This document summarizes achalasia, an esophageal motility disorder. It discusses the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of achalasia. The key points are:
1) Achalasia is caused by degeneration of ganglion cells in the esophageal myenteric plexus, resulting in loss of peristalsis and incomplete LES relaxation. The cause is unclear but may be autoimmune, viral, or neurodegenerative.
2) It has an incidence of 1 in 100,000 annually and prevalence of 10 in 100,000. Symptoms include dysphagia, chest pain, regurgitation, and weight loss. Diagnosis involves b
This document discusses challenges in diagnosing disorders related to dysmorphology and genetics in pediatric patients. It notes that an accurate diagnosis can be difficult due to genetic heterogeneity, environmental factors, incomplete family histories, and other issues. The document emphasizes the importance of a thorough clinical examination, family history, and integrating multiple sources of data to establish a diagnosis. It also discusses how early diagnosis can provide benefits by informing clinical management and prognosis.
A 19-year-old male presented with a dissecting thoraco-abdominal aneurysm. During workup, he was found to have features of Klinefelter syndrome including disproportionately long arms and feminized features. Biopsy of skin lesions revealed polyarteritis nodosa. Karyotyping showed a 47XXY pattern consistent with Klinefelter syndrome. This represents the first reported case of polyarteritis nodosa occurring concurrently with Klinefelter syndrome. Further prospective study is needed to understand the progression of these rare concurrent conditions.
This document discusses the clinical features and treatment of ANCA-associated vasculitis. It begins by defining vasculitis and describing the different types. It then focuses on ANCA-associated vasculitis, describing the characteristics of Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA), and Eosinophilic Granulomatosis with Polyangiitis (EGPA). For treatment, it recommends cyclophosphamide or rituximab combined with steroids for inducing remission of GPA and MPA. Azathioprine or methotrexate are used to maintain remission. EGPA is primarily treated with steroids, with cyclophosphamide added for more
This review summarizes recent advances in understanding the genetics and pathogenesis of inflammatory bowel disease (IBD). Genome-wide association studies have identified over 100 genetic risk loci for IBD, with about 30% shared between Crohn's disease and ulcerative colitis. These loci implicate biological pathways important for intestinal homeostasis such as barrier function, innate immune regulation, and response to microbes. Genetic variants can interact with environmental factors like smoking to influence IBD development through specific mechanisms. The review discusses candidate IBD genes in the context of relevant molecular pathways and how genetics studies continue providing insight into the complex interplay between host genetics and environmental cues in IBD.
This document reports on three cases of Kaposi's sarcoma (KS) in renal transplant recipients that developed concurrently with cytomegalovirus (CMV) infection within the first year after transplantation. The first case involved a 50-year-old man who developed KS lesions on the skin and gastrointestinal tract 3 months after being diagnosed with CMV infection. The second case was a 53-year-old man who developed KS skin lesions 5 months after transplantation accompanied by CMV infection. The third case was a 45-year-old woman who was diagnosed with KS skin lesions 8 months after transplantation during treatment for suspected CMV infection. All three patients presented with KS shortly after being diagnosed and treated for CMV infection, suggesting C
This document discusses challenges in diagnosing disorders related to dysmorphology and genetics in pediatric patients. It notes that an accurate diagnosis can be difficult due to genetic heterogeneity, environmental factors, incomplete family histories, and other issues. The document emphasizes the importance of a thorough clinical examination, family history, and integrating multiple sources of data to establish a diagnosis. It also discusses how early diagnosis can provide benefits by informing clinical management and prognosis.
A 19-year-old male presented with a dissecting thoraco-abdominal aneurysm. During workup, he was found to have features of Klinefelter syndrome including disproportionately long arms and feminized features. Biopsy of skin lesions revealed polyarteritis nodosa. Karyotyping showed a 47XXY pattern consistent with Klinefelter syndrome. This represents the first reported case of polyarteritis nodosa occurring concurrently with Klinefelter syndrome. Further prospective study is needed to understand the progression of these rare concurrent conditions.
