The Novel START trial found that among patients with mild asthma, using budesonide-formoterol as needed significantly reduced the risk of asthma exacerbations compared to using albuterol as needed. It also showed a lower exacerbation rate than the budesonide maintenance group, though the difference was not statistically significant. Based on these results, the 2022 GINA guidelines were updated to recommend using budesonide-formoterol as needed as the preferred treatment approach for mild asthma. Budesonide-formoterol is currently available as a hydrofluoroalkane inhaler in two strengths.
GINA Pocketbook, 2022
Clinical practice guidelines for diagnosis of Asthma, management, prevention of acute attacks, risk factors modifications, controller and reliever options.
GINA Pocketbook, 2022
Clinical practice guidelines for diagnosis of Asthma, management, prevention of acute attacks, risk factors modifications, controller and reliever options.
I evaluated and presented the IMPACT trial which compared the effects of once-daily triple therapy versus once-daily dual therapy on COPD exacerbations in afflicted patients. While this trial displayed strong evidence favoring triple therapy over dual therapies, certain methodologies may have inflated the difference.
this guideline based on recent articles by major education establishments concerned with building national guidelines. please dont be hurry to make comments about use of IV aminophylline. aminiphylline used under some extra care and when other treatment options are failing. benefits of those treatments yet remain controversial. IV aminophylline has its own risks including the possibility of toxicity.
Bronchial Asthma: Definition,Pathophysiology and ManagementMarko Makram
Definition and Pathophysiology of Asthma in addition to classification and recent updates in the management of asthma based on GINA-2019 Guidelines, by Dr. Marco Makram.
I evaluated and presented the IMPACT trial which compared the effects of once-daily triple therapy versus once-daily dual therapy on COPD exacerbations in afflicted patients. While this trial displayed strong evidence favoring triple therapy over dual therapies, certain methodologies may have inflated the difference.
this guideline based on recent articles by major education establishments concerned with building national guidelines. please dont be hurry to make comments about use of IV aminophylline. aminiphylline used under some extra care and when other treatment options are failing. benefits of those treatments yet remain controversial. IV aminophylline has its own risks including the possibility of toxicity.
Bronchial Asthma: Definition,Pathophysiology and ManagementMarko Makram
Definition and Pathophysiology of Asthma in addition to classification and recent updates in the management of asthma based on GINA-2019 Guidelines, by Dr. Marco Makram.
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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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.
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
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
3. LEARNING
OBJECTIVES
Outline the major change in the
2019 Global Initiative for Asthma
(GINA) guidelines
Discuss budesonide-formoterol’s
place in therapy for mild asthma
based on recent literature
Recognize the dose and dosage
form that budesonide-formoterol is
supplied as
5. CONSEQUENCES OF UNCONTROLLED
ASTHMA
Airway remodeling
Scarring of the lungs
Permanent decline in respiratory function
Journal of Allergy and Clinical Immunology. 2007;120(5):S94-S138.
6. Beasley RD et al. NEJM. 2019; 380(21):2020-2030.
NOVEL START TRIAL:
CONTROLLED TRIAL OF BUDESONIDE-
FORMOTEROL AS NEEDED FOR MILD
ASTHMA
7. PURPOSE
ICS use is low as maintenance therapy for mild asthma
An ICS + LABA takes advantage of a patient’s natural
response to use therapy when symptomatic
Two previous clinical trials have been done showing
efficacy and safety in using budesonide-formoterol as
needed
These two trials had high internal validity, but low external
validity
Novel START trial was designed to overcome limitations
of previous 2 trials
Beasley RD et al. NEJM. 2019; 380(21):2020-2030.
8. PREVIOUS TRIALS
SYGMA-1
• Conclusion: inhaled
budesonide-formoterol
when used as needed
was superior to
terbutaline, but was
inferior to budesonide
maintenance therapy
SYGMA-2
• Conclusion: inhaled
budesonide-formoterol
was non-inferior to the
budesonide
maintenance therapy
for severe
exacerbation
• Bateman E et al. NEJM. 2018;378(20):1877-1887.
9. CLINICAL QUESTION
• In patients with mild asthma treated only with as-needed
asthma, does budesonide+formoterol reliever therapy used
as-needed reduce the risk of asthma exacerbations
compared to albuterol as-needed?
