Case Report : Integrating Review Inflammation and Commorbid diseasesSoroy Lardo
Diabetes is associated with atherosclerosis and COPD contributed to the chronic inflammation within the systemic vascular. Management of CVI with diabetes and COPD requires multi-disciplinary approach
Paediatrics Clinicopathological Conference - Approach to a Child with PallorAzizul Halid, MBBS
This document presents the case of an 8-year-old boy who presented with pallor for 7 months and fever with cough for 5 days. On examination, he was found to have pallor, hepatosplenomegaly, and lymphadenopathy. Investigations revealed pancytopenia, microcytic hypochromic anemia, elevated LDH and ferritin, and prolonged aPTT. Bone marrow aspiration showed myelodysplastic syndrome. The patient was diagnosed with myelodysplastic syndrome with concurrent atypical pneumonia. He received two blood transfusions which provided only minimal improvement in his hemoglobin levels.
This document summarizes the diagnosis and management of common cardiac emergencies in children. It presents several case studies and uses them to discuss key considerations like differentiating various causes of cyanosis, shock, or arrhythmias in infants and children. For each case, it analyzes presenting signs and test results to identify the underlying condition. It then outlines the initial emergency management principles, focusing on stabilization, organ support, and addressing specific issues like restoring blood flow or minimizing pulmonary pressures. The document emphasizes the importance of early diagnosis and intervention for high mortality cardiac conditions in children.
1. The document presents a case of a 56-year-old male smoker with hypertension and diabetes presenting with acute chest pain.
2. On examination, the patient is pale, diaphoretic with a heart rate of 108 and normal blood pressure. His ECG shows ST elevation.
3. The diagnosis is an acute ST elevation myocardial infarction (STEMI) requiring timely reperfusion therapy such as thrombolytics or percutaneous coronary intervention to restore blood flow and limit damage from the heart attack.
This patient presented with prolonged fever, hepatitis, and hypodense liver lesions. Initial tests did not reveal a cause. Imaging found lesions in the liver, spleen, kidneys, and lungs. Bone marrow aspiration showed granulomatous inflammation. Blood cultures grew Burkholderia pseudomallei, confirming a diagnosis of melioidosis. The patient was treated with ceftazidime and cotrimoxazole and showed improvement in symptoms and lab values. Melioidosis can be difficult to diagnose but is important to identify given its endemic nature and risk of disseminated infection.
Jill Blumenthal, MD of the UC San Diego AntiViral Research Center presents "Cryptococcal Meningitis with Cranial Nerve Neuropathies: Predictors of Outcome and Review of ART Initiation"
1) A 1.5 month boy presented with fever and pancytopenia. Examination found pallor. Blood tests found normocytic anemia, leukopenia, thrombocytopenia.
2) Bone marrow aspiration found erythroid dysplasia and megaloblastosis. Chromosomal breakage study and karyotyping were normal.
3) Flow cytometry found B cell immune deficiency. The pancytopenia and symptoms improved with supportive care.
4) Genetic testing in Germany found a MYSM1 mutation, which has been associated with bone marrow failure and immunodeficiency. The patient will require long term supportive care including transfusions, immunoglobulins and G
1. This case presents a 1.5 month old boy with pancytopenia, fever, and respiratory symptoms.
2. Initial workup showed normocytic anemia, leukopenia, thrombocytopenia, and low corrected reticulocyte count. Bone marrow aspiration found erythroid dysplasia and megaloblastic changes.
3. Further testing found B cell immune deficiency. The patient was eventually diagnosed with MYSM1 mutation, a rare cause of congenital sideroblastic anemia and immunodeficiency. He requires supportive care including transfusions and immunoglobulin therapy.
Case Report : Integrating Review Inflammation and Commorbid diseasesSoroy Lardo
Diabetes is associated with atherosclerosis and COPD contributed to the chronic inflammation within the systemic vascular. Management of CVI with diabetes and COPD requires multi-disciplinary approach
Paediatrics Clinicopathological Conference - Approach to a Child with PallorAzizul Halid, MBBS
This document presents the case of an 8-year-old boy who presented with pallor for 7 months and fever with cough for 5 days. On examination, he was found to have pallor, hepatosplenomegaly, and lymphadenopathy. Investigations revealed pancytopenia, microcytic hypochromic anemia, elevated LDH and ferritin, and prolonged aPTT. Bone marrow aspiration showed myelodysplastic syndrome. The patient was diagnosed with myelodysplastic syndrome with concurrent atypical pneumonia. He received two blood transfusions which provided only minimal improvement in his hemoglobin levels.
