Type 2 diabetes is increasingly common in youth, especially overweight and obese adolescents. Guidelines recommend lifestyle changes and metformin as first-line treatment, with insulin as needed for glycemic control. Treatment goals include an HbA1c under 7% to reduce complications, though pediatric diabetes may be more aggressive than adult-onset disease given earlier presentation and longer disease duration. Management poses challenges due to developmental factors, requiring sensitivity to achieve adherence.
Imeglimin, What is new?
By Dr. Usama Ragab Youssif
Lecturer of Medicine - Zagazig University
Agenda
Mitochondrial function and dysfunction
Mitochondrial (dys)function in diabetes
Diabetes core defects and Imeglimin
Imeglimin drug development and approval
Imeglimin and Heart
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Imeglimin, What is new?
By Dr. Usama Ragab Youssif
Lecturer of Medicine - Zagazig University
Agenda
Mitochondrial function and dysfunction
Mitochondrial (dys)function in diabetes
Diabetes core defects and Imeglimin
Imeglimin drug development and approval
Imeglimin and Heart
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Management of CAD in Diabetes the cardiovascular equivalent is challenging.The slides take you from the epidemiology,ADD,and CV benefit and how to manage CAD
Insulin Lispro Revisited
By Dr. Usama Ragab Youssif
The discovery of insulin was one of the most dramatic and important milestones in medicine - a Nobel Prize-winning moment in science.
This prsentation explains the use of biomarker with reference to an article: Accelerating Drug Develeopment using Biomarkers-Sitagliptin.
It was presented my my 2 friends and me. Hope it helps you guys.
Sitagliptin an oral anti-diabetic agentAmruta Vaidya
A concise presentation on the DPP-IV inhibitor Sitagliptin an oral anti-diabetic agent. Its general mechanism of action, pharmacokinetics, safety is included.
This Presentation Give You A brief Information About DPP4 And New Recommendations .This Presentation Guide You How To Treat Patients With Safety.
For Further Contact:03354999496
Cardiovascular safety of anti-diabetic drugs.Cardiovascular Outcome Trials ...magdy elmasry
Cardiologists and diabetes.Target organs and action mechanism of antidiabetic drugs.Cardiovascular Outcome Trials
( CVOTs ) in Diabetes.Completed and ongoing CVOTs in type 2 diabetes.Diabetes Medications
and
Cardiovascular Impact.Recommendations for management of diabetes
Cardiovascular safety of anti-diabetic drugs.
Insulin Initiation : When We should Start with Basal Insulin?mataharitimoer MT
Insulin Initiation : When We should Start with Basal Insulin?
Dr. Agus Taolin , SpPD, FINASIM | PAPDI CABANG BOGOR
Disampaikan pada acara PIT VI IDI Kota Bogor | 9 Nopember 2013
Nutrease powder- A natural plant based nutritional shake helps to supports in...SriramNagarajan16
Supplementation of Nutrease powder is essential for proactive prevention and also for the best outcome therapy in Diabetes.
Supplementing essential and conditionally essential nutrients like Nutrease powder to support essential metabolic pathways
is required for immune defense and repair, neuro-hormone balance as well as digestive and detox competencies.
Impaired antioxidant status has been shown to have a definite role in the development of insulin resistance and type 2
diabetes. Overproduction of oxidants (reactive oxygen species and reactive nitrogen species) in the human body is
responsible for the pathogenesis of some diseases. The scavenging of these oxidants is thought to be an effective measure to
depress the level of oxidative stress of organisms. It has been reported that intake of Nutrease powder is inversely associated
with the risk of many chronic diseases, and antioxidant phytochemicals in Nutrease powder are considered to be responsible
for these health benefits. Antioxidant phytochemicals found in Nutrease powder plays an important role in the prevention
and treatment of chronic diseases caused by oxidative stress. They often possess strong antioxidant and free radical
scavenging abilities, which are also the basis of other bioactivities and health benefits, such as diabetes mellitus.
Phytonutrients in Nutrease powder play a positive role by maintaining and modulating immune function to prevent specific
diseases. Being natural products, they hold a great promise in clinical therapy. Phytonutrients are the plant nutrients with
specific biological activities that support human health. Some of the important bioactive phytonutrients include polyphenols,
terpenoids, resveratrol, flavonoids, isoflavonoids, carotenoids, limonoids, glucosinolates, phytoestrogens, phytosterols,
anthocyanins, and probiotics. They play specific pharmacological effects in human health. This article reviews the current
available scientific literature regarding the effect of Nutrease powder as an effective supplementation for a daily energy
need in life style disorders like diabetes.
