Podcasts about Salbutamol

En este episodio de Bioresp hablare de los efectos paradojicos menos mencionados del Salbutamol no sin antes dar un repaso por los proncipales receptores adrenergicos involucrados y enque hacer como medida inicial si alguno de estas reacciones aparecen de manera prematura , bienvenidos !

In dieser Folge beschäftigen wir uns mit den ß2-Sympathomimetika. Hier erkläre ich dir die Wirkung und was man alles beachten sollte. Warteliste zur Prüfungsvorbereitung: https://natuerlich-elli.de/hppruefung/ Folge mir auf Instagram: https://www.instagram.com/natuerlich_elli/?hl=de Folge Jenni auf Instagram: https://www.instagram.com/jenni_heilpraktikerin/ Komm in unsere kostenlose FB-Lerngruppe: https://www.facebook.com/groups/natuerlichelli

Folge 186: Fußpilz, Hantavirus und Salbutamol

En este capítulo hablamos del Salbutamol. Mecanismo de acción, indicaciones, reacciones adversas, y un par de cosas más. Que te sea de utilidad ! David Larrondo Fonseca   Links:   Zoll: https://www.zoll.com/es   DEAChile: https://deachile.cl/  Para consultar por alternativas para cardioproteger a tu comunidad escribe a contacto@deachile.cl    

Assessoria esportiva online e presencial: https://www.leandrotwin.com.br/ E-book Dieta Inteligente - Para Perder Gordura e Ganhar Massa Muscular só R$ 39,90: https://pay.hotmart.com/T77984348A?checkoutMode=10 Curso de Dieta (Monte a sua dieta ainda hoje): https://pay.hotmart.com/G56713152F?checkoutMode=10 Curso de Treino (Como montar seu treino periodizado): https://pay.hotmart.com/U72090251V?checkoutMode=10 Curso Sobre Esteroides Anabolizantes (Não use esteroides antes de fazer este curso): https://pay.hotmart.com/T64303539E?checkoutMode=10 Curso de Suplementação para Praticantes de Musculação: https://space.hotmart.com/pt-BR/twincursos/products Grupo do Telegram para promoções de todos os meus produtos: https://t.me/leandrotwin Instagram: https://www.instagram.com/leandrotwin/ Facebook: https://www.facebook.com/oficialleandrotwin?ref=hl Este vídeo é um oferecimento de: Oficial Farma: https://www.oficialfarma.com.br/ Growth Supplements: https://www.gsuplementos.com.br Atenção: As mensagens contidas em todos os vídeos de LeandroTwin não possuem o objetivo de substituir orientação de um profissional (independente da sua área de atuação). O vídeo é informativo. Qualquer rotina iniciada por conta própria é de responsabilidade do próprio.

Tecnologia é de fácil manuseio e a medicação é eficaz, mas tratamento pode trazer sérios riscos à saúde se não for acompanhado de orientação médica

En este video revisamos la farmacología de los principales broncodilatadores como los agonistas adrenérgicos (salbutamol, salmeterol), los antagonistas colinérgicos (ipratropio, tiotropio) y las xantinas (cafeína, tiofilína), vemos las indicaciones, los eventos adversos y las interacciones medicamentosas.Checa el video aquí: https://youtu.be/KZgO3t1nIMUVisita nuestra tienda en línea para comprar nuestros libros y material educativo:https://bit.ly/3i6eAnGSi necesitas una consulta aquí nos puedes encontrar:http://bit.ly/3aUSt12Unete al equipo de Mecenas en YouTube desde 1 dolar al mes: http://bit.ly/2O1AtsXSupport the show (https://www.paypal.com/donate?hosted_button_id=2ENWQ7V289PBE)

We’ve all seen headlines of athletes disgraced by a doping scandal, but what exactly is it the athletes are taking, and why? This week, Kate McMaster from the University of Tasmania talks to Niamh and Olly about her work researching the effects of insulin on an athlete’s performance, and the not-so-dope world of doping in sport. Kate is also the President of the newly formed UTAS Women’s Society and talks to us about the importance of a supportive feminist network.Show theme music: Kevin MacLeodHost: Niamh Chapman (@nchapmanTAS) & Olly Dove (@littledove440)Production: Meredith Castles (@meredithcastles), Olly Dove (@littledove440) & Sarah LydenMedia & Promotion: Olivia Holloway (@LivHolloway_), Kate Johnson (@KatePlantPhys)