This document summarizes the diagnosis and management of common cardiac emergencies in children. It presents several case studies and uses them to discuss key considerations like differentiating various causes of cyanosis, shock, or arrhythmias in infants and children. For each case, it analyzes presenting signs and test results to identify the underlying condition. It then outlines the initial emergency management principles, focusing on stabilization, organ support, and addressing specific issues like restoring blood flow or minimizing pulmonary pressures. The document emphasizes the importance of early diagnosis and intervention for high mortality cardiac conditions in children.
1. The document presents a case of a 56-year-old male smoker with hypertension and diabetes presenting with acute chest pain.
2. On examination, the patient is pale, diaphoretic with a heart rate of 108 and normal blood pressure. His ECG shows ST elevation.
3. The diagnosis is an acute ST elevation myocardial infarction (STEMI) requiring timely reperfusion therapy such as thrombolytics or percutaneous coronary intervention to restore blood flow and limit damage from the heart attack.
This patient presented with prolonged fever, hepatitis, and hypodense liver lesions. Initial tests did not reveal a cause. Imaging found lesions in the liver, spleen, kidneys, and lungs. Bone marrow aspiration showed granulomatous inflammation. Blood cultures grew Burkholderia pseudomallei, confirming a diagnosis of melioidosis. The patient was treated with ceftazidime and cotrimoxazole and showed improvement in symptoms and lab values. Melioidosis can be difficult to diagnose but is important to identify given its endemic nature and risk of disseminated infection.
Jill Blumenthal, MD of the UC San Diego AntiViral Research Center presents "Cryptococcal Meningitis with Cranial Nerve Neuropathies: Predictors of Outcome and Review of ART Initiation"
1) A 1.5 month boy presented with fever and pancytopenia. Examination found pallor. Blood tests found normocytic anemia, leukopenia, thrombocytopenia.
2) Bone marrow aspiration found erythroid dysplasia and megaloblastosis. Chromosomal breakage study and karyotyping were normal.
3) Flow cytometry found B cell immune deficiency. The pancytopenia and symptoms improved with supportive care.
4) Genetic testing in Germany found a MYSM1 mutation, which has been associated with bone marrow failure and immunodeficiency. The patient will require long term supportive care including transfusions, immunoglobulins and G
1. This case presents a 1.5 month old boy with pancytopenia, fever, and respiratory symptoms.
2. Initial workup showed normocytic anemia, leukopenia, thrombocytopenia, and low corrected reticulocyte count. Bone marrow aspiration found erythroid dysplasia and megaloblastic changes.
3. Further testing found B cell immune deficiency. The patient was eventually diagnosed with MYSM1 mutation, a rare cause of congenital sideroblastic anemia and immunodeficiency. He requires supportive care including transfusions and immunoglobulin therapy.
This document discusses preoperative evaluation and preparation of surgical patients. It begins with an introduction on the importance of preoperative preparation from initial patient contact through to surgery. Preoperative evaluation involves gathering a comprehensive history and physical exam, ordering appropriate investigations, assessing risks, communicating with the patient, and involving a multidisciplinary team. Key areas addressed include cardiovascular, respiratory, gastrointestinal, metabolic, coagulation disorders and ensuring medical optimization and documentation is complete prior to surgery. The goal is to minimize surgical risk and maximize postoperative outcomes.
This document contains multiple questions asking to identify medical devices, procedures, and patient scenarios. For each, the responder is asked to identify the device/procedure/scenario, indicate relevant indications or contraindications, and describe management steps or potential complications. The questions cover a wide range of topics including imaging tests, laboratory investigations, medical procedures, ventilation devices, and patient presentation.
The document describes a case report of an 80-year-old male who presented with abdominal pain for 4 days. On examination, he had tenderness in the epigastric and right upper quadrant regions. Laboratory tests showed elevated lipase, amylase and CRP, consistent with acute pancreatitis. CT imaging revealed a relatively enlarged pancreas. He was admitted and treated supportively with IV fluids, antibiotics and pain medications. His condition gradually improved and he was discharged. Common scoring systems for evaluating severity of acute pancreatitis like Ranson's criteria and BISAP score are discussed.
