The patient, a 59-year-old obese female, presented with right calf pain and swelling after prolonged periods of television watching without breaks. Diagnostic testing revealed deep vein thrombosis (DVT) in the right leg and pulmonary embolisms (PE). She was started on anticoagulation therapy with heparin and rivaroxaban. Her symptoms improved and she was discharged with lifestyle and medication recommendations to prevent further clots.
hOME MEDICATION REVIEW IS out standing self-employment opportunities with good clinical skills and hand on practice for pharm d students..its well an established program in Australia.
REVIEWING THE CLINICIANS PRESCRIPTION AND TREATMENT PROGRESSION IS THE FUNDAMENTAL RESPONSIBILITY OF PHARMACIST. THIS PRESENTATION WILL DEAL WITH VARIOUS ASPECTS OF REVIEWING PATIENT DRUGTHERAPY PLAN
hOME MEDICATION REVIEW IS out standing self-employment opportunities with good clinical skills and hand on practice for pharm d students..its well an established program in Australia.
REVIEWING THE CLINICIANS PRESCRIPTION AND TREATMENT PROGRESSION IS THE FUNDAMENTAL RESPONSIBILITY OF PHARMACIST. THIS PRESENTATION WILL DEAL WITH VARIOUS ASPECTS OF REVIEWING PATIENT DRUGTHERAPY PLAN
Adherence refers to a process, in which the appropriate person’s behaviour, taking medication , following a diet, and/or executing lifestyle changes, is decided after a proper discussion with the patient.
Compliance is defined as “the extent to which the patient’s behaviour matches the prescriber’s recommendations”
Though compliance has been frequently employed to describe medication-taking behaviour, it has proved problematic because it refers to a process where the clinician decides on a suitable treatment, which the patient is expected to comply with unquestioningly.
Studies over the past few decades have emphasized the importance of patients’ perspectives in medication-taking, based on their own beliefs, their personal circumstances, the information and resources available for them.
Fast track Designation is a designation for accelerated approval of drugs and medicines in US. Presentation contains brief view of this expedite program.
A Ward round is a visit made by a medical practitioner, alone or with a team of health care professionals and medical students to hospital in-patients at their bedside to review and follow-up the progress in their health.
Usually at least one ward round is conducted
everyday to review the progress of each
patient outcome.
Pharmacist’s participating in medical ward
rounds promotes health care
Participation of the Pharmacists in ward
rounds in various practice settings helps to
provide rational drug use.
Adherence refers to a process, in which the appropriate person’s behaviour, taking medication , following a diet, and/or executing lifestyle changes, is decided after a proper discussion with the patient.
Compliance is defined as “the extent to which the patient’s behaviour matches the prescriber’s recommendations”
Though compliance has been frequently employed to describe medication-taking behaviour, it has proved problematic because it refers to a process where the clinician decides on a suitable treatment, which the patient is expected to comply with unquestioningly.
Studies over the past few decades have emphasized the importance of patients’ perspectives in medication-taking, based on their own beliefs, their personal circumstances, the information and resources available for them.
Fast track Designation is a designation for accelerated approval of drugs and medicines in US. Presentation contains brief view of this expedite program.
A Ward round is a visit made by a medical practitioner, alone or with a team of health care professionals and medical students to hospital in-patients at their bedside to review and follow-up the progress in their health.
Usually at least one ward round is conducted
everyday to review the progress of each
patient outcome.
Pharmacist’s participating in medical ward
rounds promotes health care
Participation of the Pharmacists in ward
rounds in various practice settings helps to
provide rational drug use.
Hypertension Emergencies and their managementpptxUzomaBende
This Presentation talks about Hyprtension, the mode of presentation of hypertensive crisis and the effective management of hypertensive crisis to prevent case fatalities.
Venous thromboembolism (VTE) is a disorder that includes deep vein thrombosis and pulmonary embolism. A deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein, usually in the lower leg, thigh, or pelvis.