This document discusses the clinical features and treatment of ANCA-associated vasculitis. It begins by defining vasculitis and describing the different types. It then focuses on ANCA-associated vasculitis, describing the characteristics of Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA), and Eosinophilic Granulomatosis with Polyangiitis (EGPA). For treatment, it recommends cyclophosphamide or rituximab combined with steroids for inducing remission of GPA and MPA. Azathioprine or methotrexate are used to maintain remission. EGPA is primarily treated with steroids, with cyclophosphamide added for more
This review summarizes recent advances in understanding the genetics and pathogenesis of inflammatory bowel disease (IBD). Genome-wide association studies have identified over 100 genetic risk loci for IBD, with about 30% shared between Crohn's disease and ulcerative colitis. These loci implicate biological pathways important for intestinal homeostasis such as barrier function, innate immune regulation, and response to microbes. Genetic variants can interact with environmental factors like smoking to influence IBD development through specific mechanisms. The review discusses candidate IBD genes in the context of relevant molecular pathways and how genetics studies continue providing insight into the complex interplay between host genetics and environmental cues in IBD.
This document reports on three cases of Kaposi's sarcoma (KS) in renal transplant recipients that developed concurrently with cytomegalovirus (CMV) infection within the first year after transplantation. The first case involved a 50-year-old man who developed KS lesions on the skin and gastrointestinal tract 3 months after being diagnosed with CMV infection. The second case was a 53-year-old man who developed KS skin lesions 5 months after transplantation accompanied by CMV infection. The third case was a 45-year-old woman who was diagnosed with KS skin lesions 8 months after transplantation during treatment for suspected CMV infection. All three patients presented with KS shortly after being diagnosed and treated for CMV infection, suggesting C
This document summarizes a study examining infections caused by Enterococcus faecium, a common bacterium in the gastrointestinal tract. The study analyzed 58 patients with hematologic malignancies who developed E. faecium bloodstream infections (BSIs). It found that 23 patients were infected with the vancomycin-resistant strain (VREf) while 35 had the vancomycin-sensitive strain (VSEf). Patients with VREf experienced longer periods of neutropenia compared to controls. The study used pulsed-field gel electrophoresis (PFGE) to analyze the genetic relatedness of E. faecium strains and found they did not share genetic proximity, indicating resistance developed through different mechanisms. The
- The document discusses chronic granulomatous disease (CGD), an immunodeficiency caused by a defect in the NADPH oxidase complex resulting in recurrent infections.
- It covers the genetics, clinical presentation including infections by bacteria, fungi and mycobacteria, diagnostic testing such as NBT and DHR, and management including antimicrobial prophylaxis and IFN-γ therapy.
- Mendelian susceptibility to mycobacterial disease is also discussed, which is caused by defects in IFN-γ signaling and results in selective predisposition to mycobacterial infections despite otherwise normal health. Causative genes involved in IFN-γ production and response are identified.
Histiocytosis X refers to a group of syndromes involving abnormal proliferation of histiocytes, a type of immune cell. Langerhans cell histiocytosis is a specific disease within this group characterized by abnormal proliferation of Langerhans cells in tissues. Pulmonary Langerhans cell histiocytosis primarily affects young adult smokers and presents with nonspecific symptoms like cough, breathlessness, and chest pain. Diagnosis involves chest imaging showing characteristic nodules and cysts as well as pathology identification of Langerhans cells. Treatment involves smoking cessation and corticosteroids or chemotherapy for severe disease.
Morbidity & mortality/GI Kaposi SarcomaVidya Kollu
This document describes the case of a 48-year-old man with HIV/AIDS who presented with worsening dysphagia. He has a history of Kaposi sarcoma, pneumocystis pneumonia, and oral thrush. On examination, he has violaceous skin lesions and perianal ulcers. The leading diagnoses for his dysphagia are opportunistic infections such as candida esophagitis or herpes. He is being treated with antiretrovirals and antibiotics but his condition deteriorates and he passes away.
Golden book for Medicine OSCE: First ViewMan B Paudyal
This document provides summaries of various medical cases and images in the form of questions and answers. It covers topics like Peutz-Jeghers syndrome, Bell's palsy, cirrhosis, clubbing, multiple myeloma, Cushing's syndrome, Graves' disease, scleroderma, rheumatoid arthritis, hyperthyroidism, brain abscess, empyema, G6PD deficiency, megaloblastic anemia, Charcot-Marie-Tooth disease, Ataxia telangiectasia, infective endocarditis, and more. For each case, it provides the diagnosis, relevant physical findings, investigations, management, and complications.