Management of CAD in Diabetes the cardiovascular equivalent is challenging.The slides take you from the epidemiology,ADD,and CV benefit and how to manage CAD
Insulin Lispro Revisited
By Dr. Usama Ragab Youssif
The discovery of insulin was one of the most dramatic and important milestones in medicine - a Nobel Prize-winning moment in science.
This prsentation explains the use of biomarker with reference to an article: Accelerating Drug Develeopment using Biomarkers-Sitagliptin.
It was presented my my 2 friends and me. Hope it helps you guys.
Sitagliptin an oral anti-diabetic agentAmruta Vaidya
A concise presentation on the DPP-IV inhibitor Sitagliptin an oral anti-diabetic agent. Its general mechanism of action, pharmacokinetics, safety is included.
This Presentation Give You A brief Information About DPP4 And New Recommendations .This Presentation Guide You How To Treat Patients With Safety.
For Further Contact:03354999496
Cardiovascular safety of anti-diabetic drugs.Cardiovascular Outcome Trials ...magdy elmasry
Cardiologists and diabetes.Target organs and action mechanism of antidiabetic drugs.Cardiovascular Outcome Trials
( CVOTs ) in Diabetes.Completed and ongoing CVOTs in type 2 diabetes.Diabetes Medications
and
Cardiovascular Impact.Recommendations for management of diabetes
Cardiovascular safety of anti-diabetic drugs.
Insulin Initiation : When We should Start with Basal Insulin?mataharitimoer MT
Insulin Initiation : When We should Start with Basal Insulin?
Dr. Agus Taolin , SpPD, FINASIM | PAPDI CABANG BOGOR
Disampaikan pada acara PIT VI IDI Kota Bogor | 9 Nopember 2013
Nutrease powder- A natural plant based nutritional shake helps to supports in...SriramNagarajan16
Supplementation of Nutrease powder is essential for proactive prevention and also for the best outcome therapy in Diabetes.
Supplementing essential and conditionally essential nutrients like Nutrease powder to support essential metabolic pathways
is required for immune defense and repair, neuro-hormone balance as well as digestive and detox competencies.
Impaired antioxidant status has been shown to have a definite role in the development of insulin resistance and type 2
diabetes. Overproduction of oxidants (reactive oxygen species and reactive nitrogen species) in the human body is
responsible for the pathogenesis of some diseases. The scavenging of these oxidants is thought to be an effective measure to
depress the level of oxidative stress of organisms. It has been reported that intake of Nutrease powder is inversely associated
with the risk of many chronic diseases, and antioxidant phytochemicals in Nutrease powder are considered to be responsible
for these health benefits. Antioxidant phytochemicals found in Nutrease powder plays an important role in the prevention
and treatment of chronic diseases caused by oxidative stress. They often possess strong antioxidant and free radical
scavenging abilities, which are also the basis of other bioactivities and health benefits, such as diabetes mellitus.
Phytonutrients in Nutrease powder play a positive role by maintaining and modulating immune function to prevent specific
diseases. Being natural products, they hold a great promise in clinical therapy. Phytonutrients are the plant nutrients with
specific biological activities that support human health. Some of the important bioactive phytonutrients include polyphenols,
terpenoids, resveratrol, flavonoids, isoflavonoids, carotenoids, limonoids, glucosinolates, phytoestrogens, phytosterols,
anthocyanins, and probiotics. They play specific pharmacological effects in human health. This article reviews the current
available scientific literature regarding the effect of Nutrease powder as an effective supplementation for a daily energy
need in life style disorders like diabetes.
BETH MARTINSExplain the difference between the types of dia.docxtangyechloe
BETH MARTINS
Explain the difference between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes
Type I Diabetes is hyperglycemia due to insulin deficiency. This is caused by autoimmune destruction of B cells that are within the islets of Langerhans (Chetan, Thrower,& Narendran, 2019). Some signs surrounding Type I DM is polydipsia, polyuria, and weight loss. This is more common in children, but can be diagnosed at any age throughout life. Type I diabetes used to be called juvenile diabetes,but this is now known to not be the correct way to view this disease.