Theme: Paediatrics. Participants: Dr Surbhi Rikhi, Dr Kerf Tan, Dr Pramod Chandru, Johann De Alwis (PEM trainee) Omal Fernando (PEM trainee), Min Park (EM trainee), Shreyas Iyer, Kit Rowe, Caroline Tyers and Samoda Wilegoda Mudalige.Discussion 1:Kuppermann, N., Dayan, P., Levine, D., Vitale, M., Tzimenatos, L., & Tunik, M. et al. (2019). A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatrics, 173(4), 342. https://doi.org/10.1001/jamapediatrics.2018.5501. Presenter - Johann De Alwis.Summary: Serious bacterial infections (SBIs); which include UTI, meningitis, and bacteraemia, lead to dangerous complications in infants. This was a prospective observational study between 2011 and 2013, looking at previously healthy febrile infants aged 60 days or younger, who were evaluated for SBIs. The clinical rule considered the urinalysis, absolute neutrophil count (ANC), and serum procalcitonin, and had a sensitivity of 97.7%, with a specificity of 60%, and a negative predictive value of 99.6%. One infant with bacteraemia and two with UTI who were misclassified.  This tool decreased the number of lumbar punctures performed, antibiotics administered, and infants admitted to the hospital.  Take-Home Points: Remember that these infants are the most at-risk population; do more rather than less. Safety net: no matter what you do or what investigations reveal, always have a safety net!  Discussion 2:Pan, P. (2020). Validation of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) Score in the Diagnosis of Testicular Torsion in Children With Acute Scrotum. Indian Pediatrics, 57(10), 926-928. https://doi.org/10.1007/s13312-020-1992-6.Presenter - Omal Fernando.Summary: The TWIST score includes - testicular swelling (2), hard testicle (2), absent cremasteric reflex (1), nausea or vomiting (1), a high-riding testicle (1).  Low risk was a score of 0-2, intermediate risk was a score of 3-4 and high risk was a score 5-7. Of those with testicular torsion, the mean TWIST score was 5.7 (none in low-risk category, 13 in intermediate-risk group, and 55 in high-risk group).  Of those without testicular torsion, the mean TWIST score was 1.46 (21 in low-risk group, 7 in the intermediate-risk group, and 0 in the high-risk group). All patients with a high-riding testis or absent cremasteric reflex were found to have testicular torsion. Take-Home Points: This score reminds us what we should be looking for when assessing a patient with acute testicular pain and thus help to build clinical gestalt, however, there is not enough evidence at present to rely on this tool alone (although this may change in the years to come).  It is important to involve the urologist/general surgeon if there is any suspicion of torsion. Given the time-critical nature of this presentation, patients should be taken to the theatre (rather than further investigated with ultrasound) if testicular torsion is suspected. Discussion 3:Iramain, R., Castro‐Rodriguez, J., Jara, A., Cardozo, L., Bogado, N., Morinigo, R., & De Jesús, R. (2019). Salbutamol and ipratropium by inhaler is superior to nebulizer in children with severe acute asthma exacerbation: Randomized clinical trial. Pediatric Pulmonology, 54(4), 372-377. https://doi.org/10.1002/ppul.24244.Presenter - Min Park. Take-Home Points: 103 children between the age of 2 and 14 years with severe asthma exacerbations (pulmonary score 7) were randomly allocated to a nebulizer or metred dose inhaler (MDI) and spacer with nasal prong oxygen. The primary outcome was the rate of hospitalization with the secondary outcome being oxygen saturations at 60 and 90 minutes. Children in the MDI group had significantly improved oxygen saturation from 60 minutes compared with the nebulizer group, with significantly lower rates of admission to hospital (5.8% vs. 27.5%).  Summary: MDIs may be at least equally effective if not more effective than nebulizers. MDIs are also cheaper and provide an opportunity to educate patients regarding their use. It is important to re-assess your patients following initial treatment. There may be variability in the way you approach each patient to meet their individual needs.  Always refer to your local guidelines.  Interlude Segment 1:Presenter - Dr Surbhi Rikhi.Interlude Segment 2:Presenter - Dr Kerf Tan.Resources (to support doctor well-being) -  Applications: Shift (Black Dog Institute app for healthcare workers), Calm, Headspace, Feeling Good, Smiling Minds, Insight Timer.   JMO support line (NSW): 1300 566 321. Access EAP (free confidential service for all NSW Health employees). Doctors for doctors: www.drs4drs.com.au. Beyond Blue: 1300 224 636. Lifeline: 13 11 14.  Suicide call-back service: 1300 659 467.  Other References:“Step by step” approach to the febrile infant -  Mintegi, S., Bressan, S., Gomez, B., Da Dalt, L., Blázquez, D., & Olaciregui, I. et al. (2013). Accuracy of a sequential approach to identify young febrile infants at low risk for invasive bacterial infection. Emergency Medicine Journal, 31(e1), e19-e24. https://doi.org/10.1136/emermed-2013-202449.Original study validating the TWIST score - Barbosa, J., Tiseo, B., Barayan, G., Rosman, B., Torricelli, F., & Passerotti, C. et al. (2013). Development and Initial Validation of a Scoring System to Diagnose Testicular Torsion in Children. Journal Of Urology, 189(5), 1859-1864. https://doi.org/10.1016/j.juro.2012.10.056.Starship Hospital (NZ) study examining nebuliser vs. MDI delivery for asthma - Klassen, T. (2001). Spacers were better and less expensive than nebulisers for giving albuterol to children with moderate to severe acute asthma. Evidence-Based Medicine, 6(1), 31-31. https://doi.org/10.1136/ebm.6.1.31.Further evidence regarding female ACS presentations (as covered in our previous episode) -van Oosterhout, R., de Boer, A., Maas, A., Rutten, F., Bots, M., & Peters, S. (2020). Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta‐analysis. Journal Of The American Heart Association, 9(9). https://doi.org/10.1161/jaha.119.014733.Sederholm Lawesson, S., Isaksson, R., Thylén, I., Ericsson, M., Ängerud, K., & Swahn, E. (2018). Gender differences in symptom presentation of ST-elevation myocardial infarction – An observational multicenter survey study. International Journal Of Cardiology, 264, 7-11. https://doi.org/10.1016/j.ijcard.2018.03.084.Credits:The discussions were mediated by PEM consultant Dr Surbhi Rikhi, ED consultant Dr Kerf Tan and, ED consultant Dr Pramod Chandru. This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney, Deepa Dasgupta, Cynthia De Macedo Franco, and Paul Scott.Music/Sound Effects Fable by Free Music | https://soundcloud.com/fm_freemusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Moments by Sarah Jansen Music | https://soundcloud.com/sarahjansenmusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  New Days by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Sunset Beach by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.   Warm Duck Shuffle by arnebhus | https://soundcloud.com/arnebhus, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. ~Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.

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Das Medikament des Monats Juni 2020 ist Salbutamol. Thorben erklärt euch die Details! Der Beitrag „titriert“ Salbumatol erschien zuerst auf pin-up-docs - don't panic.

Unsere neue Folge ist da! Dieses Mal ganz viel zu SHT, Status Epilepticus, Faktor 13-Mangel, Salbutamol und Übergaben im Sekundärtransport. Dazu natürlich Journal Club und News. Viel Spaß beim hören! Kommentare Meine TJ, Roe MT, Chen AY, et al. Association of intravenous morphine use and outcomes in acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. Am Heart J. 2005;149(6):1043-1049. […] Der Beitrag Podcast Juni 2020 – Folge 17 erschien zuerst auf pin-up-docs - don't panic.

Volvemos hoy a hacer una comparativa de medicamentos que puede llevar a confusión a muchos pacientes: El salbutamol y la budesonida. Estos medicamentos se prescriben en muchas ocasiones juntos, y cuando esto ocurre por primera vez hay que saber muy bien cómo usar los inhaladores en cuanto a técnica y también es importante el orden de aplicación. En este punto los farmacéuticos no deberíamos dar por hecho que el paciente sabe usarlos, así que en el momento de la dispensación es importante preguntar al paciente. Somos así de preguntones en el mostrador! pero es que es la mejor manera de garantizar un uso correcto de los medicamentos. Para hablar de estos dos inhaladores, sus diferencias y particularidades, viene hoy a Consejo Farmacéutico Yurena Hernandez @yuyuceutica. Yurena está en Canarias y es farmacéutica adjunta en oficina de farmacia con muchísima experiencia a su espalda, ya que empezó a trabajar como auxiliar mientras estudiaba la carrera Durante el capítulo, Yurena nos aclara los siguientes puntos: 1.Qué diferencia hay entre Salbutamol y Budesonida 2.Como se deben aplicar y en qué orden el salbutamol y budesonida 3. Como sabes que se han terminado los inhaladores En unos pocos minutos Yurena nos explica estas cuestiones relacionadas con el Salbutamol y la Budesonida. Ya para despedirme, agradecer a Yurena su participación en este proyecto en el que nos unimos tantos compañeros para educar en salud igual que hacemos cada día en el mostrador de la farmacia! Ante cualquier duda, podéis dejarla en comentarios en iVoox o en nuestra cuenta de Instagram Y si todavía necesitas más ayuda, ya lo sabes, consulta a tu farmacéutico! --------------------------------------------- Yurena en Instagram: @yuyiceutica Podcast en Instagram: @consejo.farmaceutico Mis RRSS: @belgaly

This episode covers acute asthma.Written notes can be found at https://zerotofinals.com/paediatrics/respiratory/acuteasthma/ or in the respiratory section in the Zero to Finals paediatrics.The audio in the episode was expertly edited by Harry Watchman.

This episode covers the viral induced wheeze.Written notes can be found at https://zerotofinals.com/paediatrics/respiratory/viralinducedwheeze/ or in the respiratory section in the Zero to Finals paediatrics.The audio in the episode was expertly edited by Harry Watchman.

