SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Dyslipidemia management an evidence based approachDr Vivek Baliga
In this presentation by Dr Vivek Baliga, he discusses the different available statins and how you can choose the right one in different clinical situations. See articles from Dr Baliga on http://drvivekbaliga.net
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Dyslipidemia management an evidence based approachDr Vivek Baliga
In this presentation by Dr Vivek Baliga, he discusses the different available statins and how you can choose the right one in different clinical situations. See articles from Dr Baliga on http://drvivekbaliga.net
Vymada Tablet (ARNI: Angiotensin Receptor Neprilysin Inhibitor) is an anti-hypertensive drug used in combination with Sacubitril & Valsartan to reduce the risk of cardiovascular events in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.
Anti-Diabetics For Cardiac Patients The Proper Selectionmagdy elmasry
Cardiovascular Disease and Type 2 Diabetes.Tight glycaemic control can reduce microvascular complications of T2DM, but does not lower CV risk sufficiently.
Multifactorial intervention, comprising of lowering lipid levels and BP, and use of aspirin, has been shown to reduce vascular complications and mortality.Shifting the Paradigm in Diabetes Care
Treating Diabetes Beyond A1C :Considerations for Cardiovascular Protection.
DIABETES AND CARDIOVASCULAR DISEASE - THE CONTINUUMPraveen Nagula
DIABETES IS ONE OF THE MOST COMMON NONCOMMUNICABLE DISEASES WORLD WIDE.
EVERY 6 SECONDS ONE PERSON IS AFFECTED BY DIABETES..
THEME FOR 2014-2016
LETS UNITE FOR DIABETES
1. A Case report of Heart Failure
2. Discussion on Heart Failure
3. Role of Peptides in Heart Failure
4. Importance of 30 days in heart failure
5. Role of ENTRESTO in Stable Heart Failure patient (PARADIGM-HF study)(HFrEF)
6. Biomarkers in Heart Failure
7. Role of ARNI in Hospitalized Heart Failure patient (PIONEER-HF study)
8. Role of ARNI in HFpEF (PARAMOUNT Trial)
9. Safety and usefulness of ACEI/ARB/ARNI
10. Role of SGPL2 inhibitors in HF with/without DM
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Treatment strategies in patients with statin intoleranceVishwanath Hesarur
Statins are among the most prescribed drugs in the world and are first-line therapy in the management of hyperlipidemia.
Their beneficial effects on cardiovascular morbidity and mortality have been demonstrated both in primary and in secondary prevention.
They are generally safe, but in some patients, statin therapy is stopped because of intolerance to the drug that may result in muscle aches and weakness, gastrointestinal symptoms, liver enzyme abnormalities, or other nonspecific discomforts.
The rate of reported statin-related events is about 5% to 10% in randomized, placebo controlled clinical trials.
Vymada Tablet (ARNI: Angiotensin Receptor Neprilysin Inhibitor) is an anti-hypertensive drug used in combination with Sacubitril & Valsartan to reduce the risk of cardiovascular events in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.
Anti-Diabetics For Cardiac Patients The Proper Selectionmagdy elmasry
Cardiovascular Disease and Type 2 Diabetes.Tight glycaemic control can reduce microvascular complications of T2DM, but does not lower CV risk sufficiently.
Multifactorial intervention, comprising of lowering lipid levels and BP, and use of aspirin, has been shown to reduce vascular complications and mortality.Shifting the Paradigm in Diabetes Care
Treating Diabetes Beyond A1C :Considerations for Cardiovascular Protection.
DIABETES AND CARDIOVASCULAR DISEASE - THE CONTINUUMPraveen Nagula
DIABETES IS ONE OF THE MOST COMMON NONCOMMUNICABLE DISEASES WORLD WIDE.
EVERY 6 SECONDS ONE PERSON IS AFFECTED BY DIABETES..
THEME FOR 2014-2016
LETS UNITE FOR DIABETES
1. A Case report of Heart Failure
2. Discussion on Heart Failure
3. Role of Peptides in Heart Failure
4. Importance of 30 days in heart failure
5. Role of ENTRESTO in Stable Heart Failure patient (PARADIGM-HF study)(HFrEF)
6. Biomarkers in Heart Failure
7. Role of ARNI in Hospitalized Heart Failure patient (PIONEER-HF study)
8. Role of ARNI in HFpEF (PARAMOUNT Trial)
9. Safety and usefulness of ACEI/ARB/ARNI
10. Role of SGPL2 inhibitors in HF with/without DM
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Treatment strategies in patients with statin intoleranceVishwanath Hesarur
Statins are among the most prescribed drugs in the world and are first-line therapy in the management of hyperlipidemia.
Their beneficial effects on cardiovascular morbidity and mortality have been demonstrated both in primary and in secondary prevention.
