The document summarizes a clinical trial that compared the effectiveness of adding montelukast (Singulair) versus salmeterol/fluticasone (Advair) or increasing the dose of fluticasone for children with uncontrolled asthma on low-dose inhaled corticosteroids. The BADGER trial found that adding salmeterol to fluticasone or increasing the fluticasone dose resulted in better asthma control compared to adding montelukast. However, some children responded better to montelukast. The document concludes that while several options exist, the patient's current level of control indicates a need to step up therapy beyond low-dose inhaled corticosteroids alone
This presentation is all about world asthma day which is celebrated every year. this year we celebrated it on 4th may 2021. here we can get information about when, why and how we celebrate along with signs & symptoms, diagnosis and prevention of asthama.
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.
This presentation is all about world asthma day which is celebrated every year. this year we celebrated it on 4th may 2021. here we can get information about when, why and how we celebrate along with signs & symptoms, diagnosis and prevention of asthama.
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.
Recent Advances in the Treatment of Childhood Asthma - Robert LemanskeJuan Carlos Ivancevich
Congreso Latinoamericano de Alergia, Asma e Inmunología 2015
Presidente: Alfonso Mario Cepeda Sarabia
Comité Organizador Local: Edgardo Jares, Anahí Yañez, Estrella Asayag
Presidentes Sociedad Latinoamericana de Alergia, Asma e Inmunología, Slaai:
2013-2015: Alfonso Mario Cepeda Sarabia - 2015-2017: Juan Carlos Sisul Alvariza
Buenos Aires, marzo 14-16, 2015
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 Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
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!
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
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.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. Case Presentation 9 yo boy presents to clinic to establish care Hx of asthma and allergic rhinitis Current Rx: Flovent 44mcg 1 puff BID and albuterol PRN Mom asks if he can be switched to Singulair ROS: Nocturnal cough causing awakening perhaps 1 every other week Uses albuterol inhaler maybe 3/week
3. Brief Asthma Review National Asthma Education and Prevention Program’s Expert Panel Report 3 published in 2007: Asthma severity: severity when initiating therapy Asthma control: control to adjust therapy Based on impairment and risk Stepwise approach to managing long-term asthma Separated into ages 0-4, 5-11, & 12 and up
4. Stepwise Approach Inhaled corticosteroids is the preferred long-term control therapy for all ages Evidence A: randomized controlled trials, rich body of data (NHLBI)
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7. Cysteinyl Leukotrienes Eosinophils and mast cells produce cysteinyl leukotrienes (CysLT) Synthesized within minutes CysLTs bind to receptors CysLT1 and CysLT2 CysLT1 receptor mediates: Induce smooth muscle contraction and sustained bronchoconstriction “slow reacting substance of anaphylaxis” Mucus secretion Edema
8. CysLTs and Asthma Asthmatics have higher baseline levels of CysLTs Levels increase with exercise, exposure to allergens, and during exacerbations Singulair (montelukast) and Accolate (zafirlukast): CysLT1 receptor antagonists
9. Singulair Chewable (30): $138.97 Common side effects: URI, fever, HA, pharyngitis, cough, abdominal pain, diarrhea, otitis media, flu, rhinorrhea, sinusitis, otitis FDA warning: neuropsychiatric events Agitation, aggression, depression, suicide, abnormal dreams, insomnia, hallucinations, irritability, tremor were reported in both kids and adults
10. Clinical Question How does the addition of a leukotriene receptor antagonist to low-dose inhaled corticosteroids change the asthma control in children with poorly-controlled asthma, as compared to medium-dose inhaled corticosteroids? Population: children with poorly-controlled asthma on low-dose inhaled corticosteroids Intervention: leukotriene receptor antagonist + low-dose inhaled corticosteroids Comparison: medium-dose inhaled corticosteroids Outcome: change in asthma control
