Cytomegalovirus (CMV) is a common infection in liver transplant recipients that can cause direct tissue damage or indirect effects like rejection. It is transmitted from donor to recipient in 50-97% of transplant cases and reactivates due to immunosuppression. Prevention methods include preemptive antiviral therapy for high-risk patients based on viral load screening or prophylaxis for 3-6 months. Valganciclovir is commonly used but toxicity and late-onset infection are risks, especially in donor-positive/recipient-negative cases. Treatment involves reducing immunosuppression and antivirals like intravenous ganciclovir or valganciclovir for 2-6 months. CMV
This document provides information on cytomegalovirus (CMV), a herpes virus. Some key points:
- CMV was first isolated in 1956 from infants and causes lifelong latent infection. It is a major cause of disease in transplant recipients.
- CMV infection is generally asymptomatic in healthy individuals but can cause disease in the immunocompromised via direct tissue damage or indirect immune effects.
- Diagnosis involves detecting viral DNA, antigens, or culture. Treatment includes antivirals like ganciclovir or valganciclovir.
- Prevention strategies for transplant recipients include preemptive therapy based on viral monitoring or prophylaxis for high risk groups to reduce disease and
This document discusses the management of Cytomegalovirus (CMV) infection in patients with inflammatory bowel disease (IBD). It begins by presenting a case study of an 18-year-old man diagnosed with CMV-positive ulcerative colitis. It then provides background on CMV, including how it is transmitted, risk factors for reactivation, and definitions of CMV infection and disease. The document discusses diagnostic guidelines and techniques for detecting CMV in IBD patients. It explores the pathophysiology of CMV infection in IBD, prevalence and clinical findings of CMV colitis in Crohn's disease and ulcerative colitis, and influence of medical treatments on CMV reactivation. It concludes by
congenital cytomegalovirus infection is a major problem in children. severe morbidity also in some cases mortality can occur due to this infection. this presentation has highlighted updates on this topic in short.
A brief description of very common infection caused by the virus: Cytomegalovirus. Typically affects infants, and pregnant ladies. Features in HIV patients. Transmitted by saliva, fomites and at the time of delivery. Helpful for medical students, doctors, pediatricians, gynecologists, dermatologists. Useful for exams USMLE, FCPS, MCPS and MRCP, MD students.
Enteroviruses are a genus of picornaviruses that replicate in the gut. There are at least 71 serotypes including polioviruses, coxsackie A and B viruses, echoviruses, and newer enteroviruses. They are single stranded RNA viruses with icosahedral symmetry that are stable in acid pH. Poliovirus was first identified in 1909 and causes the disease poliomyelitis, which can result in paralysis. The Sabin oral polio vaccine uses live attenuated poliovirus grown in monkey kidney cells to induce long lasting immunity after multiple doses.
Cytomegalovirus is a herpesvirus that commonly infects humans. It can cause enlarged cells (cytomegalic inclusion disease) and poses a risk for severe infections in infants during pregnancy or birth as well as immunosuppressed individuals. The virus replicates slowly in human fibroblasts and establishes lifelong latent infections. Primary infection is usually asymptomatic but can resemble mononucleosis. Congenital infection may cause death, growth problems, or long-term neurological and vision issues in infants. Polymerase chain reaction testing and antigen detection are now used to diagnose active cytomegalovirus infections.
This document provides information on cytomegalovirus (CMV), a herpes virus. Some key points:
- CMV was first isolated in 1956 from infants and causes lifelong latent infection. It is a major cause of disease in transplant recipients.
- CMV infection is generally asymptomatic in healthy individuals but can cause disease in the immunocompromised via direct tissue damage or indirect immune effects.
- Diagnosis involves detecting viral DNA, antigens, or culture. Treatment includes antivirals like ganciclovir or valganciclovir.
- Prevention strategies for transplant recipients include preemptive therapy based on viral monitoring or prophylaxis for high risk groups to reduce disease and
This document discusses the management of Cytomegalovirus (CMV) infection in patients with inflammatory bowel disease (IBD). It begins by presenting a case study of an 18-year-old man diagnosed with CMV-positive ulcerative colitis. It then provides background on CMV, including how it is transmitted, risk factors for reactivation, and definitions of CMV infection and disease. The document discusses diagnostic guidelines and techniques for detecting CMV in IBD patients. It explores the pathophysiology of CMV infection in IBD, prevalence and clinical findings of CMV colitis in Crohn's disease and ulcerative colitis, and influence of medical treatments on CMV reactivation. It concludes by
congenital cytomegalovirus infection is a major problem in children. severe morbidity also in some cases mortality can occur due to this infection. this presentation has highlighted updates on this topic in short.
A brief description of very common infection caused by the virus: Cytomegalovirus. Typically affects infants, and pregnant ladies. Features in HIV patients. Transmitted by saliva, fomites and at the time of delivery. Helpful for medical students, doctors, pediatricians, gynecologists, dermatologists. Useful for exams USMLE, FCPS, MCPS and MRCP, MD students.
Enteroviruses are a genus of picornaviruses that replicate in the gut. There are at least 71 serotypes including polioviruses, coxsackie A and B viruses, echoviruses, and newer enteroviruses. They are single stranded RNA viruses with icosahedral symmetry that are stable in acid pH. Poliovirus was first identified in 1909 and causes the disease poliomyelitis, which can result in paralysis. The Sabin oral polio vaccine uses live attenuated poliovirus grown in monkey kidney cells to induce long lasting immunity after multiple doses.
Cytomegalovirus is a herpesvirus that commonly infects humans. It can cause enlarged cells (cytomegalic inclusion disease) and poses a risk for severe infections in infants during pregnancy or birth as well as immunosuppressed individuals. The virus replicates slowly in human fibroblasts and establishes lifelong latent infections. Primary infection is usually asymptomatic but can resemble mononucleosis. Congenital infection may cause death, growth problems, or long-term neurological and vision issues in infants. Polymerase chain reaction testing and antigen detection are now used to diagnose active cytomegalovirus infections.
