1. Prolia is indicated for treating postmenopausal women with osteoporosis at high risk for fracture, as defined by a history of osteoporotic fracture or multiple risk factors. It reduces the incidence of vertebral, nonvertebral, and hip fractures.
2. The document presents the hypothetical case of 69-year-old Nina, who is currently untreated for osteoporosis with BMD T-scores of -2.8 and -2.9 and additional risk factors of age, diabetes, and history of falling. She needs to start Prolia to help remain active with her grandchildren and prevent fractures.
3. Prolia is proven to significantly reduce vertebral,
This document provides an overview of endometriosis from Dr. S.N. Sethi. Some key points:
- Endometriosis is often misdiagnosed, taking an average of 8 years to diagnose correctly.
- It is estrogen-dependent and invasive, with lesions found in various locations besides the uterus.
- Symptoms include pelvic pain and infertility. Dienogest is highlighted as an effective long-term medical treatment that provides pain relief and few side effects.
- Studies show Dienogest significantly reduces endometriosis lesions and symptoms compared to placebo and has similar efficacy to leuprolide with fewer side effects.
ENDOMETRIOSIS UPDATEFocus on Dienogest Dr Sharda jain dr Jyoti Agarwal Lifecare Centre
ENDOMETRIOSIS UPDATEFocus on Dienogest
AGENDA
Background
What’s New in Endometriosis
Clinical Discussions in Managing Endometriosis
Newer Evidences on Dienogest
This document summarizes injectable contraceptives. There are two main types - progestogen-only injections which are effective for 2-3 months, and combined injections containing estrogen and progestogen effective for 1 month. Progestogen-only injections like DMPA are widely used and provide highly effective contraception through thickening cervical mucus and impairing ovulation. Combined injections like Mesigyna also suppress ovulation and are effective immediately with 1 injection. Common side effects include menstrual irregularities but are generally safe and reversible methods of contraception.
Musculoskletal manifestations of Obesityfathi neana
Systemic disorders and musculoskeletal manifestations are interrelated. With Diagnosed systemic disorders We expect musculoskeletal manifestations and the Musculoskeletal manifestations will guide us to the hidden systemic disorder. There is a Countless sources of information
Like Plain X-rays which can can tell a lot. Even the lifestyle and food selection can help in future expectations
Obesity is not only a problem of adipose tissue. It is the spark for other sequential systemic disorders including the musculoskeletal system.
- The document outlines Oncolytics Biotech's corporate presentation from September 2016. It discusses the company's oncolytic virus REOLYSIN, its two mechanisms of action, positive clinical trial data showing increased progression-free and overall survival for certain patient groups, evidence of tumor responses including reductions in liver metastases, an upcoming colorectal cancer study, potential in multiple myeloma based on preclinical data, commercial-scale manufacturing, and a strong intellectual property portfolio with over 400 issued patents worldwide. The presentation positions REOLYSIN as a promising cancer therapeutic prepared for late-stage clinical trials.
Osteoporosis is a skeletal disorder characterized by compromised bone strength and an increased risk of fracture. It is defined as a bone mineral density over 2.5 standard deviations below the young adult mean. Bone mass increases until peak bone mass is reached in early adulthood, after which age-related bone loss occurs more rapidly in women after menopause. Osteoporosis can lead to signs like kyphosis or loss of height and symptoms including back pain or difficulty with mobility following a fracture. Risk factors include lack of estrogen due to early menopause, smoking, heavy drinking, and certain medications. Current treatments aim to increase bone mass and reduce fracture risk, including antiresorptive drugs, anabolic
Recent advances in endometriosis were discussed. Endometriosis is a chronic disease where endometrial tissue grows outside the uterus, affecting around 10% of women. Dienogest, a progestin, was shown to be effective in reducing endometriosis-associated pelvic pain in randomized controlled trials. Dienogest 2mg daily for 24 weeks provided pain relief similar to leuprolide acetate but with fewer side effects. Long-term use of dienogest for 65 weeks maintained pain relief with a favorable safety profile. Dienogest was as effective as goserelin in reducing postoperative recurrence of endometriosis at 24 months.
This document provides an overview of osteoporosis including its pathophysiology, risk factors, clinical manifestations, diagnosis, and management. It discusses how osteoporosis results from an imbalance between bone resorption and formation leading to increased bone fragility and fracture risk. Key points covered include screening and diagnosis using DXA scans; assessing fracture risk factors; reducing further risk through lifestyle changes like calcium and vitamin D supplementation; and pharmacological treatments including bisphosphonates, PTH analogs, denosumab, and other drugs that build bone or reduce resorption to decrease fracture incidence. Adverse effects and monitoring of different therapies are also reviewed.
This document provides an overview of endometriosis from Dr. S.N. Sethi. Some key points:
- Endometriosis is often misdiagnosed, taking an average of 8 years to diagnose correctly.
