study group for aspiring pce,npte students

[swapnil_handa85]

hi,
im swapnil doing bachlor of physiotherapy from india. im preparing for pce and npte.I think studing in group will help us out a lot.all those who want to join me out are being welcome.

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[swapnil_handa85]

hi where are the topics of today
plz be punctual

[swapnil_handa85]

my topics are neuroprexia,saturday night palsy,upper moter neuron disease

[swapnil_handa85]

HI FRIENDS FOR OUR MOST ACTIVE MEMBERS WHO ARE PUNCTUAL TO OUR GROUP AND ARE CONTRIBUTING A LOT TO EACH OF US, I HAVE MADE A SEPERATE AREA WHERE WE CAN CARRY ON OUR STUDIES WELL. HERE WE WILL WORK INDEPENDENTLY WITHOUT ANY INTERFERANCE AS EVERY ONE NEED A PASSWORD TO ENTER. WHICH ILL ISSUE TO ONLY MOST ACTIVE MEMBERS WHO REPLY REGULARLY

[jaishingdia]

hi, i sent u an email-did u get it?? i was wondering if anyone would kindly let me know, cheers

[swapnil_handa85]

hello jess,
i have seen that you are not the regular candidate of our group so i cant give you the access to our password oriented study area as it is for regular persons only

but not to worry, if we all will found that you are replying daily to our group in this area than we will submerze u in our selves

keep regularity

[jaishingdia]

hey,
as i explained before, i have had troubles in the family and could not make it for a bit. now that it settled things look brighter. much appreciate the reply however i am not sure what you mean by a regualr memeber for the group. obviously the group meets at certain times etc which i am not aware of.

when you first set everything up- that is when i had to be away. so unfortunately i do not know the workings of the 'group' and how you guys study.

by all means i can be a regular member but i need to know what to do!?

thanks
jess

[swapnil_handa85]

hey jess,
there is nothing complicated to be regular, i have informed every body hundered times about it. you just need to post just three topics daily to study.

untill you get the regual membership you can post here only.

we all respond to your topics with our questions and queires by next day. we will also give you topics to study for which you will give your questions and so on.
for our meetings you will be already informed to you.


when we will feel that you are responding properly

we will issue a password to you to our new study area


best of luck

[physioparvez]

hi there.
i am shaikh parvez from surat just completed my bpt from bangalore, and willing to join you ...my email id is [email protected] and my contact no. is 09327672287
do reply

[jaishingdia]

ok sounds cool.
large variety of topics to choose though. what area are you guys covering as it'd make sense to do something around a similar topic.

[swapnil_handa85]

jess start with any thing you want pt cardiopulmo will be a nice start

[jaishingdia]

ahh that sounds better.
ok here goes:

1. CORONARY ARTERY DISEASE, clinical manefestations
2. medical management of CAD
3. surgical management of CAD

i have split it into three as my work here involves alot of bulk and would be beneficial to us all.

cheers, jess

[swapnil_handa85]

questions for jess topic


1. what is and how dobutamine stress echocardiography is being done for coronary disease?

2.what is hyperfibrinoginaemia?

3.what are the contraindications for use of beta blocklers and substitution should be prefered in this case?

[anisha kaushik]

swapnil sorry for not contacted for so long

i was busy with my practicals

my questions for jess topic are

1. what is the use of buccal GTN prepration like suscard buccal and imdur.

2. what is crescendo angina.

3. why males are more prone than females.

[jaishingdia]

Dobutamine stress echocardiography for CHD

Dobutamine is a similar chemical that our bodies produce when our physical activity levels increase. It acts to:
1. increase heart rate
2. increase the force of the contraction.

Indications for this type of stress test are to see if a patient has evidence to support a diagnosis of CHD, to determine whether a patients symptoms are due to a cardiac problem and to check the efficiency of medical treatments for CHD.

Patients are prescribed this kind of stress test if they have contraindications for a normal excercise test. i.e. lung disease, severe arthritis or sever PVD.

The procedure involves;
1. an IV infusion of dobutamine.
2. the placement of 10 electrodes strategically on the chest and connected to an ECG machine.
3. blood pressure monitor throughout the test.
4. an initial ultrasound image of the heart at rest.
5. IV infusions od the drud at regular intervals with ultrasound images taken periodically until the IV has stopped. usually only 4 images in total.

these ultrasound images and ECG tracings are then used for the diagnosis of a cardiac problem.



HYPERFIBRINOGENAEMIA is defined as the increase of fibrinogen (a plasma protein) in the blood. It is a biochemical risk factor for CHD.



The contraindications for the use of beta blockers include:
cardiogenic shock
hypotension
bradycardia <50
active asthma
sever respiratoy disease

usually ACE inhibitors and beta blockers are given insync as a combined therapy to which most patients are administed if they can tolerate them. However an ACE inhibitor can be given alone instead. It acts to also improve the hemodynamics of the heart by decreasing preload and afterload with vasoconstriction of the coronary arteries. ( It also blocks angiotensin 2 formation and increase nitric oxide production. This in turn reduces the inflammatory process post a cardiac event.

For example, beta blockers increase bp. fewer patients have a low bp and can tolerate beta blockers and ace inhibitors. However a patients condition has to be evaluated first. I a patient has renal insufficiency and restricted ventricular function they would need beta blockers. But if a patient had DM, with decreased ventricular function and bronchospasmic disease, then giving an ace inhibitor alone may be prudent.


hope this helps!!
jess

[jaishingdia]

hiya!

