Slideshow is from the University of Michigan Medical School's M2 Musculoskeletal sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Muscu
Module: Pharmacotherapy III
Module Coordinator: Dr. Arwa M. Amin Mostafa
Academic Level: Postgraduate, Master of Pharmacy in Clinical Pharmacy
School: Dubai Pharmacy College
Year of first presented in Class: 2018
This presentation is for Educational purpose. It has no commercial value associated with it.
Module: Pharmacotherapy III
Module Coordinator: Dr. Arwa M. Amin Mostafa
Academic Level: Postgraduate, Master of Pharmacy in Clinical Pharmacy
School: Dubai Pharmacy College
Year of first presented in Class: 2018
This presentation is for Educational purpose. It has no commercial value associated with it.
It's challenging to treat patients with gout who also have chronic kidney disease. Here's a review of literature on how to proceed. This happens to be my second PRA convention presentation.
I was asked by the organizers to review updates on the management of gout. I compared guideline recommendations from the 2008 Philippine CPG to the 2012 ACR Recommendations and the 2014 3E Initiative.
09.30.08(b): Approach to the Patient with Disorders of OsmoregulationOpen.Michigan
Slideshow is from the University of Michigan Medical School's M2 Renal sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Renal
Slideshow is from the University of Michigan Medical School’s M2 Musculoskeletal sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Muscu
It's challenging to treat patients with gout who also have chronic kidney disease. Here's a review of literature on how to proceed. This happens to be my second PRA convention presentation.
I was asked by the organizers to review updates on the management of gout. I compared guideline recommendations from the 2008 Philippine CPG to the 2012 ACR Recommendations and the 2014 3E Initiative.
09.30.08(b): Approach to the Patient with Disorders of OsmoregulationOpen.Michigan
Slideshow is from the University of Michigan Medical School's M2 Renal sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Renal
Slideshow is from the University of Michigan Medical School’s M2 Musculoskeletal sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Muscu
Endocrinal system /certified fixed orthodontic courses by Indian dental acad...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Jim Holliman, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...Open.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...Open.Michigan
This is a lecture by Michele Nypaver, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident TrainingOpen.Michigan
This is a lecture by Andrew Barnosky, DO from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Dental Emergencies and Common Dental Blocks- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Arthritis and Arthrocentesis- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Right Upper Quadrant Ultrasound- Resident TrainingOpen.Michigan
This is a lecture by Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Nursing Process and Linkage between Theory and PracticeOpen.Michigan
This is a lecture by Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
2014 gemc-nursing-lapham-general survey and patient care managementOpen.Michigan
This is a lecture by Dr. Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jessica Holly from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: The Role of Radiography in the Initial Evaluation of C-Spine TraumaOpen.Michigan
This is a lecture by Dr. Stephen Hartsell from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
1. Author(s): Seetha Monrad, M.D., 2009
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physician if you have questions about your medical condition.
Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
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4. What is gout?
• Disease state arising from the deposition
of monosodium urate crystals in assorted
tissues, with accompanying inflammatory
and/or degenerative consequences
– In joints -> inflammatory arthritis
– In soft tissue -> tophi
– In kidneys -> nephrolithiasis, nephropathy
• Most common inflammatory arthritis in
men >40
13. Ethanol
• Overproduction
– High purines
(especially beer)
– Produces excess AMP
-> metabolized into
uric acid
• Underexcretion
– Dehydration
– Organic acids ->
Torpedo Extra IPA by Milletre, Flickr.com
overwhelm urate
transporter
14. Hyperuricemia is NOT Gout
• Hyperuricemia present in 5-10% of adult
men
• 80% of hyperuricemic patients do not
develop gout
15. Is hyperuricemia bad?
• Hyperuricemia is associated with hypertension, renal disease,
metabolic syndrome, cardiovascular disease
• Studies are beginning to suggest that uric acid is an independent
risk factor for these conditions and may be involved in their
pathogenesis
– An elevated uric acid level consistently predicts the development of
hypertension.
– An elevated uric acid level is observed in 25–60% of patients with
untreated essential hypertension and in nearly 90% of adolescents with
essential hypertension of recent onset.
