Robin Lachmann, MD, PhD, and Melissa Wasserstein, MD, prepared useful Practice Aids pertaining to acid sphingomyelinase deficiency for this CME activity titled “Assessing the Potential Role of Emerging Therapies in the Early Diagnosis and Optimal Management of Chronic Visceral Acid Sphingomyelinase Deficiency.” For the full presentation, complete CME information, and to apply for credit, please visit us at https://bit.ly/35KVwoE. CME credit will be available until June 3, 2021.
Robin Lachmann, MD, PhD, and Melissa Wasserstein, MD, prepared useful Practice Aids pertaining to acid sphingomyelinase deficiency for this CME activity titled “Assessing the Potential Role of Emerging Therapies in the Early Diagnosis and Optimal Management of Chronic Visceral Acid Sphingomyelinase Deficiency.” For the full presentation, complete CME information, and to apply for credit, please visit us at https://bit.ly/35KVwoE. CME credit will be available until June 3, 2021.
Presentation on Sarcoidosis by S.K Jindal | Jindal Chest Clinic, ChandigarhJindal Chest Clinic
When the immune system overreacts, granulomas are formed, leading to a condition known as sarcoidosis. This disorder can cause mild to severe symptoms, or no symptoms at all. This Presentation describes sarcoidosis and gives an overview on Sarcoidosis including causes, symptoms, diagnosis, complications, supplements for sacrcoidosis, and treatment strategies. For more information, please contact us: 9779030507.
Presented by Jane Dematte, MD at the Scleroderma Patient Education Conference hosted by the Scleroderma Foundation on Saturday, October 12, 2019 in Chicago, IL
Serum Procalcitonin as a marker of infection in chronic kidney disease patien...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Presentation on Sarcoidosis by S.K Jindal | Jindal Chest Clinic, ChandigarhJindal Chest Clinic
When the immune system overreacts, granulomas are formed, leading to a condition known as sarcoidosis. This disorder can cause mild to severe symptoms, or no symptoms at all. This Presentation describes sarcoidosis and gives an overview on Sarcoidosis including causes, symptoms, diagnosis, complications, supplements for sacrcoidosis, and treatment strategies. For more information, please contact us: 9779030507.
Presented by Jane Dematte, MD at the Scleroderma Patient Education Conference hosted by the Scleroderma Foundation on Saturday, October 12, 2019 in Chicago, IL
Serum Procalcitonin as a marker of infection in chronic kidney disease patien...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
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.
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.
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.
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
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
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!
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Scleroderma Lung Disease: Best Practices for Monitoring and Treatment
1. Mary E. Strek MD, FCCP, ATSF
Professor of Medicine, Clinical Pharmacology & Pharmacogenomics
Director, Pulmonary Medicine Consult Service
Director, Interstitial Lung Disease Program
Scleroderma Lung Disease:
Best Practices for Monitoring and Treatment
2. Pulmonary Manifestations of Connective Tissue Disease
• Common and under-recognized
• May not track with rheumatologic symptoms
• Impairs quality of life
• May masquerade as idiopathic lung disease
• Incomplete or atypical presentation
• Presenting manifestation
• Lung dominant or limited
• TREATABLE!
3. CTD Antibody Test Interstitial Lung Disease
(ILD)
Pulmonary
Hypertension
Pleural
Disease
Scleroderma ANA, Scl-70
Centromere
Non-specific interstitial
pneumonia (NSIP)
Usual Interstitial Pneumonia
Primary
Secondary to ILD
Uncommon
Rheumatoid
arthritis
Rheumatoid factor,
CCP
UIP
NSIP
Secondary to ILD Common
SLE ANA, dsDNA, Smith Uncommon Primary Common
MCTD ANA, RNP NSIP Primary
Secondary to ILD
Uncommon
Autoimmune
Myositis
ANA, SS-A, Jo-1
Myositis associated
OP, NSIP, UIP Secondary to ILD Uncommon
Sjogren’s
Syndrome
ANA, SS-A, SS-B NSIP, UIP, LIP Secondary to ILD Uncommon
Pulmonary Complications of Connective Tissue Disease (CTD)
15. Scleroderma ILD: Treatment Options
Drug Mechanism of Action Level of Evidence
Cyclophosphamide Alkylating agent Randomized controlled trials
Scleroderma Lung Study I and II
Mycophenolate mofetil Inhibits purine synthesis Randomized controlled trial
Scleroderma Lung Study II
Azathioprine Purine antagonist Placebo controlled trial
