The document discusses parathyroid glands and parathyroid hormone (PTH). It notes that parathyroid glands secrete PTH, which regulates calcium levels in the blood. PTH acts on bone, kidneys, and stimulates vitamin D production. Secondary hyperparathyroidism occurs in kidney disease and is caused by low calcium and vitamin D levels stimulating increased PTH secretion. Treatment focuses on controlling calcium, phosphate, PTH, and vitamin D levels through diet, binders, analogs, and calcimimetics. For refractory cases, parathyroidectomy may be required.
hyperparathyroidism with detailed discussion of primary Primary hyperparathyroidism, presentation , workup management & surgery & post operative management
Secondary hyperparathyroidism is a frequently encountered problem in the management of patients with chronic kidney disease (CKD). This slideshow introduces this topic, breaking down its etiology, pathophysiology, clinical presentation, prognosis, management including investigation and treatment.
hyperparathyroidism with detailed discussion of primary Primary hyperparathyroidism, presentation , workup management & surgery & post operative management
Secondary hyperparathyroidism is a frequently encountered problem in the management of patients with chronic kidney disease (CKD). This slideshow introduces this topic, breaking down its etiology, pathophysiology, clinical presentation, prognosis, management including investigation and treatment.
Hypercalcaemia is a common disorder we doctors from all faculties face in day to day clinical practice. This was a presentation done by me to give you an update regarding hypercalcaemia and it's management.
lupus nephritis is a autoimmune disease, commonly seen in adult and child and the medical or nursing care is also very important for this type of disease condition.
Hyperparathyroidism is medical condition where overactivity of one or more of the body's four parathyroid glands leads to excess of parathyroid hormone in the bloodstream.
The Many Faces of Hyperparathyroidism & Advances in TreatmentBabak Larian
Hyperparathyroidism is a rare disease that affects the whole body and can cause potentially debilitating symptoms. Unfortunately, parathyroid disease is often poorly understood, even by parathyroid specialists. Because the signs and symptoms of hyperparathryoidism are similar to other conditions (including aging, stress, depression, menopause, fibromyalgia, etc.), patients are often misdiagnosed. As such, it is Dr Larian's goal to educate both physicians and patients more on the different manifestations of the disease and treatment so that patients can receive the care they deserve.
This presentation - The Many Faces of Hyperparathyroidism & Advances in Treatment - has the following objectives:
1- Understand the physiology of parathyroid disease and the molecular basis for it.
2- Be able to identify the different manifestations of hyperparathyroidism: Typical, Normocalcemic Hyperparathyroidism, and Normohormonal Hyperparathyroidism.
3- Understand the reasoning for the latest recommendations for treatment of disease.
For more information about hyperparathyroid disease and surgery please visit www.ParathyroidMD.com or call 310-461-0300.
Hypercalcaemia is a common disorder we doctors from all faculties face in day to day clinical practice. This was a presentation done by me to give you an update regarding hypercalcaemia and it's management.
lupus nephritis is a autoimmune disease, commonly seen in adult and child and the medical or nursing care is also very important for this type of disease condition.
Hyperparathyroidism is medical condition where overactivity of one or more of the body's four parathyroid glands leads to excess of parathyroid hormone in the bloodstream.
The Many Faces of Hyperparathyroidism & Advances in TreatmentBabak Larian
Hyperparathyroidism is a rare disease that affects the whole body and can cause potentially debilitating symptoms. Unfortunately, parathyroid disease is often poorly understood, even by parathyroid specialists. Because the signs and symptoms of hyperparathryoidism are similar to other conditions (including aging, stress, depression, menopause, fibromyalgia, etc.), patients are often misdiagnosed. As such, it is Dr Larian's goal to educate both physicians and patients more on the different manifestations of the disease and treatment so that patients can receive the care they deserve.
This presentation - The Many Faces of Hyperparathyroidism & Advances in Treatment - has the following objectives:
1- Understand the physiology of parathyroid disease and the molecular basis for it.
2- Be able to identify the different manifestations of hyperparathyroidism: Typical, Normocalcemic Hyperparathyroidism, and Normohormonal Hyperparathyroidism.
3- Understand the reasoning for the latest recommendations for treatment of disease.
For more information about hyperparathyroid disease and surgery please visit www.ParathyroidMD.com or call 310-461-0300.