Daily practice in medicine in general need awareness of critical signs and symptoms that can be the presentation of life threatening and fatal conditions
A 24-year-old woman presented with headache and left-sided weakness. Imaging showed cerebral venous thrombosis involving the superior sagittal sinus and draining veins. She was diagnosed with antiphospholipid syndrome based on recurrent pregnancy loss and positive lupus anticoagulant. She was treated with anticoagulation and anticonvulsants and showed gradual improvement over 10 days with residual mild weakness. Her long-term management plan includes lifelong anticoagulation and screening for recurrent thrombosis.
This case presentation discusses two patients. The first patient is a 66-year-old male with a history of diabetes, dyslipidemia, and other conditions who was referred for splenomegaly. Testing confirmed a diagnosis of polycythemia vera. The second patient is a 73-year-old male admitted for tarry stool and chest tightness. Testing showed pancytopenia, cirrhosis, and splenomegaly. A bone marrow biopsy was suggestive of myelofibrosis. Both polycythemia vera and primary myelofibrosis were discussed in detail.
This document provides an overview of preanesthesia evaluation. The key purposes are to obtain relevant medical history, assess perioperative risks, order appropriate tests, and formulate an anesthetic plan. Important components of the medical history include past and current medical problems, medications, allergies, and lifestyle factors. A physical exam focuses on vital signs, airway assessment, and systemic examination. For patients with cardiovascular or pulmonary diseases, specific evaluations and tests are recommended to optimize management and identify high-risk patients. The preanesthesia evaluation aims to detect underlying conditions, evaluate perioperative risks, and develop a customized anesthetic plan tailored to each patient's needs.
Presentation by Dr. Mishal Saleem on the topic of Extra hepatic manifestation of hep C, which is a grey area nut very important topic for FCPS Residents.
Hypertensive emergencies require immediate blood pressure reduction to prevent end organ damage. They are characterized by severely elevated blood pressure and signs of acute target organ injury. The goal is to lower mean arterial pressure by 20-25% within minutes to hours using intravenous antihypertensive drugs like sodium nitroprusside. Hypertensive urgencies also involve severely high blood pressure but without acute organ injury, allowing for oral drugs to safely lower blood pressure within 24 hours. Rapid blood pressure reduction is avoided to prevent hypotension in both conditions.
This case presentation describes a 58-year-old female patient who presented with fever, myalgia, severe headaches, and generalized weakness. Investigations revealed anemia, elevated inflammatory markers, and a positive transesophageal echocardiogram showing mitral valve vegetation. The patient was diagnosed with infective endocarditis of the mitral valve and underwent mitral valve replacement surgery. The document then provides details on the definition, diagnosis, and treatment of infective endocarditis, including descriptions of the Duke criteria for diagnosis and appropriate antibiotic therapy based on the infecting organism.
Celiac common presentation of a uncommon disease saved with dateMuhammad Arshad
A 38-year-old female presented with abdominal distention, leg edema, and loose motions for 4-6 months. Her history revealed multiple hospital admissions for anemia. Testing showed liver cirrhosis, hypothyroidism, and iron deficiency anemia. Upper endoscopy found flattened duodenal folds and villous atrophy. Biopsy revealed celiac disease. She was started on a gluten-free diet with improvement in symptoms. Celiac disease causes villous atrophy and malabsorption from intolerance to gluten, presenting variably from anemia to osteoporosis. Diagnosis requires biopsy showing villous atrophy after gluten exposure.
This patient is a 55-year-old male with uncontrolled hypertension, uncontrolled type 2 diabetes, stage 1 chronic kidney disease, and dyslipidemia who presents with fatigue, headaches, and erectile dysfunction. His medical history and lab results indicate high cardiovascular risk. The treatment plan involves lifestyle modifications, optimizing medications to better control his blood pressure and blood glucose, and monitoring by a multidisciplinary team to reduce complications.
This document summarizes a clinical case report of a 79-year-old female patient admitted for heart failure with acute exacerbation likely due to infection. Key details include:
- The patient has a history of hypertension, atrial fibrillation, hyperuricemia, and impaired glucose tolerance.