A blockage of blood flow to the heart muscle. A heart attack is a medical emergency.A heart attack usually occurs when a blood clot blocks blood flow to the heart.Without blood,tissues loses oxygen and dies
Multi-source connectivity as the driver of solar wind variability in the heli...Sérgio Sacani
The ambient solar wind that flls the heliosphere originates from multiple
sources in the solar corona and is highly structured. It is often described
as high-speed, relatively homogeneous, plasma streams from coronal
holes and slow-speed, highly variable, streams whose source regions are
under debate. A key goal of ESA/NASA’s Solar Orbiter mission is to identify
solar wind sources and understand what drives the complexity seen in the
heliosphere. By combining magnetic feld modelling and spectroscopic
techniques with high-resolution observations and measurements, we show
that the solar wind variability detected in situ by Solar Orbiter in March
2022 is driven by spatio-temporal changes in the magnetic connectivity to
multiple sources in the solar atmosphere. The magnetic feld footpoints
connected to the spacecraft moved from the boundaries of a coronal hole
to one active region (12961) and then across to another region (12957). This
is refected in the in situ measurements, which show the transition from fast
to highly Alfvénic then to slow solar wind that is disrupted by the arrival of
a coronal mass ejection. Our results describe solar wind variability at 0.5 au
but are applicable to near-Earth observatories.
Earliest Galaxies in the JADES Origins Field: Luminosity Function and Cosmic ...Sérgio Sacani
We characterize the earliest galaxy population in the JADES Origins Field (JOF), the deepest
imaging field observed with JWST. We make use of the ancillary Hubble optical images (5 filters
spanning 0.4−0.9µm) and novel JWST images with 14 filters spanning 0.8−5µm, including 7 mediumband filters, and reaching total exposure times of up to 46 hours per filter. We combine all our data
at > 2.3µm to construct an ultradeep image, reaching as deep as ≈ 31.4 AB mag in the stack and
30.3-31.0 AB mag (5σ, r = 0.1” circular aperture) in individual filters. We measure photometric
redshifts and use robust selection criteria to identify a sample of eight galaxy candidates at redshifts
z = 11.5 − 15. These objects show compact half-light radii of R1/2 ∼ 50 − 200pc, stellar masses of
M⋆ ∼ 107−108M⊙, and star-formation rates of SFR ∼ 0.1−1 M⊙ yr−1
. Our search finds no candidates
at 15 < z < 20, placing upper limits at these redshifts. We develop a forward modeling approach to
infer the properties of the evolving luminosity function without binning in redshift or luminosity that
marginalizes over the photometric redshift uncertainty of our candidate galaxies and incorporates the
impact of non-detections. We find a z = 12 luminosity function in good agreement with prior results,
and that the luminosity function normalization and UV luminosity density decline by a factor of ∼ 2.5
from z = 12 to z = 14. We discuss the possible implications of our results in the context of theoretical
models for evolution of the dark matter halo mass function.
Richard's aventures in two entangled wonderlandsRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
What is greenhouse gasses and how many gasses are there to affect the Earth.moosaasad1975
What are greenhouse gasses how they affect the earth and its environment what is the future of the environment and earth how the weather and the climate effects.
Cancer cell metabolism: special Reference to Lactate PathwayAADYARAJPANDEY1
Normal Cell Metabolism:
Cellular respiration describes the series of steps that cells use to break down sugar and other chemicals to get the energy we need to function.
Energy is stored in the bonds of glucose and when glucose is broken down, much of that energy is released.
Cell utilize energy in the form of ATP.
The first step of respiration is called glycolysis. In a series of steps, glycolysis breaks glucose into two smaller molecules - a chemical called pyruvate. A small amount of ATP is formed during this process.
Most healthy cells continue the breakdown in a second process, called the Kreb's cycle. The Kreb's cycle allows cells to “burn” the pyruvates made in glycolysis to get more ATP.
The last step in the breakdown of glucose is called oxidative phosphorylation (Ox-Phos).
It takes place in specialized cell structures called mitochondria. This process produces a large amount of ATP. Importantly, cells need oxygen to complete oxidative phosphorylation.
If a cell completes only glycolysis, only 2 molecules of ATP are made per glucose. However, if the cell completes the entire respiration process (glycolysis - Kreb's - oxidative phosphorylation), about 36 molecules of ATP are created, giving it much more energy to use.
IN CANCER CELL:
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
introduction to WARBERG PHENOMENA:
WARBURG EFFECT Usually, cancer cells are highly glycolytic (glucose addiction) and take up more glucose than do normal cells from outside.