HYPERCALCEMIA ASSOCIATED WITH MALIGNANCY.pptm (2).pptxVijendrapatle1
THIS PPT WILL CLEAR YOUR CONCEPTS FOR THE VARIOUS CAUSES OF HYPERCALCEMIA INCLUDING MALIGANCY AND HELP YOU TO FOLLOW SYSTEMATIC APPRAOCH FOR THE DAIGNOSIS AND MANAGEMENT
Hyperparahyroidsm is an endocrinal disorder majorly affecting the parathyroid glands which secrete parathyroid hormone and calcitonin.
A condition characterised by excessive secretion of calcium in blood and Bone resorption and inanbility to metabolise calcium in blood.
Parathyroid hormone (PTH) is one of three key hormones modulating calcium and phosphate homeostasis; the other two are calcitriol (1,25-dihydroxyvitamin D) and fibroblast growth factor 23 (FGF23).
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
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
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.
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!
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
2. PARATHYROID GLANDS
Two pairs of parathyroid
glands positioned
behind the outer wings
of thyroid.
Superior and inferior
parathyroid glands.
Secretes parathyroid
hormone
3. PARATHYROID HORMONE(PTH)
84 aminoacid single chain peptide.
Primary function is to maintain the ECF calcium
concentration with in normal range.
Acts directly on
bone(calcium resorption)
kidney(calcium reabsorption)
Stimulates 1 alpha hydroxylase activity, increases
production of 1,25(OH)2D,which increases the
efficiency of calcium absorption.
4. PTH secretion increases steeply to a maximum value
of about 5 times the basal rate of secretion as calcium
concentration falls to the range of 7.5-8mg/dl.
ECF calcium controls PTH secretion by interaction
with a calcium sensor, a G protein coupled
receptor(GPCR)
5.
6. PTHrP(parathyroid hormone related protein)
Responsible for most instances of hypercalcemia of
malignancy.
A syndrome that resembles hyperparathyroidism but
without elevated PTH levels.
Produced by brain,pancreas,heart,lung,mammory
tissue,placenta and endothelial cells.
7. PRIMARY HYPER PARATHYROIDISM.
A generalized disorder of calcium,phosphate and
bone metabolism due to increased secretion of
PTH leading to hypercalcemia and
hypophosphatemia.
8. parathyroid tumors
solitary adenoma
rarely a parathyroid carcinoma
MEN syndromes.
MEN1 (wermers syndrome)
MEN2A
Hyperparathyroid jaw tumors.
Non syndromic familial isolated hyperparathyroidism.
Etiology
9. Secondary hyperparathyroidism
Is an adaptive process that develops in response to
declining kidney function, impaired phosphate excretion
and failure to bioactivate vitD.
Teritiary hyperparathyroidism
Is a state of severe hyperparathyroidism in patients with
renal failure that requires surgery .
10. SECONDARY HYPERPARATHYROIDISM
Etiology
Kidney failure requiring dialysis.
Stomach or intestine bypass surgery for obesity surgery.
Celiac disease.
Crohns disease.
Severe vit D deficiency.
11. Pathophysiology
Continuous stimulation of the parathyroid glands by a
combination of
increased phosphate concentration and
decreased calcium concentration and markedly reduced
serum calcitriol
increased PTH secretion and synthesis
parathyroid hyperplasia
12.
13.
14. vitaminD
Is an essential factor for regulation of calcium and
phophorous.
Active form is 1,25dihydroxy vitaminD .
Increases the intestinal absorption of calcium and
phosphorous.
Increase reabsorption of calcium and phosphorous in the
renal tubules.
Direct effect on the parathyroid glands to supress PTH
secretion
16. FGF23(fibroblast derived growthfactor)
Secreted mainly by osteocytes (and possibly osteoblasts).
Now consider to be the most important factor for
regulation of phosphorous homeostasis.
Acts mainly on the kidneys to increase phosphorous
clearance.
Inhibits 1αhydroxylase activity causing a low 1,25, dihydroxy
vitamin D level.
Hyperphosphatemia is the main stimulant for FGF23
17.
18. Calcium and phosphorous metabolism in renal
failure
When GFR falls,the phopsphorous clearance decrease
leading to phopshate retention.
Hyperphosphatemia induces PTH secretion by 3 ways
1. Direct stimulatory effect on parathyroid.
2. Induction of mild hypocalcemia by precipitating with
calcium to form (caHpo4).