- Exams and tests show signs of congestive heart failure including jugular vein distension and crackles in the lungs. Echocardiogram finds diastolic dysfunction.
- She is treated with antibiotics, diuretics, and other heart failure medications. Her symptoms improve with treatment and she is discharged with medications including valsartan and furosemide.
1) Infective endocarditis is an infection of the heart valves or endocardial surface. It can be caused by various organisms and has multiple risk factors.
2) It presents with non-specific symptoms like fever and heart murmur, and can lead to complications affecting the heart, brain, spleen and other organs. Investigations include blood cultures, echocardiography and modified Duke's criteria.
3) Management involves long-term intravenous antibiotics based on culture results, treating complications, and possibly surgery to repair or replace infected valves. Patients are monitored in the hospital for resolution of symptoms and complications of infective endocarditis.
Preventable ICU admissions at community level - Interactive CasesVitrag Shah
This document discusses 10 interactive case studies presented by Dr. Vitrag Shah on preventing ICU admissions at the community level. Each case outlines a patient's medical history and presenting symptoms. Dr. Shah then discusses differential diagnoses, abnormal lab or test findings, additional workup needed, and how the situation could have been prevented. The goal is to recognize issues early and optimize treatment to avoid ICU admissions. Key lessons include monitoring for drug side effects, holding certain medications in acute illnesses, considering secondary causes, and screening high-risk patients proactively.
The document presents a case study of a 66-year-old female patient admitted to the cardiology department with complaints of chest pain, shortness of breath, fever, and weakness for 3-4 days. Examinations found moderate left ventricular systolic dysfunction and an abnormal ECG. The patient was diagnosed with congestive heart failure, fever, arrhythmias, acidity, angina, constipation, and high cholesterol and treated accordingly with medications and lifestyle counseling.
This document provides guidelines and templates for critical care documentation, including summaries of a patient's history and physical exam, daily progress notes, procedure notes, and discharge summaries. It outlines what information should be included in each section, such as vital signs, cardiac exam findings, lab results, assessments, and treatment plans by body system. It also provides guidelines for fluid and electrolyte replacement and blood component therapy.
Kshamendra, a 22-year-old male, presented with fever, rash, joint pains, fatigue, and cough for several weeks. He was initially diagnosed with typhoid fever but developed a drug reaction. Examination found a vesicular rash, joint pain, and pneumonia. Tests showed pancytopenia, positive ANA and anti-Ro/La antibodies. A diagnosis of Rowell's syndrome was made based on meeting the criteria of lupus erythematosus, ANA positivity, erythema multiforme-like lesions, and a positive anti-Ro antibody.
A 67-year-old female presented with right upper quadrant abdominal pain following meals and diarrhea for two weeks. Imaging studies including CT, MRI, and MIBG scan revealed bilateral adrenal masses consistent with pheochromocytoma. Laboratory tests showed markedly elevated urine and plasma metanephrines levels confirming the diagnosis. Pheochromocytoma is a rare catecholamine-secreting tumor that arises from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia. It is usually benign but can be malignant in 10% of cases.
This document discusses preoperative evaluation and preparation of surgical patients. It begins with an introduction on the importance of preoperative preparation from initial patient contact through to surgery. Preoperative evaluation involves gathering a comprehensive history and physical exam, ordering appropriate investigations, assessing risks, communicating with the patient, and involving a multidisciplinary team. Key areas addressed include cardiovascular, respiratory, gastrointestinal, metabolic, coagulation disorders and ensuring medical optimization and documentation is complete prior to surgery. The goal is to minimize surgical risk and maximize postoperative outcomes.
This document contains multiple questions asking to identify medical devices, procedures, and patient scenarios. For each, the responder is asked to identify the device/procedure/scenario, indicate relevant indications or contraindications, and describe management steps or potential complications. The questions cover a wide range of topics including imaging tests, laboratory investigations, medical procedures, ventilation devices, and patient presentation.
The document describes a case report of an 80-year-old male who presented with abdominal pain for 4 days. On examination, he had tenderness in the epigastric and right upper quadrant regions. Laboratory tests showed elevated lipase, amylase and CRP, consistent with acute pancreatitis. CT imaging revealed a relatively enlarged pancreas. He was admitted and treated supportively with IV fluids, antibiotics and pain medications. His condition gradually improved and he was discharged. Common scoring systems for evaluating severity of acute pancreatitis like Ranson's criteria and BISAP score are discussed.