Ritiximab Binds to CD-20 on B lymphocytes Randomized controlled trial vs
cyclophosphamide
Stem cell transplant Ablates immune system Randomized controlled trial vs
cyclophosphamide
Tocilizumab IL-6 receptor antibody Randomized placebo controlled trial
Nintedanib Tyrosine kinase inhibitor Randomized placebo controlled
trial; Mycophenolate allowed
16. Mycophenolate Mofetil (CellCept)
Potent and well tolerated
Inhibits critical enzyme in purine synthesis in activated lymphocytes
Starting dose 500 mg twice daily, target dose 1500 mg twice daily
Side effects: Diarrhea, Infections, skin cancer
Lower rate side effects: hospitalizations, GI, infections
If GI side effect: decrease dose, more frequent intervals (TID), Myfortic
MONITOR: Blood count, Metabolic panel every 3 months
TERATOGENIC/AVOID DURING PREGNANCY
Marder, Semin Respir Crit Care Med 2007; 28:398-417
17. Scleroderma Lung Study II: CYC vs Mycophenolate
• Randomized, double-blind, parallel
group trial 14 US centers
• Cyclophosphamide (CYC) x 12 mos vs
mycophenolate mofetil 1500 mg twice
daily x 24 mos
• Study Design:
• Scleroderma < 7yrs
• Dyspnea grade ≥ 2
• Restriction on PFT’s (FVC 45-85% and
DLCO >30% predicted)
• HRCT must show ground glass opacity
• Primary end-point change FVC as %
predicted normal x 24 mos
Tashkin, Lancet Respir Med 2016; 4:708-719
18. Scleroderma Lung Study II: Results
CYCLOPHOSPHAMIDE MYCOPHENOLATE MOFETIL
Number Enrolled N=73 N=69
Number Analyzed N=53 N=53
Number Stopped N=36 N=20
Target Dose 2.0 mg/kg/day 1500 mg BID
Change % Predicted FVC +2.88% (95%CI 1.19-4.58) +2.19% (95%CI 0.53-3.84)
DLCO Declined No change
Adverse Effects Leucopenia n=30
Thrombocytopenia n=4
n=4
n=0
Tashkin, Lancet Respir Med 2016; 4:708-719
Patients who continued on therapy did better!
19. focuSSced Study: Tocilizumab vs Placebo
• Randomized, double-blind, international
• Tocilizumab 162 mg injection vs placebo
x 48 wks
• Study Design
• Diffuse skin Scleroderma < 5 yrs
• Elevated ESR, CRP or platelet count
• Excluded FVC % pred < 55% or DLCO < 45%
• Primary endpoint: change skin score
• Secondary endpoint: % predicted FVC at 48
wks
• Primary skin fibrosis endpoint negative
• Infection 52% tocilizumab vs 50% placebo
Khanna, Lancet Respir Med 2020;8:963-74
20. Scleroderma SENSCIS Study: Nintedanib vs Placebo
• Randomized, double-blind, international trial
• Scleroderma < 7 yrs, Pulmonary fibrosis > 10% lung on CT
• Nintedanib x 12 mos vs placebo
• Mycophenolate mofetil allowed
• Study Results:
• N= 576 pts
• Adjusted annual rate change in nintedanib group -52.9 ml/yr vs -93.3 ml/yr in placebo
• No change in skin thickening
Distler et al. N Engl J Med 2019; epub
23. Scleroderma: Pulmonary Hypertension
• Often unrelated to extent of interstitial lung disease
• Risk factors: Raynauds, limited skin scleroderma, anticentromere
• Pulmonary Function Tests
• Forced Vital Capacity (FVC) 80% predicted (Normal)
• Diffusing Capacity (DLCO) 40%predicted (Very reduced)
• May be severe
• Heart dysfunction common
• Echo may not correlate
• Treatment responsive with better outcomes if therapy started early
27. Assessing Disease Severity/Progression
• Patient reported symptoms
• 6-minute walk testing
• Ambulatory oxygen saturation
• Pulmonary Function Testing
• Following signs/symptoms regularly
over time
• Stable
• Slowly progressive
• Rapidly progressive
28. CTD-ILD
Mild and non-
progressive
ILD
Follow
PFTs/6MWT
3-6 mos
Minimize risk
factors
(GERD, meds)
Moderate/severe
and/or progressive
TREAT
MEDS
O2, Rehab,
GERD
Chartrand, Rheum Dis Clin N Am 2015; 41:279-294
Scleroderma-ILD: Whom and When To Treat
29. Best Practices: Monitoring for ILD and Pulmonary Hypertension
General Parameter Specific Parameter Time Course
Lung Function Pulmonary Function Tests Every 4-6 months
Oxygen Levels Six-minute Walk Test Every 4-6 months
Chest Imaging ILD Protocol Chest CT Every 1-2 years, sooner if
change in symptoms
Heart Function Echocardiogram Yearly
Pulmonary Hypertension Right and Left Heart
Catheterization
If echocardiogram or other
cardiac tests abnormal
Vaccination Influenza
COVID-19
Yearly
Every 6 months?
Vaccination Pneumococcal PCV20
Shingrix
Once
Two doses
30. Conclusions: Best Practices Scleroderma Lung Disease
• Interstitial Lung Disease (ILD)
• Diagnosis: ILD Chest CT scan and Pulmonary Function Testing (PFTs)
• Effective Therapies: Mycophenolate, Tocilizumab, Nintedanib
• Monitoring: PFTs every 4-6 mos, CT every 1-2 yrs
• Pulmonary Hypertension (PH)
• Diagnosis: Echo and Catheterization
• Therapies: Vasodilators, Tyvaso
• Monitoring: Echo every 12 mos