Otto Heinrich Warburg (; 8 October 1883 – 1 August 1970) In 1931 was awarded the Nobel Prize in Physiology for his "discovery of the nature and mode of action of the respiratory enzyme.
WARNBURG EFFECT : cancer cells under aerobic (well-oxygenated) conditions to metabolize glucose to lactate (aerobic glycolysis) is known as the Warburg effect. Warburg made the observation that tumor slices consume glucose and secrete lactate at a higher rate than normal tissues.
A brief information about the SCOP protein database used in bioinformatics.
The Structural Classification of Proteins (SCOP) database is a comprehensive and authoritative resource for the structural and evolutionary relationships of proteins. It provides a detailed and curated classification of protein structures, grouping them into families, superfamilies, and folds based on their structural and sequence similarities.
Seminar of U.V. Spectroscopy by SAMIR PANDASAMIR PANDA
Spectroscopy is a branch of science dealing the study of interaction of electromagnetic radiation with matter.
Ultraviolet-visible spectroscopy refers to absorption spectroscopy or reflect spectroscopy in the UV-VIS spectral region.
Ultraviolet-visible spectroscopy is an analytical method that can measure the amount of light received by the analyte.
This pdf is about the Schizophrenia.
For more details visit on YouTube; @SELF-EXPLANATORY;
https://www.youtube.com/channel/UCAiarMZDNhe1A3Rnpr_WkzA/videos
Thanks...!
Body fluids_tonicity_dehydration_hypovolemia_hypervolemia.pptx
Soap format on dvt
1. SOAP FORMAT ON DVT & PE
From Prolonged Television
Watching
PRESENTED BY : Premal Vaghela
2. PATIENT’S DETAILS
• Name : ABC
• Age : 59 years
• Gender : Female
• Weight : -
• Height : -
• BMI : 51 kg/m²
• Mental status : -
3. HISTORY OF PRESENT ILLNESS
• She has past medical history of obesity , autoimmune hepatitis, and
osteoporosis presented to emergency department (ED).
• Complaining of right calf pain and swelling.
• She had no history of previous venous thromboembolic disease.
• The patient stated that the pain started after watching television for
eight continuous hours.
• The following day, she noted persistent right calf pain.
• However, she was particularly engaged in national convention coverage
and watched television continuously for approximately eight more
hours.
4. Cont….
• She recalls that she did not take any breaks from watching the convention
in fact she stated she only moves from the chair once to go to the
bathroom.
• After two days of mild throbbing pain and swelling , she decided to have
family members drive her to ED.
5. PAST MEDICAL HISTORY
• The patient has a history of immune hepatitis which had been stable for
years , treated with Imuran.
• Hiatal hernia (hiatal hernia occurs when the upper part of your stomach
bulges through the large muscle separating your abdomen and chest
(diaphragm).
• Sleep apnea requiring nighttime continuous positive airway pressure
(CPAP) machine.
• Osteoporosis.
6. PAST SURGICAL HISTORY
• She had no previous no surgeries other than a left wrist surgery 20 years
previously.
•PAST SOCIAL HISTORY
• She never smoked and She dose not drink alcohol.
7. FAMILY HISTORY
• The family history was notable for Paget’s disease (A disease that disrupts
the replacement of old bone tissue with new bone tissue)
• She denied any family history was
thromboembolism , bleeding , or clotting disorders
8. PAST MEDICATION HISTORY
• Other than Imuran (Azathioprine ; is an immunosuppressive medication)
and Fosamax (Alendronic acid ; is a bisphosphonate medication used to
treat osteoporosis and Paget's disease of bone) .
10. PATIENT’S COMPLAINTS :
• Chief complain : Persistent right calf pain
• She was having occasional dizziness and dyspnea on exertion
11. In patients undergoing general
and abdominal-pelvic surgeries,
the Caprini score is used to
assess the risk of DVT.
Interpretation of the Caprini
risk score
The Caprini score is calculated
by adding the scores of all
factors present in the patient.
The Caprini score is interpreted
in the following way:
Score 0–1: Low risk of VTE
Score 2: Moderate of VTE
Score 3–4: High risk of VTE
Score ≥5: Highest risk for VTE.
15. OTHER DIAGNOSTIC TEST
• Her pain score was 5/10 and she was anxious.
