This document discusses the role of Panchakarma in managing Madhumeha (diabetes mellitus). It begins by defining diabetes as a metabolic disorder characterized by high blood glucose levels due to defects in insulin production or action. It then describes the types and complications of diabetes, including retinopathy, nephropathy, and neuropathy. The document emphasizes that Panchakarma helps manage diabetes by eliminating toxins from the body and controlling high blood sugar levels.
Keynote Address - By Dr. K. Shiva Rama Prasad, Assessment and Utility of Sneha Karma in Disease Management - CME On
19th June 2012, Organized by Department of Panchakarma, At: Seminar Hall,
MGAC, DMIMS, Selod (H), Wardha, Maharastra
Rightly diagnosed is half cured so thorough examination of the patient is very much essential for the diagnosis and management of udara roga. Here an attempt made to understand udara roga in parlance with modern science which will be helpful for treating the patient at right time.
Keynote Address - By Dr. K. Shiva Rama Prasad, Assessment and Utility of Sneha Karma in Disease Management - CME On
19th June 2012, Organized by Department of Panchakarma, At: Seminar Hall,
MGAC, DMIMS, Selod (H), Wardha, Maharastra
Rightly diagnosed is half cured so thorough examination of the patient is very much essential for the diagnosis and management of udara roga. Here an attempt made to understand udara roga in parlance with modern science which will be helpful for treating the patient at right time.
this is an ppt presentation by dr.b.arun kumar, who is working as a lecturer in MNR ayurvedic medical college, sangareddy, near hyderabad. in this presentation i given all details of virechana karma.
The Avabahuka disease is nearer to Frozen shoulder of musculoskeletal disorders.
Avabahuka is a Vata vikar as per Ayurveda that affects the ansha sandhi i.e. shoulder joint. The description available in Charak samhita, Sushruta samhita, Ashtanga Hridaya etc. The pain, stiffness, and decreased ROM range of motion is a classical feature of a frozen shoulder.
The treatment of frozen shoulder is possible in Ayurveda through drugs and various treatment modalities depending on the stages of the case.
this is an ppt presentation by dr.b.arun kumar, who is working as a lecturer in MNR ayurvedic medical college, sangareddy, near hyderabad. in this presentation i given all details of virechana karma.
The Avabahuka disease is nearer to Frozen shoulder of musculoskeletal disorders.
Avabahuka is a Vata vikar as per Ayurveda that affects the ansha sandhi i.e. shoulder joint. The description available in Charak samhita, Sushruta samhita, Ashtanga Hridaya etc. The pain, stiffness, and decreased ROM range of motion is a classical feature of a frozen shoulder.
The treatment of frozen shoulder is possible in Ayurveda through drugs and various treatment modalities depending on the stages of the case.
Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel.
With diabetes, your body doesn’t make enough insulin or can’t use it as well as it should. When there isn’t enough insulin or cells stop responding to insulin, too much blood sugar stays in your bloodstream. Over time, that can cause serious health problems, such as heart disease, vision loss, and kidney disease.
Diabetes is a disease chronic disease which affects global population from long time. This review is an update on unknown complications, causes, treatment modalities of this disease. This article also provides a summary on disease management through various strategies. Suraj Nagwanshi | Smita Aher | Rishikesh Bachhav "Management of Diabetes Mellitus: A Review" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd46348.pdf Paper URL : https://www.ijtsrd.com/pharmacy/other/46348/management-of-diabetes-mellitus-a-review/suraj-nagwanshi
Type 2 diabetes - A 2016 update by Zeena NackerdienZeena Nackerdien
The International Diabetes Federation maintains that one in two adults are undiagnosed for diabetes and that estimates that one in eleven people had diabetes in 2015. If one takes into account that most of the cases involves the preventable condition of Type 2 diabetes, it comes as no surprise that many countries are being hit by staggering socioeconomic costs. Diabetes sites, chat rooms, aps, and ads for ever-evolving and increasingly complex disease management schemes are commonplace on Google. But what does all the information mean? The American Diabetes Association, American Association of Clinical Endocrinologists, The Canadian Diabetes Association, WebMD, and the International Diabetes Federation resources served as the major resources for this accompanying slide deck that tries to unpack some of the major subtopics related to prediabetes and Type 2 diabetes. The slide deck is organized according to disease definition, epidemiology, etiology/pathophysiology, diagnosis, treatment, and prevention. Particular topics such as the early use of insulin could be expanded into several separate slide decks narrating benefits and risks with supporting evidence. However, this deck is meant to provide interested readers with an overview of the Type 2 diabetes literature landscape, with the caveat that specific cases and Type 2 diabetes-related complications should always be discussed with a healthcare provider.