– Raising the uric acid level in rodents results in hypertension with the
clinical, hemodynamic, and histologic characteristics of hypertension.
– Reducing the uric acid level with xanthine oxidase inhibitors lowers
blood pressure in adolescents with hypertension of recent onset
• However, currently not sufficient evidence to support treatment of
asymptomatic hyperuricemia
Feig et al, NEJM, 2008
16. Epidemiology of gout
• Most common
inflammatory arthritis
in men>40
• Total prevalence
~3%; 6-9% if >80
• U.S. incidence may
be rising (>2 fold)
Arromdee, Drugs, 2002
17. 3 phases of gout
• Asymptomatic hyperuricemia
• Acute gout flares
• Chronic (tophaceous) gout
Primer, 2008
18. Acute gout
The victim goes to bed and sleeps in
good health. About 2 o'clock in the
morning, he is awakened by a severe
pain in the great toe; more rarely in the
heel, ankle or instep. This pain is like
that of a dislocation, and yet the parts
feel as if cold water were poured over
them. Then follows chills and shiver
and a little fever. The pain which at
first moderate becomes more intense.
With its intensity the chills and shivers
increase. After a time this comes to a
full height, accommodating itself to the
bones and ligaments of the tarsus and
metatarsus. Now it is a violent
stretching and tearing of the
ligaments-- now it is a gnawing pain
and now a pressure and tightening. So
exquisite and lively meanwhile is the
feeling of the part affected, that it
cannot bear the weight of bedclothes
nor the jar of a person walking in the
room.
Thomas Sydenham
19. The Gout by James Gillray, Crankyprofessor.com
20. Acute gout
• 4th-6th decade (men); later in
women
• Sudden onset, rapid escalation
• 1st MTP (podagra)
– 50% have as first attack
– 90% will have eventually
• Other lower extremity joints
• Systemic symptoms
• Extraarticular (bursitis,
tenosynovitis)
• Triggered by: trauma, surgery,
sepsis, overindulgence
(alcohol, purine-rich foods),
drugs
Clinical Slide Collection on the Rheumatic
Diseases, American college of Rheumatology,
1972-2004
22. Chronic gout
• Chronic destructive
arthritis
• Flares become
polyarticular, additive,
ascending
• Can be mistaken for
rheumatoid arthritis
Rheumatology Image Bank
28. Renal Disease
• Acute uric acid nephropathy (tumor lysis
syndrome)
• Chronic urate nephropathy
(tubulointerstitial disease)
– MSU deposition in renal medulla
– Not seen in the absence of gouty arthritis
• Uric acid nephrolithiasis
– 10-25% of gout patients
– Increased non-urate nephrolithiasis as well
29. Diagnosis: Arthrocentesis
• Can be performed
even if not in acute
attack
• Inflammatory joint
fluid, sometimes
septic appearing
Source Undetermined
33. Serum uric acid
• If high, suggestive but not diagnostic
• Up to 1/3 of patients having an acute gout
attack may have a uric acid <7
• 24 hour urine collections for uric acid
– Difficult to perform
– May be useful in select cases (young patient,
history of urolithiasis)
35. Acute treatment
• NSAIDs • Colchicine
• Steroids – Never IV
– Intraarticular – Used prophylactically
– Oral/IV in intercritical periods
– Toxicities: diarrhea
• ACTH (common),
• Anakinra neuromyopathy, bone
marrow suppression,
hematologic
abnormalities
– Not dialyzable
36. Lowering uric acid
• Adjust offending • Purine rich foods
medications (ex. – Beer, other alcoholic
diuretics) beverages.