- It is estrogen-dependent and invasive, with lesions found in various locations besides the uterus.
- Symptoms include pelvic pain and infertility. Dienogest is highlighted as an effective long-term medical treatment that provides pain relief and few side effects.
- Studies show Dienogest significantly reduces endometriosis lesions and symptoms compared to placebo and has similar efficacy to leuprolide with fewer side effects.
ENDOMETRIOSIS UPDATEFocus on Dienogest Dr Sharda jain dr Jyoti Agarwal Lifecare Centre
ENDOMETRIOSIS UPDATEFocus on Dienogest
AGENDA
Background
What’s New in Endometriosis
Clinical Discussions in Managing Endometriosis
Newer Evidences on Dienogest
This document summarizes injectable contraceptives. There are two main types - progestogen-only injections which are effective for 2-3 months, and combined injections containing estrogen and progestogen effective for 1 month. Progestogen-only injections like DMPA are widely used and provide highly effective contraception through thickening cervical mucus and impairing ovulation. Combined injections like Mesigyna also suppress ovulation and are effective immediately with 1 injection. Common side effects include menstrual irregularities but are generally safe and reversible methods of contraception.
Musculoskletal manifestations of Obesityfathi neana
Systemic disorders and musculoskeletal manifestations are interrelated. With Diagnosed systemic disorders We expect musculoskeletal manifestations and the Musculoskeletal manifestations will guide us to the hidden systemic disorder. There is a Countless sources of information
Like Plain X-rays which can can tell a lot. Even the lifestyle and food selection can help in future expectations
Obesity is not only a problem of adipose tissue. It is the spark for other sequential systemic disorders including the musculoskeletal system.
- The document outlines Oncolytics Biotech's corporate presentation from September 2016. It discusses the company's oncolytic virus REOLYSIN, its two mechanisms of action, positive clinical trial data showing increased progression-free and overall survival for certain patient groups, evidence of tumor responses including reductions in liver metastases, an upcoming colorectal cancer study, potential in multiple myeloma based on preclinical data, commercial-scale manufacturing, and a strong intellectual property portfolio with over 400 issued patents worldwide. The presentation positions REOLYSIN as a promising cancer therapeutic prepared for late-stage clinical trials.
Osteoporosis is a skeletal disorder characterized by compromised bone strength and an increased risk of fracture. It is defined as a bone mineral density over 2.5 standard deviations below the young adult mean. Bone mass increases until peak bone mass is reached in early adulthood, after which age-related bone loss occurs more rapidly in women after menopause. Osteoporosis can lead to signs like kyphosis or loss of height and symptoms including back pain or difficulty with mobility following a fracture. Risk factors include lack of estrogen due to early menopause, smoking, heavy drinking, and certain medications. Current treatments aim to increase bone mass and reduce fracture risk, including antiresorptive drugs, anabolic
Recent advances in endometriosis were discussed. Endometriosis is a chronic disease where endometrial tissue grows outside the uterus, affecting around 10% of women. Dienogest, a progestin, was shown to be effective in reducing endometriosis-associated pelvic pain in randomized controlled trials. Dienogest 2mg daily for 24 weeks provided pain relief similar to leuprolide acetate but with fewer side effects. Long-term use of dienogest for 65 weeks maintained pain relief with a favorable safety profile. Dienogest was as effective as goserelin in reducing postoperative recurrence of endometriosis at 24 months.
This document provides an overview of osteoporosis including its pathophysiology, risk factors, clinical manifestations, diagnosis, and management. It discusses how osteoporosis results from an imbalance between bone resorption and formation leading to increased bone fragility and fracture risk. Key points covered include screening and diagnosis using DXA scans; assessing fracture risk factors; reducing further risk through lifestyle changes like calcium and vitamin D supplementation; and pharmacological treatments including bisphosphonates, PTH analogs, denosumab, and other drugs that build bone or reduce resorption to decrease fracture incidence. Adverse effects and monitoring of different therapies are also reviewed.
This document discusses issues related to women with epilepsy, including:
- About half of women with epilepsy are of reproductive age. Enzyme-inducing antiepileptic drugs can reduce the effectiveness of contraceptives.
- Catamenial epilepsy involves seizures related to the menstrual cycle. Hormonal treatments like progesterone can help control seizures.
- Epilepsy during pregnancy presents challenges of balancing seizure control and risks of medication. Risks include fetal malformations, developmental effects, and pregnancy complications. Lower-risk drugs include lamotrigine and levetiracetam. Frequent monitoring is important.
- Pregnancy can impact epilepsy through hormonal changes and drug level fluctuations requiring dose adjustments
we need to update our knowledge regarding management of endometriosis.