19. 3. Stimulation of FBG23
Decreased 1αhydroxylase
Decreased 1,25 dihydroxyvitaminD
Down regulation of vitD receptors
parathyroidgland
20.
21. Clinical features
Renal osteodystrophy
bone and joint pains.
bone deformation and fractures during late stages .
Some times called as silent crippler .
Osteitis fibrosis cystica.
A dynamic or aplastic bone disease.
22. Osteitis fibrosis cystica
Classic and former most common form of osteodysrophy.
High bone turn over caused by high circulating PTH.
Histologically ,an increase in gaint multinucleated
osteoclasts on the surface of the bone and replacement of
normal cellular and marrow elements with fibrofatty
tissue.
Xray changes include sub periosteal resorption of the
phalangeal tufts.
24. Aplastic or adynamic bone disease
Low bone turn over by excessive supression of PTH during
late stages of disease.
The number of PTH receptors is downregulated in the
skeleton leading to skeletal resistance.
It is a normal mechanism of the bone to defend itself
against high circulating levels of PTH.
25.
26. Treatment
Management of secondary hyperparathyroidism in CKD
should start at the beginning of stage 3
It can be divided in to 3 steps
1. Optimize the levels of serum calcium and phosphate.
2. Control of PTH and vitaminD
3. The dosages of phosphate binders, calcimimmetics and
vitD analogues should be adjusted to achieve K/DOQI
value
27. 1st step is to optimize the levels of serum phosphate and calcium
through dietary restriction of phosporous and phosphate
binders
Dietary restriction of phosphorous
For ptnts with CKD stage 3 and 4 when serum phosphorous is
more than 4.6 and 5.5 mg/dl in CKD 5.
Dietary restriction of phosphorous to 800-1000mg/day
Two main sources dietary proteins and phosphorous additives
Additives are manily present in the processed foods such as
meat,beverages,cheese and dietary products.
28.
29. Phosphate binders
main stay of therapy in secondary hyperparathyroidism.
To limit the dietary absorption of phopsphorous.
Aluminium hydroxide forms aluminium precipitates in the
intestine and lowers phosphatemia levels.
Used when serum phosphorous is >7mg/dl for lessthan 4 weeks
Aluminium toxicity leads to severe refractory microcytic
anemia,osteomalacia,dementia
Calcium salts as calcium carbonates and calcium acetates
30. Sevelamer hydrochloride is non calcium,non aluminium and
non magnesium compound.
it forms a cationic polymer that binds to dietary phosphorous
through ion exchange.
Sevelamer carbonate replacement of chloride ion with a
carbonate.
decrease s the chances of metaboilic acidosis caused by sevalmer
hydrochloride.
Lanthum carbonates is a rare earth element and has the
property of phosphorous binding.
31. Step 2 is to control of PTH and vitD by the use of vit D
analogues and calcimimetics.
vitD and its derivatives is the oldest treatment for secondary
hyperparathyroidism.
Calcitriol deficiency and resistance are the major contributors to
the pathophysiology of the disease.
Calcitriol(1,25dihydroxyvitaminD3)is the natural form of vitamin
D produced by the humanbody.
Intermittent and IV administration is more effective than oral
calcitriol
Ergocalciferol s vitamin D2 or the nutritional vitamin D
Is only indicated if 25-hydoxy vitamin D levels<30ng/ml;
32. Selective vitamin D analogues are paricalcitol and
doxercalciferol.
Selective agents that have more affinity towards kidney rather
than intestinal receptors.
Calcimimetics are the newer agents that allosterically
increase the sensitivity to calcium and calcium sensing receptors
in the parathyroid gland thus supressing PTH.
Cinacalcet is indicated in dialysis patients when
sercalcium>8.4mg/dl and PTH levels>300pg/ml.
Side effects include GI symptoms and qt prolongation syndrome.
34. It can be performed by either subtotal or total
parathyroidectomy with autotransplantation.
Small amounts of resected parathyroid tissue can be
autografted in the muscles of the forearm or neck as
well as in subcutaneous tissues of chest or abdomen.
Hungry bone syndrome is the lack of osteoclastic
activity caused by decreased PTH postoperatively
causes fall in calcium levels.
Monitoring of calcium levels is important in follow up
after surgery.