FOAMmedic PHARMA ser denne gang på et af de allerførste medikamenter vi fik i medicinmapperne. Salbutamol eller ofte bedre kendt som Ventoline er nemlig fokus for denne episode. Inhalationsmedicin er spændende fordi det modsat mange af vores andre medikamenter primært har lokal virkning. Derfor har salbutamol ikke så mange bivirkninger eller stor systemisk optag. Der er mange ting at være opmærksom på ved anvendelsen af salbutamol. I PHARMA serien ser vi hovedsageligt på farmakologien, men når vi ser på salbutamol og de tilstande vi administrerer salbutamol til, kræver det også viden om respiration, ventilation og begreber som V/Q forhold. Salbutamol er en type af beta-2-agonister og salbutamol indgår også i flere kombinationspræparater. I dette afsnit forholder vi os til salbutamol som "stand alone" præparat men det er oplagt at vi senere kigger på andre beta-2-agonister eller ipratropium som indgår i flere af kombinationspræparaterne. Hør episoden her Hør med her når vi gennemgår salbutamol efter vores faste drejebog, og leg eventuelt med ved at udfylde det digitale skema som også kan bruges til at øve sig med. Det er en god ide at øve sig ved at forsøge at huske indholdet med passende mellemrum, det skaber bedre forbindelser i hjernen og sikrer at det kan hentes i langtidshukommelsen. Abonner eller hent via iTunes for iOS og for android via Podbean. Nu også via TUNE IN, STITCHER, Podimo Dette afsnits introspeak var leveret af vores gode ven og og Hall of FOAM'er Hans Henrik Schultz. Tak til Henrik for igen at være med her i FOAMmedic podcast. Hvis du ikke har hørt vores afsnit med Hans Henrik om stetoskopi så er det bestemt et lyt værd. Støt FOAMmedics arbejde med 5 eller 10 kr pr. podcast. Hvis du har lyst til at støtte vores arbejde med at lave lækker lyd og skrift så klik ind på 10er.dk og støt os med 5, 10 eller 15 pr. podcast episode, så bliver vi så sindsygt stolte og glade. Eller klik på 10'er logo her under og en pop-up løsning kommer frem. Disclaimer Det her er vores fortolkning af det pågældende medikament, det er ikke den endegyldige sandhed og vi opfordre som altid til at være kritisk over for den viden man hører og selv tjekke op på relevant viden og fakta. Du vil muligvis høre information eller om tilstande vedr. et medikament, hvor du ikke har delegation til at benytte medikamentet, men som udelukkende bliver omtalt, for at vi kan blive klogere i processen.Denne podcast er ikke en erstatning for pro.medicin.dk eller vores lokale retningslinjer Quiz Svar på forrige episodes quiz Spørgsmålet i quizzen fra PHARMA episoden om tranexamsyre og det var jo selvfølgelig et spørgsmål i noget med blod og blødninger. Spørgsmålet var: For mange mange år siden blev et af de første, hvis ikke verdens første randomiserede studie udført, under en krig, af en Britisk læge ved navn Alexander L. Hamilton. Men hvilken behandling var det han undersøgte med sit nytænkende måde at lave forsøg på,  ved hjælp af lodtrækning, hvor patienter altså blev lodtrukket til den ene eller den anden type behandling.  Svaret er "Bloodletting" eller på dansk Åreladning.  Mange år tilbage i tiden har der været en tro på at man ved at lade sig årelade. På den måde troede man at man kunne opnå en form for renselsesproces for legemet. Man mente det var en måde hvorpå man kunne komme af med "onde safter". Dengang var faktisk almindeligt at lade sig årelade én eller to gange om året. Det har også været anvendt som behandling for infektioner og selveste George Washington døde faktisk efter en infektion i halsen, hvor han over en ti timers periode lod sig årelade hele 3,5 liter. Hvad han så reelt døde af må stå hen i det uvisse. Der var desværre ingen som fandt det rigtige svar denne gang. Læs mere om Alexander L. Hamilton og han mange forsøg her. Spørgsmålet i denne episode er Denne gang tager vi til sportens verden hvor vi skal finde spørgsmålet til den...

ALBUTEROL (SALBUTAMOL) TANIM Albuterol (salbutamol olarak da bilinir), astım ve kronik obstrüktif akciğer hastalığı (KOAH) tedavisinde kullanılan kısa etkili, selektif bir β2-adrenerjik reseptör agonistidir. β2 reseptörleri için β1 reseptörlerine göre 29 kat daha seçicidir, bu da kalpte bulunan β1-adrenerjik reseptörlere karşı pulmoner beta reseptörleri için daha yüksek özgüllük sağlar. Albuterol, R ve S-izomerlerinin rasemik bir karışımı olarak formüle edilir. R-izomeri β2-reseptörü için S-izomerinden 150 kat daha fazla afiniteye sahiptir ve S-izomeri toksisite ile ilişkilendirilmiştir. Albuterol genellikle bronşiyal astım, kronik bronşit ve KOAH gibi diğer kronik bronkopulmoner bozuklukların neden olduğu akut bronkospazm atakları için kullanılır. Ayrıca egzersize bağlı astım için profilaktik olarak kullanılır. Etki Başlangıcı: Nebulizasyon solusyonu: ≤5 dakika. Kuru toz inhaleri

ALBUTEROL (SALBUTAMOL) TANIM Albuterol (salbutamol olarak da bilinir), astım ve kronik obstrüktif akciğer hastalığı (KOAH) tedavisinde kullanılan kısa etkili, selektif bir β2-adrenerjik reseptör agonistidir. β2 reseptörleri için β1 reseptörlerine göre 29 kat daha seçicidir, bu da kalpte bulunan β1-adrenerjik reseptörlere karşı pulmoner beta reseptörleri için daha yüksek özgüllük sağlar. Albuterol, R ve S-izomerlerinin rasemik bir …

Alle nordmenn, i alle fall de med ski på beina, har kjennskap til salbutamol. Eller kanskje hadde det vært greit med en liten gjennomgang av dette selv for dere?

I denne lille wee vender vi spørgsmålet om hvorfor der ikke må administreres forstøvet Salbutamol til børn under 1 år. Ved du det mon? eller er du på lige så dybt vand som vi var vedr. dette spørgsmål. Det viser sig at være et mysterie som både bunder i manglende udvikling af receptorer men også et område som ikke er fuldt afdækket. Men skader det? Det og meget mere i denne lille Wee. Abonner eller hent via iTunes for iOS og for android via Podbean. Nu også via TUNE IN En stor tak til Læge Camilla Birgitte Sørensen som også er en del af scanFOAM crewet, og til Paramediciner Nikolaj Folkersen for sparring og debat om dette emne. Det er dage som dem med jer der skaber alle de spændende ideer der ligger til grund for indhold som dette. Easing the wheeze - Wiley Online Library Astma hos børn - Dansk pædiatrisk selskab Allergologi og pulmonologi - Dansk Pædiatrisk selskab Medicin.dk - Ventoline Astma Bronkitis - behandling og definitioner af sværhedsgrad og alder - Region H Støt FOAMmedics arbejde med 5 eller 10 kr pr. podcast. Hvis du har lyst til at støtte vores arbejde med at lave lækker lyd og skrift så klik ind på 10er.dk og støt os med 5, 10 eller 15 pr. podcast episode, så bliver vi så sindsygt stolte og glade. Eller klik på 10'er logo her under og en pop-up løsning kommer frem. DISCLAIMER De råd og informationer som gives i denne podcast er vores fortolkning af det pågældende indhold, det er ikke den endegyldige sandhed og vi opfordrer som altid til at være kritisk over for den viden man hører og selv tjekke op på relevant viden og fakta. Du vil muligvis høre information om tilstande, produkter eller medikament, hvor du ikke har uddannelse eller delegation til at benytte den mulighed, men som udelukkende bliver omtalt, for at vi kan blive klogere i processen.Denne podcast er ikke en erstatning for dine lokale retningslinjer.