Daily practice in medicine in general need awareness of critical signs and symptoms that can be the presentation of life threatening and fatal conditions
A 24-year-old woman presented with headache and left-sided weakness. Imaging showed cerebral venous thrombosis involving the superior sagittal sinus and draining veins. She was diagnosed with antiphospholipid syndrome based on recurrent pregnancy loss and positive lupus anticoagulant. She was treated with anticoagulation and anticonvulsants and showed gradual improvement over 10 days with residual mild weakness. Her long-term management plan includes lifelong anticoagulation and screening for recurrent thrombosis.
This case presentation discusses two patients. The first patient is a 66-year-old male with a history of diabetes, dyslipidemia, and other conditions who was referred for splenomegaly. Testing confirmed a diagnosis of polycythemia vera. The second patient is a 73-year-old male admitted for tarry stool and chest tightness. Testing showed pancytopenia, cirrhosis, and splenomegaly. A bone marrow biopsy was suggestive of myelofibrosis. Both polycythemia vera and primary myelofibrosis were discussed in detail.
This document provides an overview of preanesthesia evaluation. The key purposes are to obtain relevant medical history, assess perioperative risks, order appropriate tests, and formulate an anesthetic plan. Important components of the medical history include past and current medical problems, medications, allergies, and lifestyle factors. A physical exam focuses on vital signs, airway assessment, and systemic examination. For patients with cardiovascular or pulmonary diseases, specific evaluations and tests are recommended to optimize management and identify high-risk patients. The preanesthesia evaluation aims to detect underlying conditions, evaluate perioperative risks, and develop a customized anesthetic plan tailored to each patient's needs.
Presentation by Dr. Mishal Saleem on the topic of Extra hepatic manifestation of hep C, which is a grey area nut very important topic for FCPS Residents.
Hypertensive emergencies require immediate blood pressure reduction to prevent end organ damage. They are characterized by severely elevated blood pressure and signs of acute target organ injury. The goal is to lower mean arterial pressure by 20-25% within minutes to hours using intravenous antihypertensive drugs like sodium nitroprusside. Hypertensive urgencies also involve severely high blood pressure but without acute organ injury, allowing for oral drugs to safely lower blood pressure within 24 hours. Rapid blood pressure reduction is avoided to prevent hypotension in both conditions.
This case presentation describes a 58-year-old female patient who presented with fever, myalgia, severe headaches, and generalized weakness. Investigations revealed anemia, elevated inflammatory markers, and a positive transesophageal echocardiogram showing mitral valve vegetation. The patient was diagnosed with infective endocarditis of the mitral valve and underwent mitral valve replacement surgery. The document then provides details on the definition, diagnosis, and treatment of infective endocarditis, including descriptions of the Duke criteria for diagnosis and appropriate antibiotic therapy based on the infecting organism.
Celiac common presentation of a uncommon disease saved with dateMuhammad Arshad
A 38-year-old female presented with abdominal distention, leg edema, and loose motions for 4-6 months. Her history revealed multiple hospital admissions for anemia. Testing showed liver cirrhosis, hypothyroidism, and iron deficiency anemia. Upper endoscopy found flattened duodenal folds and villous atrophy. Biopsy revealed celiac disease. She was started on a gluten-free diet with improvement in symptoms. Celiac disease causes villous atrophy and malabsorption from intolerance to gluten, presenting variably from anemia to osteoporosis. Diagnosis requires biopsy showing villous atrophy after gluten exposure.
This patient is a 55-year-old male with uncontrolled hypertension, uncontrolled type 2 diabetes, stage 1 chronic kidney disease, and dyslipidemia who presents with fatigue, headaches, and erectile dysfunction. His medical history and lab results indicate high cardiovascular risk. The treatment plan involves lifestyle modifications, optimizing medications to better control his blood pressure and blood glucose, and monitoring by a multidisciplinary team to reduce complications.
This document summarizes a clinical case report of a 79-year-old female patient admitted for heart failure with acute exacerbation likely due to infection. Key details include:
- The patient has a history of hypertension, atrial fibrillation, hyperuricemia, and impaired glucose tolerance.