1) A 5-year-old girl presented with sudden onset calf pain and difficulty walking after 3 days of fever. She was initially diagnosed with benign acute childhood myositis due to elevated creatine kinase levels.
2) The next day, she developed a rash and a positive dengue IgM test confirmed she had dengue fever.
3) Despite dengue being common in Malaysia, this is a rare reported case of myositis (calf muscle inflammation and pain) as an unusual presentation of dengue infection.
This document summarizes epidemiological, clinical, diagnostic, and treatment aspects of primary sclerosing cholangitis (PSC). It provides statistics on prevalence, incidence, risk factors, and outcomes. Diagnostic methods like MRCP and liver biopsy are discussed. Treatment options reviewed include ursodeoxycholic acid (UDCA), which may improve biomarkers and histology at high doses. Liver transplantation is an option for advanced disease, though PSC can recur after transplant in 20-40% of cases. No definitive treatments exist and management aims to alleviate symptoms while monitoring for complications like cholangiocarcinoma and colon cancer that increase mortality risk over time.
Lombardi et al: XMRV/CFS Inflammatory Signaturedegarden
This document summarizes a study that identified a signature of 10 cytokines and chemokines that can correctly identify patients with chronic fatigue syndrome (CFS) associated with xenotropic murine leukemia virus-related virus (XMRV) infection. The study used Luminex multi-analyte profiling to measure cytokine and chemokine levels in the plasma of 118 CFS patients who tested positive for XMRV, compared to 138 healthy controls. Analysis identified a cytokine/chemokine signature that diagnosed XMRV-associated CFS with 93% specificity and 96% sensitivity. This signature provides immunological evidence for the role of XMRV in CFS pathology and the associated inflammatory response.
This document summarizes achalasia, a rare condition that causes difficulty swallowing (dysphagia) due to failure of the lower esophageal sphincter to relax. It discusses the pathophysiology, symptoms, diagnosis and treatment options for achalasia. Key points include:
- Achalasia is caused by degeneration of neurons in the esophagus leading to failure of the lower esophageal sphincter to relax during swallowing.
- Symptoms include chest pain, difficulty swallowing, regurgitation of undigested food. Diagnosis involves tests like barium swallow and esophageal manometry.
- Treatment options presented are medications for symptom relief, botulinum toxin injections, pneum
Previous year question on leptospirosis based on neet pg, usmle, plab and fmg...Medico Apps
Revision with a Short Quiz of 13 questions based on NEET PG Sample Questions on Leptospirosis from Previous Year NEET PG Online Exams. Also very useful for students preparing for USMLE , PLAB, FMGE /MCI Screening Entrance Exams
This document discusses a case of fever of unknown origin (FUO) in a young HIV-positive man with high viral load and low CD4 count. It provides definitions and classifications of FUO. The most common etiologies in HIV-positive patients are infections like atypical mycobacteria, and malignancies like non-Hodgkin's lymphoma. Diagnostic testing and biopsy of organs like the liver, lymph nodes, and bone marrow can help identify the cause. Positron emission tomography may also help locate sites of inflammation or malignancy. Therapeutic trials rarely establish a diagnosis for FUO. Polycythemia vera is a rare event in HIV patients, with only a few cases reported.
This document is the January 2009 issue of the International Pleural Newsletter. It contains two articles related to pleural effusions associated with rheumatic diseases. The first article summarizes previous literature on pleural effusions related to rheumatoid arthritis (RA), noting that they occur in 3.8% of asymptomatic RA patients. The effusions are typically exudative with low pH and glucose. Cytology can show tadpole-shaped cells. The second article discusses the prevalence and outcomes of lupus-associated pleural effusions, noting wide variability in reported prevalence depending on study criteria.
Dialysis and Transplant for Lupus NephritisLupusNY
This document summarizes lupus nephritis and its treatment. It discusses how lupus nephritis is defined by the presence of abnormal elements in the urine of patients with systemic lupus erythematosus. It outlines the classification system for lupus nephritis and describes biopsy findings. It also discusses the goals of treatment which are to normalize kidney function, reduce proteinuria, and prevent progressive loss of kidney function. Treatment involves immunosuppressive medications like corticosteroids combined with cyclophosphamide or mycophenolate mofetil to induce remission, followed by maintenance treatment to prevent relapse.