15. Run-in Period To determine whether asthma poorly-controlled on fluticasone 100 mcg BID Daily diary Uncontrolled if during a 2-week period, had >2 days/week of: Moderate or severe coughing Mild, moderate, or severe wheezing ≥2 puffs/day of rescue inhaler Peak flows <80% predicted
16. Crossover Trial Randomized and double-blinded Placebo tablets Dummy disks 16 week periods: Flovent 250 mcg BID Advair (fluticasone 100 mcg + salmeterol 50 mcg) BID Flovent 100 mcg BID + Singulair (5 or 10 mg) daily Initial 4 weeks considered active washout
17. Asthma Action Plan Customized written action plan Visits every 4 weeks Received albuterol inhaler Standardized course of prednisone was initiated if predetermined clinical criteria met at the physician’s discretion
18. Outcome Measures Based on composite of: Need for treatment with oral prednisone for acute asthma exacerbation Number of asthma-control days FEV1 Treatment period ranked better if: Total prednisone during period 180mg less Annualized asthma-control days 31 days more Final FEV1 5% higher
19. Asthma-Control Day Documented in diary No use of albuterol (other than preexercise) No use of nonstudy asthma medication No day or night asthma symptoms No unscheduled visit to health care provider for asthma No peak expiratory flow <80% Proportion during the 12 weeks x 365 = annualized asthma-control days Adjusted for seasonal differences
20. Recruitment March 2007 to July 2008 Patients aged 6-17 Childhood Asthma Research and Education (CARE) Network Centers: National Jewish Health University of Wisconsin University of California San Diego Washington University School of Medicine Arizona Respiratory Center 480 enrolled
21. Inclusion Criteria Mild to moderate asthma Ability to perform reproducible spirometry FEV1 ≥ 60% before bronchodilation Increase in FEV1 of at least 12% or methacholine provocation causing a 20% fall Nonsmoker
22. Patients 298 patients excluded during run-in period Compliance issues Asthma exacerbation Asthma symptoms controlled 182 underwent randomization 157 patients completed the entire study 90% adherence to study visits 96% adherence to paper diary 84% adherence to study tablets (electronic cap monitor) 87% adherence to study inhalers (disk counter)
24. Data Null hypothesis: ≤25% of patients would have a differential response If significant response (0.01 level), then perform logistic regression to determine whether 4 preselected characteristics predicted differential responses Differential response in 161/165 patients (98%)
30. Age (no difference) Also no difference for gender A model with only the significant predictors, correctly classified the ranks 68% of the time
31. Conclusion Possible ceiling effect for ICS Addition of LABA more likely to provide better asthma control But some children had best response to the other step-up therapies Increasing ICS dosage is similar to addition of LTRA Study does NOT address long-term safety of LABAs Potential increased risk of severe exacerbations and death Never to be used as monotherapy FDA label: discontinue LABA when possible
32. Validity pros concerns No placebo or gold standard Increased monitoring by participating in study Medications donated Physician consulting fees, lecture fees, grants by pharmaceutical companies Adequate power Double blinded Randomized Kids Diverse population Decent adherence Individuals vs average
33. Answering Mom Switch to Singulair? No! Patient currently poorly controlled on low-dose ICS Needs step up in therapy One of several options to discuss with Mom LABA, medium-dose ICS, or LTRA Other factors: race, history of eczema Need to reassess control and follow-up
34. Application The secret of the care of the patient is in caring for the patient. -Francis Weld Peabody
35. References Von Mutius, E and JM Drazen. “Choosing asthma step-up care.” N Eng J Med. 362(11): 1042-1043. Lemanske, RF, et al. “Step-up therapy for children with uncontrolled asthma receiving inhaled steroids.” N Eng J Med. 362(11): 975-985, 2010. National Asthma Education and Prevention Program. “Expert panel report 3 (ERP-3) summary report 2007: Guidelines for the diagnosis and management of asthma.” 2007. Accessed online: http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.pdf. Weinberger, MM. “Use of LABAs in asthmatic children requires close monitoring.” AAP News. 31(9): 20, 2010. Databases: Clinical Evidence, Dynamed, Medline, UpToDate. Google images.