- Exams and tests show signs of congestive heart failure including jugular vein distension and crackles in the lungs. Echocardiogram finds diastolic dysfunction.
- She is treated with antibiotics, diuretics, and other heart failure medications. Her symptoms improve with treatment and she is discharged with medications including valsartan and furosemide.
1) Infective endocarditis is an infection of the heart valves or endocardial surface. It can be caused by various organisms and has multiple risk factors.
2) It presents with non-specific symptoms like fever and heart murmur, and can lead to complications affecting the heart, brain, spleen and other organs. Investigations include blood cultures, echocardiography and modified Duke's criteria.
3) Management involves long-term intravenous antibiotics based on culture results, treating complications, and possibly surgery to repair or replace infected valves. Patients are monitored in the hospital for resolution of symptoms and complications of infective endocarditis.
Preventable ICU admissions at community level - Interactive CasesVitrag Shah
This document discusses 10 interactive case studies presented by Dr. Vitrag Shah on preventing ICU admissions at the community level. Each case outlines a patient's medical history and presenting symptoms. Dr. Shah then discusses differential diagnoses, abnormal lab or test findings, additional workup needed, and how the situation could have been prevented. The goal is to recognize issues early and optimize treatment to avoid ICU admissions. Key lessons include monitoring for drug side effects, holding certain medications in acute illnesses, considering secondary causes, and screening high-risk patients proactively.
The document presents a case study of a 66-year-old female patient admitted to the cardiology department with complaints of chest pain, shortness of breath, fever, and weakness for 3-4 days. Examinations found moderate left ventricular systolic dysfunction and an abnormal ECG. The patient was diagnosed with congestive heart failure, fever, arrhythmias, acidity, angina, constipation, and high cholesterol and treated accordingly with medications and lifestyle counseling.
This document provides guidelines and templates for critical care documentation, including summaries of a patient's history and physical exam, daily progress notes, procedure notes, and discharge summaries. It outlines what information should be included in each section, such as vital signs, cardiac exam findings, lab results, assessments, and treatment plans by body system. It also provides guidelines for fluid and electrolyte replacement and blood component therapy.
Kshamendra, a 22-year-old male, presented with fever, rash, joint pains, fatigue, and cough for several weeks. He was initially diagnosed with typhoid fever but developed a drug reaction. Examination found a vesicular rash, joint pain, and pneumonia. Tests showed pancytopenia, positive ANA and anti-Ro/La antibodies. A diagnosis of Rowell's syndrome was made based on meeting the criteria of lupus erythematosus, ANA positivity, erythema multiforme-like lesions, and a positive anti-Ro antibody.
A 67-year-old female presented with right upper quadrant abdominal pain following meals and diarrhea for two weeks. Imaging studies including CT, MRI, and MIBG scan revealed bilateral adrenal masses consistent with pheochromocytoma. Laboratory tests showed markedly elevated urine and plasma metanephrines levels confirming the diagnosis. Pheochromocytoma is a rare catecholamine-secreting tumor that arises from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia. It is usually benign but can be malignant in 10% of cases.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
4. HISTORY OF PRESENT ILLNESS
• Onset: 5 days prior to admission
• Characteristic: both inhale and exhale, gradually progressive SOB
• Exacerbating: Exertional, when pt have mild excertion
• Relieving factor: take a rest
• Associated symptoms:
• No cough
• No chest pain
• Edema at both leg, fever 2 day resolved itself before edema happened
Shortness of breath
5. HISTORY
1. PMH: unremarkable
2. PSH: unremarkable
3. medication: None
4. Allergies: No allergic history
5. Social history: sexually active, No traveling recently, no alcohol intake, no
smoking
6. Family history: unremarkable
7. PHYSICAL EXAMINATION
• General status: alert and full of awareness, oriented x 3, No distress, no rash, BMI 21
• VS: Temp: 37 degree Celcius, HR: 115 bpm, BP: 130/75 mmHg, RR: 20 , SpO2 95-96% ambient air
• HEENT: no abnormalities
• CV: RRR, muffled heart sound ; systolic murmurs at 4th intercostal space left sternal edge, no rubs,
or gallops, no jugular distention
• Lungs: no wheezes, no rale, clear to percussion bilaterally, normal tactile fremitus.
• Abdomen: no distention, soft, no tenderness.