Type 2 Diabetes is impaired insulin secretion and abnormal suppression of postprandial (Hurtado & Vella, 2019). Type 2 DM the pancreas resists insulin, or does not produce enough insulin on its own. Often Type I and Type 2 DM are diagnosed incorrectly or mistaken for each other as signs and symptoms are similar. Being overweight or reduced amount of exercise is though to be a contributing factor as well as genetics, but this is till not fully understood.
Gestational diabetes is characterized by spontaneous hyperglycemia during pregnancy. Some risk factors include family history of diabetes, obesity during pregnancy, and advanced maternal age (Plows, Stanley, Baker, 2019). B cell dysfunction which lacks the ability to release insulin when the body needs it is what causes gestational diabetes.
Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.
Patients who have Type 2 DM have both insulin resistance and impaired insulin secretion (Rosenthal & Burchum, 2021). The liver, muscle and adipose tissue are insulin resistant and increased blood sugar causes B cell function to fail. Insulin secretion decreases and B cells must increase how hard they must work to work against insulin resistance within the tissues (Rosenthal & Burchum, 2021).
The medication I chose os Metformin from the class of Biguanide medications for treatment of Type 2 DM. Metformin uses 3 mechanisms to help lower blood sugar.
Inhibits glucose production in the liver
Reduces glucose absorption in the gut
Sensitizes insulin receptors in fat and skeletal muscle
Metformin is taken by mouth and is absorbed by the small intestines and excreted by the kidneys. Metformin is known to be a great choice for those who skip meals as it will not make blood sugar levels become dangerously low. Those with DM Type 2 should eat healthy carbs such as fruits and vegetables and not indulge in sugary drinks. Protein and polyunsaturated fats should be a staple in the everyday diet. Alcohol should be avoided, and the patient should try to eat several small “meals” per day tp keep blood sugar steady. If blood sugar becomes low having a sugary snack with a complex carbohydrate such as peanut butter and crackers should be on hand.
Short-term and long-t.
Although type 1 diabetes continues to remain the most common form of childhood diabetes in most of the
countries including India, the prevalence of type 2 diabetes is increasing worldwide. This increase is attributed to the modern sedentary lifestyle causing a phenotype of insulin resistance in genetically predisposed individuals. The differentiation between type 1 and type 2 diabetes can be done in most of the cases but may be difficult in obese adolescents with relatively acute presentation. The demonstration of various antibodies is helpful in such circumstances. The earlier age of onset puts patients at risk of earlier age of complications. The management is very challenging as lifestyle modification by the patient and the family is the mainstay of the management. Emphasis should be done on primary prevention with a focus on
healthier lifestyles among children.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This Journal publishes original research work that contributes significantly to further the scientific knowledge in pharmacy.
Materi Workshop Diabetes Melitus untuk Dokter Umum - Practical Management of ...Dayu Agung Dewi Sawitri
Materi Workshop Diabetes Melitus untuk Dokter Umum - Practical Management of Diabetes and Its Complication for General Practitioner.
Diselenggarakan oleh Perkeni, Kementerian Kesehatan RI dan STENO Diabetes Center
Peer #1 Nicholette ThomasTypes of diabetes Type 1 .docxpauline234567
Peer #1
Nicholette Thomas
Types of diabetes:
Type 1 diabetes only accounts for 5% of diabetes cases and is usually diagnosed in childhood or adolescent ages (Rosenthal & Burchum, 2017). In type 1, the body destroys its own pancreatic beta cells through an autoimmune process. For this reason, no insulin can be produced innately, hence why it is known as insulin-dependent diabetes (Rosenthal & Burchum, 2017). Juvenile diabetes used to be used interchangeably with the term Type 1 diabetes, although the incidence of children developing type 2 diabetes is on the rise as well as the correlated rates of childhood obesity (Valaiyapathi et al., 2020).
Type 2 diabetes, which will be the main focus of this discussion, is usually diagnosed after the age of 40, and while there is a large hereditary component, it is often brought on largely by modifiable risk factors such as obesity, poor diet and sedentary lifestyle (Rosenthal & Burchum, 2017). It is characterized by the development of insulin resistance within target tissues such as the liver and adipose tissue, as well as an impaired or delayed secretion of insulin (Rosenthal & Burchum, 2017). Diagnosis of diabetes can include a combination of different tests including a fasting plasma glucose (FPG) of greater than 126 mg/dL, a random glucose of greater than 200, an oral glucose tolerance test (OGTT) of greater than 11, and an A1c of greater than 6.5% (Quattrocchi et al., 2020). It is important to note that other conditions can affect the hgb A1c as well, such as sickle cell, anemia, blood transfusions, dialysis and pregnancy (Quattrocchi et al., 2020). Therefore, multiple tests should be performed and possibly repeated before making a definitive diagnosis.