This document provides an overview of diffuse large B-cell lymphoma (DLBCL), including epidemiology, risk factors, presentation, histology, genetics, therapy, and treatment options. DLBCL is the most common subtype of non-Hodgkin lymphoma. The standard first-line treatment is rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). For early stage disease, options include full chemotherapy or abbreviated chemotherapy with radiation. Advanced disease is treated with full chemotherapy. Refractory cases may be treated with newer agents or CAR T-cell therapy.
This document describes a 61-year-old male presenting with progressive lower extremity weakness and spasticity. Imaging showed possible diagnoses of infarct, transverse myelitis, multiple sclerosis, or arteriovenous malformation (AVM). Further review found a dural AVM supplied by dural branches from intercostal, lumbar or sacral arteries, drained by perimedullary veins, with the nidus located in the dura covering a proximal nerve root. Dural AVMs typically cause Foix-Alajouanine syndrome, a slowly progressive ascending myelopathy due to cord edema. Treatment involves occlusion of draining veins by endovascular or surgical means.
1. The document provides an overview of cytology cases and diagnoses, including examples of LSIL, HSIL, and ASC from Pap smear samples.
2. Case examples also include diagnoses of ALK positive diffuse large B-cell lymphoma from lymph node biopsy samples and Hodgkin lymphoma with LCH from cervical lymph nodes.
3. The final case discusses a diagnosis of progressive transformation of germinal centre from cervical lymph node biopsy in a patient with history of ALL.
Epidemiologie und Risikofaktoren von Pilzinfekten.FFP Masken bei Pilzinfekten...Wolfgang Geiler
Ursache für zusätzliches Auftreten von Pilzinfekten oft hämatologische Vorerkrankungen des Blutes.Welchen Stellenwert haben Mucormycosen.Was sind die Hauptmanifestationsorte von Pilzmykosen.Die antimykotische Therapie erfolgt standardmäßig mit Amphotericin .Verteilung von Pilzen in Nase,Lunge und Sinusitiden.
Dominieren von Rhizopodes Spezies. Bei A. fumigatus: keine Zunahme der Triazol-Resistenz.Heterogenität der Isolate durch Genotypisierung gesichert.In einem großen französischen Zentrum hat sich eine Ausbreitung Triazol-resistenter Aspergillen unter dem Einsatz von Voriconazol und Posaconazol bislang nicht nachweisen lassen.
Candida-Isolate und Species.Mortalitätsverteilung bei Eintreten.Therapeutisch eingesetzte Antimykotika.Erhöhte Sterblichkeit bei Venenkatheter und Beatmung
Signifikante Verschiebung des Erregerspektrums.Rückgang der Sterblichkeit während Hospitalisierung von 47% auf 22% .Candida albicans bleibt die bei weitem häufigste Spezies.C. glabrata belegt mit 20-25% den zweiten Rang. Eine zunehmende Bedeutung der non-albicans Candida spp. ist keineswegs generell zu beobachten.C. parapsilosis kommt vor allem bei Kindern vor und ist deshalb statistisch mit einer niedrigeren Letalität assoziiert.Sterblichkeit 29% ohne signifikante Speziesdifferenz (p = 0,32) Fluconazol-Resistenz bei C. glabrata 15%.Adäquate antimykotische Primärtherapie nur in 65% der Fälle vorausgegangen.Bedeutung der sofortigen ZVK-Entfernung bei Nachweis dort.