• Weight loss – Anchovies, sardines in oil,
fish roes, herring
• Dietary adjustments – Yeast
– Less meat, seafood – Organ meat (liver, kidneys,
– Less alcohol (particularly sweetbreads)
beer) – Meat extracts, consomme,
– Less fructose containing gravies
soft drinks
– ?More dairy – Mushrooms, spinach,
asparagus, cauliflower,
legumes (dried beans,
peas) less associated with
gout
37. Indications for uric acid lowering
medication
• Tophaceous gout
• Erosive gout
• Unacceptably frequent attacks (>3-4/year)
• Nephrolithiasis
• Serum uric acid >12 with other risk factors for
gout or nephrolithiasis
• Goals: lower serum urate <6.0 (<5.0 if tophi)
• Should not be initiated during an acute flare
40. Allopurinol
• Purine analog of xanthine
• Competitive xanthine oxidase inhibitor
• Active metabolite = oxypurinol
• Potentiates azathioprine and warfarin
• Side effects:
– Rash/toxic epidermolysis/Stevens Johnson
syndrome
– GI intolerance/liver enzyme elevation
– Cytopenia
41. Allopurinol hypersensitivity
syndrome
• Idiosyncratic; usually develops within first
3 months of initiation
• Fever, rash, hepatitis, interstitial nephritis,
myocarditis, rhabdomyolysis, eosinophilia
• Incidence ~0.4%, mortality 25%
• Arellano, et al. 1993: ~75% of patients
developing syndrome were receiving
allopurinol for asymptomatic
hyperuricemia
42. Renal dosing?
• Guidelines for dose adjustment in patients
with renal insufficiency to minimize toxicity
• However,
– Unclear if this is successful
– Results in significant undertreatment of gout
• Recommend carefully advancing
allopurinol as high as needed to lower
serum urate
44. Special instances of gout
• Organ transplant patients on cyclosporine
– More likely to develop rapidly, be tophaceous,
involve atypical joints
– Steroid use may mask acute attacks despite
accumulation of total body urate load
• Gout in young men (<25) or
premenopausal women: likely genetic
45. CPPD disease
• Calcium pyrophosphate deposition disease
– Pseudogout
– Also pseudo-septic, pseudo-RA, pseudo-OA
• Associated with aging
• Also associated with
– Hemochromatosis
– Hyperparathyroidism
– Hypomagnesemia/hypophosphatemia
– Gout
– Trauma
– Hypothyroidism
46. Pseudogout
• Acute inflammatory attacks
• Asymptomatic in between
• Flares involve large joints: knees,
shoulders, wrists, ankles
• Also can involve MCPs
• May take longer to reach peak intensity,
longer to subside than gout
• Not due to uric acid
53. Additional Source Information
for more information see: http://open.umich.edu/wiki/CitationPolicy
Slide 5: Cecil Medicine, 23rd ed.
Slide 6: Seetha Monrad
Slide 7: Teng, Drugs, 2006
Slide 9: Cecil Medicine, 23rd ed.
Slide 12: Teng, 2006
Slide 13: Torpedo Extra IPA by Milletre, Flickr.com, http://www.flickr.com/photos/71781509@N00/3252864721
Slide 15: Feig et al, NEJM, 2008
Slide 16: Arromdee, Drugs, 2002
Slide 17: Primer, 2008
Slide 18: Thomas Sydenham
Slide 19: The Gout by James Gillray, Crankyprofessor.com, http://www.crankyprofessor.com/archives/001383.html
Slide 20: Clinical Slide Collection on the Rheumatic Diseases, American college of Rheumatology, 1972-2004,
http://www.msnbc.msn.com/id/27848025/
Slide 22: Rheumatology Image Bank, http://images.rheumatology.org/
Slide 23: Rheumatology Image Bank, http://images.rheumatology.org/ ; American College of Rheumatology
Slide 24: Source Undetermined; Source Undetermined
Slide 25: American College of Rheumatology
Slide 26: Rheumatology Image Bank, http://images.rheumatology.org/
Slide 27: Source Undetermined
Slide 29: Source Undetermined
Slide 30: American College of Rheumatology; American College of Rheumatology
Slide 31: Source Undetermined; Source Undetermined; Source Undetermined
Slide 32: American College of Rheumatology
Slide 39: Source Undetermined
Slide 47: Source Undetermined
Slide 48: Rheumatology Image Bank, http://images.rheumatology.org/
Slide 49: Kelley s Textbook of Rheumatology (Both Images)
Slide 50: Source Undetermined
Slide 52: American College of Rheumatology; Source Undetermined