Which is better: medications or surgery? let's see what can this talk tell us about
This document provides an introduction and overview of osteoporosis, including its definition, risk factors, diagnosis, and treatment. It begins with defining osteoporosis as a systemic skeletal disease characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and fracture risk. It then discusses the main and other risk factors, methods of diagnosis including laboratory tests and DEXA scans, pharmacological treatment options including bisphosphonates, denosumab, teriparatide, and hormone therapies, as well as prevention strategies. The document concludes with several case studies examples to demonstrate treatment approaches.
Rheumatoid Arthritis patient wants to get Pregnant ( Clinical Scenario )Ahmed AL Blasi
1. Rheumatoid arthritis does not affect fertility or the chances of getting pregnant. It also does not affect the unborn baby.
2. During pregnancy, RA symptoms often improve in the first and second trimesters due to changing hormone levels. Symptoms may worsen in the third trimester or after delivery.
3. Medications like methotrexate and leflunomide must be stopped before pregnancy due to risks. Hydroxychloroquine, sulfasalazine, low-dose steroids are considered safe options during pregnancy and breastfeeding.
Threatened Miscarriage Verdict is out on Hormonal Treatment Dr Jyoti AgarwalLifecare Centre
- Threatened miscarriage occurs in around 15% of clinically recognized pregnancies and can cause significant emotional and psychological stress for couples.
- Multiple meta-analyses and randomized controlled trials have found that oral administration of dydrogesterone is more effective at reducing the risk of miscarriage in cases of threatened miscarriage compared to vaginal progesterone or no treatment.
- Dydrogesterone has higher bioavailability when taken orally compared to micronized progesterone, requires a lower dose, and may have immunomodulatory properties that further reduce the risk of miscarriage.
The document discusses osteoporosis prevention and management. It describes how gynecologists can help achieve peak bone mass during adolescence and adulthood, prevent bone loss during peri-menopause through screening and treatment if needed, and manage age-related osteoporosis. Key roles include promoting physical activity and nutrition, addressing drug-related bone loss, and treating with exercise, calcium/vitamin D supplementation, and medications like bisphosphonates or hormones if screening shows low bone mineral density.
Osteoporosis is a skeletal disorder characterized by compromised bone strength and increased fracture risk. It is common, resulting in significant costs, morbidity, and mortality. Healthcare professionals should identify those at high risk for screening via DXA scan or FRAX assessment. Those at high fracture risk should be treated individually with proven medications like bisphosphonates that are generally safe and effective in reducing fractures. Ongoing monitoring and lifestyle management are also important to maintain strong, healthy bones.
This document summarizes the principles of teratology and developmental toxicology. It discusses key concepts like critical periods of development, dose-response relationships, mechanisms of action of teratogens, and manifestations of deviant development. Historical cases of thalidomide, Bendectin, and diethylstilbestrol are reviewed. The limitations of animal studies for assessing human teratogenic risk are covered. Methods for evaluating safety and risk of drugs in pregnancy are examined, including FDA classification systems and graphical representations. The roles of teratology information services like the Korean Motherisk Program in counseling on inadvertent exposures are described.
The document discusses various topics related to contraception including:
1. Temporary contraceptive methods like pills, patches, rings, and injections act by stopping ovulation and thickening cervical mucus. They come in various hormone formulations and dosages.
2. Long-acting reversible contraceptives like IUDs and implants can provide contraception for years. IUDs with progestins can suppress ovulation while implants release progestins to thicken cervical mucus.
3. Other methods discussed include vaginal microbicides, tubal occlusion procedures, and emerging male contraceptives that aim to suppress sperm production.
The document provides a high-level overview of many common reversible contraceptive options,
Advances in Frailty-understanding and managementv3venu
1. The document discusses the concept of frailty in older adults, describing it as a medical syndrome characterized by decreased reserves and resilience leading to vulnerability. It provides several definitions and models of frailty.
2. Assessment tools for frailty are discussed, including the Fried phenotype model and the FRAIL scale. Management strategies covered include exercise, nutritional supplementation, vitamin D, and reducing polypharmacy.
3. The effects of different interventions are summarized from systematic reviews, including benefits of exercise on physical function, high protein diets on outcomes, and vitamin D on strength and balance. Comprehensive geriatric assessment is recommended for full evaluation and management of frailty.
Dr Rowan Molnar #DrRowanMolnar - Popular profiles on GoogleDr. Rowan Molnar
Dr Rowan Molnar is dedicated to medical education at all levels, particularly in establishment, deployment and implementation of simulation based teaching. Dr Rowan Molnar is a recognised leader with a demonstrated ability to constantly strive for excellence in the ever changing world of medicine.
#DrRowanMolnar, #RowanMolnar, #DrRowan, #Molnar, #DrRowanMolnarAustralia, #RowanMolnarAustralia, #DrRowanMolnarMelbourneAustralia
Importance of nutrition in hospitalized patientsAzam Jafri
Malnutrition is common in hospitalized patients and is associated with increased complications, prolonged hospital stays, and higher mortality rates. Proper nutrition is important for recovery, as malnutrition can weaken the body and impair the healing process. Oral nutritional supplements have been shown to improve patient outcomes by helping maintain muscle mass and support recovery from illness, surgery, or injury. Hospitals should screen patients for risk of malnutrition and consider supplemental nutrition to improve health outcomes.