• On physical exam, the patient appeared mildly anxious with obvious
swelling of her right calf. There was moderate right calf tenderness
with +1 pitting edema(least severe type of edema).
16. Computed Tomography Angiography (CTA) of the chest was positive for
bilateral pulmonary emboli specifically right upper lobe, right middle lobe,
and left lower lobe segmental thrombi.
18. CONT..
• Anticoagulation with Thrombolytic was initiated in the ER with IV
heparin.
• She had a 2D echocardiogram that revealed mild right ventricular
dysfunction, mild tricuspid regurgitation, and an elevated pulmonary
artery pressure of 25–30 mmHg at rest.
• The pulmonary/critical team was consulted and given that the patient
had normal troponin, BNP, and oxygenation on RA.
• Additionally, the patient’s tachycardia improved with IV fluids.
20. DIAGNOSIS
• On the basis of history , complaints of patient, Laboratory parameters
and other diagnostic test, we may conclude that patient is suffering
from DVT & PE from prolonged Television watching.
21. ETIOLOGY
• Have been inactive or immobile for long periods of time due to bed rest
or surgery.
• Have a personal or family history of a blood clotting disorder, such as
deep vein thrombosis (DVT) or pulmonary embolism (PE).
• Have a history of cancer or are receiving chemotherapy.
• Sit for prolonged periods.
• Smoking
22. NEED OF THERAPY
• To Reduce morbidity and mortality rates.
• To Resolve complaints of patient.
• To improve overall health status of patient.
• To prevent further complication of the disease.
• To improve patient’s quality of life.
27. CONT..
M/A: Mechanism for low dose: Inactivates factor Xa and inhibits conversion of prothrombin to
thrombin
Mechanism for high dose: Inactivates factors IX, X, XI, and XII and thrombin and inhibits
conversion of fibrinogen to fibrin
• Also inhibits activation of factor VIII
A/E: Heparin-induced thrombocytopenia, possibly delayed (10-30% ), Mild pain ,Hemorrhage
,Injection site ulcer (after deep SC injection), Increased liver aminotransferase, Anaphylaxis,
Immune hypersensitivity reaction, Osteoporosis (long-term, high-dose use)
Contraindication : History of pentosan polysulfate-induced thrombocytopenia (HIT) (with or
without thrombosis),Uncontrolled, active bleeding (except DIC), Known hypersensitivity to heparin
NOTE : This drug is rational.
28. 2. Drug: rivaroxaban
Class: Anticoagulants, Factor Xa Inhibitors
Dose: -
Frequency:-
Route of administration:
Indication: stroke, atrial fibrillation, DVT and /or PE, venous
thromboembolism
29. CONT..
• M/A: Factor Xa inhibitor that inhibits platelet activation by selectively blocking the
active site of factor Xa without requiring a cofactor for activity ,Blood coagulation
cascade is dependent on the activation of factor X to factor Xa via the intrinsic and
extrinsic pathways, which play a central role in the blood coagulation cascade.
• A/E: Hematoma (<3%),Back pain (2.9%),Wound secretion (2.8%),Abdominal pain
(2.7%),Dizziness (2.2%),Pruritus (2.1-2.2%),Pain in extremity (1.7%), Insomnia
(1.6%),Anxiety (1.4%), Blister (1.4%),Fatigue (1.4%), Muscle spasm (1.3%),Syncope
(1.2%), Muscle spasm (1.2%),Depression (1.2%) ,Major bleeding
• Contraindication : Hypersensitivity ,Active pathological bleeding, Patients who have had
transcatheter aortic valve replacement.
NOTE: This drug is rational
33. GOAL OF THERAPY
GENERAL GOALS
-To reduce the morbidity and
mortality rates.
- To improve patients quality of
life.
- To prevent further
complications.
PATIENT SPECIFIC GOAL
- To provide the best possible
treatment to patient.
- To overcome the complaints of
the patient.
- To give the best treatment
whichever is possible.
35. Drug Therapeutic monitoring Toxicity monitoring
Rivaroxaban The rivaroxaban assay
measures circulating levels of
rivaroxaban based on its
anticoagulant action. Measuring
rivaroxaban concentration will allow
dose adjustment to prevent too
much anticoagulant effect and risk
for bleeding or no anticoagulant
action and inadequate therapy.