In this episode I cover Chronic Obstructive Pulmonary Disease (COPD).If you want to follow along with written notes on chronic obstructive pulmonary disease go to https://zerotofinals.com/copd or find the respiratory section in the Zero to Finals medicine book.This episode covers the pathophysiology, triggers, presentation, diagnosis and management of COPD. We also discuss acute exacerbations of COPD. The audio in the episode was expertly edited by Harry Watchman.

In this episode I cover acute asthma.If you want to follow along with written notes on asthma go to https://zerotofinals.com/medicine/respiratory/acuteasthma/ or find the respiratory section in the Zero to Finals medicine book.This episode covers the pathophysiology, triggers, presentation, diagnosis and management of acute asthma. The audio in the episode was expertly edited by Harry Watchman.

In this episode I cover asthma.If you want to follow along with written notes on asthma go to https://zerotofinals.com/asthma or find the respiratory section in the Zero to Finals medicine book.This episode covers the pathophysiology, triggers, presentation, diagnosis and management of asthma. The audio in the episode was expertly edited by Harry Watchman.

All About Salbutamol, for paramedics. For show notes visit www.paramedicine.com

Stefan Fatsis and Josh Levin are joined by Dallas Wings star Liz Cambage to discuss the state of the WNBA. VeloNews’ Frederick Dreier talks about the Tour de France. Finally, Keith Barnes of the Mamie Johnson Little League talks his history-making team. Liz Cambage (1:42): The All-Star center has spoken out against basketball's gender wage gap and WNBA officiating. Will the league listen? Tour de France (19:25): What do we know about Tour de France winner Geraint Thomas? Is it good for cycling that the Chris Froome era is winding down? And what should we make of Lance Armstrong’s latest apology? Little League (38:04): A squad representing the Mamie "Peanut" Johnson Little League just became the first all-black team to win the Washington D.C. city championship. The league president explains how they got there. Afterballs(51:15): Stefan on a beloved Boston journalist who wrote about the ravages of the NFL and Josh on what LeBron James Jr. can learn from Michael Jordan’s kids. Learn more about your ad choices. Visit megaphone.fm/adchoices

Stefan Fatsis and Josh Levin are joined by Dallas Wings star Liz Cambage to discuss the state of the WNBA. VeloNews’ Frederick Dreier talks about the Tour de France. Finally, Keith Barnes of the Mamie Johnson Little League talks his history-making team. Liz Cambage (1:42): The All-Star center has spoken out against basketball's gender wage gap and WNBA officiating. Will the league listen? Tour de France (19:25): What do we know about Tour de France winner Geraint Thomas? Is it good for cycling that the Chris Froome era is winding down? And what should we make of Lance Armstrong’s latest apology? Little League (38:04): A squad representing the Mamie "Peanut" Johnson Little League just became the first all-black team to win the Washington D.C. city championship. The league president explains how they got there. Afterballs(51:15): Stefan on a beloved Boston journalist who wrote about the ravages of the NFL and Josh on what LeBron James Jr. can learn from Michael Jordan’s kids. Learn more about your ad choices. Visit megaphone.fm/adchoices

Why do so many pro cyclists have asthma and what can the rest of us learn from it? In this show 33Fuel co-founder, endurance athlete and 35-year Salbutamol user Warren digs into this thorny subject, and uncovers the huge (legal) marginal gain that pro and amateur athletes alike are overlooking. It's such an easy win, it's incredible no one's made the most of it before now and it has huge implications for all athletes, particularly any suffering with asthma. At 33Fuel we deliver maximum value to endurance athletes. We do that in this podcast by sharing the latest in training & nutrition advice, inspiration & motivation. We do it at 33fuel.com with our unique & powerful natural nutrition products for runners, cyclists & triathletes. WEBSITE: https://www.33fuel.com/all-products/ TWITTER: www.twitter.com/33fuel FACEBOOK: www.facebook.com/33fuel INSTAGRAM: https://www.instagram.com/33fuel/ EMAIL: contact@33shake.com

Adam Green, Molly Weaver and Bradley Wiggins discuss the first few days of racing at the 2018 Tour de France and preview all the main GC and green jersey contenders.They also look into The World Anti-Doping Agency clearing Chris Froome plus reveal the secrets of the 'gruppetto'. See acast.com/privacy for privacy and opt-out information.

As far as lead-ups to the Tour de France are concerned, 2018 has been one of the craziest. First, Tour organizer ASO bans Chris Froome from racing. Then, the UCI clears him of any wrongdoing in the Salbutamol case. So now he's back in! How did this all take place? What do anti-doping experts say? What do other pro teams think? And will Froome even win this race? We answer all those questions and more. This episode of the VeloNews podcast is sponsored by CycleOps, makers of the Hammer indoor smart trainer. The VeloNews editorial staff may be hunched over computers all day during the Tour de France, but we can stay fit all July, day or night, by hopping on the Hammer and riding in our favorite virtual training app, like Zwift, Rouvy, TrainerRoad, or The SufferFest. Learn about the Hammer here: https://www.cycleops.com/product/hammer

As far as lead-ups to the Tour de France are concerned, 2018 has been one of the craziest. First, Tour organizer ASO bans Chris Froome from racing. Then, the UCI clears him of any wrongdoing in the Salbutamol case. So now he's back in! How did this all take place? What do anti-doping experts say? What do other pro teams think? And will Froome even win this race? We answer all those questions and more. This episode of the VeloNews podcast is sponsored by CycleOps, makers of the Hammer indoor smart trainer. The VeloNews editorial staff may be hunched over computers all day during the Tour de France, but we can stay fit all July, day or night, by hopping on the Hammer and riding in our favorite virtual training app, like Zwift, Rouvy, TrainerRoad, or The SufferFest. Learn about the Hammer here: https://www.cycleops.com/product/hammer

Val di Sole, Mercedes-Benz UCI MTB Weltcup, RED BULL TV, Noirmoutier-en-l'Île, Bretagne, Tour de France, UCI, Team Sky, Chris Froome, Salbutamol

Caner Eler ile İnan Özdemir, Tour de France öncesi Salbutamol davasından aklanan Chris Froome'u konuştu. Bu karar adil mi? Çifte standart mı var? Bundan sonra ne olacak?