Image credits: slideteam.net; Wikimedia
Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.
The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs.
Diabetes Mellitus type 1 major comorbidity now days.
Insulin injection being the major treatment Diabetes Mellitus.
Some other drugs used to treat the Diabetes Mellitus are Tablet Metformin 500 mg and other hypoglycemic drugs.
Diabetes Mellitus and Hypertension how they are interlinked.
DEFINITION OF DIABETES MELLITUS :
It is the group of metabolic disorders which characterised by hyperglycemia and abnormalities of carbohydrate, fat and protein metabolism. resulting from defects in insulin secretion, insulin action, or. Both .
Causes:-
Life style
Genetics factor
Obesity
Diet time variation
Etiological Classification of Diabetes:
Type :-1 Diabetes (insulin dependent)
Type :-2 Diabetes (non insulin dependent)
Gestational diabetes
DEFINTION OF TYPE 1 DIABETES :
Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition by the beta cells in islets of Langerhans in the pancreas in which the pancreas produces little or no insulin, due to the autoimmune destruction of the beta cells in the pancreas. Although onset frequently occurs in childhood, the disease can also develop in adults.
DEFINITION OF TYPE 2 DIABETES :
known as adult-onset diabetes, is a form of diabetes that is characterized by high blood sugar, due to body cells don’t respond normally to insulin; this is called insulin resistance.
DEFINITION OF GESTATIONAL DIABETES :
Gestational Diabetes: Is the increasing of blood sugar levels for Some women tend to experience high levels of blood glucose as during pregnancy due to reduced sensitivity of insulin receptors.
CAUSES :
The exact cause of type 1 diabetes is unknown. Usually, the body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys cells which the insulin-producing (islets of Langerhans) cells in the pancreas. Other possible causes include:
Genetics
Exposure to viruses and other environmental factors
Endocrine disorders such as acromegaly , Cushing's syndrome
Endocrine disorders e.g. Pancreatitis .
Medications e.g. glucocorticoids , niacin , pentamine alpha- interferons .
Micro vascular complications (zeroplateas , neutrophils , eosinophil's )
Macro vascular complications (CHF , stroke , peripheral vascular disease)
SYMPTOMS :
Type 1 diabetes signs and symptoms can appear relatively suddenly and may include:
Increased thirst
Frequent urination
Bed-wetting in children who previously didn't wet the bed during the night
Extreme hunger
Unintended weight loss
Irritability and other mood changes
Fatigue and weakness
Blurred vision
PHARMACOLOGICAL TREATMENT :
Insulin:
People with type 1 diabetes must take insulin every day. You usually take the insulin through an injection.
Metformin :
Metformin is a type of oral diabetes medication. For many years, it was only used in people with type 2 diabetes. However, some people with type 1 diabetes can develop insulin resistance. That means the insulin they get from injections doesn’t work as well as it should.
Metformin helps lower sugar in the blood by reducing sugar production in the liver. Your doctor may advise you to take Metformin in addition to insulin.
B) NON- PHARMACOLOGICAL TREATMENT :
CONTROL THE SYMPTOMS .
EXERCISES
MONITORING THE SUGAR LEVELS
HEALTHY FOODS .
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
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
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
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- 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?
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- 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
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Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Role of Panchakarma in the Management of Madhumeha
1. ROLE OF PANCHAKARMA IN
THE MANAGEMENT OF
MADHUMEHA
Dr. PRASHANTH. A. S.
M.D.(Ayu), Ph.D. P.G.M.H., M.H.A.
PROFESOR
AYURVEDA MAHAVIDYALAYA, HUBLI
MO. 9448135575
Email:drprashanthayurved@gmail.com
ROLE OF PANCHAKARMA IN
THE MANAGEMENT OF
MADHUMEHA
Dr. PRASHANTH. A. S.
M.D.(Ayu), Ph.D. P.G.M.H., M.H.A.
PROFESOR
AYURVEDA MAHAVIDYALAYA, HUBLI
MO. 9448135575
Email:drprashanthayurved@gmail.com
5. What is diabetes?
Diabetes mellitus (DM) is a group of diseases
characterized by high levels of blood glucose resulting
from defects in insulin production, insulin action, or both.