Clinically there is moderate evidence to prove that Buccal GTN is more effective at controlling exertional angina chest pain due to its longer acting duration. There is not an overwhelming collection of evidence about different drug delivery systems and whether one is more effective than the other. However it is possible to state that BGTN and SLGTN are equally effective at relieving acute coronary chest pain/angina. Yet BGTN is proven to be more effective over a longer period of time than single dose SLGTN.

It also has less side effects like headache. And Increases a patients exertional tolerance due to its delivery system.


CRESCENDO ANGINA
Many people have angina that can come on with exercise but is well controlled with drugs. This is known as stable angina. Unstable (or crescendo) angina is defined as episodes of angina on minimal effort or at rest. It can occur when you get angina for the first time, or when your angina has recently worsened. If you get severe chest pain at rest, which comes on suddenly, and reoccurs even after you have used nitrate tablets or spray

Gender differences:
Premenopausal women have a lower risk of angina than men, probably due to the favourable effect of natural oestrogen on the blood lipid profile. After menopause this advantage is lost and the female risk of CAD and symptoms rapidly approaches that of men of similar age.

jess

[jaishingdia]

ok guys...was that enough info for you?? let me know if you want more.

topics for the day:
1 arrhythmias
2 PTCA and intravenous stents
3 CABGs

this does not cover the rehab part just yet...to come!

jess

[bhuvneshshah]

thanks you for the information jess on buccal GTN

I was wondering what exectly you mean by clinically moderate evidence. As buccal GTN has been shown to be effective in multiple Random controlled trials and choice drug in acute angina.

cheers
Bhuvnesh Shah

[bhuvneshshah]

thanks you for the information jess on buccal GTN

I was wondering what exectly you mean by clinically moderate evidence. As buccal GTN has been shown to be effective in multiple Random controlled trials and choice drug in acute angina.

cheers
Bhuvnesh Shah

[bhuvneshshah]

hi there,
Regarding the dobutamine stress test, I feel one more thing to add in the information.

this version of Pharmacological stress test, is only indicated in the person with otherwise the exercise base stress test in not possible for eg. someone with orthopaedic impairment preventing him to starndard bycycle or treadmill stress test.

cheers
Bhuvnesh shah

[jaishingdia]

hey...

what i meant was that there is moderate evidence to suggest a comparison for the buccal gtn with the other. however, yes i agree with your statement that there is sufficient evidence to support the use of buccal gtn and angina.

cheers
jess

[swapnil_handa85]

questions for jess topic are

1. what diuretics would do in cardiac arrythmias?
2. explain cardiac defibrillation.
3. how can hypokalaemia and hypomagnesaemia can be treated?

topic from my side
1. cystic fibrosis
2. lung funtion testing
3. breathing exercise

[jaishingdia]

Hypomagnesaemia

In treating magnesium deficiency, it is important to detect and
correct any associated potassium and calcium deficiencies.

In mild magnesium deficiency, restoration of body stores occurs quickly after providing a diet high in magnesium. In more severe magnesium deficiency, parenteral administration of magnesium salts is safe and effective but must be used cautiously in patients with renal insufficiency. Initial treatment requires 8 to 12 g of intravenous magnesium sulfate in divided doses over the first 24 hours, followed by 4 to 5 g daily for 3 to 4 days. It is important to replete magnesium stores in patients with hypomagnesaemia but not to provide an excess.

Magnesium oxide is typically supplied as 600 mg tablets containing 30 mEq/L of magnesium per tablet. Several days of 4 to 6 tablets per day should be sufficient to restore the deficit in most patients. Administration of oral magnesium can cause diarrhoea.
( a little detailed doubt us physios would need to know figures...just here to bore you! 8) )

Hypokalaemia

patients are placed on a cardiac monitor
the physician will establish an iv access
and the respiratory staus including ABG's will be periodically assessed.
Potassium replacemtn therapy is given via oral tablets or in severe cases of hypokalaemia, by iv infusion

As for diuretics, they help the body get rid of unneeded water and salt through the urine. Getting rid of excess fluid makes it easier for your heart to pump and controls blood pressure.
We know that abnormal levels of of potassium in the body distort nervous transmission, cardiac contraction and renal functions.

So, diuretics themselves actually reduce potassium levels (especially in the elderly) which can lead to hypokalaemia and as a consequence cardiac arrhythmias. Instead, patients should be given potassium-sparing diuretics which help retain potassium levels rather than deplete them.



[b]Cardiac defibrillation[/b]

Defibrillation is an emergency procedure that restores the normal electrical activity of the heart by applying an electric shock to the chest. -Involves high energy shocks applied for the purpose of ending the fibrillation.

[jaishingdia]

hey....

which are the most commonly used lft's by physios? and how reliable are they?

as for breathing exercises....naturally you mean active cycle breathing techniques and manual techniques. what else have you found on this?

cheers
jess

[anisha kaushik]

jess,
About breathing exercises i am agree with you that it consists not more than some manual tech.. but one important factor which i feel is the pulmo management for icu patients(ex. comma) where the subject is subconsious or unconsious and application of breathing exercises are obtructed

well see what swapnil replies to your questions

for swapnil my questions are
1. how common cystic fibrosis is within indians?
2. what are the contraindications of treadmill testing?
3. what are cardiac conditioning exercises?

tommorow ill send my topics.

[anisha kaushik]

jess will you please inform me about the topic which you gave previously
intravenous stents
CABGs

ill be thankfull to you