• Other organ : unremarkable finding
9. ONE LINER
A 22-years-old male patient with normal history presented to hospital because of
his exertional SOB after 2 days of fever. On PE, he had edema and systolic
murmur at mitral valve.
20. ECG
UPTODATE
• ST changes
• Single atrial or ventricular ectopic beats,
• complex ventricular arrhythmias (couplets or nonsustained ventricular
tachycardia),
• atrial tachycardia or AF
21. Endomyocardial Biopsy
Histology + immunohistochemical stains (Dallas criteria): Gold
standard -Definitive diagnosis of myocarditis
uptodate
22. Endomyocardial Biopsy
EMB is recommended in the following settings:
• unexplained fulminant HF
• Unexplained new onset HF (2weeks-3 months) associated with a dilated
LV and new ventricular arrhythmias, Mobitz type II second-degree AV
block, third-degree AV block, or failure to respond to usual care within
one to two weeks
uptodate
23. Endomyocardial Biopsy
EMB is suggested in the following settings (when other evaluation is
inconclusive):
• HF of >3 months duration associated with dilated LV and new
ventricular arrhythmias, second or third degree AV block, or failure to
respond to usual care within one or two weeks
• HF associated with dilated cardiomyopathy associated with suspected
allergic reaction and/or eosinophilia.
• Other specific clinical settings when other evaluation is inconclusive
and diagnosis may impact treatment or prognosis
uptodate
25. “Clinically suspected myocarditis ” CRITERIA
clinical presentation + noninvasive diagnostic findings abnormalities
(CMR)
uptodate
identify patients who may be
candidates for EMB
- patients who do not have one
indication for EMB
- undergone EMB with
nondiagnostic results
WHEN TO APPLY
CRITERIA
27. PCR and immunohistochemistry
• "immunohistochemical criteria”: ≥14 leukocytes/mm2, including up to
4 monocytes/mm2 with the presence of CD3-positive T-lymphocytes
≥7 cells/mm2
• enteroviral genomes in the myocardium of HF patients were a
biomarker of worse outcomes
• persistence of viral genome by PCR was associated with progressive
LV dysfunction, while clearance of viral genome was associated with
improved LV function
uptodate
28. Management
uptodate
• Heart failure therapy
• Therapy for arrhythmias
GENERAL
MANAGEMENT
• Therapy for arrhythmias
• Giant cell myocarditis
• Eosinophilic myocarditis
• Cardiac sarcoidosis
• Treatment of non-viral infections
• Celiac disease
MANAGEMENT
OF SPECIFIC
DISORDERS
29. TEACHING POINT
• Suspect Myocarditis in patients with or without cardiac signs and
symptoms , raised cardiac biomarkers, ECG changes suggestive of
acute myocardial injury, arrhythmia, global/regional abnormalities of
LV systolic function, particularly clinical findings are new and
unexplained
• Gold standard: EBM histology (Dallas criteria) +immunohistochemical
stains
• criteria for clinically suspected myocarditis: identify candidate for
EBM or provide a clinical diagnosis for patients who do not have one
indication for EMB
Enlargement of the cardiac silhouette
Phe huyet quan tang dam
-a history of recent upper respiratory infection or enteritis was present in 36 percent of patients in a series of patients with biopsy-proven myocarditis
The clinical manifestations of myocarditis are highly variable, ranging from subclinical disease to fatigue, chest pain, heart failure (HF), cardiogenic shock, arrhythmias, and sudden death
Acute myocarditis has been defined as a condition with symptoms of HF developing over three months or less, while chronic myocarditis has been defined as developing over greater than three months
Acute coronary syndrome-like with acute chest pain in the absence of angiographic evidence of coronary artery disease (CAD):
•Acute chest pain frequently starts within one to four weeks after a respiratory or gastrointestinal infection and is frequently associated with severe and recurrent symptoms.•ST/T wave changes include ST segment elevation or depression and T wave inversions.•Global or regional LV and/or RV dysfunction may or may not be detected.•Troponin T may or may not be elevated. The time course of troponin elevation may be similar to that with acute myocardial infarction (MI) or may be prolonged and sustained over several weeks or months.