The term diabetes mellitus describes a metabolic
disorder of multiple aetiology characterized by chronic
hyperglycaemia with disturbances of carbohydrate, fat
and protein metabolism resulting from defects in insulin
secretion, insulin action, or both.
The effects of diabetes mellitus include long–term
damage, dysfunction and failure of various organs.
6. Diabetes
Diabetes mellitus may present with characteristic
symptoms such as thirst, polyuria, blurring of vision, and
weight loss.
In its most severe forms, ketoacidosis or a non–ketotic
hyperosmolar state may develop and lead to stupor, coma
and, in absence of effective treatment, death.
Often symptoms are not severe, or may be absent, and
consequently hyperglycaemia sufficient to cause
pathological and functional changes may be present for a
long time before the diagnosis is made.
7. Diabetes Long-term Effects
The long–term effects of diabetes mellitus include
progressive development of the specific complications of
retinopathy with potential blindness, nephropathy that may
lead to renal failure, and/or neuropathy with risk of foot
ulcers, amputation, Charcot joints, and features of
autonomic dysfunction, including sexual dysfunction.
People with diabetes are at increased risk of
cardiovascular, peripheral vascular and cerebrovascular
disease.
8. Burden of Diabetes
The development of diabetes is projected to reach pandemic proportions
over the next10-20 years.
International Diabetes Federation (IDF) data indicate that by the year
2025, the number of people affected will reach 333 million –90% of these
people will have Type 2 diabetes.
In most Western societies, the overall prevalence has reached 4-6%, and
is as high as 10-12% among 60-70-year-old people.
The annual health costs caused by diabetes and its complications
account for around 6-12% of all health-care expenditure.
10. Type 1 diabetes
Was previously called insulin-dependent diabetes mellitus (IDDM) or
juvenile-onset diabetes.
Type 1 diabetes develops when the body’s immune system destroys
pancreatic beta cells, the only cells in the body that make the
hormone insulin that regulates blood glucose.
This form of diabetes usually strikes children and young adults,
although disease onset can occur at any age.
Type 1 diabetes may account for 5% to 10% of all diagnosed cases
of diabetes.
Risk factors for type 1 diabetes may include autoimmune, genetic,
and environmental factors.
11. Type 2 diabetes
Was previously called non-insulin-dependent diabetes mellitus
(NIDDM) or adult-onset diabetes.
Type 2 diabetes may account for about 90% to 95% of all diagnosed
cases of diabetes.
It usually begins as insulin resistance, a disorder in which the cells
do not use insulin properly. As the need for insulin rises, the
pancreas gradually loses its ability to produce insulin.
Type 2 diabetes is associated with older age, obesity, family history
of diabetes, history of gestational diabetes, impaired glucose
metabolism, physical inactivity, and race/ethnicity.
African Americans, Hispanic/Latino Americans, American Indians,
and some Asian Americans and Native Hawaiians or Other Pacific
Islanders are at particularly high risk for type 2 diabetes.
Type 2 diabetes is increasingly being diagnosed in children and
adolescents.
37. Signs of background diabetic retinopathy
Microaneurysms usually
temporal to fovea
Intraretinal dot and
blot haemorrhages
Hard exudates
frequently
arranged in clumps or
rings
Retinal oedema seen as
thickening on biomicroscopy
38. Diffuse diabetic maculopathy
• Diffuse retinal thickening • Generalized leakage on FA
• Guarded prognosis
• Grid photocoagulation• Frequent cystoid macular oedema
• Variable impairment of visual acuity
39. Ischaemic diabetic maculopathy
• Macula appears relatively normal • Capillary non-perfusion on FA
• Poor visual acuity • Treatment not appropriate
41. D.N.- Pathogenesis
Familial - Genetic
Only 35-40% patients with IDDM develop DN.
There is an increased risk of DN in a patient with
family member having DN.
42. D.N.- Pathogenesis
Glycemic Control-in both expt & human
DN does not occur in euglycemic patients.
Confirmed role of hyperglycemia in pathogenesis of DN.