Adriatica Ionica Race, Terre di Asolo e Montegrappa, Elia Viviani, Quick-Step Floors, Simone Consonni, UAE Team Emirates, Mihkel Raim, Israel Cycling Academy, Ukrainische Meisterschaften im Einzelzeitfahren, Adrnej Grivko, Astana, Schwedische Meisterschaften im Einzelzeitfahren, Tobias Ludvigsson, Groupama-FDJ, Meisterschaften im Einzelzeitfahren in Slowenien, Jan Tratnik, CCC Sprandi, Chris Froome, Team Sky, Salbutamol, Bernard Hinault, Eddy Merckx, Telegraph

Mit ihm hatte am Ende wohl keiner ganz oben gerechnet. Chris Froome gewinnt trotz eines Sturzes zum Auftakt, trotz zäher zweieinhalb Woche tatsächlich den Giro d'Italia 2018. Auf der 19. Etappe hatte er dafür mit einem Soloritt den Grundstein gelegt. Allerdings ist dieser dritte Grand-Tour-Sieg in Folge für Froome erstmal unter Vorbehalt zu genießen. Denn ob er ihn behalten darf, wird erst die anhängige Entscheidung in der Salbutamol-Affäre, erweisen. Malte Asmus und Lukas Kruse über den Erfolg des Briten, die Zweifel die damit einhergehen und alles weitere zum Radsportwochende....

Mit ihm hatte am Ende wohl keiner ganz oben gerechnet. Chris Froome gewinnt trotz eines Sturzes zum Auftakt, trotz zäher zweieinhalb Woche tatsächlich den Giro d'Italia 2018. Auf der 19. Etappe hatte er dafür mit einem Soloritt den Grundstein gelegt. Allerdings ist dieser dritte Grand-Tour-Sieg in Folge für Froome erstmal unter Vorbehalt zu genießen. Denn ob er ihn behalten darf, wird erst die anhängige Entscheidung in der Salbutamol-Affäre, erweisen. Malte Asmus und Lukas Kruse über den Erfolg des Briten, die Zweifel die damit einhergehen und alles weitere zum Radsportwochende. Du möchtest deinen Podcast auch kostenlos hosten und damit Geld verdienen? Dann schaue auf www.kostenlos-hosten.de und informiere dich. Dort erhältst du alle Informationen zu unseren kostenlosen Podcast-Hosting-Angeboten.

Niklas Larsen, der mest er kendt fra banen, vandt i den forgangne uge to landevejsløb. Niklas fortæller om sin karriere og de seneste fremgange. Magnus Cort afslører hvordan han æder sig selv i spurten, som f.eks. da han besejrede Greg Van Avermaet i Tour de Yorkshire og vandt en etape. Vi analyserer Chris Froome-sagen og sætter fokus på Salbutamol og de seneste studier. Ligesom vi naturligvis vender den aktuelle udvikling i årets Giro d'Italia.

The first grand tour of the 2018 season gets underway on Friday. The Giro d'Italia kicks off with a time trial in Jerusalem, making it the first grand tour to begin beyond European soil. The start list is an impressive one, with Chris Froome (Sky) making an attempt at the first half of a Giro-Tour double — assuming he is not suspended for his adverse analytical finding for Salbutamol — and he's not the only big name set to be in attendance. Defending champ Tom Dumoulin (Sunweb), Fabio Aru (UAE Team Emirates), Thibaut Pinot (Groupama-FDJ), and rising star Miguel Ángel López (Astana) will also be in the mix for the three-week race. The Recon Ride talks route and favorites ahead of the Italian grand tour — and also hears from GC contender Simon Yates, who forms part of a dangerous Mitchelton-Scott two-pronged attack with Esteban Chaves.

The first grand tour of the 2018 season gets underway on Friday. The Giro d'Italia kicks off with a time trial in Jerusalem, making it the first grand tour to begin beyond European soil. The start list is an impressive one, with Chris Froome (Sky) making an attempt at the first half of a Giro-Tour double — assuming he is not suspended for his adverse analytical finding for Salbutamol — and he's not the only big name set to be in attendance. Defending champ Tom Dumoulin (Sunweb), Fabio Aru (UAE Team Emirates), Thibaut Pinot (Groupama-FDJ), and rising star Miguel Ángel López (Astana) will also be in the mix for the three-week race. The Recon Ride talks route and favorites ahead of the Italian grand tour — and also hears from GC contender Simon Yates, who forms part of a dangerous Mitchelton-Scott two-pronged attack with Esteban Chaves.

Met Dave Bruylandts himself reviewen we in feite het voorjaar van 2018. Van ronde wielen tot borden leegeten en van het belang van een ploeg tot salbutamol!

Met Dave Bruylandts himself reviewen we in feite het voorjaar van 2018. Van ronde wielen tot borden leegeten en van het belang van een ploeg tot salbutamol!

(14.2.2018) V Kolumbii si môžu po premiérovom ročníku Colombia Oro y Paz gratulovať. Top borci domácej scény žali úspech na rovine aj v kopcoch a v spojení s juhoamerickým temperamentom popri trati sa bolo na čo pozerať. V Dubaji zaknihoval úspešný týždeň Elia Viviani, čo sa nedá povedať o súhre vlaku Marcela Kittela. Na Ruta del Sol sa postaví na štart donekonečna skloňovaný Chris Froome, ktorý by sa v dohľadnej dobe mal postaviť pred antidopingový tribunál UCI. Očakávame solídny cirkus. Foto: facebook.com/RideArgyle

With brutal mud on a gnarly course, 'cross worlds didn't disappoint... and neither did the U.S. women's team. We recap and analyze the battle between Sanne Cant and Katie Compton. Then, we try to make sense of why the tables turned in the ongoing rivalry between Mathieu van der Poel and Wout van Aert. Of course, the podcast wouldn't be complete without an update on Chris Froome. Turns out, he's going to race in a week or so, despite the Salbutamol scandal. We debate whether this is the right move or not. Andrew Hood takes the pulse of the peloton to see if fellow pro riders want to see Froome back at the races.

With brutal mud on a gnarly course, 'cross worlds didn't disappoint... and neither did the U.S. women's team. We recap and analyze the battle between Sanne Cant and Katie Compton. Then, we try to make sense of why the tables turned in the ongoing rivalry between Mathieu van der Poel and Wout van Aert. Of course, the podcast wouldn't be complete without an update on Chris Froome. Turns out, he's going to race in a week or so, despite the Salbutamol scandal. We debate whether this is the right move or not. Andrew Hood takes the pulse of the peloton to see if fellow pro riders want to see Froome back at the races.

Chris Froome leverde in de Vuelta a España een positieve Salbutamol-plas af. 'Een schok voor de wielerwereld' en 'schorsen die man!', klonk het op tv en sociale media. UCI-voorzitter David Lappartient riep Team Sky zelfs op Froome voorlopig te schorsen. Froome zelf zei Salbutamol nodig te hebben om zijn astma te bestrijden. Uitdroging en nierproblemen zouden de te hoge waarde in zijn urine hebben veroorzaakt. Met dopingexpert Douwe de Boer bespreekt Benjamin de Bruijn in deze tweede aflevering van Cassette het aanstaande proces in de zaak-Froome. De Boer: "Zet hem in een sauna, geef hem hetzelfde aantal pufjes als in de Vuelta en kijk dan wat zijn waarde is."