Patientencharakteristika:Parenterale Ernährung 75:Organtransplantation 26 Sensitivität und negativer prädiktiver Wert bei PCR höher,akkerdings etwas naiv, da Spezifität und positiver prädiktiver Wert bei Mikroskopie: fast 100%.eine alleinige PCR-Positivität beweist noch keine Pneumocystis-Pneumonie, sondern ist häufig – in Abhängigkeit von der Prätest-Wahrscheinlichkeit – falsch positiv.CDC-Leitlinien empfehlen das Tragen dicht sitzender FFP2- bzw. N95-Masken für Patienten mit schwerer Neutropenie oder nach allogener Stammzelltransplantation Maligne Erkrankung 20 Neutropenie 8. Antimykotische Vorbehandlung 43. Hier bestätigt sich, dass die Schwere der Grunderkrankung für die Prognose bei Candidämie entscheidend ist.Durch rasche Einleitung einer adäquaten antimykotischen Therapie und prompte Entfernung des Venenkatheters lässt sich jedoch die Sterblichkeit vermindern – wie es in aktuellen Leitlinien auch empfohlen wird.Resultat der Wirksamkeit von Mundschutz hier:
In beiden Gruppen je 8 invasive Pilzinfektionen. Kein erkennbarer Effekt der Mundschutzmasken.Auch Pilzvermehrung auf Mundschutz.Ein Nutzen der weit verbreitete Verwendung von FFP2-Mundschutzmasken lässt sich mit dem Ergebnis dieser bislang einzigen randomisierten Studie nicht untermauern.Eine größere Zahl eingeschlossener Patienten hätte die Aussagekraft dieser Studie zweifellos noch erhöht.
Neue Antimykotika wurden auch gut vertragen.Ergebnisse zu Caspofungin bei Stammzelltransplantation.
Hydatid cysts are most commonly found in the liver and lungs, although they may also occur in other organs, bones and muscles. The cysts can increase in size to 5 – 10 cm or more and may survive for decades. Non-specific signs include loss of appetite, weight loss and weakness
Echinococcus granulosus sensu lato occurs practically worldwide, and more frequently in rural, grazing areas where dogs ingest organs from
diagnosis
epidemiology
managment
The document discusses the anatomy, development, function, and clinical presentation of appendicitis of the appendix. It describes the appendix as a thin tube located in the lower right abdomen that develops from the cecum and contains lymphoid tissue. While its function was originally unknown, it is now believed to play a role in immune function as lymphoid tissue accumulates after birth, exposing white blood cells to antigens from the gastrointestinal tract. Acute appendicitis occurs when the appendix becomes blocked and infected, most commonly from lymphoid hyperplasia or fecaliths. Clinical features include abdominal pain that localizes to the right lower quadrant along with nausea, vomiting, and fever. Diagnosis involves examination
The document discusses the anatomy, development, and functions of the appendix. It begins by describing how the appendix was first described in 1889 and its typical location in the lower right abdomen attached to the cecum. It then discusses how the appendix acts as lymphoid tissue and may help the immune system by exposing white blood cells to antigens in the gastrointestinal tract. The document also covers acute appendicitis, including symptoms, investigations, and treatments like appendectomy. It notes the appendix's role may decrease with age after the third decade.
This document summarizes the pathogenesis of antineutrophil cytoplasmic autoantibody (ANCA)-mediated disease. It discusses how ANCAs are associated with and likely cause a distinct form of vasculitis. The leading theory is that circulating primed neutrophils and monocytes display ANCA antigens on their surface. When ANCAs interact with these antigens, it activates the neutrophils and initiates vascular inflammation. This involves neutrophil respiratory burst, degranulation, and necrosis, which damages vessel walls. Neutrophil activation also activates the alternative complement pathway, amplifying inflammation. Extravascular granulomatosis may result from ANCA activation of primed neutrophils in tissues, causing necrosis and a granulo
This document summarizes a study examining infections caused by Enterococcus faecium, a common bacterium in the gastrointestinal tract. The study analyzed 58 patients with hematologic malignancies who developed E. faecium bloodstream infections (BSIs). It found that 23 patients were infected with the vancomycin-resistant strain (VREf) while 35 had the vancomycin-sensitive strain (VSEf). Patients with VREf experienced longer periods of neutropenia compared to controls. The study used pulsed-field gel electrophoresis (PFGE) to analyze the genetic relatedness of E. faecium strains and found they did not share genetic proximity, indicating resistance developed through different mechanisms. The
- The document discusses chronic granulomatous disease (CGD), an immunodeficiency caused by a defect in the NADPH oxidase complex resulting in recurrent infections.
- It covers the genetics, clinical presentation including infections by bacteria, fungi and mycobacteria, diagnostic testing such as NBT and DHR, and management including antimicrobial prophylaxis and IFN-γ therapy.
- Mendelian susceptibility to mycobacterial disease is also discussed, which is caused by defects in IFN-γ signaling and results in selective predisposition to mycobacterial infections despite otherwise normal health. Causative genes involved in IFN-γ production and response are identified.
