Rheumatic heart disease is an autoimmune condition that can develop after a streptococcal throat infection. The bacteria produces antigens that are similar to heart tissue, leading to molecular mimicry where the immune system attacks the heart. Approximately 3% of untreated streptococcal infections lead to rheumatic fever, which can cause inflammation of the heart valves and joints. Repeated bouts of rheumatic fever over time can cause scarring of the heart valves, leading to stenosis or incompetence requiring valve replacement. Treatment involves antibiotics to prevent future streptococcal infections, while prophylaxis aims to protect those with a history of rheumatic fever from additional attacks.
Tetralogy of Fallot (TOF) is a congenital heart defect, which has four anatomical components:
Anterior malalignment ventricular septal defect (VSD)
Aortic override over the muscular septum
Variable degrees of subvalvar, valvar, and supravalvar pulmonary stenosis
Right ventricular (RV) infundibular narrowing and RV hypertrophy
Tetralogy of Fallot (TOF) is a congenital heart defect, which has four anatomical components:
Anterior malalignment ventricular septal defect (VSD)
Aortic override over the muscular septum
Variable degrees of subvalvar, valvar, and supravalvar pulmonary stenosis
Right ventricular (RV) infundibular narrowing and RV hypertrophy
Rheumatic fever (acute rheumatic fever) is a disease that can affect the heart, joints, brain, and skin. Rheumatic fever can develop if strep throat and scarlet fever infections are not treated properly. Early diagnosis of these infections and treatment with antibiotics are key to preventing rheumatic fever.
Rheumatic fever (RF) is an inflammatory disease that can involve the heart, joints, skin, and brain.[1] The disease typically develops two to four weeks after a streptococcal throat infection.[2] Signs and symptoms include fever, multiple painful joints, involuntary muscle movements, and occasionally a characteristic non-itchy rash known as erythema marginatum.[1] The heart is involved in about half of the cases.[1] Damage to the heart valves, known as rheumatic heart disease (RHD), usually occurs after repeated attacks but can sometimes occur after one. The damaged valves may result in heart failure, atrial fibrillation and infection of the valves.[1]
Case study- An 11 year old Polynesian male presents with fever up to 39 degrees (102 degrees F), joint pain and swelling, along with shortness of breath. The fever comes and goes at random times of the day. The symptoms have been present now for 4 days.
Rheumatic fever (acute rheumatic fever) is a disease that can affect the heart, joints, brain, and skin. Rheumatic fever can develop if strep throat and scarlet fever infections are not treated properly. Early diagnosis of these infections and treatment with antibiotics are key to preventing rheumatic fever.
Rheumatic fever (RF) is an inflammatory disease that can involve the heart, joints, skin, and brain.[1] The disease typically develops two to four weeks after a streptococcal throat infection.[2] Signs and symptoms include fever, multiple painful joints, involuntary muscle movements, and occasionally a characteristic non-itchy rash known as erythema marginatum.[1] The heart is involved in about half of the cases.[1] Damage to the heart valves, known as rheumatic heart disease (RHD), usually occurs after repeated attacks but can sometimes occur after one. The damaged valves may result in heart failure, atrial fibrillation and infection of the valves.[1]
Case study- An 11 year old Polynesian male presents with fever up to 39 degrees (102 degrees F), joint pain and swelling, along with shortness of breath. The fever comes and goes at random times of the day. The symptoms have been present now for 4 days.
Rheumatic fever (acute rheumatic fever) is a disease that can affect the heart, joints, brain, and skin.
Rheumatic fever can develop if strep throat and scarlet fever infections are not treated properly.
Early diagnosis of these infections and treatment with antibiotics is key to preventing rheumatic fever.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. Objectives
• To understand basis of rheumatic fever as an
immunologically mediated late complication of
Streptococcal infection
• To know that autoimmunity results from production
of cross reacting antibodies against Streptococcal
antigens
• To describe rheumatic heart disease as one of the
several manifestations of rheumatic fever
• To know the signs, symptoms, pathogenesis,
treatment and prophylaxis of rheumatic heart
disease
3. Rheumatic Fever
• Epidemiology of Rheumatic Fever (RF)
• ~3% of persons with untreated group A streptococcal
pharyngitis develop rheumatic fever
• 15-20 million new cases a year in developing
countries
• Risk factors
– Low standard of living
– Crowding
4. Rheumatic fever
• Individual (HLA) susceptibility is also
important
• Antigen-presenting cells bearing the HLA-DR7
molecule from RHD patients preferentially
recognize heart-tissue protein
(Guilherme L, Kalil J. Ann N Y Acd Sci 2007,1107:426-433)
• Other views in the literature exist, due to
+ The various HLA-typing methods.
+ Ways of grouping the cases.
5. Rheumatic fever
• Rheumatic fever is an inflammatory disease
which may develop after a Group A
Streptococcal infection such as:
– Strep. throat infection or scarlet fever
• Can involve the heart, joints, skin, and brain
• It commonly appears in children ages 5
through 15
6. Organism
• Caused by group A
streptococcus
• There is a latent period of
~3 weeks (1–5 weeks)
between the group A
streptococcal infection and
the appearance of the
clinical features of RF
7. Group A b-haemolytic streptococcus
• All cases associated with recent infection (e.g.
pharyngitis)
• Antibody and cellular immune response
cross-reacts with human connective tissue
8. Nimishikavi S, Stead L Streptococcal Pharyngitis – Images in Clinical Medicine.
NEJM 2005: 352:e10.