The document provides information on several topics related to dermatology. It discusses personalized therapy for some cancers like melanoma that will use genetic and molecular biomarkers to select patients for targeted therapies including immunotherapy. It also discusses painless photodynamic therapy for actinic keratoses that reduces treatment time from 14-18 hours to only 90 minutes with less pain reported by patients. Finally, it summarizes the results of two clinical trials showing that the drug Otezla was effective for treating moderate to severe plaque psoriasis, with 33% of patients achieving a 75% improvement in symptoms compared to only 5% on placebo.
Intraarticular platelet-rich plasma (PRP) injections involve extracting a patient's own blood, concentrating the platelets, and reinjecting the platelet-rich plasma into injured tissues like tendons or ligaments. PRP contains growth factors that promote healing. A typical treatment involves 3 weekly injections of 3-8 mL of PRP with ultrasound guidance. PRP appears safe but may cause minor temporary discomfort. While PRP shows promise for cartilage injuries, its benefits are usually limited and best for younger patients without advanced tissue degeneration.
This document summarizes key points about iatrogenesis and drug-related risks in the elderly. It discusses age-related changes that increase risks, such as changes in body composition and drug distribution. Examples of high-risk drug classes are provided, like anticoagulants, psychotropic drugs, and antineoplastic agents. Specific situations that increase risks, such as polypharmacy and malnutrition, are also described.
Slides on Diabetes in the South Focus on Prevention.2018hivlifeinfo
Learn how to overcome common barriers to diabetes prevention with this downloadable slideset.
Richard E. Pratley, MD
Format: Microsoft PowerPoint (.ppt)
File Size: 3.16 MB
Released: October 23, 2018
This document discusses treatment options for patients with hormone receptor-positive, HER2-negative metastatic breast cancer who have progressed on initial endocrine therapy. It considers fulvestrant monotherapy or the combination of everolimus and exemestane as potential second-line hormonal therapies. Trial data is presented showing that fulvestrant 500mg improves median overall survival by 4.1 months compared to 250mg. The TAMRAD trial found the combination of tamoxifen and everolimus increased clinical benefit rate over tamoxifen alone. The BOLERO-2 trial demonstrated that adding everolimus to exemestane significantly prolonged progression-free survival compared to exemestane alone. Subgroup analyses from
This document provides information on risk factors used in the FRAX tool for assessing fracture risk. It describes the following key risk factors that are considered: age, sex, weight, height, prior fractures, parental hip fracture, smoking, alcohol use, glucocorticoid use, rheumatoid arthritis, secondary osteoporosis, and bone mineral density. For each risk factor, it provides details on how the information should be entered into the FRAX model, such as specifying yes or no responses for certain factors and entering values in appropriate units for others. It also includes notes clarifying how some risk factors like prior fractures, smoking, and rheumatoid arthritis are assessed.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
This document discusses issues related to women with epilepsy, including:
- About half of women with epilepsy are of reproductive age. Enzyme-inducing antiepileptic drugs can reduce the effectiveness of contraceptives.
- Catamenial epilepsy involves seizures related to the menstrual cycle. Hormonal treatments like progesterone can help control seizures.
- Epilepsy during pregnancy presents challenges of balancing seizure control and risks of medication. Risks include fetal malformations, developmental effects, and pregnancy complications. Lower-risk drugs include lamotrigine and levetiracetam. Frequent monitoring is important.
- Pregnancy can impact epilepsy through hormonal changes and drug level fluctuations requiring dose adjustments
we need to update our knowledge regarding management of endometriosis.
Which is better: medications or surgery? let's see what can this talk tell us about
This document provides an introduction and overview of osteoporosis, including its definition, risk factors, diagnosis, and treatment. It begins with defining osteoporosis as a systemic skeletal disease characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and fracture risk. It then discusses the main and other risk factors, methods of diagnosis including laboratory tests and DEXA scans, pharmacological treatment options including bisphosphonates, denosumab, teriparatide, and hormone therapies, as well as prevention strategies. The document concludes with several case studies examples to demonstrate treatment approaches.
Rheumatoid Arthritis patient wants to get Pregnant ( Clinical Scenario )Ahmed AL Blasi
1. Rheumatoid arthritis does not affect fertility or the chances of getting pregnant. It also does not affect the unborn baby.
2. During pregnancy, RA symptoms often improve in the first and second trimesters due to changing hormone levels. Symptoms may worsen in the third trimester or after delivery.
3. Medications like methotrexate and leflunomide must be stopped before pregnancy due to risks. Hydroxychloroquine, sulfasalazine, low-dose steroids are considered safe options during pregnancy and breastfeeding.