Histiocytosis X refers to a group of syndromes involving abnormal proliferation of histiocytes, a type of immune cell. Langerhans cell histiocytosis is a specific disease within this group characterized by abnormal proliferation of Langerhans cells in tissues. Pulmonary Langerhans cell histiocytosis primarily affects young adult smokers and presents with nonspecific symptoms like cough, breathlessness, and chest pain. Diagnosis involves chest imaging showing characteristic nodules and cysts as well as pathology identification of Langerhans cells. Treatment involves smoking cessation and corticosteroids or chemotherapy for severe disease.
Morbidity & mortality/GI Kaposi SarcomaVidya Kollu
This document describes the case of a 48-year-old man with HIV/AIDS who presented with worsening dysphagia. He has a history of Kaposi sarcoma, pneumocystis pneumonia, and oral thrush. On examination, he has violaceous skin lesions and perianal ulcers. The leading diagnoses for his dysphagia are opportunistic infections such as candida esophagitis or herpes. He is being treated with antiretrovirals and antibiotics but his condition deteriorates and he passes away.
Golden book for Medicine OSCE: First ViewMan B Paudyal
This document provides summaries of various medical cases and images in the form of questions and answers. It covers topics like Peutz-Jeghers syndrome, Bell's palsy, cirrhosis, clubbing, multiple myeloma, Cushing's syndrome, Graves' disease, scleroderma, rheumatoid arthritis, hyperthyroidism, brain abscess, empyema, G6PD deficiency, megaloblastic anemia, Charcot-Marie-Tooth disease, Ataxia telangiectasia, infective endocarditis, and more. For each case, it provides the diagnosis, relevant physical findings, investigations, management, and complications.
1) A 5-year-old girl presented with sudden onset calf pain and difficulty walking after 3 days of fever. She was initially diagnosed with benign acute childhood myositis due to elevated creatine kinase levels.
2) The next day, she developed a rash and a positive dengue IgM test confirmed she had dengue fever.
3) Despite dengue being common in Malaysia, this is a rare reported case of myositis (calf muscle inflammation and pain) as an unusual presentation of dengue infection.
This document summarizes epidemiological, clinical, diagnostic, and treatment aspects of primary sclerosing cholangitis (PSC). It provides statistics on prevalence, incidence, risk factors, and outcomes. Diagnostic methods like MRCP and liver biopsy are discussed. Treatment options reviewed include ursodeoxycholic acid (UDCA), which may improve biomarkers and histology at high doses. Liver transplantation is an option for advanced disease, though PSC can recur after transplant in 20-40% of cases. No definitive treatments exist and management aims to alleviate symptoms while monitoring for complications like cholangiocarcinoma and colon cancer that increase mortality risk over time.
Lombardi et al: XMRV/CFS Inflammatory Signaturedegarden
This document summarizes a study that identified a signature of 10 cytokines and chemokines that can correctly identify patients with chronic fatigue syndrome (CFS) associated with xenotropic murine leukemia virus-related virus (XMRV) infection. The study used Luminex multi-analyte profiling to measure cytokine and chemokine levels in the plasma of 118 CFS patients who tested positive for XMRV, compared to 138 healthy controls. Analysis identified a cytokine/chemokine signature that diagnosed XMRV-associated CFS with 93% specificity and 96% sensitivity. This signature provides immunological evidence for the role of XMRV in CFS pathology and the associated inflammatory response.
This document summarizes achalasia, a rare condition that causes difficulty swallowing (dysphagia) due to failure of the lower esophageal sphincter to relax. It discusses the pathophysiology, symptoms, diagnosis and treatment options for achalasia. Key points include:
- Achalasia is caused by degeneration of neurons in the esophagus leading to failure of the lower esophageal sphincter to relax during swallowing.
- Symptoms include chest pain, difficulty swallowing, regurgitation of undigested food. Diagnosis involves tests like barium swallow and esophageal manometry.