Renal transplant with early DN showed structural recovery in euglycemic
receipient. (Abouna)
44. D.N.- Pathogenesis
Extracellular matrix accumulation
- Imbalance between synthesis & degradation of
ECM components
- Linkage between glucose concentration & ECM
accumulation
- Transforming growth factor-Beta associated with
increased production of ECM molecules
45. D.N.- Pathogenesis
Extracellular matrix accumulation
- TGF-B can down regulate synthesis of ECM
degrading enzymes & upregulate inhibitors of
these enzymes
- Angiotensin II can stimulate ECM synthesis
through TGF-B activity
- Hyperglycemia activates protein kinase C,
stimulating ECM production through cyclic AMP
Pathway
54. Classification of diabetic peripheral
neuropathies
Somatic:
Polyneuropathies (bilateral
sensory)
Paresthesias, including
numbness and tingling
Impaired pain, temperature,
light touch, two-point
discrimination, and vibratory
sensation
Decreased ankle and knee-jerk
reflexes
Mononeuropathies
Involvement of a mixed nerve
trunk that includes loss of
sensation, pain, and motor
weakness.
Amyotrophy
Associated with muscle
weakness, wasting, and severe
pain of muscles in the pelvic
girdle and thigh.
Autonomic:
Impaired vasomotor function
Postural hypotension
Impaired gastrointestinal function
Gastric atony
Diarrhea, often postprandial
and nocturnal
Impaired genitourinary function
Paralytic bladder
Incomplete voiding
Impotence
Retrograde ejaculation
Cranial nerve involvement
Extraocular nerve paralysis
Impaired pupillary responses
Impaired special senses
56. Presentations
3 types of neuropathy:
1. Progress steadily with increasing duration of
diabetes and associated with other diabetic
complications-common
2. Acute onset with resolution over period of
months-rare
3. Pressure palsies
61. Autonomic Neuropathy
Closely associated with sensorimotor
neuropathy
Signs are common if looked for (40%
subjects have abnormal CVS tests) but
symptoms are rare (<1%)
Affects the response to hypos but not
awareness
If symptoms: mortality=30-50% over 10
years
66. Macro-vascular Complications
Ischemic heart disease
Cerebrovascular disease
Peripheral vascular disease
Diabetic patients have a 2 to 6 times higher risk for
development of these complications than the
general population
67. Macro-vascular
Complications
The major cardiovascular risk factors in the
non-diabetic population (smoking,
hypertension and hyperlipidemia) also
operate in diabetes, but the risks are
enhanced in the presence of diabetes.
Overall life expectancy in diabetic patients is
7 to 10 years shorter than non-diabetic
people.
68. Macro-vascular
Disease
Once clinical macro-vascular disease
develops in diabetic patients they have a
poorer prognosis for survival than
normoglycemic patients with macrovascular
disease
The protective effect females have for the
development of vascular disease are lost in
diabetic females
69. Cardiovascular disease
Cardiovascular disease (also called heart disease) is a
class of diseases that involve the heart, the blood
vessels (arteries, capillaries, and veins) or both.
Cardiovascular disease refers to any disease that affects
the cardiovascular system, principally cardiac disease,
vascular diseases of the brain and kidney, and peripheral
arterial disease. The causes of cardiovascular disease are
diverse but atherosclerosis and/or hypertension are the most
common. Additionally, with aging come a number
of physiological and morphological changes that alter
cardiovascular function and lead to subsequently increased
risk of cardiovascular disease, even in healthy asymptomatic
individuals.
70. Coronary artery
disease (CAD)
Coronary artery disease (CAD) also known
as atherosclerotic heart disease,coronary heart
disease,[
or ischemic heart disease (IHD),the
most common type of heart disease and cause
of heart attacks.The disease is caused
by plaque building up along the inner walls of the
arteries of the heart, which narrows the arteries
and reduces blood flow to the heart.
71. Micrograph of a coronary artery with
the most common form of coronary
artery disease(atherosclerosis) and
marked luminal narrowing.
72. Peripheral vascular
disease
Peripheral vascular disease (PVD), commonly referred to
as peripheral artery disease (PAD) or peripheral artery
occlusive disease (PAOD) or peripheral obliterative
arteriopathy, refers to the obstruction of
large arteries not within the coronary, aortic arch vasculature,
or brain. PVD can result
from atherosclerosis, inflammatory processes leading
to stenosis, an embolism, or thrombus formation. It causes
either acute or chronic ischemia (lack of blood supply). Often
PVD is a term used to refer to atherosclerotic blockages found
in the lower extremity.