Gestational diabetes is brought on by pregnancy and subsides rapidly after the birth of the child (Rosenthal & Burchum, 2017). It can be difficult to control due to elevated cortisol levels during pregnancy, other placental hormones that can antagonize the actions of insulin, and also due to the ability of glucose to freely get into the blood of the fetus (Rosenthal & Burchum, 2017). For this reason, blood glucose levels often need to be checked six to seven times per day and be correlated properly with meals / amount of carbohydrates to avoid harm to the fetus. Diet and insulin are utilized primarily to treat this type of diabetes (Rosenthal & Burchum, 2017).
Drug Therapy: Metformin
There are many different types of oral medications and different types of insulin that can be used to manage diabetes. Each class of oral medications works differently in the body to help lower blood sugar. A stepwise approach for managing diabetes, especially alongside different comorbidities such as heart disease and CKD should be implemented, as noted by the recommendations by the ADA, which I will link the updated 2023 articles for standards of care for pharm management under the references listed below. For the purpose o.
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!
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
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.
1. Type 2 Diabetes in Young
& its Management
Dr. Sushama Jotkar
M.D. (Medicine)
Professor
D.Y.Patil Medical College, Kolhapur
2. Emergence of Type 2 Diabetes in Youth
T2DM was traditionally thought of as a disorder of middle-aged &
elderly adults.
However, diabetes has become more common, not only in young
adults, but also in adolescents & children.
Overweight or obese children & adolescents are presenting with
Type 2 diabetes associated insulin resistance
Earlier age of onset will affect the future global burden of diabetes
and prevention activities
Lancet Diabetes Endocrinol. 2014 Jan_2(1)56-64.
3. Emergence of Type 2 Diabetes & Prediabetes in Youth
As obesity in young people increases in Asian countries like India, without
effective intervention strategies to reduce obesity, more people will develop
T2DM at younger ages
Lancet Diabetes Endocrinol. 2014 Jan_2(1)56-64.
4. Emergence of Type 2 Diabetes & Prediabetes in Youth
Microalbuminuria of
close to 100%
Blindness of 20% 15 years of
life lost
Lancet Diabetes Endocrinol. 2014 Jan_2(1)56-64.
T2DM that develops between the ages of 15 and 24 years will result in
a lifetime risk of
5. Type 2 Diabetes in Children
In India, type 2 diabetes is reaching epidemic proportions
Type 2 diabetes mellitus in children is becoming common in
many countries, especially among the Asian-Indian
population
In India, the age at onset of T2DM is generally low and this
form of diabetes in children is being detected more
frequently now
Diabetes Care 26:1022–1025, 2003
6. Diabetes in Young - The Scenario is changing
Population-based estimates of T2DM in the young are lacking as
screening for diabetes is not recommended in children and
adolescents.
Clinic-based data suggest that T2DM is increasing in the young,
although this could be due to increased awareness and/ or referral
bias.
The ICMR-INDIAB study also showed that there is a shift of T2DM
to younger age groups and that the takeoff point of prevalence of
diabetes occurs at ages 25–34 years in India
ICMR INDIAB) study. Diabetologia. 2011;54(12):3022-7.
7. The Dutch Famine Birth Cohort Study
Diabetes Risk in Adulthood
Decreased Fetal
Nutrition
It is defined as heritable changes in gene expression that are not associated with
changes in DNA sequence, but rather through DNA methylation and histone
modification
An Important Mechanism for this Involves Epigenetic Modification
Lancet 1998; 351: 173–77.
Lancet Diabetes Endocrinol. 2014 Jan_2(1)56-64.
8. Dabalea D, Hanson RL, Bennett PH, et al. Increasing prevalence of Type II diabetes in American Indian children. Diabetologia. 1998;41(8):904–910
Diabetes in pregnancy can lead to a cycle of diabetes affecting future
generations
Gestational Diabetes as a Driver of T2
9. Is Pediatric T2DM a global epidemic?
• Cohort of 535 obese Italian children
IFG (7.6%), IGT (3.2%), T2DM (0.18%)
Cambuli, VM, et.al. Diab Metab Res Rev, 2009
• Prevalence of T2DM among 0-20 year old German children
estimated at 2.3 cases per 100,000.
