2012
retrospective analysis
304 patients
University of Alabama at
Birmingham Hypertension Clinic
>5 drugs
10%
Dudenbostel et
al, 2015
700 patients
Prospective analysis
University of Alabama at
Birmingham
>5 drugs including,
chlorthalidone and
spironolactone 4%
Modolo et al,
2015
116 patients
cross-sectional analysis
>5 drugs
All of the refractory patients
were receiving a diuretic and
most were receiving
spironolactone (76%).
31%
Calhoun et al,
2014
REGARDS study n=30239
community-based cohort
>5 drugs
Diuretic use, including
specifically chlorthalidone and
spironolactone, was not
required as part of the definition
3.6%
Prevalence of Refractory HTN
39. Response of Renal artrey denervation
Favourable response in:
High SBP (≥180 mm Hg), age <65 years, eGFR ≥60 mL/min/ m2
Bhat et al, BioMed Research International 2015
40. Baroreceptor Activation Therapy
Rheos Pivotal Trial
• 265 patients with resistant
hypertension underwent
surgical implantation.
• One month after surgery,
patients were randomly
assigned to have BAT turned
on immediately or to have
BAT turned on six months
later.
• The patients were followed
for at least 12 months
Bakris et al. J of Am Soc of HTN 2012
41. RHEOS PIVOTAL
6 months
Patients receiving BAT
• Had a nonsignificantly larger
decrease in systolic pressure
• Significantly more likely to
achieve a goal systolic
pressure of 140 mmHg.
12 months
• Mean reduction in systolic
pressure in the BAT group
was 25 mmHg
• More than 80 % of these
patients had at least a 10
mmHg decrease in systolic
pressure
Within one month of surgery
35 % of patients had serious adverse effects
including facial nerve injury
Bakris et al. J of Am Soc of HTN 2012
43. Take Home Messages
• ABPM mandatory for diagnosis and follow up.
• HBPM is also suitable. Limitation is night-time BP.
• One BP lowering drug at night time.
• White Coat HTN is not benign.
• Rule out secondary causes. OSA is commonest.
• PFK score to decide utilization of Spiranolactone
44. Take Home Messages (Cont.)
• Pseudo-resistance is 50%. Ensure 3A: accuracy,
adherence, adequacy. Rule out NSAIDS/ OCP.
• Chlorthalidone to start with. Add Spiranolactone
when resistant. Ameloride+HCTZ is reasonable.
• >5 drugs: Refractory HTN. High sympathetic activity.
Thank You