73. The illustration
shows how P.A.D.
can affect arteries in
the legs. Figure A
shows a normal
artery with normal
blood flow. The inset
image shows a
cross-section of the
normal artery. Figure
B shows an artery
with plaque buildup
that's partially
blocking blood flow.
The inset image
shows a cross-
section of the
narrowed artery.
75. Hypertension in Type 1
and 2 Diabetes
Type 1
Develop after
several years of
DM
Ultimately affects
~30% of patients
Type 2
Mostly present at
diagnosis
Affects at least 60%
of patients
76. Diabetic Carbuncle
A carbuncle is an abscess larger than a boil, usually with
one or more openings draining pus onto the skin. It is
usually caused by bacterial infection, most
commonly Staphylococcus aureus, or Streptococcus namo
kines, which can turn lethal. However, the presence of
carbuncles is actually a sign that the immune system is
working. The infection is contagious and may spread to
other areas of the body, or other people; those living in the
same residence may develop carbuncles at the same time.
78. Cutaneous
Manifestations
Nearly all patients with diabetes eventually develop
cutaneous manifestations of the disease.
Can be first sign that a patient has diabetes.
Cutaneous signs of diabetes can be valuable to
physician for diagnosis, management, and
treatment.
79. Necrobiosis Lipoidica
Diabeticorum
Degenerative disease of collagen in the
dermis and subcutaneous fat
with an atrophic epidermis.
Precedes onset of diabetes
in 15-20% of patients
Lesions progress to ulcers
if predisposed to trauma
Location:
85% anterior aspect-pretibial region of
lower extremeties, 15% hands,
forearms, face, scalp
80. Necrobiosis Lipoidica Diabeticorum
Etiology unknown: seem to occur and persist independent of
hyperglycemic control
Theory one: immunologic role-release of cytokines from
inflammatory cells may lead to destruction of the collagen
matrix.
Theory two: Microvascular effects of diabetic retinopathy
and neuropathy lead to a degradation of collagen.
Women > Men
81. Necrobiosis Lipoidica
Diabeticorum
Treatment: Lesions can spontaneously resolve, however most
do not. No standard therapy.
-used to arrest progression
Support stockings/rest
NSAIDs
Intrelesional, systemic,
topical corticosteriods
Aspirin and dipyridamole
Tumor necrosis factor
Laser surgery
Excision/grafting
82. Diabetic Dermopathy
Also known as shin spots, most common cutaneous finding in
diabetics (approximately 50% of diabetics).
Round to oval atrophic hyperpigmented lesions on the
pretibial areas of the lower extremities. Early lesions usually
raised, then flatten. Brownish hyperpigmentation due to
hemosiderin deposits.
Occur bilateral with asymmetrical distribution.
84. Diabetic Bullae
Blisters occur spontaneously in diabetic patients,
atraumatic/asymptomatic lesions on feet and legs.
Patients tend to have adequate circulation in the
affected extremities and peripheral neuropathy.
Three types of Diabetic Bullae:
-Most common: Sterile fluid
containing that heal without
scarring.
-Hemorrhagic, heals with
scarring.
-Multiple nonscarring on
sun exposed/tan skin.
85. Diabetic Bullae
Usually resolve without treatment within 2-5 weeks.
Therapy should be aimed at preventing ulceration and
secondary infection.
86. Diabetic Bullae
When they occur in the feet can resemble friction blisters,
however usually an absence of trauma.
87. Eruptive Xanthomas
Occur in hyperlipidemic/hyperglycemic states: uncontrolled
diabetic patients.
Most common in young men with Type 1 diabetes
Resistance to insulin makes it difficult for the body to clear the
fat from the blood.
88. Eruptive Xanthomas
Usually asymptomatic firm, waxy, yellow papules in
the skin.
Enlargements can have erythematous halo, can itch.
Occurs most often on the back of hands/feet,
arms/legs, buttocks, face-eyes.
89. Eruptive Xanthomas
Increase risk of developing pancreatitis.
Eruptions can resolve in a few weeks with
hyperlipidemic/hyperglycemic control, lipid lowering
medications.
90. Acanthosis Nigricans
Hyperpigmentation and thickening of epidermis
Precedes diabetes, considered a marker for the disease,
most common in overweight diabetic patients.
Usually occurs in skin folds, often described as velvety
Neck, back, axillae, groin region, over joints in the
hands/feet.
91. Kyrle’s Disease
Also known as perforating dermatosis.
Rare condition, except in setting of diabetes with
chronic renal failure.
