doc rich videos
Loading...
49
subscribers
235,502
video views
Featured Playlists
Sepsis Guidelines
Severe sepsis and septic shock are major healthcare problems affecting millions of individuals around the world each year. In 2004, an international group of experts in the diagnosis and management of infection and sepsis published the first internationally accepted guidelines that the clinicians could use to improve outcomes in severe sepsis and septic shock. The 2008 guideline is an update to the previous guideline.
The key recommendations include: early goal-directed resuscitation of the septic patient during the first 6 hours after recognition; blood cultures prior to antibiotic therapy; imaging studies performed promply; administration of broad-spectrum antibiotic therapy within 1 hour of diagnosis; reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate; a usual 7-10 days of antibiotic therapy guided by clinical response; source control; administration of either crystalloid or colloid resuscitation; fluid challenge to restore mean circulating filling pressure; reduction in rate of fluid administration with rising filing pressures and no improvement in tissue perfussion;
5 videos
Play all(5)
5 videos
Play all(5)
Rigodon de Honor, JR Borja Gen. Hospital
Rigodon de Honor, JR Borja Gen. Hospital
5 videos
Play all(5)
5 videos
Play all(5)
Doctors on Center Stage
PCP Doctors on Center Stage
Dance Drama Concert
Atrium, Limketkai, Cagayan de Oro City, Philippines December 6, 2008
9 videos
Play all(9)
9 videos
Play all(9)
Incretin-Based Therapy in Type 2 Diabetes Mellitus
Type 2 diabetes mellitus today is a global epidemic, a continuing challenge despite the availability of effective therapeutic agents. Current treatment guidelines emphasize early and aggressive treatment targetting the known pathophysiological defects in type 2 diabetes. Yet the reality in clinical practice shows that fewer than 50% of patients under treatment achieve HbA1c levels even in developed countries. More recently, the addition of incretin-based therapy offers significant solutions to the progressive loss of pancreatic beta cell function and other unmet needs in effective diabetes management. In this session, the role of diminished incretin effects in the metabolic derangements in type 2 diabetes will be reviewed. The mechanism of actions and the therapeutic uses of both incretin enhancers and incretin mimetics will be discussed, highlighting efficacy and safety data since they have been available for use in clinical practice. The role of these agents in addressing earliest defects in glucose homeostasis and postprandial hyperglycemia implies potential of preservation of beta cell function. Incretin-based therapy should clearly be considered as a major part of effective diabetes management in current clinical practice.
Category: Science & Technology
4 videos
Play all(4)
4 videos
Play all(4)
Obstructive Sleep Apnea (SOA)
WHAT IS OBSTRUCTIVE SLEEP APNEA(OSA)?
Loud snoring which is interrupted by respiratory arrest (apnea) of more than 10 secs in duration is obstructive sleep apnea. This is usually accompanied by a reduction in blood oxygen saturation followed by a microawakening to breath. In severe cases, hundreds of breathing pauses can occur every night.
In obstructive apnea, the throat closes during inhalation due to excessive relaxation of the pharynx muscles and the floor of the mouth, accompanied by increased tissue pressure from outside. This prevents air from entering the lungs, and the patient is threatened with suffocation.
IS OSA DANGEROUS? WHAT ARE THE EFFECTS?
OSA has been associated with an increased mortality ratio of 3.33. Sleep apnea has been associated with an up to 23-fold increased risk of heart attack. A number of studies have now documented sleep apnea in over two-thirds of male stroke victims. In the las JNC-7 Guidelines of hypertension, OSA was the most common etiology for secondary hypertension. In fact, in some series, almost half of subjects with hypertension demonstrated sleep apnea. In many patients, treating sleep apnea can bring blood pressure readings under control: often with less medication.
In some cases, OSA may be fatal. In many instances, the idea that someone died peacefully during sleep clearly must have amounted to wishful thinking, since instead, the deceased was probably fighting violently for breath up to the very end.
The most frequent symptom of sleep apnea is tiredness during the day. The continual lack of quality sleep can affect one's life in many ways including depression, irritability, loss of memory, lack of energy, sexual dysfunction, a high risk of auto and workplace accidents, and many other problems.
Other common complications of sleep apnea include heart failure, cardiac arrhythmias, and increased levels of fasting blood glucose, insulin, and glycosylated hemoglobin, independent of body weight.
IS OSA COMMON?
Yes, extremely common! Sleep apneaoccurs in all age groups and both sexes but is more common in men. Four percent of middle-aged men and 2 percent of middle0aged women have sleep apnea.
WHO GETS OSA?
People most likely to have or develop sleep apnea include those who snore loudly and also are overweight, or have high blood pressure, or have some physical abnormality in the nose, throat, or other parts of the upper airway. Sleep apnea seems to run in some families, suggesting a possible genetic basis.
HOW WILL I KNOW IF MY PATIENT HAS OSA?
The only definite way to diagnose is to spend a night in a sleep laboratory to have a polysomnogram. The Chong Hua Hospital Center for Sleep Disorders is the first and only complete sleep laboratory outside Manila. During the sleep study, 16 recordings (including Electroencephalogram, EKG, Electromyogram, electrooculogram, sleep position, pulse oximetry, airflow measurements by oronasal thermistor and nasal pressure transducer, thoracic and abdominal efforts, real time video recording, snoriing sensors and limb movement monitor) will be analyzed to make a definitive diagnosis and initiate treatment. Diagnosis of sleep apnea is not simple because there can be many different reasons for disturbed sleep.
6 videos
Play all(6)
6 videos
Play all(6)
Advertisement