Threatened Miscarriage Verdict is out on Hormonal Treatment Dr Jyoti AgarwalLifecare Centre
- Threatened miscarriage occurs in around 15% of clinically recognized pregnancies and can cause significant emotional and psychological stress for couples.
- Multiple meta-analyses and randomized controlled trials have found that oral administration of dydrogesterone is more effective at reducing the risk of miscarriage in cases of threatened miscarriage compared to vaginal progesterone or no treatment.
- Dydrogesterone has higher bioavailability when taken orally compared to micronized progesterone, requires a lower dose, and may have immunomodulatory properties that further reduce the risk of miscarriage.
The document discusses osteoporosis prevention and management. It describes how gynecologists can help achieve peak bone mass during adolescence and adulthood, prevent bone loss during peri-menopause through screening and treatment if needed, and manage age-related osteoporosis. Key roles include promoting physical activity and nutrition, addressing drug-related bone loss, and treating with exercise, calcium/vitamin D supplementation, and medications like bisphosphonates or hormones if screening shows low bone mineral density.
Osteoporosis is a skeletal disorder characterized by compromised bone strength and increased fracture risk. It is common, resulting in significant costs, morbidity, and mortality. Healthcare professionals should identify those at high risk for screening via DXA scan or FRAX assessment. Those at high fracture risk should be treated individually with proven medications like bisphosphonates that are generally safe and effective in reducing fractures. Ongoing monitoring and lifestyle management are also important to maintain strong, healthy bones.
This document summarizes the principles of teratology and developmental toxicology. It discusses key concepts like critical periods of development, dose-response relationships, mechanisms of action of teratogens, and manifestations of deviant development. Historical cases of thalidomide, Bendectin, and diethylstilbestrol are reviewed. The limitations of animal studies for assessing human teratogenic risk are covered. Methods for evaluating safety and risk of drugs in pregnancy are examined, including FDA classification systems and graphical representations. The roles of teratology information services like the Korean Motherisk Program in counseling on inadvertent exposures are described.
The document discusses various topics related to contraception including:
1. Temporary contraceptive methods like pills, patches, rings, and injections act by stopping ovulation and thickening cervical mucus. They come in various hormone formulations and dosages.
2. Long-acting reversible contraceptives like IUDs and implants can provide contraception for years. IUDs with progestins can suppress ovulation while implants release progestins to thicken cervical mucus.
3. Other methods discussed include vaginal microbicides, tubal occlusion procedures, and emerging male contraceptives that aim to suppress sperm production.
The document provides a high-level overview of many common reversible contraceptive options,
Advances in Frailty-understanding and managementv3venu
1. The document discusses the concept of frailty in older adults, describing it as a medical syndrome characterized by decreased reserves and resilience leading to vulnerability. It provides several definitions and models of frailty.
2. Assessment tools for frailty are discussed, including the Fried phenotype model and the FRAIL scale. Management strategies covered include exercise, nutritional supplementation, vitamin D, and reducing polypharmacy.
3. The effects of different interventions are summarized from systematic reviews, including benefits of exercise on physical function, high protein diets on outcomes, and vitamin D on strength and balance. Comprehensive geriatric assessment is recommended for full evaluation and management of frailty.
Dr Rowan Molnar #DrRowanMolnar - Popular profiles on GoogleDr. Rowan Molnar
Dr Rowan Molnar is dedicated to medical education at all levels, particularly in establishment, deployment and implementation of simulation based teaching. Dr Rowan Molnar is a recognised leader with a demonstrated ability to constantly strive for excellence in the ever changing world of medicine.
#DrRowanMolnar, #RowanMolnar, #DrRowan, #Molnar, #DrRowanMolnarAustralia, #RowanMolnarAustralia, #DrRowanMolnarMelbourneAustralia
Importance of nutrition in hospitalized patientsAzam Jafri
Malnutrition is common in hospitalized patients and is associated with increased complications, prolonged hospital stays, and higher mortality rates. Proper nutrition is important for recovery, as malnutrition can weaken the body and impair the healing process. Oral nutritional supplements have been shown to improve patient outcomes by helping maintain muscle mass and support recovery from illness, surgery, or injury. Hospitals should screen patients for risk of malnutrition and consider supplemental nutrition to improve health outcomes.
The document provides information on several topics related to dermatology. It discusses personalized therapy for some cancers like melanoma that will use genetic and molecular biomarkers to select patients for targeted therapies including immunotherapy. It also discusses painless photodynamic therapy for actinic keratoses that reduces treatment time from 14-18 hours to only 90 minutes with less pain reported by patients. Finally, it summarizes the results of two clinical trials showing that the drug Otezla was effective for treating moderate to severe plaque psoriasis, with 33% of patients achieving a 75% improvement in symptoms compared to only 5% on placebo.