Large papules with central keratin plugs,
widespread pattern seen in patients undergoing
dialysis.
Itching/scratching present
92. Kyrle’s Disease
Primary location: extensor surfaces of the lower
extremity, but can occur on face and trunk.
Seen with DM, CHF, hepatic abnormalities-alcoholic
cirrhosis, renal disease
Elimination of collagen and elastin throughout
epidermis.
93. Kyrle’s Disease
Can be difficult to treat: have to manage underlying systemic
disorder
Antihistamines, antipruritics, topical corticosteriods,
Retinoic acid, UV light therapy, laser therapy
Rapid improvement and resolution of lesions is seen once
underlying disease is treated.
Diabetic nephropathy can be divided into 4 phases: microalbuminuria (urinary albumin excretion 30-300 mg/24 h), macroalbuminuria or proteinuria (&gt;300 mg/24 h), the nephrotic syndrome, and chronic renal failure (Grundy et al, 1999). Microalbuminuria is the first clinical sign of diabetic damage to the kidney and is a harbinger of progressive kidney damage. Microalbuminuria also reflects a higher risk for cardiovascular disease. Once microalbuminuria is present, it progresses over 5-10 years to macroalbuminuria in 22%-50% of patients (Mogensen, 1984; Cooper et al, 1988; Haneda et al, 1992; Ravid et al, 1992; John et al, 1994; Lebovitz et al, 1994). Macroalbuminuria denotes significant diabetic nephropathy and will be followed by a decline in glomerular filtration rate (GFR). Once a patient with type 2 diabetes develops macroalbuminuria, further decline in renal function appears to be inevitable; GFR declines at a rate of 4-12 mL/min/year (Pugh et al, 1993; Gall et al, 1993; Hasslacher et al, 1993). Some patients develop the nephrotic syndrome, which usually heralds progressive renal insufficiency and end-stage renal disease.
In diabetic nephropathy studies, where the time of onset of type 2 diabetes is known, these patients follow a time course similar to that seen in patients with type 1 diabetes. However, the date of onset of type 2 diabetes is often unknown and usually precedes the clinical diagnosis by several years (Grundy et al, 1999). By the time patients are diagnosed with type 2 diabetes, many have already developed hypertension, signs of nephropathy (including microalbuminuria or even macroalbuminuria) and cardiovascular disease (Mogensen et al, 1992; The Hypertension in Diabetes Study Group, 1993a; American Diabetes Association, 1998). Whereas patients with type 1 diabetes are usually normotensive until overt renal disease develops, hypertension commonly occurs in patients with type 2 diabetes before the onset of overt diabetic nephropathy, and about 40% of newly diagnosed patients with type 2 diabetes are already hypertensive (The Hypertension in Diabetes Study Group, 1993a). Both the onset of microalbuminuria and the progression of renal disease after the onset of macroalbuminuria are accelerated by hypertension (Epstein and Sowers, 1992).
The majority of patients with type 2 diabetes who have macroalbuminuria also have hypertension (Grundy et al, 1999). In these patients, control of hypertension slows the decline in GFR. The main goal of any treatment for patients with type 2 diabetic nephropathy should be to prevent the natural progression from microalbuminuria to macroalbuminuria to end-stage renal disease. Effective antihypertensive treatment is the best inhibitor of diabetic nephropathy (Ravid et al, 1993). Since reducing albuminuria delays progression of diabetic nephropathy, this parameter can be used as a benchmark for measuring the efficacy of therapeutic interventions (Rossing et al, 1994).
Note that the high risk of cardiovascular mortality in patients with type 2 diabetes, even early in their disease, may not allow for the development of nephropathy (Ismail et al, 1999).
Diabetic nephropathy can be divided into 4 phases: microalbuminuria (urinary albumin excretion 30-300 mg/24 h), macroalbuminuria or proteinuria (&gt;300 mg/24 h), the nephrotic syndrome, and chronic renal failure (Grundy et al, 1999). Microalbuminuria is the first clinical sign of diabetic damage to the kidney and is a harbinger of progressive kidney damage. Microalbuminuria also reflects a higher risk for cardiovascular disease. Once microalbuminuria is present, it progresses over 5-10 years to macroalbuminuria in 22%-50% of patients (Mogensen, 1984; Cooper et al, 1988; Haneda et al, 1992; Ravid et al, 1992; John et al, 1994; Lebovitz et al, 1994). Macroalbuminuria denotes significant diabetic nephropathy and will be followed by a decline in glomerular filtration rate (GFR). Once a patient with type 2 diabetes develops macroalbuminuria, further decline in renal function appears to be inevitable; GFR declines at a rate of 4-12 mL/min/year (Pugh et al, 1993; Gall et al, 1993; Hasslacher et al, 1993). Some patients develop the nephrotic syndrome, which usually heralds progressive renal insufficiency and end-stage renal disease.