Bill and Geoff are back to break down the top stories in the world of sport and beyond. This week the guys react to some recent doping stories including Chris Froome’s explanation for his Salbutamol levels and the controversy surrounding Munster’s Gerbrandt Grobler. Also on the agenda are the likely Champions Cup quarter final line-ups and John Murnane breaks down the Divisional Round in the NFL playoffs, some guerrilla PR in the NBA and the end of the world in Hawaii. Segments include the debut of the “Gary Lineker Woke-O-Meter”. This episode is brought to you by Waterford Beer Tours. Use the offer code " SPORTSBEEF" for a €5 discount. Mention John “Heavy in the Streets” Murnane and get €6 off! For more info, go to waterfordbeertours.com

Merry Xmas! This weeks post was inspired by a recent unexpected case of severe hyperkalaemia in a severe pre-eclamptic - I have put together a fictitious case which is a little more severe in order to illustrate the principles of managing hyperkalaemia - I hope you enjoy & take it easy over Xmas! CASE HISTORY (*A fictitious patient history ) Your pager goes off - code blue medical labour ward! On arrival you are told the patient for whom the code was called has just arrived following an urgent transfer from another hospital. She presented to their service at 31 weeks with a headache, BP 190/100, proteinuria and mildly raised creatinine. She was diagnosed with severe pre-eclampsia, given labetalol, nifedipine and then transferred. She now appears confused with the following vital signs: HR 33/min, BP 74/55, SpO2 92%, RR 17/min (*Image courtesy www.lifeinthefastlane ) An immediate venous blood gas shows the following result: Na 139, K 8.4, pH 7.23, pCO2 37, pO2 63, Lactate 1.8 How are you going to manage this patient?   Immediate Standard Mgmt 1 - Is it real? Common causes of high potassium includes hemolysis of red cells from the sampling and handling process.  Always do an ECG whilst awaiting a repeat result - if the patient is compromised and the ECG is abnormal / consistent with hyperkalaemia then assume it is real and don't delay your treatment! The quickest way to get a repeat sample is usually a VBG this usually only takes a few minutes and will also give you the glucose and pH - important values to know for both mgmt and diagnosis. 2 - Prevent an arrhthymia Immediate mgmt - stabilise the cardiac membrane with intravenous calcium. Most guidelines recommend calcium if there are ECG changes or the absolute K level is over 7mmol/L. *Calcium chloride has 3 times more calcium than calcium gluconate. 3 - Shift K intracellularly a) Insulin / Glucose. Usual dose 10units actrapid + 25-50ml 50% Dextrose Stimulates Na/K/ATPase Give glucose to prevent hypoglycaemia' Lowers K by 0.5 -1 mmol/L per hour b) Salbutamol 20mg neb Good choice if the patient is bradycardic (common in severe hyperK) Stimulates Na/K/ATPase also c) NaHCO3 (if acidotic) When acidosis exists H+ is exchanged for intracellular K+ Makes sense to consider NaHCO3 if acidosis is present 50-100ml of NaHCO3 8.4% 4 - Eliminate K from the body (usually renal) - Enhance renal elimination - diuretics (e.g. frusemide), K free crystalloid (if indicated - saline) or both! - Dialysis - institute early in patients with complete renal failure -  GI exchange resins (eg resonium) most guidelines now consider they have no role in the acute management. 5 - Identify and treat the cause! - You need to address this issue to stop if from recurring! Usually multiple factors combine to lead to hyperkalaemia. Fix reversible causes especially drugs! Don't rely on your memory - get their medication chart out then google all the known drugs that can cause hyperkalaemia! Drugs Known to Cause / Contribute to hyperkalaemia (either impair excretion or promote transcellular shift) ACE inhibitors / AT2 antagonists Spironolactone / Amiloride NSAIDs Beta blockers (see discussion below) Trimethoprim Heparin Pentamidine Suxamethonium Renal dysfunction - almost always there is a degree of renal impairment preventing excretion of the excess K load. Make sure you aren't missing important reversible causes - e.g. obstruction (consider USS renal tract urgently).  Cell release (eg hemolysis, tumour lysis, trauma or extensive surgical injury). In our O& G patients this includes widespread tissue injury especially after major surgery or perhaps chemotherapy. BUT This is a pregnant woman with PET - renal impairment, acidosis, hemolysis, transfusion - these are common events in our pregnant patients. Cardiac Arrest Secondary to Hyperkalaemia