Epstein-Barr Virus (EBV) and Cytomegalovirus (CMV) by Dr. Himanshu KhatriDrHimanshuKhatri
This document summarizes Epstein-Barr virus (EBV) and cytomegalovirus (CMV), two herpesviruses that cause infectious mononucleosis. EBV infects B cells and epithelial cells and spreads through kissing or sharing items. It can cause infectious mononucleosis, tumors like Burkitt's lymphoma, or infections in immunocompromised individuals. CMV infects epithelial cells and glands and spreads through secretions, causing congenital infections or mononucleosis. Both viruses are diagnosed through antigen detection, isolation, and serology, with treatment focusing on symptoms.
DNA viruses and disease is a very important topic for pg entrance.....all important topics and questions have been discussed in detail....do make use of it......
This document provides an overview of X-linked agammaglobulinemia (XLA). It discusses that XLA is caused by mutations in the BTK gene, resulting in an absence of circulating B cells and severely reduced immunoglobulin levels. Patients present with recurrent bacterial infections from an early age. Treatment involves long-term IgG replacement therapy and antimicrobial prophylaxis and treatment to manage infections. The document covers epidemiology, pathogenesis, clinical manifestations, diagnosis, management and complications of XLA.
This document discusses Varicella-Zoster Virus, which causes chickenpox and shingles. It describes how chickenpox is highly contagious and mainly affects children, while shingles results from reactivation of the virus in nerve ganglia and mainly affects adults and immunocompromised individuals. Complications can be more severe in adults, newborns and immunocompromised patients. Treatment involves antiviral medications like acyclovir to reduce symptoms and duration. Vaccination and immune globulin can help prevent or lessen the disease in high-risk groups following exposure.
This document discusses arboviruses, which are viruses transmitted by arthropods like mosquitoes and ticks. It defines arboviruses and provides their classification. The major families of arboviruses are Togaviridae, Flaviviridae, Bunyaviridae, Reoviridae, and Arenaviridae. Some important arboviruses and the diseases they cause include dengue, yellow fever, Japanese encephalitis, West Nile virus and chikungunya. Diagnosis involves virus isolation, antigen detection, genome detection and serology. Major vectors are mosquitoes and ticks.
Antigenic shift and antigenic drift are two mechanisms by which influenza viruses evolve. Antigenic shift involves the reassortment of genomic segments between different influenza virus strains, resulting in a virus with a novel combination of surface antigens. This allows the virus to evade existing immunity. Antigenic drift is the accumulation of small mutations in the genes encoding surface antigens, allowing influenza viruses to gradually evade recognition by antibodies. Antigenic drift occurs in both influenza A and B viruses on an annual basis, while antigenic shift is rare but can cause pandemics when it produces a virus with no preexisting immunity in the human population.
This document discusses influenza and influenza vaccines. It defines influenza as a highly contagious viral infection that typically causes seasonal outbreaks. There are three types of influenza viruses (A, B, and C) that are classified into different strains. Influenza A and B cause seasonal epidemics and are included in vaccines. The flu spreads through respiratory droplets and surfaces. It can cause severe illness especially in young, old, and those with underlying conditions. Annual influenza vaccination is recommended to prevent infection. There are two main types of vaccines - inactivated and live attenuated. Both work to induce immune responses but have different safety and effectiveness profiles.
The lecture gives concise review about the main four groups of viruses causing hemorrhagic fever i.e. Flavivirues, Filoviruses, Arenaviruses and Bunyaviruses.
This document provides an overview of several congenital, perinatal, and neonatal viral infections. It summarizes the characteristics, risks, outcomes, prevention, and diagnosis of rubella, cytomegalovirus, herpes simplex virus, parvovirus B19, and varicella-zoster virus infections during pregnancy and in newborns. For each virus, it discusses transmission routes, clinical features of infection, risks of transmission and outcomes for the fetus or newborn, methods of diagnosis, and approaches to prevention and management.
This document discusses Varicella Zoster Virus (VZV) which causes chickenpox (varicella) and shingles (herpes zoster). VZV establishes latency in dorsal root ganglia after primary infection of chickenpox which can later reactivate and cause shingles. Both diseases present with characteristic vesicular rashes but shingles lesions are limited to a single dermatome. Complications of shingles include postherpetic neuralgia. VZV is diagnosed through virus isolation, serology, PCR or antigen detection and treated with antiviral drugs like acyclovir. Vaccination provides effective protection against chickenpox.
Influenza is a contagious respiratory illness caused by influenza viruses. There are three main types of influenza viruses (A, B, C) with Type A causing the most severe illness. Influenza viruses are constantly evolving through antigenic drift and antigenic shift, allowing them to evade host immunity. Vaccines aim to induce antibodies against predicted circulating strains, but the viruses' evolution requires continuous surveillance and vaccine updates. Influenza poses a significant disease burden, with estimated annual deaths ranging from 3,000 to 48,000 in the US alone.
Zika virus is transmitted to humans primarily through the bite of infected Aedes mosquitoes. It typically causes mild fever, rash, joint pain, and conjunctivitis lasting up to a week. While most infections are asymptomatic, Zika virus infection during pregnancy can cause microcephaly and other birth defects. The virus was first identified in 1947 and outbreaks have occurred in Africa, Asia, Pacific Islands and the Americas. There is no vaccine or specific treatment, so prevention focuses on controlling the mosquito vector and protecting against bites.
This document discusses H1N1 influenza (swine flu). It provides an introduction to swine influenza viruses and how they can be transmitted from pigs to humans. It then discusses the history of swine flu in humans, including the 1918 Spanish flu pandemic. It describes outbreaks of swine flu that occurred in the US in 1976 and India in 2009. The document goes on to describe the influenza virus structure, transmission, pathogenesis and immunity. It notes that people at high risk for H1N1 include young children, elderly, pregnant women and those with chronic health conditions. The most common symptoms of the 2009 H1N1 pandemic are also summarized.
This document discusses rotavirus prevention and control. It provides an overview of rotavirus epidemiology, transmission, clinical presentation, diagnosis and treatment. It discusses infection control measures including handwashing and vaccination. Two oral rotavirus vaccines are described and their efficacy, safety and use in HIV-infected infants is summarized. Surveillance efforts in South Africa and Africa are outlined. WHO recommendations for rotavirus vaccination through routine immunization programs are also mentioned.