They are generally safe, but in some patients, statin therapy is stopped because of intolerance to the drug that may result in muscle aches and weakness, gastrointestinal symptoms, liver enzyme abnormalities, or other nonspecific discomforts.
The rate of reported statin-related events is about 5% to 10% in randomized, placebo controlled clinical trials.
Statin drugs and their harmful side effectsGeorge Mark
With the knowledge about statin drugs becoming clearer now, there is much confusion in the medical community as to their usability for decreasing cholesterol levels
I'm Sorry. I Can't. Don't Hate Me. The Post-it BreakupKyle Soucy
This talk was presented in 2017 at the IA Summit (#ias17) in Vancouver, BC and at the Big Design Conference (#BigD17) in Addison, TX. A video recording of the talk can be viewed here: http://bit.ly/ias17kyle The audio is a bit poor between 6-12 mins, but it clears up afterward. Enjoy!
Abstract:
I know, I know. UX researchers are supposed to be in love with their post-it notes and affinity diagrams. Forgive me, but when it comes to note-taking and distilling findings from user research and usability testing, I think we might have gone a bit overboard. Affinity diagramming is one of the most popular methods for organizing ideas and qualitative data, but if misused, it can easily become a fatiguing exercise, which looses its merit. In this session you will learn some of the pitfalls to avoid when using affinity diagramming for user research and explore some alternative methods that have proven to be successful for collaborative analysis.
This a is a slide set (42 slides) covering clinically used drugs for lipid lowering. This is an updated version of the lecture series for the 2021-2022 academic year. Suitable for intermediate level learners
Hypolipidemic agents, also known as cholesterol-lowering drugs or antihyperlipidemic agents, are a diverse group of pharmaceuticals that are used in the treatment of high levels of fats (lipids), such as cholesterol, in the blood (hyperlipidemia). They are also called lipid-lowering drugs.
Anticonvulsants are a diverse group of pharmacological agents used in the treatment of epileptic seizures. Charles Locock commented in the Lancet on his use of potassium bromide in 15 cases of "hysterical" epilepsy in young women. The next development was the serendipitous discovery of the anticonvulsant properties of phenobarbital by Alfred Hauptmann in 1912. This predated by more than 20 years the screening of potential therapeutic agents against "electrical seizures" in cats by Houston Merritt and Tracy Putnam. The result was the launching of phenytoin in 1938. Next came primidone, ethosuximide, carbamazepine and valproic acid, all of which can be regarded as first generation antiepileptic drugs (AEDs). Shortly after their synthesis, the benzodiazepines were rapidly recognised as having anticonvulsant activity. The modern era focused on the systematic screening of many thousands of compounds against rodent seizure models under the Anticonvulsant Drug Development Program in the US. This resulted in the global licensing, in chronological order, of vigabatrin, zonisamide, oxcarbazepine, lamotrigine, felbamate, gabapentin, topiramate, tiagabine, levetiracetam, pregabalin and lacosamide.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
Antimicrobial stewardship to prevent antimicrobial resistance
Statin intolerant patients
1. Approaches to the management
of statin intolerant patients
By
Ashraf Reda, MD,FESC
Prof and head of Card. Dep., Menofiya University
President of WGLVR
Chairman of EGYBAC
2. The problem
• 5% -10% side effects with statin
• More patients become statin eligible
• The use of high dosage
• Combination therapy
• Special situations: Pregnancy-Elderly-Children
• Run in phases may underestimate the
problem
3. Higher doses= More adverse effects
“TNT”
Non CV mortality with the high doses need further evaluation
Elevated liver enzymes:1.2% vs 0.2% p<0.001
Rhabdomyolysis 2 cases(80mg) vs 3 cases(10mg)