Neu A, et.al. Pediatric Diabetes, 2009
• Highest risk populations (obese, Latino, positive fam hx) from
Los Angeles from 2000-2007 showed prevalence of 1.3% on OGTT
Goran MI, et.al. J Pediatr, 2008
• Taiwanese children aged 6-18 taking part in screening program
found diabetes prevalence of 9 (♂) and 15.3 (♀) per 100,000
children. After 3 years, 54% of cases identified as type 2.
Wei JN, et.al. JAMA, 2003
10. Known and diagnosed cases of
pediatric T2D
Undiagnosed cases of pediatric pre-T2D
(IGT/metabolic syndrome)
“Pre-pre” T2D: insulin resistance
with risk factors
12. Obesity rates are highest among adolescents of
ethnic backgrounds
Prevalence of obesity among boys
aged 12-19 years
Prevalence of obesity among girls
aged 12-19 years
Source: CDC (NHANES data)
17. Is the Presentation the Same as in Adults?
Does not appear to be preceded by long
asymptomatic period
Do not find undiagnosed cases on
screening
18. Years from Clinical Diagnosis
B-cellFunction(%)
UKPDS Data
Type 2 Diabetes
Progressive Pancreatic B-cell Failure
Prevention and Early Treatment
? Curve for Youth
19. Question
Is the Pathophysiology the Same as in Adults?
Associated with significant ß-cell failure as well as
insulin resistance
Occurs at the time of puberty due to intense
insulin resistance
22. Primary Factors Contributing to
Development of T2DM in Children
INSULIN RESISTANCE
PRENATAL
ENVT.
FEMALE GENDER
ETHNIC BACK
GROUND
FAMILY HISTORY
PUBERTY
T2DM
OTHER GENES
SEDENTARY L
IFESTYLE
OBESITY
• visceral
ACCELERATED
BETA CELL FAI
LURE
IFG/IGT
23. Features to Differentiate T1DM, T2DM and Monogenic Diabetes
in Children and Adolescents
IDF/ ISPAD Guideline For Diabetes In Children And Adolescence 2011: 1-132
28. Challenges in Management
Management of T2DM in a child or adolescent is
entirely different from that of diabetes in adults
Lifestyle change and adherence to medication are
difficult to achieve in this age group
Diabetes onset so early in life usually means many years
of disease and treatment
Children & Adolescents with T2DM are at a higher risk
of both microvascular and macrovascular complications
Lancet Diabetes Endocrinol. 2014 Jan_2(1)56-64.
29. PEDIATRICS Volume 131, Number 2, February 2013
The most recent American Academy of Pediatrics (AAP) clinical practice
guidelines for the management of T2DM in patients 10 to 18 years old
recommend prompt initiation of lifestyle modifications and either insulin
or metformin as first-line pharmacological options
Metformin Dosage Start at a low dose of 500 mg daily, increasing by 500
mg every 1 to 2 weeks, up to an ideal and maximum dose of 2000 mg
daily in divided doses
32. • Lifestyle change should be initiated at the time of diagnosis
of T2DM
• Initial pharmacologic treatment of youth with T2DM should
include Metformin and insulin alone or in combination.
•Pediatric Diabetes 2014: 15(Suppl. 20): 26–46
33. ISPAD Clinical Practice Consensus Guidelines Approach to Initial
and Subsequent Treatment of Youth with T2DM
Pediatric Diabetes 2014: 15(Suppl. 20): 26–46
34. Diabetes(type 1 and type 2) in children and young people:
Diagnosis and management
NICE Guideline 18
Methods, evidence and recommendations
August 2015
35. NICE Guidelines 2015
Type 2 Diabetes: Specific Recommendations
• Dietary management:
- At each contact with those who are overweight or obese, advise about the
benefits of physical activity and weight loss, and provide support towards
achieving this in accordance with NICE guidance.
- Provide dietary advice in a sensitive manner, taking into account the
difficulties many people encounter with weight reduction, and emphasise
the additional advantages of healthy eating for blood glucose control and
avoiding complications.
• Offer metformin from diagnosis to children and young people with type 2
diabetes. [new 2015]
36. • Metformin is the initial pharmacologic treatment of choice,
if metabolically stable
• If insulin was initially required,
transition from insulin to metformin over 2-6 weeks
( beginning when metabolic stability is reached, usually 1-2
weeks after diagnosis).