Mumps is caused by a paramyxovirus that typically presents as swelling of the parotid or other salivary glands. It is spread through respiratory droplets and saliva. While most infections are asymptomatic or mild, complications can include orchitis, meningitis, and deafness. Diagnosis is made through PCR detection of viral RNA or serology. Treatment is supportive and includes analgesics. Vaccination with the live attenuated Jeryl Lynn strain as part of the MMR vaccine provides around 90% protection with two doses and has significantly reduced mumps cases worldwide.
Hepatitis E is caused by the hepatitis E virus (HEV) and spreads primarily through contaminated drinking water. It was first identified during an outbreak in India in 1955. Dr. Balayan helped discover HEV in 1983 while investigating an outbreak in Central Asia. HEV has three overlapping genes and infects the liver, with symptoms including jaundice. Pregnant women are particularly at risk, with mortality rates as high as 20% in the third trimester. Prevention focuses on proper sanitation and hygiene. A vaccine has been developed in China but is not yet widely available.
The Epstein–Barr virus (EBV), also called human herpesvirus 4 (HHV-4), is one of eight known human herpesvirus types in the herpes family, and is one of the most common viruses in humans.
Swine influenza, also known as swine flu, is a respiratory disease in pigs caused by influenza viruses. In 2009, a new strain of H1N1 virus emerged that was able to infect humans. This outbreak led to the first influenza pandemic of the 21st century. The virus spreads from person to person through close contact and coughing or sneezing. Symptoms in humans include fever, cough, sore throat and body aches. Treatment involves antiviral drugs and supportive care. Public health measures aim to prevent and control the spread through social distancing, hand washing, isolation of infected individuals and vaccination.
Cytomegalovirus (CMV) is a betaherpesvirus with an enveloped, icosahedral virion containing a linear double-stranded DNA genome between 140-240 kb. It establishes lifelong latent infection in humans following primary infection, which is usually asymptomatic but can cause mononucleosis. CMV is a major cause of birth defects if acquired during pregnancy and disease in immunocompromised individuals. Treatment involves antiviral drugs like ganciclovir, while control relies on screening of blood/organ donors, as there is no vaccine.
Epstein-Barr Virus (EBV) and Cytomegalovirus (CMV) by Dr. Himanshu KhatriDrHimanshuKhatri
This document summarizes Epstein-Barr virus (EBV) and cytomegalovirus (CMV), two herpesviruses that cause infectious mononucleosis. EBV infects B cells and epithelial cells and spreads through kissing or sharing items. It can cause infectious mononucleosis, tumors like Burkitt's lymphoma, or infections in immunocompromised individuals. CMV infects epithelial cells and glands and spreads through secretions, causing congenital infections or mononucleosis. Both viruses are diagnosed through antigen detection, isolation, and serology, with treatment focusing on symptoms.
DNA viruses and disease is a very important topic for pg entrance.....all important topics and questions have been discussed in detail....do make use of it......
This document provides an overview of X-linked agammaglobulinemia (XLA). It discusses that XLA is caused by mutations in the BTK gene, resulting in an absence of circulating B cells and severely reduced immunoglobulin levels. Patients present with recurrent bacterial infections from an early age. Treatment involves long-term IgG replacement therapy and antimicrobial prophylaxis and treatment to manage infections. The document covers epidemiology, pathogenesis, clinical manifestations, diagnosis, management and complications of XLA.
This document discusses Varicella-Zoster Virus, which causes chickenpox and shingles. It describes how chickenpox is highly contagious and mainly affects children, while shingles results from reactivation of the virus in nerve ganglia and mainly affects adults and immunocompromised individuals. Complications can be more severe in adults, newborns and immunocompromised patients. Treatment involves antiviral medications like acyclovir to reduce symptoms and duration. Vaccination and immune globulin can help prevent or lessen the disease in high-risk groups following exposure.
This document discusses arboviruses, which are viruses transmitted by arthropods like mosquitoes and ticks. It defines arboviruses and provides their classification. The major families of arboviruses are Togaviridae, Flaviviridae, Bunyaviridae, Reoviridae, and Arenaviridae. Some important arboviruses and the diseases they cause include dengue, yellow fever, Japanese encephalitis, West Nile virus and chikungunya. Diagnosis involves virus isolation, antigen detection, genome detection and serology. Major vectors are mosquitoes and ticks.
Antigenic shift and antigenic drift are two mechanisms by which influenza viruses evolve. Antigenic shift involves the reassortment of genomic segments between different influenza virus strains, resulting in a virus with a novel combination of surface antigens. This allows the virus to evade existing immunity. Antigenic drift is the accumulation of small mutations in the genes encoding surface antigens, allowing influenza viruses to gradually evade recognition by antibodies. Antigenic drift occurs in both influenza A and B viruses on an annual basis, while antigenic shift is rare but can cause pandemics when it produces a virus with no preexisting immunity in the human population.
This document discusses influenza and influenza vaccines. It defines influenza as a highly contagious viral infection that typically causes seasonal outbreaks. There are three types of influenza viruses (A, B, and C) that are classified into different strains. Influenza A and B cause seasonal epidemics and are included in vaccines. The flu spreads through respiratory droplets and surfaces. It can cause severe illness especially in young, old, and those with underlying conditions. Annual influenza vaccination is recommended to prevent infection. There are two main types of vaccines - inactivated and live attenuated. Both work to induce immune responses but have different safety and effectiveness profiles.
The lecture gives concise review about the main four groups of viruses causing hemorrhagic fever i.e. Flavivirues, Filoviruses, Arenaviruses and Bunyaviruses.
This document provides an overview of several congenital, perinatal, and neonatal viral infections. It summarizes the characteristics, risks, outcomes, prevention, and diagnosis of rubella, cytomegalovirus, herpes simplex virus, parvovirus B19, and varicella-zoster virus infections during pregnancy and in newborns. For each virus, it discusses transmission routes, clinical features of infection, risks of transmission and outcomes for the fetus or newborn, methods of diagnosis, and approaches to prevention and management.