Intraarticular platelet-rich plasma (PRP) injections involve extracting a patient's own blood, concentrating the platelets, and reinjecting the platelet-rich plasma into injured tissues like tendons or ligaments. PRP contains growth factors that promote healing. A typical treatment involves 3 weekly injections of 3-8 mL of PRP with ultrasound guidance. PRP appears safe but may cause minor temporary discomfort. While PRP shows promise for cartilage injuries, its benefits are usually limited and best for younger patients without advanced tissue degeneration.
This document summarizes key points about iatrogenesis and drug-related risks in the elderly. It discusses age-related changes that increase risks, such as changes in body composition and drug distribution. Examples of high-risk drug classes are provided, like anticoagulants, psychotropic drugs, and antineoplastic agents. Specific situations that increase risks, such as polypharmacy and malnutrition, are also described.
Slides on Diabetes in the South Focus on Prevention.2018hivlifeinfo
Learn how to overcome common barriers to diabetes prevention with this downloadable slideset.
Richard E. Pratley, MD
Format: Microsoft PowerPoint (.ppt)
File Size: 3.16 MB
Released: October 23, 2018
This document discusses treatment options for patients with hormone receptor-positive, HER2-negative metastatic breast cancer who have progressed on initial endocrine therapy. It considers fulvestrant monotherapy or the combination of everolimus and exemestane as potential second-line hormonal therapies. Trial data is presented showing that fulvestrant 500mg improves median overall survival by 4.1 months compared to 250mg. The TAMRAD trial found the combination of tamoxifen and everolimus increased clinical benefit rate over tamoxifen alone. The BOLERO-2 trial demonstrated that adding everolimus to exemestane significantly prolonged progression-free survival compared to exemestane alone. Subgroup analyses from
This document provides information on risk factors used in the FRAX tool for assessing fracture risk. It describes the following key risk factors that are considered: age, sex, weight, height, prior fractures, parental hip fracture, smoking, alcohol use, glucocorticoid use, rheumatoid arthritis, secondary osteoporosis, and bone mineral density. For each risk factor, it provides details on how the information should be entered into the FRAX model, such as specifying yes or no responses for certain factors and entering values in appropriate units for others. It also includes notes clarifying how some risk factors like prior fractures, smoking, and rheumatoid arthritis are assessed.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
5 Effective Homeopathic Medicines for Irregular Periods
test
1. 1 in 2 women over age 50 will fracture due to osteoporosis.1
Each day that women with osteoporosis go untreated is a day closer to
possible fracture.
Indication: Prolia®
is indicated for the treatment of postmenopausal women with osteoporosis at high risk
for fracture, defined as a history of osteoporotic fracture, or multiple risk factors for fracture; or patients
who have failed or are intolerant to other available osteoporosis therapy. In postmenopausal women with
osteoporosis, Prolia®
reduces the incidence of vertebral, nonvertebral, and hip fractures.
Contraindications: Prolia®
is contraindicated in patients with hypocalcemia, women who are pregnant, and
patients with a history of systemic hypersensitivity to any component of the product. Perform pregnancy
testing in women of reproductive potential prior to initiating treatment with Prolia®
.
Please see additional Important Safety Information on pages 4-5.
Naomi, age 65
Currently Untreated for Osteoporosis
Her BMD* T-scores
• -2.5 at the lumbar spine, -2.7 at the total hip
Her additional risk factors for fracture
• Low body weight and her mother’s history of hip fracture
Why she needs to start with Prolia®
• She wants to keep enjoying her active, independent lifestyle and a fracture
could change all of that
• After seeing the impact that a fracture had on her mom, Naomi is
determined to take care of herself by taking control of her health
Hypothetical patient
For the treatment of postmenopausal women with osteoporosis at high risk for fracture
*Bone Mineral Density.
F D A A P P R O V E D F O R 1 0 Y E A R S
USA-162-81952
2. Prolia
®
|
2
IMPORTANT SAFETY INFORMATION
Clinically significant hypersensitivity including anaphylaxis has been reported with Prolia®
. Symptoms have included
hypotension, dyspnea, throat tightness, facial and upper airway edema, pruritus and urticaria. If an anaphylactic or other
clinically significant allergic reaction occurs, initiate appropriate therapy and discontinue further use of Prolia®
.
Please see additional Important Safety Information on pages 4-5.
Prolia®
is proven to significantly reduce fracture risk at
vertebral, hip, and nonvertebral sites at 3 years2,3
70% of patients treated with Prolia®
in the study had no prior osteoporosis therapy.4
PIVOTAL PHASE 3 STUDY DESIGN: Multicenter, international, randomized, double-blind, placebo-controlled clinical trial. Patients were
postmenopausal women between 60 and 91 years of age with a BMD T-score between -2.5 and -4.0 at the lumbar spine or total hip. 7808
patients were randomized to receive Prolia®
60 mg (n = 3902) or placebo (n = 3906) subcutaneously (SC) every 6 months (Q6M). All patients
were supplemented with daily calcium and vitamin D.2,3
For the treatment of postmenopausal women with osteoporosis at high risk for fracture
When your patient is at high risk for fracture, start
with Prolia®
as initial therapy
Prolia
®
|
3
93% of Medicare Part B fee for service patients*
and 80% of
Medicare Part D patients†
have access‡
to Prolia®
as an initial
therapy with no step edit7,†
*
Channel Mix based on IMS Prolia®
data pack integrated units from 9/15/2017 to 9/7/2018.