5461 pts. were excluded in the run in phase
4. IDEAL Trial: Serious Adverse Events
2.2% p<0.001
2%
p<0.001
ALT >3x upper
limit of normal
1.1%
0.97%
%
1%
0.11%
0%
Liver Enzyme Elevation Myalgia
Atorvastatin Simvastatin
Liver enzyme elevation and myalgia (%) Presented at AHA 2005
5. Elevated Liver Enzymes: What to do?
• Less than 1%
• Usually asymptomatic
• Rarely cause Liver failure
• Reversible
• Usually improve with continuing statin or
reducing the dose
• Change to another statin is an option
6. Muscle Symptoms
• Myalgia is the most common (1.5-3.5%)
• Myopathy: Less common (0.05%)
• Rhabdomyolysis: Serious ( 1/10000)
7. Co-Q 10
• May reduce statin induced muscle symptoms
• No large well controlled studies
• Minimal side effects
9. Populations at risk
• Elderly > 75-80
• Small body mass index
• Hepatic or renal dysfunction
• Concomitant medications
• Large amount of Grapefruit
• Combination lipid lowering therapy
10. Steps to Minimize the Risk of Muscle Toxicity with Fibrate–Statin
Combination Therapy
Use statin alone for non-HDL-C goals
Use fish oils or niacin rather than fibrates
Keep the doses of the statin and fibrate low
Dose the fibrate in the AM and the statin in the PM
Avoid in renal impairment
Discontinue therapy if muscle symptoms are present and
CK is >10 times the upper limit of normal
11. Drug–Drug Interactions with Statins
CYP2C9 CYP3A4
Amlodipine Quinidine
Alprenolol
Diltiazem
Fluvastatin Sildefanil
Hexobarbital Clopidogril Warfarin
N- desmethyldiazepan Protease inhibitors Clarithromycin
Tolbutamide Terbinafine Cyclosporine A
Warfarin Verapamil Erythromycin
Erythtromycine
Ketoconazole
Midazolam
Itraconazole
Nefazodone
Nifedipine Mibefradil
Atorvastatin Simvastatin
Cerivastatin Lovastatin
Adapted form Corsini A et al. Atherosclerosis, 2002; 35–40.
12. If not tolerated what to do?
• DC Statin temporarily to be sure that the Side
effects are statin related
• Re-challenge with a lower dose or change to
other statin
• If multiple statins are not tolerated we can use
less effective
drugs(Resin, Ezetimibe, Niacin, Fibrate)
• More intense Life style change program
14. Referred because of abnormal lipid profile
• 32 yrs female
• 30 weeks twin pregnancy
• IUF
• +ve FH (CABG for the Father @ 45yrs)
• Father T Cholesterol known to be more than
300 mg/dl
• Border line Bl. G.
• No Ho DM or hypertension
15. Lipid profile
• 1st set : T.Ch: 320mg/dl, TGs: 580onmg/dl
• The day of exam: T ch: 310mg/dl ,TGs: 640
mg/dl
16. Plan
• No statin during pregnancy and lactation
• Fibrates are tumerogenic for the fetous
WHAT TO DO?
• Omega III : safe but no LDL lowering effect
• Glucose-Insulin infusion
• Immunoadsorpton session??
17.
18. New Statin Intolerance Clinic:
Work up
• Validated questionnaire including FH of statin
intolerance
• Level of CK and Vit. D
• Renal and thyroid function tests
• Genetic testing for statin efficacy and
potential toxicity
• Proximal muscle strength evaluation
• Percutaneous muscle biopsy
21. Conclusions
• Statin intolerance is not common however the
numbers are increasing as Millions are
receiving statin
• Side effects with a statin do not mean that
other statin couldn’t be used
• Elderly, Low BMI, hepatic or renal
dysfunction, high dosage and combinations
are important predictors
22. Immunoadsorption- LDL aphaeresis (to take away
[Greek])
Indications:
*failure medical (>LDL>200 mg/dl with CAD)
and > 300 mg/dl without CAD
*Coast s 3000 / tt every 2 weeks for life
23. Statin in childhood for familial dyslipidemia
• The earlier to start the better (CIMT)
• As early as 8 years is effective and probably
safe
24. Apo A-1 Milano
• Five weekly infusions of an ApoA-I Milano/ phospholipid
complex produced significant regression of coronary
atheroma burden by IVUS.
• Adverse events were similar to placebo.
• Coronary disease is more dynamic than previously
realized and can be rapidly affected by agents that
augment reverse cholesterol transport.
24
26. Characteristics of human
ApoA-IMilano Carriers
Discovered in 1979 Limone sul Garda
•Rare R173C mutation in apoA-I
•Circulates as dimers and monomers
•HDL/apoA-I deficiency
•Mild hypertriglyceridemia
•Paradoxical resistance to heart
“Gain of Function” disease
Mutation 26
27.
28. With LDL 300, TG 520mg/dl start with
1. Fenofibrate
2. statin
3. Statin + Fibrate
4. Statin+ Ezetemib
29. When liver enzymes increase to 1.5
times base line
1. Continue with the same dose
2. Change to another statin
3. Reduce the dose
4. Replace with fibrate
30. All are contraindications to statin
therapy except
1. Pregnancy
2. Lactation
3. Liver cirhosis
4. Active hepatitis
31. All are RF for statin muscle toxicity
except
• Age below 40 yrs
• Renal impairment
• Liver dysfunction
• Combination therapy
32. All can improve statin intolerance
except
• Adding Co Q10
• Giving fibrate @AM and Statin @PM
• Using 2c9 metabolized statin
• Using Cyp3A4 metabolized statin
33. CardioEgypt 2011
1. 16-20 October
2. 17- 21 October
3. 18-22 October
4. 19-23 October