This document discusses Varicella Zoster Virus (VZV) which causes chickenpox (varicella) and shingles (herpes zoster). VZV establishes latency in dorsal root ganglia after primary infection of chickenpox which can later reactivate and cause shingles. Both diseases present with characteristic vesicular rashes but shingles lesions are limited to a single dermatome. Complications of shingles include postherpetic neuralgia. VZV is diagnosed through virus isolation, serology, PCR or antigen detection and treated with antiviral drugs like acyclovir. Vaccination provides effective protection against chickenpox.
Influenza is a contagious respiratory illness caused by influenza viruses. There are three main types of influenza viruses (A, B, C) with Type A causing the most severe illness. Influenza viruses are constantly evolving through antigenic drift and antigenic shift, allowing them to evade host immunity. Vaccines aim to induce antibodies against predicted circulating strains, but the viruses' evolution requires continuous surveillance and vaccine updates. Influenza poses a significant disease burden, with estimated annual deaths ranging from 3,000 to 48,000 in the US alone.
Zika virus is transmitted to humans primarily through the bite of infected Aedes mosquitoes. It typically causes mild fever, rash, joint pain, and conjunctivitis lasting up to a week. While most infections are asymptomatic, Zika virus infection during pregnancy can cause microcephaly and other birth defects. The virus was first identified in 1947 and outbreaks have occurred in Africa, Asia, Pacific Islands and the Americas. There is no vaccine or specific treatment, so prevention focuses on controlling the mosquito vector and protecting against bites.
This document discusses H1N1 influenza (swine flu). It provides an introduction to swine influenza viruses and how they can be transmitted from pigs to humans. It then discusses the history of swine flu in humans, including the 1918 Spanish flu pandemic. It describes outbreaks of swine flu that occurred in the US in 1976 and India in 2009. The document goes on to describe the influenza virus structure, transmission, pathogenesis and immunity. It notes that people at high risk for H1N1 include young children, elderly, pregnant women and those with chronic health conditions. The most common symptoms of the 2009 H1N1 pandemic are also summarized.
This document discusses rotavirus prevention and control. It provides an overview of rotavirus epidemiology, transmission, clinical presentation, diagnosis and treatment. It discusses infection control measures including handwashing and vaccination. Two oral rotavirus vaccines are described and their efficacy, safety and use in HIV-infected infants is summarized. Surveillance efforts in South Africa and Africa are outlined. WHO recommendations for rotavirus vaccination through routine immunization programs are also mentioned.
Mumps is caused by a paramyxovirus that typically presents as swelling of the parotid or other salivary glands. It is spread through respiratory droplets and saliva. While most infections are asymptomatic or mild, complications can include orchitis, meningitis, and deafness. Diagnosis is made through PCR detection of viral RNA or serology. Treatment is supportive and includes analgesics. Vaccination with the live attenuated Jeryl Lynn strain as part of the MMR vaccine provides around 90% protection with two doses and has significantly reduced mumps cases worldwide.
Hepatitis E is caused by the hepatitis E virus (HEV) and spreads primarily through contaminated drinking water. It was first identified during an outbreak in India in 1955. Dr. Balayan helped discover HEV in 1983 while investigating an outbreak in Central Asia. HEV has three overlapping genes and infects the liver, with symptoms including jaundice. Pregnant women are particularly at risk, with mortality rates as high as 20% in the third trimester. Prevention focuses on proper sanitation and hygiene. A vaccine has been developed in China but is not yet widely available.
The Epstein–Barr virus (EBV), also called human herpesvirus 4 (HHV-4), is one of eight known human herpesvirus types in the herpes family, and is one of the most common viruses in humans.
Swine influenza, also known as swine flu, is a respiratory disease in pigs caused by influenza viruses. In 2009, a new strain of H1N1 virus emerged that was able to infect humans. This outbreak led to the first influenza pandemic of the 21st century. The virus spreads from person to person through close contact and coughing or sneezing. Symptoms in humans include fever, cough, sore throat and body aches. Treatment involves antiviral drugs and supportive care. Public health measures aim to prevent and control the spread through social distancing, hand washing, isolation of infected individuals and vaccination.
Cytomegalovirus (CMV) is a betaherpesvirus with an enveloped, icosahedral virion containing a linear double-stranded DNA genome between 140-240 kb. It establishes lifelong latent infection in humans following primary infection, which is usually asymptomatic but can cause mononucleosis. CMV is a major cause of birth defects if acquired during pregnancy and disease in immunocompromised individuals. Treatment involves antiviral drugs like ganciclovir, while control relies on screening of blood/organ donors, as there is no vaccine.
El citomegalovirus (CMV) es un virus de ADN de la familia Herpesviridae que infecta principalmente a recién nacidos y personas inmunodeprimidas. Es la causa más frecuente de anomalías congénitas virales y puede causar daños en el feto si la madre se infecta durante el embarazo. No existe una vacuna para el CMV y la prevención se centra en el uso de preservativos y controlar la transmisión a través de la sangre y trasplantes.
El CMV es la causa más común de infección viral congénita y causa de hipoacusia neurosensorial y retraso mental. Se transmite de madres a fetos a través de la placenta, durante el parto o la lactancia. El diagnóstico en madres incluye pruebas serológicas e identificación de la infección fetal mediante métodos invasivos y no invasivos. No hay tratamiento efectivo durante el embarazo, pero el ganciclovir puede usarse para tratar la enfermedad congénita sintomática.
O documento resume as principais mudanças e novidades da versão PHP 7, incluindo melhorias de desempenho, novas funcionalidades como tipos escalares e operadores, e incompatibilidades em relação à versão anterior. Algumas funcionalidades foram removidas ou marcadas como deprecated.
This resume summarizes the qualifications and experience of Cristina C. Galo. She has a Bachelor's degree in Accounting Technology from Central Luzon State University. She has several years of experience in accounting and finance roles, including her current role as Company Cashier at Simatech Shipping and Forwarding LLC in Dubai, where she is responsible for cash management, bank reconciliations, and accounting entries. Prior to that, she worked as a Branch Support Assistant at Producers Savings Bank Corporation in the Philippines, where she assisted with collections, reports, and account maintenance. She is proficient in accounting software and Microsoft Office programs.