†
Medical Payer Mix based on SHS Mx claims from Apr-2017 to Mar-2018.
‡
Access is defined as the ability for a patient to obtain Prolia®
, although patient out-of-pocket cost and insurance requirements may vary.
How many of your patients may be at high risk for fracture?
Look for women with 2 or more of the following factors.5-6
• Age ≥ 65 years
• BMD T-score ≤ -2.5
• Low body weight
• Prior fragility fracture
• Long-term glucocorticoid use
• Excessive alcohol intake
(>3 drinks/day)
• Cigarette smoking
• Immobilization
• Parental history of hip fracture
• Risk of falling
• Rheumatoid arthritis
• Diabetes
Vertebral fracture relative risk reduction (RRR) vs placebo2,3,*
Primary endpoint was incidence of new vertebral
fractures at 3 years2,3
61%
†
(ARR‡
= 1.4%)
p < 0.0001
Year 1
(0 to 12 months)
71%
†
(ARR‡
= 3.5%)
p < 0.0001
Year 2
(0 to 24 months)
68%
†
(ARR‡
= 4.8%)
p < 0.0001
Primary Endpoint
Year 3
(0 to 36 months)
HIP2,3
40%
†
RRR
vs placebo at 3 years
(ARR‡
= 0.3%, p = 0.04)
Year 3
(0 to 36 months)
NONVERTEBRAL2,3,§
RRR
20%
†
vs placebo at 3 years
(ARR‡
= 1.5%, p = 0.01)
Year 3
(0 to 36 months)
Secondary endpoints were time to first nonvertebral§
and hip fracture, assessed at 3 years2,3
*
Includes 7393 patients with a baseline and at least one
post-baseline radiograph.2,3
†
Relative risk reduction.
‡
Absolute risk reduction.
§
Composite measurement excluding pathological fractures and
those associated with severe trauma, fractures of the vertebrae,
skull, face, mandible, metacarpals, fingers, and toes.2,3
F D A A P P R O V E D F O R 1 0 Y E A R S
3. • Serious Infections: In a clinical trial (N = 7808), serious infections
leading to hospitalization were reported more frequently in the
Prolia®
group than in the placebo group. Serious skin infections,
as well as infections of the abdomen, urinary tract and ear, were
more frequent in patients treated with Prolia®
.
Endocarditis was also reported more frequently in Prolia®
-treated
patients. The incidence of opportunistic infections and the overall
incidence of infections were similar between the treatment groups.
Advise patients to seek prompt medical attention if they develop signs or symptoms of severe infection, including cellulitis.
Patients on concomitant immunosuppressant agents or with impaired immune systems may be at increased risk for serious infections.
In patients who develop serious infections while on Prolia®
, prescribers should assess the need for continued Prolia®
therapy.
• Dermatologic Adverse Reactions: Epidermal and dermal adverse
events such as dermatitis, eczema and rashes occurred at a
significantly higher rate with Prolia®
compared to placebo. Most
of these events were not specific to the injection site. Consider
discontinuing Prolia®
if severe symptoms develop.
• Musculoskeletal Pain: Severe and occasionally incapacitating
bone, joint, and/or muscle pain has been reported in patients taking Prolia®
. Consider discontinuing use if severe symptoms develop.
• Suppression of Bone Turnover: Prolia®
resulted in significant suppression of bone remodeling as evidenced by markers of bone
turnover and bone histomorphometry. The significance of these findings and the effect of long-term treatment are unknown. Monitor
patients for consequences, including ONJ, atypical fractures, and delayed fracture healing.
• Adverse Reactions: The most common adverse reactions
(>5% and more common than placebo) are back pain, pain in
extremity, musculoskeletal pain, hypercholesterolemia, and cystitis.
Pancreatitis has been reported with Prolia®
.
The overall incidence of new malignancies was 4.3% in the placebo
group and 4.8% in the Prolia®
group. A causal relationship to drug
exposure has not been established. Denosumab is a human
monoclonal antibody. As with all therapeutic proteins, there is
potential for immunogenicity.
Please click here to see Prolia®
full Prescribing Information, including Medication Guide.
References: 1. US Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Office of the Surgeon General, 2004. 2. Prolia®
(denosumab) prescribing information, Amgen. 3. Cummings SR, San Martin J, McClung MR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009;361:756-765. 4. Data on file, Amgen.
2008. 5. Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis–2020.
