Surgical management is generally better than medical management for treating non-alcoholic fatty liver disease (NAFLD). Weight loss through bariatric surgery results in better outcomes for NAFLD resolution and metabolic syndrome treatment than lifestyle and dietary interventions alone. While bariatric surgery is not without risks, registry data shows low complication and mortality rates when performed by experienced surgeons. Overall, for obese patients with NAFLD, bariatric surgery provides significant health benefits and better NAFLD control compared to medical management alone.
NAFLD is a vast topic and recently gaining a lot of importance. Fatty liver, NASH, are other topics discussed here. sleissenger, sheila sherlock and Harrisons are used for reference
NAFLD is a vast topic and recently gaining a lot of importance. Fatty liver, NASH, are other topics discussed here. sleissenger, sheila sherlock and Harrisons are used for reference
Clinical Impact of New NAFLD/NASH Data From San Francisco 2018hivlifeinfo
Expert faculty summarize key NAFLD/NASH studies from this important annual conference. Use these slides to review data on noninvasive screening, clinical outcomes, emerging treatments.
Ira M. Jacobson, MD
Philip N. Newsome, PhD, FRCPE
Format: Microsoft PowerPoint (.ppt)
File Size: 421 KB
Released: December 3, 2018
Clinical Impact of New NAFLD/NASH Data From San Francisco 2018hivlifeinfo
Expert faculty summarize key NAFLD/NASH studies from this important annual conference. Use these slides to review data on noninvasive screening, clinical outcomes, emerging treatments.
Ira M. Jacobson, MD
Philip N. Newsome, PhD, FRCPE
Format: Microsoft PowerPoint (.ppt)
File Size: 421 KB
Released: December 3, 2018
Does being overweight or obese have a negative affect on your life? Learn how weight loss surgery can help you improve your health, feel better, and get your life back! Join us for a review of surgical options, including discussion about lifestyle changes to keep you on track with a healthy weight after weight loss surgery.
Sleeve vs Mini-Gastric Bypass
IN EVERY STUDY, by every measure, the Mini-Gastric Bypass is equal to or better than every other form of bariatric surgery
A presentation by Dr Jacob Chisholm on Developments In Gastrointestinal Therapies.
Jacob Chisholm is an upper gastrointestinal and general surgeon with an interest in weight loss and metabolic surgery. Jacob received his undergraduate degree (MBBS) from the University of Adelaide, a postgraduate research degree (Masters of Surgery) from Flinders University and is a Fellow of the Royal Australasian College of Surgeons. He trained in surgery at the Royal Adelaide and Flinders Medical Centre before completing a bariatric fellowship in 2007. Jacob was appointed chief surgical resident at Flinders Medical Centre in 2008 and has been a consultant surgeon at that institution since 2010. Jacob joined the Adelaide Bariatric Centre in 2010.
Join Dr. Kara Long Roche, Associate Director of the Gynecologic Oncology Fellowship Program at Memorial Sloan Kettering Cancer Center, as she breaks down new advancements in ovarian cancer research and treatment.
Tonight’s speakers: Dr. Dan Sargent and Kim Ryan
Disclaimer: “This Report is not an official event of the 2012 Gastrointestinal Cancers Symposium. Not sponsored or endorsed by any of the cosponsoring organizations of the 2012 Gastrointestinal Cancers Symposium.”
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
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.
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
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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Surgery is Better than Medical Management for Non-Alcoholic Fatty Liver Disease
1. Surgical Management is Better Than
Medical Management for
Non-Alcoholic Fatty Liver Disease
Abeezar I. Sarela MSc MS MD FRCS
Consultant in Upper GI & Bariatric Surgery
Hon. Senior Lecturer in Surgery
St James’s University Hospital, Leeds
2. Treatment of NAFLD
Surgery vs. Medicine
What can we agree?
1.
Weight-loss is the first line therapeutic measure
in all overweight or obese patients with NAFLD
A position statement on NAFLD/NASH based on the EASL 2009 special conference.
Ratziu et al. Journal of Hepatology 2010;53:72-84
www.foregutsurgeon.com
3. Treatment of NAFLD
Surgery vs. Medicine
What can we agree?
2.
“Lose Weight” is easier said than done
Maintaining weight loss is harder!
www.foregutsurgeon.com
4. Weight Loss by Diet
and Life-Style Intervention
Best Outcomes
Only 15% of participants lost 10% of their initial
weight. For 80%, average weight loss was 4 kg.
Sacks FM et al. Comparison of weight-loss diets with different
compositions of fat, protein, and carbohydrates. N Engl J Med
2009;360:859–873.
Even with an incentivized program, average
weight loss was only 7.4 kg (7.9%) at 2 years.
Rock et al. Effect of a free prepared meal and incentivized weight loss program on
weight loss and weight loss maintenance in obese and overweight women: a
randomized controlled trial. JAMA 2010;304 (16):1803-1810
www.foregutsurgeon.com
5. Treatment of NAFLD
Surgery vs. Medicine
What can we agree?
3.
Bariatric surgery is
not for everyone.
• BMI>35 kg/m2 + co-
morbidity
• BMI>40 kg/m2
• BMI>50 kg/m2
www.foregutsurgeon.com
7. Treatment of NAFLD
Surgery vs. Medicine
Disputes
1
How much weight loss is necessary?