This resume is for Cristina C. Galo, who has a background in accounting. She has a Bachelor's degree in Accounting Technology and is a certified bookkeeper and registered cost accountant. Her work experience includes positions as a company cashier, accountant/branch support officer, and receptionist. She has skills in accounting, administration, customer service, and proficiency in MS Office applications and accounting software.
The document discusses how various media technologies were used at different stages of a media project. A website was created using WIX to display research, planning, production, and evaluation. Photoshop was used to create a film magazine and poster, including a double exposure technique to portray a character suffering from psychosis. Presentation software like Google Slides and Emaze were used to present research and planning in eye-catching ways beyond standard formats provided by the school.
A Biofísica estuda sistemas vivos do ponto de vista físico e físico-químico, incluindo processos moleculares, dinâmicos, de transformação de energia e comunicação celular, bem como a organização de processos biológicos a diferentes níveis.
Jeffrey Kaney is an entertainment business major and freelance mechanic who is passionate about the automotive industry and entertainment. He has 5 years of experience in high-dollar automotive paint restoration and currently works as a freelance mechanic and exterior restoration specialist. His goal is to create a career at the intersection of automotive and entertainment, through multimedia projects and entrepreneurship.
Haploid induction of allelic diversity populations in maizeNaveen Jakhar
This document summarizes a power point presentation on haploid induction of allelic diversity in maize populations. It discusses two hypotheses for how haploid embryos are formed, outlines the objectives and methods used, and summarizes the results. The methodology involved selecting maize races from different elevations and examining their haploid induction rates when crossed with a maternal haploid inducer. Races from low elevations had significantly higher haploid induction rates than mid or high elevation races. Certain races like TuxpeñoNorteño also had significantly higher rates than others like Conico. The document provides background on haploid induction and doubling techniques in maize breeding.
This document provides guidance on abdominal auscultation. It discusses listening to different areas of the abdomen to identify various potential findings. The areas covered include the right hypochondrium, epigastric, left hypochondrium, periumbilical, and pelvis regions. Sounds that may be detected include friction rubs indicating conditions like peri-hepatitis or peri-splenitis, arterial bruits potentially related to hemangiomas or vascular anomalies, venous hums associated with issues like portal hypertension, intestinal sounds, and fetal sounds in the uterus. Examining all areas of the abdomen can help identify sounds that may confirm diseases or abnormalities in the liver, spleen, blood vessels, stomach, intestines,
Cytomegalovirus infection in kidny transplantationhadi lashini
HCMV infection is a frequent complication of kidney transplantation, especially in the period 1 to 4 months after transplantation. Overall incidences of HCMV infection and disease during the first 100 days post-transplantation, 60% and 25% respectively, when no HCMV prophylaxis or pre-emptive therapy is given. HCMV infection is an independent risk-factor for kidney graft rejection and associated with high morbidity and mortality rates .
Scout - How Create Successful Brand Protection ProgramFākR™
This document discusses how to create a successful brand protection program. It notes that counterfeiting costs legitimate brands over $1 trillion annually. A strong brand protection program requires tracking counterfeiters worldwide using brand protection software. Such software allows companies to organize investigations, share information mobilely, and mitigate risks to their brands from counterfeiting. The document recommends the software products Scout and FākRTM to help companies effectively manage brand protection efforts.
We are solution to your power bank needs. E-mail: raymond.a@bocoor.com. This catalogue shows a snapshot of our power bank presentation. You'll find different designs and capacities. Great prices!
This document provides guidance on abdominal percussion techniques for evaluating various organs and conditions. It discusses how percussion can detect gas, fluid, and confirm the location of organs. Specific techniques are described for evaluating the liver, spleen, kidneys, urinary bladder, ascites, and other abdominal features. Percussion is most accurate for the lower liver border and can help identify abnormalities, detect dullness associated with various conditions, and assess organ size and borders. Proper patient positioning and techniques like shifting dullness are emphasized to accurately evaluate abdominal contents using percussion.
An Intra-oral Cement Control System. A Great Solution to a Big ProblemEmil Svoboda
1. This document discusses issues with excess cement and implant misfits that can occur with traditional screwed prosthetic techniques and outlines a cement control system to address these problems.
2. The cement control system involves assembling abutments and prosthetics intraorally to optimize fit and prevent excess cement from directing into tissues.
3. This technique aims to reduce peri-implant complications by 60% by preventing issues caused by excess cement and misfit while still allowing for retrievability of prosthetics.
Ascariasis, or roundworm infection, is caused by the nematode Ascaris lumbricoides. It is one of the most common helminthic infections worldwide, affecting an estimated 1-1.2 billion people, primarily children in warm, moist climates. While often asymptomatic, ascariasis can cause growth retardation, pneumonia, intestinal obstruction and other issues. Diagnosis is made via stool examination for eggs. Treatment involves deworming medications like albendazole. Prevention focuses on community education and sanitation programs to reduce transmission.
This document discusses cytomegalovirus (CMV) infection in renal transplant patients. It begins with an introduction and overview of CMV, including its definition, epidemiology, risk factors, pathogenesis, clinical presentation, diagnosis, prevention and treatment. It then discusses CMV in more depth, covering topics like transmission, replication within host cells, immune evasion mechanisms, clinical manifestations in different organs, diagnosis methods, prevention strategies like prophylaxis and preemptive therapy, antiviral treatment and drug resistance.
Cytomegalovirus infection in critically ill patients: Focus on HSCT recipientsZeena Nackerdien
Medline Plus has this to say about bone marrow transplants (here used interchangeably to refer to hematopoietic stem cell transplantation [HSCT]): “Bone marrow is the soft, fatty tissue inside your bones. The bone marrow produces blood cells. Stem cells are immature cells in the bone marrow that give rise to all of your different blood cells.” According to the literature, HSCT has become a standard of care for hematologic malignancies, congenital or acquired disorders of the hematopoietic system, and it is also applied as a therapeutic option in some of the solid tumors.