Nadie Entrena vuelve, con su 5º programa, en vísperas de la Navidad, y cargadito de regalos. Es este capítulo Pedro y Paolo os hablamos de los aparatos tecnológicos que usamos cuando entrenamos, y después del entrenar o hacer deporte y por supuesto, os recomendamos los mejores. Pero también tenemos una lista de regalos de todo tipo para que esta Navidad te vayas perfectamente equipado, y ya no tengas excusas para "no entrenar". ¿Qué usamos nosotros? - Garmin Edge 520: http://amzn.to/2ySHcZ9 - Garmin Edge 520 con el pack de cinta de pulso y sensores de candencia y velocidad http://amzn.to/2BFg4SG - Lifesum, app muy buena para medición de calorías y control del % de nutrientes. - Cycling Analytics: Medición y seguimiento de entrenamientos especialmente para quienes entrenan con vatios. - Garmin Forerunner 235 - Sólo el dispositivo, en OFERTA ahora- http://amzn.to/2BDMWvh - Strava, por supuesto. - Y hablamos del Apple Watch (http://amzn.to/2oKuk7F) como complemento deportivo y como uno de los mejores smartwatchs del mercado. Es un perfecto aliado para un seguimiento pasivo de recuperación (track de pulsaciones, descanso, sueño) Y para ello, recomendación de dos aplicaciones para el Apple Watch imprescindibles: - HeartWatch: Seguimiento de pulso a lo largo del día - AutoSleep: Medición del pulso y la calidad del sueño Entrenamiento por pulsaciones: Cómo calcular tus zonas de frecuencia cardíaca http://www.palabraderunner.com/karvonen-calcular-zonas-de-pulsaciones/ Y vamos a lo importante, a la GUÍA DE REGALOS Tecnológicos: Para Ciclistas: - Para todos los niveles -Previo Medio- Garmin Edge 520 http://amzn.to/2ySHcZ9 - Para iniciarse con un medidor de potencia Powertap G3: Pack con las dos ruedas http://www.wiggle.es/ruedas-de-aleacion-powertap-g3-dt-swiss-460-para-cubierta/ - Plataformas para seguimiento de entrenamientos: La más popular Strava Premium, la más profesional: Training Peaks, una opción gratuita: StriveMax, o la mejor calidad/precio: Cycling Analitics. - Báscula de peso Xiaomi MI Scale 2: Medición de grasa, músculo, y con app para hacer un seguimiento https://www.gearbest.com/body-scale/pp_615115.html?lkid=11794224 Para Corredores: - Dispositivo básico para corredores Opción 1: Garmin Forerunner 35 http://amzn.to/2oFjcJ2 - Dispositivo básico para corredores Opción 2: Polar M200 http://amzn.to/2oEOW10 - Dispositivo Gama Media para corredores: Garmin Forerunner 235 http://amzn.to/2BDMWvh - Dispositivo Gama Media para corredores: Polar M430 http://amzn.to/2BG4man - Banda de frecuencia cardíaca por Blueetoth para usarla con el móvil: Decathlon Geonaute y las bandas, un poco más completas de Wahoo http://amzn.to/2CYIHbm - Auriculares para corredores Bluetooth mejor Calidad/precio: Mpow (http://amzn.to/2oIZRa2) o los SoundPeats (http://amzn.to/2B8T1jI) - Auriculares para corredores Bluetooth Premium: Plantronics http://amzn.to/2oFg7sf - Más opciones de auriculares para correr http://www.palabraderunner.com/los-mejores-auriculares-bluetooth-para-correr/ Regalos no Tecnológicos: - Ropa interior de Lana de Merino y Guantes de Seda: Los mejores aliados contra el frío. - Gafas de sol fotocromáticas buenísima relación Calidad / Precio - Medias de compresión para después de hacer ejercicio: INDISPENSABLES - Calcetines de calidad y técnicos: Estos o estos otros. - Foam Roller para estirar y relajar músculos ó una Duo Ball http://amzn.to/2yT41LZ Más información sobre el forma roller: http://www.palabraderunner.com/foam-roller/ - Bandas elásticas para ejercitarte en casa http://amzn.to/2CV8zVw - Prueba de esfuerzo o análisis Biomecánico, para corredores o ciclistas. http://www.bionort.es/ Y para terminar y dejar tanto regalo, hablamos de RETOS y propósitos. Nos hemos animado a correr un par de cosas antes de que acabe el año. Descúbrelas escuchando el podcast :P Y os recomendamos mucho y muy fuerte una carrera que se hace en Madrid. Reserva el 14 de Enero porque es El Trail del Serrucho. Un precioso trail de 24 kms con unos 400 metros de desnivel, con una organización magnífica. De lo mejor que puedes correr en Madrid. ANEXO: Comentamos el positivo por dopaje de Salbutamol de Chris Froome durante la pasada Vuelta a España. Recuerda, puedes seguirnos en: Facebook: https://www.facebook.com/nadieentrena Instagram: https://www.instagram.com/nadie_entrena/ Twitter: https://twitter.com/nadie_entrena/ Club de Nadie Entrena en Strava: https://www.strava.com/clubs/Nadientrena Hasta el próximo programa :) Síguenos en: Club de Nadie Entrena en Strava: https://www.strava.com/clubs/Nadientrena Pedro en Instagram: https://instagram.com/palabraderunner/ Paolo en Instagram: https://instagram.com/paoloac/ Diario Runner, el podcast de Pedro https://www.ivoox.com/podcast-diario-runner_sq_f1821071_1.html Facebook: https://www.facebook.com/nadieentrena/ Instagram: https://www.instagram.com/nadie_entrena/ Twitter: https://twitter.com/nadie_entrena/ Pedro en Twitter https://twitter.com/palabraderunner/ Paolo en Twitter https://twitter.com/paoloac/

We break down the key storylines behind Chris Froome's doping test from the Vuelta. He went over the limit for Salbutamol. Now, Froome and Sky have a chance to explain themselves, but a pall of doubt has been cast over his four Tour wins and that Vuelta victory. We speak with Andrew Hood who has insider knowledge from an anti-doping expert and a lawyer. This is cycling's biggest story in years — stay tuned as new developments come to light. Want to win a smart trainer? Enter Bkool's winter VeloNews giveaway. Everyone who signs up gets three free months of the Bkool online simulator! Go to: http://www.bkool.com/partners/velonews

We break down the key storylines behind Chris Froome's doping test from the Vuelta. He went over the limit for Salbutamol. Now, Froome and Sky have a chance to explain themselves, but a pall of doubt has been cast over his four Tour wins and that Vuelta victory. We speak with Andrew Hood who has insider knowledge from an anti-doping expert and a lawyer. This is cycling's biggest story in years — stay tuned as new developments come to light. Want to win a smart trainer? Enter Bkool's winter VeloNews giveaway. Everyone who signs up gets three free months of the Bkool online simulator! Go to: http://www.bkool.com/partners/velonews

Doctor Mark Fulcher, who talks about the use of Salbutamol and how professional athletes might look to use and abuse it, after the case of cyclist Chris Froome saw him produce samples at 2 times the limitLISTEN ABOVE AS MARK FULCHER SPEAKS WITH D'ARCY AND GORAN

Doctor Mark Fulcher, who talks about the use of Salbutamol and how professional athletes might look to use and abuse it, after the case of cyclist Chris Froome saw him produce samples at 2 times the limitLISTEN ABOVE AS MARK FULCHER SPEAKS WITH D'ARCY AND GORAN

December 14 | In this episode of The Cycling Podcast, Richard Moore, Lionel Birnie and Daniel Friebe react to the news that the 2017 Tour de France and Vuelta a España winner Chris Froome has questions to answer after a urine sample from the Vuelta showed higher than permitted levels of the asthma drug salbutamol. What has happened, what are the precedents and what will happen next? The Cycling Podcast is supported by Rapha and Science In Sport.

El médico español Pedro Manonelles dijo que el medicamento usado por Froome es estimulante y anabolizante.See omnystudio.com/listener for privacy information.

En este episodio de ‘Al Cierre, con Andrés Mompotes’ escuche la conversación con el editor Internacional de EL TIEMPO, Eduard Soto, quien analiza las razones que movieron al gobierno de Donald Trump a ofrecer un diálogo directo y sin condiciones al régimen de Kim Jong-Un. La decisión ha sido aplaudida por la comunidad internacional y representa un giro en la política estadounidense que hasta ahora había reaccionado con dureza a todos los avances nucleares de los norcoreanos. ¿Significa esto que la Casa Blanca considera que cada vez es más seria la probabilidad de que Corea del Norte realice alguna aventura bélica de carácter nuclear? Además, en este podcast ¿qué puede perder realmente el ciclista Chris Froome en caso de que se llegue a confirmar que usó de forma intencional para mejorar su rendimiento deportivo el medicamento Salbutamol, droga utilizada para controlar los episodios de asma?, qué debate está inmerso en el caso del asiático Wu Yongning, un escalador que acostumbraba a grabarse en video en las cimas de rascacielos sin ningún tipo de protección y que murió frente a una de sus cámaras cuando cayó al vacío mientras intentaba ganar más admiradores en las redes sociales y ¿qué consejos debe tener en cuenta para la nueva edición de la ciclovía nocturna de este jueves en Bogotá?