Endoc Pract. 2020;26 (suppl 1):1-46. 6. National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2014. 7. Data on file, Amgen. 2018.
Prolia®
(N = 3886)4
Placebo (N=3876)4
Abdomen: 36 (0.9%) 28 (0.7%)
Urinary tract: 29 (0.7%) 20 (0.5%)
Skin: 15 (0.4%) 3 (< 0.1%)
Ear: 5 (0.1%) 0 (0.0%)
Prolia
®
(N = 3886)2,4
Placebo (N=3876)2,4
Rash: 96 (2.5%) 79 (2.0%)
Eczema: 50 (1.3%) 25 (0.6%)
Dermatitis: 22 (0.6%) 14 (0.4%)
Prolia®
(N = 3886)2
Placebo (N = 3876)2
Back pain: 1347 (34.7%) 1340 (34.6%)
Pain in extremity: 453 (11.7%) 430 (11.1%)
Musculoskeletal pain: 297 (7.6%) 291 (7.5%)
Hypercholesterolemia: 280 (7.2%) 236 (6.1%)
Cystitis: 228 (5.9%) 225 (5.8%)
Prolia
®
|
5
Prolia
®
|
4
Important Safety Information
• Contraindications: Prolia®
(denosumab) is contraindicated in patients with hypocalcemia. Pre-existing hypocalcemia must be
corrected prior to initiating Prolia®
. Prolia®
is contraindicated in women who are pregnant and may cause fetal harm. In women of
reproductive potential, pregnancy testing should be performed prior to initiating treatment with Prolia®
. Prolia®
is contraindicated
in patients with a history of systemic hypersensitivity to any component of the product. Reactions have included anaphylaxis, facial
swelling and urticaria.
• Same Active Ingredient: Prolia®
contains the same active ingredient (denosumab) found in XGEVA®
. Patients receiving Prolia®
should
not receive XGEVA®
.
• Hypersensitivity: Clinically significant hypersensitivity including anaphylaxis has been reported with Prolia®
. Symptoms have included
hypotension, dyspnea, throat tightness, facial and upper airway edema, pruritus and urticaria. If an anaphylactic or other clinically
significant allergic reaction occurs, initiate appropriate therapy and discontinue further use of Prolia®
.
• Hypocalcemia: Hypocalcemia may worsen with the use of Prolia®
, especially in patients with severe renal impairment. In patients
predisposed to hypocalcemia and disturbances of mineral metabolism, including treatment with other calcium-lowering drugs,
clinical monitoring of calcium and mineral levels is highly recommended within 14 days of Prolia®
injection. Concomitant use of
calcimimetic drugs may worsen hypocalcemia risk and serum calcium should be closely monitored. Adequately supplement all
patients with calcium and vitamin D.
• Osteonecrosis of the Jaw (ONJ): ONJ, which can occur spontaneously, is generally associated with tooth extraction and/or
local infection with delayed healing, and has been reported in patients receiving Prolia®
. An oral exam should be performed by
the prescriber prior to initiation of Prolia®
. A dental examination with appropriate preventive dentistry is recommended prior to
treatment in patients with risk factors for ONJ such as invasive dental procedures, diagnosis of cancer, concomitant therapies (e.g.
chemotherapy, corticosteroids, angiogenesis inhibitors), poor oral hygiene, and co-morbid disorders. Good oral hygiene practices
should be maintained during treatment with Prolia®
. The risk of ONJ may increase with duration of exposure to Prolia®
.
For patients requiring invasive dental procedures, clinical judgment should guide the management plan of each patient. Patients who
are suspected of having or who develop ONJ should receive care by a dentist or an oral surgeon. Extensive dental surgery to treat ONJ
may exacerbate the condition. Discontinuation of Prolia®
should be considered based on individual benefit-risk assessment.
• Atypical Femoral Fractures: Atypical low-energy, or low trauma fractures of the shaft have been reported in patients receiving
Prolia®
. Causality has not been established as these fractures also occur in osteoporotic patients who have not been treated with
antiresorptive agents.
During Prolia®
treatment, patients should be advised to report new or unusual thigh, hip, or groin pain. Any patient who presents with
thigh or groin pain should be evaluated to rule out an incomplete femur fracture. Interruption of Prolia®
therapy should be considered,
pending a risk/benefit assessment, on an individual basis.
• Multiple Vertebral Fractures (MVF) Following Discontinuation of Prolia®
Treatment: Following discontinuation of Prolia®
treatment, fracture risk increases, including the risk of multiple vertebral fractures. New vertebral fractures occurred as early as
7 months (on average 19 months) after the last dose of Prolia®
. Prior vertebral fracture was a predictor of multiple vertebral fractures
after Prolia®
discontinuation. Evaluate an individual’s benefit/risk before initiating treatment with Prolia®
. If Prolia®
treatment is
discontinued, patients should be transitioned to an alternative antiresorptive therapy.