Here, I have provided a brief overview of CMV, with a focus on HSCT recipients. DISCLAIMER: Extracted research data from ongoing clinical trials are subject to change. This is not a substitute for medical advice. Please consult your doctor for any medical condition.
Francisco M. Marty, MD, and Kathleen Mullane, DO, PharmD, FIDSA, prepared useful Practice Aids pertaining to cytomegalovirus management for this CME activity titled "Refining the Management of CMV in HCT Recipients: What Does the Future Hold?" For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2uk5G0q. CME credit will be available until April 3, 2019.
Roy F. Chemaly, MD, MPH, FIDSA, FACP, and Genovefa Papanicolaou, MD, prepared useful Practice Aids pertaining to cytomegalovirus for this CME activity titled "Managing CMV in the New Era of Antiviral Therapy: Practical Considerations in the HCT Setting." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2EUH2GI. CME credit will be available until March 25, 2020.
This document summarizes key information about cytomegalovirus (CMV) infection in kidney transplant recipients. CMV is the most important viral infection following solid organ transplantation and can cause significant disease. The risk of CMV infection and disease depends on the CMV status of the donor and recipient. Strategies to prevent CMV include prophylactic antiviral treatment based on risk factors. Preemptive treatment using viral monitoring is also used. Ganciclovir and valganciclovir are effective therapies for both prophylaxis and treatment of CMV infection and disease in transplant patients.
This lecture is about Spectrum of HCV infection presented by Dr. Muhammad Mostafa Abdel Ghaffar, Head of Tropical Medicine Department, Ahmed Maher Teaching Hospital.
The lecture was presented in the scientific meeting of Internal and Tropical Medicine departments, Ahmed Maher Teaching Hospital titled (Towards Eradication of HCV in Egypt) in celebration of World Hepatitis Day on July 28, 2016.
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This document discusses renal disease associated with viral hepatitis. It covers the basic virology of hepatitis B and C, describes different testing methods used to diagnose active infection, and reviews the epidemiology of both viruses globally and in the UK. It then examines associations between viral hepatitis, chronic kidney disease, and end-stage renal disease, describing different types of renal pathology that can occur. Treatment approaches for hepatitis-related renal conditions are outlined.
Hepatitis C is a global problem caused by the hepatitis C virus (HCV). HCV is a blood-borne virus that infects approximately 200 million people worldwide. Laboratory testing plays an important role in diagnosing HCV, evaluating patients for treatment, monitoring patients during treatment, and following up after treatment. There are 6 major genotypes of HCV with genotypes 1 and 4 being more difficult to treat and less responsive to interferon-based therapy.
The document discusses hepatitis C virus (HCV) infection in patients with kidney disease. It covers several topics:
1) HCV is highly prevalent among patients undergoing dialysis, with rates ranging from 1.4-28.3% in developed countries and 4.7-41.9% in developing countries.
2) HCV can accelerate progression of chronic kidney disease and increase risk of end-stage renal disease. Successful treatment of HCV with antiviral therapy can improve kidney function and reduce dialysis risk.
3) Several direct-acting antiviral regimens, including paritaprevir/ritonavir/ombitasvir/dasabuvir, paritaprevir/
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Cytomegalovirus (cmv), the hidden enemy in liver transplantation 2015
1. Cytomegalovirus (CMV), the
hidden enemy in liver
transplantation
Ayman Alsebaey, MD.
Lecturer of hepatology,
National liver Institute,
National Liver Institute Congress
Conrad, April 2015
3. Cytomegalovirus (CMV) is a double stranded DNA virus.
CMV infects 50−97% of the human population. It remains lifelong latent in
the hematopoietic cells.
MODE OF INFECTION IN LT STATUS
Primary CMV infection (D+/R−):
A sero−negative recipient receives organ from sero−positive donor.
Secondary CMV infection (Reactivation D±/R+):
The recipient is sero−positive and immunosuppression induces
reactivation of latent CMV infection.
Superinfection (D+/R+):
Both the donor and the recipient are sero−positive. Here there is
reactivation of the donor CMV.
3
4. INCIDENCE OF CMV INFECTION IN LT RECIPIENTS
1. If no prevention used post LT, 18−30% of the recipients will develop
CMV disease especially in the 1st 3 months.
a. D−/R−: 1−2%.
b. D+/R−: up to 65%.
c. D±/R+: up to 20%.
2. With prevention by 3 month of valganciclovir or oral ganciclovir
prophylaxis:
a. D+/R−: 10−30%.
b. D±/R+: <10%.
3. Late CMV:
a. is the reactivation of CMV following 3 months prophylaxis so
prophylaxis should be prolonged to 6 months.
b. D+/R−: 15%.
4
5. RISK FACTORS FOR CMV INFECTION IN LT RECIPIENTS:
Donor/Recipient status:
a. Risk of infection in CMV D+/R− > CMV D±/R+.
Immunosuppressive dose and prolonged use:
a. Lymphocyte-depleting drugs (alemtuzumab >anti−thymocyte globulin
>basiliximab).
b. High doses mycophenolate mofetil.
c. Sirolimus and everolimus decrease CMV replication.
Defects in innate immunity and cytokine defects:
a. Polymorphisms in mannose-binding lectin and toll-like receptor 2 genes.
Allograft rejection (bi-directional):
a. Rejection TNF CMV re−activation Pulse steroids.
b. Rejection increases CMV replication.
Co-infections with HHV-6 and HHV-7 : as being immunomodulatory.
Cold ischemia time, bacterial, fungal infections, sepsis, the amount of blood
loss and fulminant hepatic failure.
5
6. Risk factors for CMV infection in LT recipients
Traditional Risk Factors Recently Described Risk Factors
CMV D+/R–
Lack of CMV−specific CD4+ T cells
Lack of CMV−specific CD8+ T cells
Allograft rejection
High viral replication
Type of organ transplant
Mycophenolate mofetil
Muromonab−CD3
Antithymocyte globulin
Alemtuzumab
HHV−6
HHV−7
Renal insufficiency
Toll−like receptor 2 polymorphism
Toll−like receptor 4 polymorphism
Mannose−binding lectin deficiency
Chemokine and cytokine defects
(interleukin 10, monocyte chemotactic
protein 1, C−C chemokine receptor
type 5)
6
7. CLINICAL MANIFESTATIONS OF CMV DISEASE
DIRECT EFFECTS INDIRECT EFFECTS
Asymptomatic:
Only positive PCR
CMV syndrome (60%):
Fever, flu like
Myelosuppression with leukopenia and
neutropenia
Tissue-invasive CMV disease:
GIT (70%); esophagitis, gastritis,
enteritis, colitis.