In diabetic nephropathy studies, where the time of onset of type 2 diabetes is known, these patients follow a time course similar to that seen in patients with type 1 diabetes. However, the date of onset of type 2 diabetes is often unknown and usually precedes the clinical diagnosis by several years (Grundy et al, 1999). By the time patients are diagnosed with type 2 diabetes, many have already developed hypertension, signs of nephropathy (including microalbuminuria or even macroalbuminuria) and cardiovascular disease (Mogensen et al, 1992; The Hypertension in Diabetes Study Group, 1993a; American Diabetes Association, 1998). Whereas patients with type 1 diabetes are usually normotensive until overt renal disease develops, hypertension commonly occurs in patients with type 2 diabetes before the onset of overt diabetic nephropathy, and about 40% of newly diagnosed patients with type 2 diabetes are already hypertensive (The Hypertension in Diabetes Study Group, 1993a). Both the onset of microalbuminuria and the progression of renal disease after the onset of macroalbuminuria are accelerated by hypertension (Epstein and Sowers, 1992).
The majority of patients with type 2 diabetes who have macroalbuminuria also have hypertension (Grundy et al, 1999). In these patients, control of hypertension slows the decline in GFR. The main goal of any treatment for patients with type 2 diabetic nephropathy should be to prevent the natural progression from microalbuminuria to macroalbuminuria to end-stage renal disease. Effective antihypertensive treatment is the best inhibitor of diabetic nephropathy (Ravid et al, 1993). Since reducing albuminuria delays progression of diabetic nephropathy, this parameter can be used as a benchmark for measuring the efficacy of therapeutic interventions (Rossing et al, 1994).
Note that the high risk of cardiovascular mortality in patients with type 2 diabetes, even early in their disease, may not allow for the development of nephropathy (Ismail et al, 1999).
Slide 21
Renal autoregulation
-If occurs in regions other than the legs, less association with diabetes.
-Anterior aspect of lower leg-shin typical location
-Posterior aspect of legs-B/L nature of the disease.
-Important-physcial exam….can advise pt. to see PCP for screening of DM
-Resolution/prognosis not related to glycemic control
-Treatment aimed at stopping progression and preventing ulceration/infection. Unless ulcerated do not have to treat.
-Many treatments because exact etiology is unclear, more than listed here.
-topical/intralesional steriods lessen the inflammation of early active lesions.
-Antiplatelet aggregation therapy, causes vasodilation, inhibits platelet aggregation.
-Recurrence common after excision/grafting due to underlying vascular damage.
-Can occur in anyone after an injury or trauma to the area. Can occur forearm, thighs, side of foot, scalp, trunk. &gt; 4 or more lesions indicative of diabetes. Can take up to 2 years to resolve.
-Lysis of erythrocytes leaves hemosiderin deposits causing brownish hyperpigmentation.
-No treatment necessary.
-Etiology-diabetes causes changes to small blood vessels that supply the skin. Leakage of blood products from vessels to skin
-Asympromatic, no treatment necessary.
-Small percentage of patients with diabetes develop spontaneous blistering on feet/legs.
-Heal without treatment, however can rupture-develop an ulcer and become infected secondarily.
-Picture: Intact blister
-Left: spontaneous blister with crusted region
-Right: ulcer and cellulitis that developed as a complication of a ruptured blister.
Again occur spontaneously etiology unkown: possible photosensitivity, increased in pressure resulting from edema of cardiac failure possible enough to result in blisters, decreased threshold to trauma.
One paper said develop more frequently in patients with uncontrolled diabetes and severe peripheral neuropathy.
-Close up of eruptive xanthoma
-Spontaneously resolve when serum lipids return to normal.
-Diet modifications, exercise-weight loss, medication
-Work up includes sugar levels, LFT, renal function-UA, creatinine
-Cause unknown, host inflammatory response, alteration of dermal connective tissue, inherited
-No known triggers