New onset or worsening HF
New onset or progressive HF over two weeks to three months with symptoms including dyspnea, peripheral edema, chest discomfort, and fatigue.•Impaired LV and/or RV systolic function; the LV and/or RV may or may not be dilated and wall thicknesses may or may not be increased, as assessed by echocardiography or CMR. Some patients with ventricular dysfunction may progress to dilated cardiomyopathy. Symptoms may start after a respiratory or gastrointestinal infection or in the peripartum period. The electrocardiogram (ECG) may show non-specific changes, bundle branch block, atrioventricular (AV) block, or ventricular arrhythmias
Life-threatening condition: Life-threatening arrhythmias and aborted sudden death, Cardiogenic shock, Severely impaired LV function
chronic myocarditis : Some patients with myocarditis present with an indistinct onset of illness (ie, developing over more than three months), which has been described as subacute or chronic myocarditis.
An ECG is not required to diagnose myocarditis but is generally obtained to exclude alternate causes of cardiac symptoms such as ischemia, to evaluate for arrhythmias, and to identify features (eg, high grade AV block) that may suggest certain causes of myocarditis. The ECG in patients with myocarditis may be normal or show nonspecific abnormalities.
The ECG in some patients with myocarditis is similar to the ECG pattern of acute isolated pericarditis (which is suggestive of myopericarditis) or acute MI [6,26-29,40]. Like acute MI, myocarditis may be associated with regional ST elevations and Q waves. Myocarditis should be suspected in young patients who present with a possible MI but have a normal coronary angiogram
High grade AV block is uncommon in lymphocytic myocarditis, but common in Lyme disease, cardiac sarcoidosis, and idiopathic giant cell myocarditis
A definitive diagnosis of myocarditis is based upon identification of diagnostic findings on EMB, including histology (Dallas criteria) as well as immunohistochemical stains. When EMB findings are diagnostic, myocarditis is diagnosed even in the setting of concurrent heart disease, such as CAD
IMAGING: Endomyocardial biopsy of the right ventricle showing acute diffuse myocarditis. There is prominent myofiber necrosis and loss in association with a high-grade mononuclear infiltrates
Most patients presenting with subacute to chronic HF in whom a diagnosis of idiopathic dilated cardiomyopathy is made should first be managed with appropriate therapy for HF (see "Overview of the management of heart failure with reduced ejection fraction in adults"). Most of these patients will respond to medical therapy alone and do not require EMB.
Dallas criteria — The Dallas criteria were developed by a panel of cardiac pathologists as a working standard for the United States Myocarditis Treatment Trial; these criteria are now used by most investigators to define the disease
●Active myocarditis is defined as "an inflammatory infiltrate of the myocardium with necrosis and/or degeneration of adjacent myocytes not typical of the ischemic damage associated with coronary artery disease." The infiltrates are usually mononuclear, but may be neutrophilic, or occasionally, eosinophilic
●"Borderline myocarditis" is the term used when the inflammatory infiltrate is too sparse or myocyte injury is not demonstrated.
A combination of clinical presentation and noninvasive diagnostic findings including typical CMR abnormalities may be used to make a diagnosis of "clinically suspected" myocarditis. While histology remains the gold standard for establishing the diagnosis of myocarditis, low-risk patients may be diagnosed with "clinically suspected myocarditis" on the basis of a compatible clinical presentation
When to apply criteria for clinically suspected myocarditis
- To help identify patients who may be candidates for EMB
- To provide a clinical diagnosis for patients who do not have one indication for EMB or who have undergone EMB with nondiagnostic results
updated Lake Louise criteria were developed to incorporate T1 and T2 mapping and to enhance specificity compared to criteria requiring only a T1-based or a T2-based marker for myocarditis.
"immunohistochemical criteria" for myocarditis to include an abnormal inflammatory infiltrate defined as ≥14 leukocytes/mm2, including up to 4 monocytes/mm2 with the presence of CD3-positive T-lymphocytes ≥7 cells/mm2
Myocarditis should be suspected in patients with or without cardiac signs and symptoms (table 2), who have a rise in cardiac biomarkers (eg, troponin), ECG changes suggestive of acute myocardial injury, arrhythmia, or global or regional abnormalities of LV systolic function, particularly if the clinical findings are new and unexplained
Clinical suspicion for myocarditis should be high in a patient who presents with clinical signs and symptoms of an acute MI, particularly if the patient lacks cardiovascular risk factors or the coronary angiogram is normal