Hepatitis.
Pneumonitis.
CNS disease.
Retinitis.
Intrauterine transmission.
Mortality
Acute allograft rejection
Chronic allograft rejection
Vanishing bile duct syndrome
Chronic ductopenic rejection
HAT
Hepatitis C virus recurrence
Allograft hepatitis, fibrosis
Allograft failure
Opportunistic and other infections
Fungal superinfection
Nocardiosis
Bacterial superinfection
Epstein−Barr virus and PTLD
HHV−6 and HHV−7 infections
Vascular thrombosis
New onset diabetes mellitus
Mortality IMMUNOMODULATORY &
IMMUNE EXHAUSTION
7
8. DIAGNOSIS
1. CMV NAT:
a. Rapid and more accurate (CMV DNA >RNA).
b. Quantitative, useful in initiation and follow up of treatment.
c. Prognostic:
i. Pre−treatment CMV DNA <18,200 IU/ml 1.5 fold higher
chance for CMV disease resolution.
ii. CMV suppression to <137 IU/mL is predictive of clinical response
to antiviral treatment.
2. pp65 antigenemia assay:
a. is secreted by CMV-infected peripheral blood leukocytes.
b. Comparable to NAT
c. Semi−quantitative, processed within 6−8 h of blood collection,
d. but requires a large sample volume, subjective interpretation of results
and falsely negative in patients with severe leukopenia.
8
9. DIAGNOSIS:
1. Histopathology:
a. Gold standard for the
diagnosis of tissue-invasive
CMV disease though
invasive.
b. Cytomegalic cells with
positive
immunohistochemical testing.
c. Nowadays indicated to
exclude rejection and
diagnose
compartmentalization.
2. Non useful tests:
a. Serology (Ig M and Ig G).
b. Viral cultures.
COMPARTMENTALIZED
CMV DISEASE:
1. Positive tissue CMV infection
with negative blood PCR.
2. So follow up of PCR may
escape viral detection as
preemptive therapy.
3. Commonly seen in the GIT
and retina.
9
10. Methods Principle Sample and Equipment Turnaround Time Clinical Usefulness Advantages Disadvantages
Serology Antibody detection
(IgG, IgM)
Serology facility 6 h IgG indicates previous
infection
IgM implies acute or
recent infection
Screening of donors and
recipients before
transplantation
Screening transplant
recipients after
transplantation to detect
seroconversion
Delayed antibody
production in transplant
recipients (false-negative
results)
False-positive IgM
screening results
Virus culture
Tube culture Viral replication Recovery of PMN within few hours;
cell culture facility; light microscopy
2–4 wk Detection of
cytopathic effects
High specificity for
infection and disease
Phenotypic susceptibility
testing
Prolonged processing time
Low sensitivity
Rapid loss of CMV viability
ex vivo (false-negative
results)
Shell vial assay Viral replication Recovery of PMN within few hours;
cell culture facility;
immunofluorescence detection
16–48 h Infectious foci
detected by
monoclonal antibody
directed to immediate
early antigen (72 kDa)
of CMV
High specificity for CMV
infection and disease
More sensitive and rapid
than tube cultures
Relatively low sensitivity
compared with molecular
methods
Antigenemia pp65 Antigen Recovery of PMN within 4–6 h;
Cytospin; light microscopy or
immunofluorescence
6–24 h Number of CMV-
infected cells per total
(eg, 2 × 105) cells
evaluated; early
detection of CMV
replication
Rapid diagnosis of CMV
Guide for initiation of
preemptive therapy
Guide for treatment
responses
Subjective interpretation of
results
Requires rapid processing
Nucleic acid
detection
DNA or RNA Plasma, whole blood, leukocytes,
other body fluids
4–24 h Reported as CMV
copies per milliliter of
sample (should now
be standardized to
IU/ml of sample)
Detection of CMV
infection; monitor CMV
DNA decline;
surrogate marker for
antiviral drug
resistance
Highly sensitive
Correlation with clinical
disease severity
Guides preemptive
therapy
Rapid diagnosis of CMV
infection and disease
Monitor therapeutic
response
Modest positive predictive
value for CMV disease
Needs standardization
among various assays
10
12. PREEMPTIVE THERAPY
a. Regular weekly screening for +ve CMV PCR or +ve pp56 antigenemia till
week 12 especially after antilymphocyte antibody therapy.
b. Aim:
a. is to prevent progression to symptomatic clinical disease.
b. Once CMV is detected, start the treatment.
c. Less cost:
a. Offset by the cost of laboratory testing, increased logistic
coordination.
d. Less likely associated with late onset CMV disease.
e. Not effective in D+/R− liver recipients so antiviral prophylaxis is the rule.
f. Should be used only with D±/R+ liver recipients
12
13. ANTIVIRAL PROPHYLAXIS
a. Administration of antiviral drugs such as valganciclovir to all patients at risk
of CMV disease after liver transplantation.
a. Used drugs: oral ganciclovir, I.V ganciclovir, valganciclovir.
b. Advantages:
a. Prevention of direct and indirect CMV effects.
b. Decreased incidence of herpes, bacterial, protozon infections, rejection
and mortality
c. Should be used to D+/R− liver recipients.
c. Disadvantages:
a. antiviral drug cost, drug-related toxicity and resistance.
b. incidence of late-onset CMV disease (esp. D+/R– LT recipients.
d. Valganciclovir vs. ganciclovir prophylaxis:
a. Oral ganciclovir is poorly absorbed so IV should be used.
b. Oral 950 mg valganciclovir = 5mg/kg IV ganciclovir.
c. New studies 450 mg = 950 mg valganciclovir.