10. TRIAL DESIGN
• Multicenter, open-label, parallel-group, randomized, controlled
trial
• N=668
• Albuterol (n=223)
• Budesonide BID+albuterol PRN (n=225)
• Budesonide+formoterol PRN (n=220)
• Setting: 16 centers in New Zealand, United Kingdom, Italy, and
Australia
• Enrollment: 2016-2017
• Follow-up: 52 weeks
• Analysis: Intention-to-treat
• Primary outcome: Asthma exacerbations per patient per year
11. POPULATION
Inclusion Criteria
• Aged 18-75 years
• Asthma diagnosis, with one of the following:
• If no severe exacerbations in the prior year, SABA use on ≥2
occasions in the prior 4 weeks and ≤2 occasions per day
(average) in prior 4 weeks
• If a severe exacerbation in the prior year (not requiring
hospitalization), SABA use ≤2 occasions per day in the
previous 4 weeks
12. • Exclusion Criteria
• Hospitalization for asthma in the previous 12 months, or any
admissions to an ICU for asthma
• Smoking with >20 PYH
• Self-reported onset of respiratory symptoms after the ago of 40
years in current or previous smokers with at least a 10 pack-year
smoking history
• Maintenance therapy with ICS, LABA, leukotriene receptor
antagonist, theophylline, anticholinergic agent or cromone in prior
3 months
• Treatment with oral prednisone in the prior 6 weeks, or a home
supply of prednisone for use in worsening asthma
• COPD, bronchiectasis, ILD, HF, unstable CAD, AF, other
significant cardiac disease
• Pregnancy
• Unwilling to switch asthma treatment
• FEV1 ≤50% predicted at visit 1
13.
14. INTERVENTIONS
• Randomized 1:1:1 to a group:
• Albuterol PRN - Albuterol dose 100 ug
• Budesonide BID+albuterol PRN - Budesonide dose 200 ug,
albuterol dose 100 ug
• Budesonide+formoterol PRN - Budesonide+formoterol dose 200-6
ug
• Electronic monitors recorded inhaler use
• Withdrawal from trial after a severe exacerbation (worsening
asthma leading to prescription of systemic glucocorticoid
treatment for at ≥3 days or hospitalization/ED visit leading to
systemic glucocorticoid treatment), 3 exacerbations separated
by ≥7 days, or unstable disease requiring change in
medication from what they were assigned
15. OUTCOMES
• Presented as budesonide+formoterol PRN vs. albuterol PRN vs.
budesonide BID+albuterol PRN
Primary Outcomes
• Annual rate of asthma exacerbationsExacerbations was defined
as worsening asthma that leading to an urgent outpatient, ED, or
inpatient medical care consultation, prescription of systemic
glucocorticoids for any duration, or an episode of high β2-agonist
use (>16 actuations of albuterol or >8 actuations of
budesonide+formoterol in 24 hours).
18. Secondary outcomes
• The risk of exacerbation in the budesonide–formoterol group was
lower than that in the albuterol group, as assessed in a time-to-
first-event analysis and did not differ significantly from that in the
budesonide maintenance group.
• Across all time points, the score on the ACQ-5 was lower in the
budesonide–formoterol group than in the albuterol group, but
was higher in the budesonide–formoterol group than in the
budesonide maintenance group.
19. STRENGHTS
• Good trial design
• Good monitoring and follow up.
• Criticisms
• Insufficiently powered (225
participants per study arm
required to achieve sufficient
power as per reported calculation)
• Lack of smoking pack-year history
(SPYH) stratification
• Mean age of 35.6 limits external
validity for older patient
populations
WEAKNESSES
CRITICISM
20. IMPLICATIONS
• If available and not costly a very budesonide-formoterol will be
practice changing in our setting
23. AUTHOR’S
CONCLUSIONS
• Among patients with mild
asthma, the risk of asthma
exacerbations was lower with
budesonide-formoterol used as
needed than with albuterol used
as needed
Beasley RD et al. NEJM. 2019; 380(21):2020-
2030.
25. CURRENT BUDESONIDE-
FORMOTEROL FORMULATION
HFA inhaler available in the US
Label: NOT for use during acute bronchospasm
Asthma approved dose: 80 mcg/4.5 mcg or 160 mcg/4.5 mcg
Formoterol onset of action: 15 minutes
Albuterol onset of action: 25 minutes
Budesonide- Formoterol. Lexi-Drugs. Lexicomp
26. BUDESONIDE 80 MCG &
FORMOTEROL 4.5 MCG
BUDESONIDE 160 MCG &
FORMOTEROL 4.5 MCG
BUDESONIDE-FORMOTEROL
Dose = 2 inhalations twice daily
27. SUMMARY
Budesonide-formoterol as-needed
lowers exacerbation rates
2022 GINA guidelines have been
updated to include using
budesonide-formoterol as-needed
first line for mild asthma
Budesonide-formoterol is an HFA
inhaler available as 2 strengths