Testing for Protein C, antithrombin
and fibrinogen activity should be
accurate on rivaroxaban. according
to bleeding risk - restart the drug 24
– 72 hours after a procedure.
-
37. POINTS TO PHYSICIAN
• There are improper documentation.
• Patient’s height and weight are not measured.
• No measurement of lipid levels, uric acid levels and thyroid hormone levels
is carried out.
• Keep the patient well hydrated as there are more chances of dehydration
because of blood loss due to injury and also it will be helpful for
improvement in patient’s blood pressure
38. POINTS TO PATIENT
DISEASE RELATED:
• PE : Pulmonary embolism is when a
blood clot stuck in an artery in the
lung and blocks blood flow to the
lung.
• It usually arises from a thrombus
(clot) that originates in the deep
venous system of the lower
extremities.
39. DRUG RELATED
1) HEPARIN
Patient / Family education:
• Caution patient to avoid IM injections.
• Advise patient to avoid activities that carry risk of injury. Inform patient of potential for hair loss.
• Explain that this effect may occur several months after heparin therapy is started.
• Inform female patients that menstruation may be somewhat increased and prolonged.
• Advise patient that smoking and alcohol may alter response to heparin, and therefore, are not
advised.
• Inform patient that abrupt withdrawal of heparin may precipitate increased coagulability.
40. ADMINISTRATION AND STORAGE
• Heparin is strongly acidic and is incompatible with many drugs.
• Avoid mixing any drug with heparin unless specifically advised by health care provider.
• Do not aspirate patient to check entry into blood vessel. Apply gentle pressure to puncture site for
about 1 min; do not massage. Rotate injection sites frequently and keep record.
• IV administration may be given undiluted over 1 min.
• For IV infusion, dilute prescribed amount in 0.9% Sodium Chloride for Injection, D5W, or Ringer's
Injection solution.
• Use infusion pump to ensure accuracy. Store at room temperature. Protect from freezing.
• Inspect all preparations for particulate matter prior to administration.
• Also inspect for discoloration; note that slight discoloration does not alter potency.
41. 2) rivaroxaban
Patient / Family education:
• If you have difficulty swallowing the tablet whole, talk to your doctor
about other ways to take .
• Do not stop taking XARELTO without talking with your doctor first.. tell
your doctor if you go for any surgery,
• Take with or without food.
• Inform your healthcare provider if you have any symptoms like headache ,
pain, swelling or discomfort dizziness , nose bleeding bleeding of gums
42. ADMINISTRATION AND STORAGE
• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.
• Store at room temperature between 68° F to 77°F (20° to 25° C).
43. LIFE STYLE MODIFICATION
• Stop smoking
• Loose weight if you are over weight and try to maintain healthy weight.
• Limiting the amount of time you spend sitting
• Exercise regularly mainly walking and move your legs to prevent the blood from
pooling.
• Avoid wearing tight-fitting clothes for extended periods
• Drinking lots of fluids
• Consuming foods that act as natural blood thinners to reduce the risk of developing
blood clots, such as vitamin E, ginger, cayenne pepper, garlic, turmeric, and cinnamon.
44. DIETARY MODIFICATIONS
• Limit unhealthy fats and sodium.
• Avoid sugary and processed foods.
• Eat more fruits and vegetables.
• Choose whole grains.
• Choose low-fat protein sources.
• Limit caffeine and alcohol.
• Healthy fats like olive and canola oil.
45. FOLLOW-UP AND REVIEW
• The patient was hemodynamically stable upon leaving the emergency
department for the ICU .
• She was transitioned over to novel anticoagulant rivaroxaban for
following day ( hospital day number 1 ) and was discharged home
three day later without complication.
46. REFERENCES
• Joseph T. DiPiro, Pharmacotherapy: A Pathophysiologic Approach, 10th
Edition, Mc Graw Hill Education.
• David S. Tatro, A to Z Drug Facts, Facts and Comparison.
• Leslie Kane (2018) Medscape, Available at www.Medscape.com (Last
Accessed on: 10th January 2020).
• https://www.webmd.com/dvt/foods-help-prevent-dvt.
• https://heartofdixieveincenter.com/lifestyle-choices-can-reduce-risk-
blood-clots/