IDF/ ISPAD Guideline For Diabetes In Children And Adolescence 2011: 1-132
37. Recommended Dosage of Metformin in T2DM in Children
• ISPAD Clinical Practice Consensus Guidelines
Begin with 500 mg daily×7 d. Titrate by 500 mg once a week over 3–4
wk to the maximal dose of 1000 mg twice-daily (BID)
• AAP clinical practice guidelines
Start at a low dose of 500 mg daily, increasing by 500 mg every 1 to 2
weeks, up to an ideal and maximum dose of 2000 mg daily in divided
doses
• IDF/ ISPAD Guideline For Diabetes In Children And Adolescence
Begin with 250 mg daily for 3-4 days, if tolerated, increase to 250 mg
twice a day, titrate in this manner over 3-4 weeks until the maximal
dose of 1,000 mg twice a day is reached.
1.Pediatric Diabetes 2014: 15(Suppl. 20): 26–46 2. PEDIATRICS Volume 131, Number 2, February 2013
3. IDF/ ISPAD Guideline For Diabetes In Children And Adolescence 2011: 1-132
38. Annals of Pharmacotherapy, 2016, 1–10
• Relevant articles and preliminary data from clinical trials on me
tformin, insulin, sulfonylureas, thiazolidinediones (TZDs),
GLP -1 receptor agonists, DPP-4 inhibitors, and α-glucosidase
inhibitors for the treatment of pediatric T2DM were reviewed.
• Data Sources: A search from January 1990 to April 2016 was
conducted using PubMed and clinicaltrials.gov
39. • As per USFDA guidelines Metformin is recommended for the
management of T2DM in children with 10 to 18 years
• Metformin and insulin, either alone or in combination,remain
the safest treatment options for management of pediatric
T2DM.
• Metformin & Insulin remain the mainstay of treatment for
T2DM in pediatric patients.
Annals of Pharmacotherapy, 2016, 1–10
40. Objective :
•To review oral antidiabetic agents that have completed pediatric
drug development programs and undergone FDA review.
•This review summarizes results of 4 pediatric drug development
programs for T2DM
The Journal of Clinical Pharmacology 2015, 55(7) 731–738
41. • Each agent achieved reductions in glycemic parameters; however, 3 of 4
failed to reach the threshold efficacy relative to their control(s) to gain FDA
approval.
• Only 1 drug (metformin) of the first 4 T2DM drugs to complete testing in
children gained FDA approval.
The Journal of Clinical Pharmacology 2015, 55(7) 731–738
42. Expert Opin. Biol. Ther. (2014) 14(3):355-364
• Highlights
• Diabetes management is challenging during childhood and adolescence
due to age-specific characteristics.
• Insulin therapy is the cornerstone of treatment of type 1 diabetes.
• Treatment of type 2 diabetes is based on lifestyle interventions and
metformin as the first-line drug for children older than 10 years.
• Insulin should be implemented in youth with type 2 diabetes and metabo
lic decompensation or in cases of difficult controls with oral agents.
44. TREATMENT GOALS
• Glucose control, HbA1c <7%
– Eliminate symptoms of hyperglycemia
• Maintenance of reasonable body weight
• Improve cardiovascular risk factors
• Reduce microvascular complications
• Improvement in physical and emotional
well-being
Goals
(Diabetes
Care, 2000)
FG 80-120
PP 100-160
Bed 100-160
A1c <7.0
45. Adolescents during their pubertal growth spurt have higher insulin resistance compared to
other periods in life.
The use of Metformin in many diseases in which insulin resistance constitutes an essential
part of the pathogenesis appears promising with variable rates of success.
These include obesity, prediabetes, polycystic ovary disease, premature pubarche, and non-
alcoholic fatty liver disease.
Metformin is a good insulin sensitizer that proved effective in adults and recently in
adolescents with T2DM.
46. Summary
Type 2 diabetes in Indian youth is rising at an alarming rate.
Early detection and treatment are the cornerstones to reduce
morbidity and mortality due to youth-onset type 2 diabetes.
Lifestyle change and adherence to medication are difficult to
achieve in this age group.
Major Pediatric guidelines recommends use of metfomin in
the management of T2DM in children with 10 to 18 years old.
Metformin & Insulin remain the mainstay of treatment for
T2DM in pediatric patients.
47. Conclusion
• Increased incidence
• Difficult to distinguish from type 1
• Occurs at the time of intense insulin resistance due
to puberty
• Does not appear to be preceded by long
asymptomatic period
• More insulin deficiency and requirement for
exogenous insulin early
• Safety and efficacy of therapeutic agents
• Rapid progression of co-morbidities and
complications