13
14. 12
17
15
18
0
2
4
6
8
10
12
14
16
18
20
6m 12m
Valganciclovir Oral Ganciclovir
19
12
0
2
4
6
8
10
12
14
16
18
20
CMV disease in liver recipients
Valganciclovir Oral Ganciclovir
A randomized trial of 372 CMV D+/R– kidney, liver, pancreas,
and heart recipients
FDA has cautioned against valganciclovir prophylaxis in liver recipients,
although many experts still recommend its use in liver recipients
14
15. a. Maribavir prophylaxis: is investigation drug that is less effective than oral
ganciclovir so is on hold.
b. CMV immunoglobulin: Its role when combined with anti CMV drugs is
debate.
HYBRID APPROACH
Prophylaxis is started for 3 month then preemptive strategy is the role.
LATE−ONSET CMV DISEASE
In high−risk CMV D+/R− individuals, the use of antiviral prophylaxis for
100 d has only delayed the onset of CMV disease to 3−6 month after liver
transplantation.
associated with allograft failure and mortality
Prevention:
Clinical follow-up with early treatment of CMV disease when
symptoms occur;
Virologic surveillance after completion of antiviral prophylaxis
Prolonging antiviral prophylaxis.
15
16. 16.1
36.8
0
5
10
15
20
25
30
35
40
200 day Val 100 day Val
CMV disease
A randomized trial compared 200 versus 100 days of
valganciclovir prophylaxis in 318 CMV D+/R– kidney recipients
16
17. Antiviral Prophylaxis Preemptive Therapy
Efficacy • Highly efficacious for CMV
disease prevention
• Risk of late-onset CMV disease
• Prevents CMV disease but not
CMV infection
Logistics of use • Needs monitoring of potential
adverse effects such as
leukopenia
• Difficult to coordinate weekly
viral load testing and results
follow-up
• Viral load thresholds not
standardized
Late-onset CMV
disease
• Common among CMV D+/R–
transplant recipients
• Less common
Cost • Higher drug costs • Higher laboratory costs
Toxicity • Greater drug toxicity
(leukopenia and bone marrow
suppression)
• Less drug toxicity (shorter
courses of antiviral treatment)
Indirect effects (graft
loss, mortality, and
opportunistic infections)
• Reduction in indirect effects • May not reduce indirect effects
(limited data available)
Drug resistance • Yes (but still uncommon) • Yes (but still uncommon)
17
18. TREATMENT
1. Used drugs:
1. Oral ganciclovir should not be used.
2. Oral valganciclovir and IV ganciclovir.
3. Less used drugs:
a. Cidofovir and foscarnet are high active, highly nephrotoxic.
b. IV immunoglobulin maybe adjuvant therapy.
2. Decrease to immunosuppressive level:
1. to allow the immune system to act against CMV.
2. Shift to mTor inhibitors.
3. Mild to moderate disease: oral valganciclovir and IV ganciclovir are
comparable.
4. Severe disease, high viral load, GIT invasion:
1. use only IV ganciclovir,
2. after improvement use oral valganciclovir.
5. Duration of treatment:
a. 14-21 day followed by 4-12 week prophylaxis to prevent relapse (35%).
6. End point of treatment: 2 negative PCRs one week apart.
18
19. Antiviral drugs for CMV prevention and treatment
Drug
Preemptive Therapy and
Treatment of CMV Disease
Antiviral Prophylaxis Comments on Use and Toxicity
Valganciclovir • 900 mg by mouth twice daily • 900 mg by mouth once
daily
• Ease of administration
Leukopenia
Oral ganciclovir • Not recommended • 1 g by mouth 3 times
daily
• Low oral bioavailability
High pill burden
• Leukopenia
• Risk of resistance
IV ganciclovir • 5 mg/kg IV every 12 h • 5 mg/kg IV once daily • IV access
Leukopenia
Valacyclovir • Not recommended • 2 g by mouth 4 times
daily
• Kidney transplant recipients only
• Not recommended for heart, liver,
pancreas, lung, intestinal, and
composite tissue transplant recipients
High pill burden
• Neurologic adverse effects
Foscarnet • 60 mg/kg IV every 8 h (or 90
mg/kg every 12 h)
• Not recommended for
preemptive therapy
• Not recommended • Second-line agent for treatment
• Highly nephrotoxic
• Treatment of UL97-mutant
ganciclovir-resistant CMV
Cidofovir • 5 mg/kg once weekly × 2 then
every 2 wk thereafter
• Not recommended for
preemptive therapy
• Not recommended • Third-line agent
• Highly nephrotoxic
• Treatment of UL97-mutant
ganciclovir-resistant CMV
19
20. 1. It is a common with prolonged anti CMV drugs use e.g. antiviral
prophylaxis or preemptive therapy and D+/R– recipients.
2. It is detected when the viral load did not decrease from the baseline or
even breakthrough.
3. Incidence: is low (0.26%) but common with D+/R– recipients, over
immunosuppression and recurrent rejection.
4. Phenotypes:
a. Ganciclovir resistance is more common.
b. Isolated or cross resistance to cidofovir or foscarnet is less common.
5. Genetics:
a. UL97: phosphorylates ganciclovir to ganciclovir triphosphate. So
mutations cause only ganciclovir resistance.
b. UL54: activates ganciclovir triphosphate to inhibit CMV DNA
polymerase. So mutations cause ganciclovir resistance and
foscarnet and cidofovir resistance.
c. Combined mutations.
20
DRUG-RESISTANT CMV INFECTION AND DISEASE
21. TREATMENT OF DRUG-RESISTANT CMV INFECTION
Decrease immunosuppression ±shift to mTOR inhibitors.
Genetic mapping of UL54 and UL97 genes.
UL54 mutations:
• Vaccines.
• intravenous immunoglobulin.
• Letermovir (AIC246): UL56 terminase inhibitor.
• Maribavir
• Brincidofovir (CMX001): prodrug of cidofovir
• Leflunomide: drug for rheumatoid arthritis inhibiting viral kinases.
• Artesunate: anti-malarial
• CMV-specific T cells.
21