Die kongenitalen myasthenen Syndrome (CMS) stellen eine Gruppe seltener hereditärer Erkrankungen dar, die auf einer Störung im Nerv-Muskel-Signalübertragungsweg beruhen. Hinsichtlich Pathogenese, Molekulargenetik und klinischer Symptomatik zeichnen sich diese Syndrome durch eine starke Heterogenität aus, die eine Einteilung in CMS-Unterformen erforderlich macht. Die bislang bekannt gewordenen krankheitsursächlichen CMS-Gene kodieren in vielen Fällen für Synapsen-assoziierte Proteine. Um so überaschender war die kürzliche Entdeckung, dass Mutationen im Gen GFPT1, kodierend für das Schlüsselenzym des Hexosamin-Stoffwechselwegs, und zwar der Glutamin-Fruktose-6-Phosphat-Amidotransferase 1 (GFAT1), krankheitsauslösend für ein CMS mit Gliedergürtelbetonung sind. Dies ließ vermuten, dass ein neuer Pathomechanismus – nämlich Glykosylierungsstörungen – dieser CMS-Untergruppe zugrunde liegen könnte. Damit rückten weitere Gene für Enzyme des Hexosamin-Stoffwechselweges als Kandidatengene für CMS in den Fokus. Hauptschwerpunkt dieser Promotionsarbeit war deshalb, eine Kohorte von CMS-Patienten auf krankheitsrelevante Mutationen in den Hexosamin-Biosynthese-Genen GNPNAT1, PGM3, UAP1 und OGT zu untersuchen. Die Kohorte bestand aus insgesamt 44 CMS-Patienten, größtenteils solchen mit dem besonderen Phänotyp der Gliedergürtelbeteiligung (38 Patienten), zum kleineren Teil solchen mit bisher ungeklärter genetischer Ursache (6 Patienten). Jedoch konnte in keinem dieser Fälle eine mutmaßlich pathogene Sequenzveränderung in den genannten vier Kandidatengenen detektiert werden. Ein weiterer Schwerpunkt der vorliegenden Arbeit lag darin, die vorgestellte Gliedergürtel-Kohorte auf bereits bekannte, jedoch nur äußerst selten nachgewiesene, CMS-verursachende Mutationen zu analysieren. Hierzu zählen vor allem Mutationen in MUSK, einem essentiellen Gen für eine an der neuromuskulären Synapsenbildung beteiligten Kinase. Weltweit sind hier überhaupt nur 5 Fälle/Familien in der Literatur beschrieben. Erstmals konnten im Rahmen dieser Arbeit bei einem Patienten die Sequenzvariante MUSK p.Asp38Glu und eine größere Deletion im MUSK-Gen nachgewiesen werden. Funktionelle Studien auf Ebene der MUSK-mRNA-Transkripte im Patientenmuskel, bioinformatische Daten und die Segregationsanalyse in der Familie lassen den Schluss zu, dass diese beiden Mutationen sehr wahrscheinlich als pathogen einzustufen sind. Klinisch fiel ein ausgezeichnetes Ansprechen auf Salbutamol auf, welches bei MUSK-CMS-Patienten bisher noch nicht beschrieben war. Die Analyse weiterer bekannter CMS-Gene in Patienten beider Kohorten führte zum Nachweis bereits beschriebener Frameshift-Mutationen in CHRNE, die bekanntermaßen zu einer verminderten Expression des Acetylcholinrezeptors an der Oberfläche von Muskelzellen führen. Neben den häufigen Mutationen c.1327delG in homozygoter Form und c.1353dupG in homozygoter und compound heterozygoter Form - beides Founder-Mutationen in der Population der Roma bzw. der nordafrikanischen Bevölkerung - wurde die Mutation c.70insG in compound heterozygoter Form gefunden. Interessanterweise lag bei zwei der hier beschriebenen vier CHRNE-Patienten ein Phänotyp mit prominenter Gliedergürtelschwäche vor, was für CHRNE-CMS-Patienten mit typischerweise im Vordergrund stehender okulärer Beteiligung ungewöhnlich ist. Zusammengefasst zeigen die im Rahmen dieser Arbeit identifizierten Patienten mit CHRNE-Mutationen klinisch eine unerwartet große Heterogenität. Ein Patient mit distal betonter Muskelschwäche aus der Kohorte mit ungewöhnlichen Phänotypen wies die Sequenzvariante c.866C>A/p.Ser289Tyr in CHRND in heterozygoter Form auf. Diese bisher nicht funktionell untersuchte Variante stellt eine autosomal dominant vererbte Slow-Channel-Mutation dar und führt möglicherweise wie die an gleicher Position lokalisierte, jedoch schon funktionell charakterisierte Mutation p.Ser289Phe zu einer verlängerten Kanalöffnungszeit des Acetylcholinrezeptors. Im Unterschied zu anderen CHRND-Patienten war phänotypisch jedoch keine respiratorische Beteiligung erkennbar. Bei einem weiteren Patienten mit Gliedergürtelphänotyp konnten zwei Sequenzvarianten nachgewiesen werden, deren pathogenes Potential aufgrund der Ergebnisse der in silico- und Segregationsanalyse, wenn überhaupt, als sehr gering einzustufen ist. Zum einen fand sich in CHRNB1 die Sequenzveränderung p.Val113Met heterozygot. Daneben war der Patient Träger der Sequenzvariante c.1137-3del in OGT, die abschließend auf Grund der Ergebnisse der in silico- und Segregationsanalyse ebenfalls als nicht krankheitsverursachend einzuschätzen ist. Zusammenfassend konnte im untersuchten Patientenkollektiv zwar keine krankheitsursächliche Mutation der Kandidatengenene des Hexosamin-Biosynthesewegs, i.e. GNPNAT1, PGM3, UAP1 und OGT, nachgewiesen werden. Die grundsätzliche pathogene Relevanz von Genen, die eine Rolle bei Glykosylierungsvorgängen spielen, wurde jedoch zwischenzeitlich durch Identifikation von Mutationen in den Genen DPAGT1, ALG2 und ALG14 bei CMS gezeigt. Eine vergleichende Gegenüberstellung der Phänotypen der im Rahmen der Arbeit genetisch aufgeklärten CMS-Patienten bestätigte die große klinische Heterogenität innerhalb der Krankheitsgruppe und zum Teil auch unter Patienten mit identischen Genotypen. Die Ergebnisse der vorliegenden Arbeit ermöglichen eine Erweiterung des Phänotyps sowohl für häufig als auch für seltener ursächliche CMS-Gene und machen deutlich, welche klinische Relevanz die Analyse von seltenen CMS-Genen wie MUSK haben kann. Im Hinblick auf Salbutamol als eine Therapieoption bei MUSK-CMS wird ein neuartiger medikamentöser Behandlungsansatz aufgezeigt. Neben einem besseren Verständnis für die genetischen Hintergünde der Erkrankung leisten die Ergebnisse somit auch einen Beitrag für eine bessere Versorgung bzgl. Diagnostik und Therapie von Patienten mit dieser seltenen neuromuskulären Erkrankung.

Thu, 2 Feb 2012 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/14262/ https://edoc.ub.uni-muenchen.de/14262/1/Raithel_Eva.pdf Raithel, Eva Johanna

Thu, 24 Feb 2011 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/12778/ https://edoc.ub.uni-muenchen.de/12778/1/Kuscha_Moritz.pdf Kuscha, Moritz

Salbutamol podcast from Chemistry World - the magazine of the Royal Society of Chemistry