9. M proteins
Adherence of Streptococcus pyogenes to
host cells & inhibiting the host immune
response
Hyaluronic acid capsule: Camouflages the bacterium
Streptokinases: Dissolve blood clots
Peptidases:
Degrades proteins involved in immune response
Pyrogenic toxins: Stimulate fever, rash & shock
Streptolysins:
Lyse erythrocytes, leukocytes & platelets
10. PATHOGENESIS
• Rheumatic fever affect the peri-arteriolar
connective tissue
• It is believed to be caused by antibody cross-
reactivity
• This cross-reactivity is a Type II hypersensitivity
reaction and is termed molecular mimicry
11. • Group A streptococcus pyogenes has a cell wall
composed of branched polymers which sometimes
contain "M proteins " that are highly antigenic
• The antibodies which the immune system generates
against the "M proteins" may cross react with
cardiac myofiber protein myosin and smooth muscle
cells of arteries, inducing cytokine release and tissue
destruction
• This inflammation occurs through direct attachment
of complement and Fc receptor-mediated
recruitment of neutrophils and macrophages
12.
13. Diagram illustrating the process of initial mimicry which leads to granuloma formation, gamma
interferon production and scarring in the valve. After the initial process has developed inflammation
in the valve, other proteins in the valve may then be recognized by the immune system leading
potentially to epitope spreading and responses against other valve proteins such as vimentin and
collagen.
“Molecular mimicry in the autoimmune pathogenesis of rheumatic heart disease” by L. Guilherme; J. Kalil; M.W. Cunningham.
15. Pathophysiology
• During a Strep. infection activated antigen presenting
cells such as macrophages present the bacterial
antigen to helper T cells
• Helper T cells subsequently activate self reactive B
cells and induce the production of antibodies against
the cell wall of Streptococcus
• However the antibodies may also react against the
myocardium and joints, producing the symptoms of
rheumatic fever
18. Heart
• Up to 60% of patients with ARF
progress to Rheumatic Heart
Disease (RHD)
• only manifestation of ARF with
significant potential to cause
long-term disability and/or death
• The endocardium, pericardium,
or myocardium may be affected
(pancarditis)
• Valvular damage is the hallmark
of rheumatic carditis. The mitral
valve is almost affected
Left ventricle has been cut open to display
characteristic severe thickening of mitral
valve, thickened chordae tendineae, and
hypertrophied left ventricular
19. Joints (arthritis)
• This is usually polyarthritis,
sometimes flitting from
joint to joint (migratory),
affecting the larger joints
more than the smaller
ones.
• Swelling, redness and
tenderness are the
common findings and
occasionally joint effusions.
• Inflamed Keen Joint
20. Skin (Erythema Marginatum)
• Skin lesions: The classical erythema marginatum—
lesions with prominent margins slightly raised
21. Central nervous system (chorea)
• Sydenham's chorea
• Occurs in children, rare in adults
• The choreiform movements affect
particularly the head and the upper
limbs
• They may be generalized or restricted
to one side of the body (hemi-
chorea)
• Chorea eventually resolves
completely, usually within 6 weeks
• likely due to molecular mimicry, with
autoantibodies reacting with brain
ganglioside
22. Subcutaneous nodules
• Subcutaneous nodules :
These are painless, round,
firm lumps overlaid by
normal looking skin
• They range from a few
millimeters to 1.5 cm in
diameter, and are localized
over bony prominences like
the elbow, shin and spine.
They sometimes last longer
than a month
23.
24. Investigation of Rheumatic Fever
• Anti-streptolysin O (ASO) titer
– At least 80% of patients with ARF have an elevated anti-
streptolysin O titer at presentation
• Rising titer is more convincing
– Anti-DNAse B
– Anti-hyaluronidase test
• Throat culture for group A streptococci (obtain 2 or 3
cultures)
25. Rheumatic Fever – Clinical Course
• Subsequent attacks
– Increased vulnerability to reactivation of disease
with subsequent strep infections
– Same symptoms with each attack
– Carditis worsens with each attack
– Heart valves are frequently deformed (mitral)
– Heart failure develops after decades
26. Acute, recurring, chronic:
• Symptoms prone to recur with subsequent Strep. infections
• Chronic disease leads to fibrosis (chordae of heart valves +
valve cusps)
Stenotic mitral valve seen from left atrium Opened stenotic mitral valve
27. Treatment of Rheumatic Fever
• Treat first strep throat infection with penicillin
• Treat other manifestations symptomatically
• Prophylactic long term anti-strep therapy
given to anyone who has had rheumatic fever
28. Take home message
• Rheumatic heart disease results from cross reacting
antibodies binding the heart valves
• Repeated attacks of Streptococcal throat infection
over the years damage heart valves resulting in
either stenotic or incompetent heart valves
• Treatment involves surgical replacement of the
damaged heart valves
• In patients with rheumatic fever long term
administration of penicillin is recommended for
prevention of future infections by group A
Streptococcus