Modest overall weight loss produces results in
significant decrease in liver fat
Target for NAFLD treatment: 7% weight loss
A position statement on NAFLD/NASH based on the EASL 2009 special conference.
Ratziu et al. Journal of Hepatology 2010;53:72-84
www.foregutsurgeon.com
9. Gut Hormones, Metabolic Surgery &
Insulin Resistance
Murphy & Bloom
Nature
2006;444:854
www.foregutsurgeon.com
10. “The whole is greater than the sum of
its parts”
Aristotle
www.foregutsurgeon.com
11. Treatment of NAFLD
Surgery vs. Medicine
Disputes
2
Efficacy of Bariatric Surgery
Does it do what it is supposed to do?
Effectiveness of Bariatric Surgery
How does it compare with non-surgical
treatment?
www.foregutsurgeon.com
12. Bariatric Surgery
Weight Loss
Sjostrom L et al. Effects of Bariatric Surgery on Mortality in Swedish Obese
Subjects. N Engl J Med 2007;357:741-52.
www.foregutsurgeon.com
13. Bariatric Surgery
Resolution of Metabolic Syndrome
• 621 studies: 1990-2006
• 135, 246 patients
• Mean BMI 48 kg/m2
• Resolution of Type 2 Diabetes Mellitus: 78%
Effects of Bariatric Surgery on Type 2 Diabetes Mellitus: A Systematic
Review and Meta-analysis. Buchwald et al. Am J Med 2009;122:248-256
www.foregutsurgeon.com
14. Metabolic Surgery
Efficacy in Treatment of NAFLD
Effect of Bariatric Surgery on Non-Alcoholic Fatty Liver Disease:
Systematic Review & Meta-Analysis.
Mummadi et al. Clin Gastroenterol Hepatol.2008;6:1396-1402.
www.foregutsurgeon.com
15. Effect of Bariatric Surgery on NAFLD
766 paired biopsies
Improvement Complete
or Resolution Resolution
Steatosis 92% NR
NASH 81% 70%
Fibrosis 65% NR
Effect of Bariatric Surgery on Non-Alcoholic Fatty Liver Disease: SystematicReview &
Meta-Analysis. Mummadi et al. Clin Gastroenterol Hepatol. 2008;6:1396-1402.
www.foregutsurgeon.com
16. Bariatric Surgery & NAFLD
Prospective, Long-Term Study
1994-2005
381 patients
Liver Biopsy at Liver Biopsy at
Liver Biopsy during
1 year 5 years
Bariatric Surgery
follow-up follow-up
Prospective study of long-term effects of bariatric surgery on
liver injury in patients without advanced liver disease.
Mathurin et al. Gastroenterology. 2009;137:532-540
www.foregutsurgeon.com
17. Bariatric Surgery & NAFLD
381 patients
Steatosis
1 Year after Bariatric 5 Years after Bariatric
Baseline
Surgery Surgery
82%
36% 38%
NASH
1 Year after Bariatric 5 Years after Bariatric
Baseline
Surgery Surgery
27%
12% 14%
Prospective study of long-term effects of bariatric surgery on
liver injury in patients without advanced liver disease.
Mathurin et al. Gastroenterology. 2009;137:532-540
www.foregutsurgeon.com
18. Bariatric Surgery & NAFLD
Long-Term Follow-Up
What about Fibrosis?
• Baseline: 77% F0
• 80%: Regressed or remained at same stage
• 20%: Progressed
– Higher baseline BMI & NAS
– > 90% progressed from F0 to F1
– Bariatric surgery or intrinsic disease?
Prospective study of long-term effects of bariatric surgery on liver injury in patients
without advanced liver disease. Mathurin et al. Gastroenterology. 2009;137:532-540
www.foregutsurgeon.com
19. Bariatric Surgery
versus
Medical Treatment
• Selection Criteria: All RCTs evaluating any
bariatric procedure vs. no intervention,
placebo or other intervention in patients with
NASH
• Results: No RCTs or quasi-randomized studies
that fulfilled selection criteria
Bariatric surgery for non-alcoholic steatohepatitis in obese patients.
Chavez-Tapia et al. Cochrane Database Syst Rev. 2010
www.foregutsurgeon.com
20. Medical Treatment of NAFLD
49 RCTs: 30 in NASH
1. Short duration: none exceeds 2 years
2. 5% weight loss improves steatosis but not
necrosis and inflammation
3. Only 40% of patients achieved target weight
loss – even with multi-disciplinary life-style
intervention and behavioral therapy
A meta-analysis of randomized trials for the treatment of nonalcoholic
fatty liver disease. Musso et al. Hepatology 2010;52:79-104.
www.foregutsurgeon.com
24. UK National Bariatric Surgery Registry
First Registry Report to March, 2010
• 7045 operations in 2009 & 2010
• Complications: 2.6%
• 80% discharged by post-operative day 3
• Mortality: 0.1%
www.foregutsurgeon.com
26. For Obese Patients with NAFLD:
1. Bariatric surgery provides significant general
health benefits
2. Bariatric surgery most likely controls NAFLD
better than medical management
3. Bariatric surgery is cost-effective
4. Bariatric surgery is safe
www.foregutsurgeon.com