- Treatment options presented are medications for symptom relief, botulinum toxin injections, pneum
Previous year question on leptospirosis based on neet pg, usmle, plab and fmg...Medico Apps
Revision with a Short Quiz of 13 questions based on NEET PG Sample Questions on Leptospirosis from Previous Year NEET PG Online Exams. Also very useful for students preparing for USMLE , PLAB, FMGE /MCI Screening Entrance Exams
This document discusses a case of fever of unknown origin (FUO) in a young HIV-positive man with high viral load and low CD4 count. It provides definitions and classifications of FUO. The most common etiologies in HIV-positive patients are infections like atypical mycobacteria, and malignancies like non-Hodgkin's lymphoma. Diagnostic testing and biopsy of organs like the liver, lymph nodes, and bone marrow can help identify the cause. Positron emission tomography may also help locate sites of inflammation or malignancy. Therapeutic trials rarely establish a diagnosis for FUO. Polycythemia vera is a rare event in HIV patients, with only a few cases reported.
This document is the January 2009 issue of the International Pleural Newsletter. It contains two articles related to pleural effusions associated with rheumatic diseases. The first article summarizes previous literature on pleural effusions related to rheumatoid arthritis (RA), noting that they occur in 3.8% of asymptomatic RA patients. The effusions are typically exudative with low pH and glucose. Cytology can show tadpole-shaped cells. The second article discusses the prevalence and outcomes of lupus-associated pleural effusions, noting wide variability in reported prevalence depending on study criteria.
Dialysis and Transplant for Lupus NephritisLupusNY
This document summarizes lupus nephritis and its treatment. It discusses how lupus nephritis is defined by the presence of abnormal elements in the urine of patients with systemic lupus erythematosus. It outlines the classification system for lupus nephritis and describes biopsy findings. It also discusses the goals of treatment which are to normalize kidney function, reduce proteinuria, and prevent progressive loss of kidney function. Treatment involves immunosuppressive medications like corticosteroids combined with cyclophosphamide or mycophenolate mofetil to induce remission, followed by maintenance treatment to prevent relapse.
This document provides an overview of diffuse large B-cell lymphoma (DLBCL), including epidemiology, risk factors, presentation, histology, genetics, therapy, and treatment options. DLBCL is the most common subtype of non-Hodgkin lymphoma. The standard first-line treatment is rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). For early stage disease, options include full chemotherapy or abbreviated chemotherapy with radiation. Advanced disease is treated with full chemotherapy. Refractory cases may be treated with newer agents or CAR T-cell therapy.
This document describes a 61-year-old male presenting with progressive lower extremity weakness and spasticity. Imaging showed possible diagnoses of infarct, transverse myelitis, multiple sclerosis, or arteriovenous malformation (AVM). Further review found a dural AVM supplied by dural branches from intercostal, lumbar or sacral arteries, drained by perimedullary veins, with the nidus located in the dura covering a proximal nerve root. Dural AVMs typically cause Foix-Alajouanine syndrome, a slowly progressive ascending myelopathy due to cord edema. Treatment involves occlusion of draining veins by endovascular or surgical means.
1. The document provides an overview of cytology cases and diagnoses, including examples of LSIL, HSIL, and ASC from Pap smear samples.
2. Case examples also include diagnoses of ALK positive diffuse large B-cell lymphoma from lymph node biopsy samples and Hodgkin lymphoma with LCH from cervical lymph nodes.
3. The final case discusses a diagnosis of progressive transformation of germinal centre from cervical lymph node biopsy in a patient with history of ALL.
Epidemiologie und Risikofaktoren von Pilzinfekten.FFP Masken bei Pilzinfekten...Wolfgang Geiler
Ursache für zusätzliches Auftreten von Pilzinfekten oft hämatologische Vorerkrankungen des Blutes.Welchen Stellenwert haben Mucormycosen.Was sind die Hauptmanifestationsorte von Pilzmykosen.Die antimykotische Therapie erfolgt standardmäßig mit Amphotericin .Verteilung von Pilzen in Nase,Lunge und Sinusitiden.
Dominieren von Rhizopodes Spezies. Bei A. fumigatus: keine Zunahme der Triazol-Resistenz.Heterogenität der Isolate durch Genotypisierung gesichert.In einem großen französischen Zentrum hat sich eine Ausbreitung Triazol-resistenter Aspergillen unter dem Einsatz von Voriconazol und Posaconazol bislang nicht nachweisen lassen.
Candida-Isolate und Species.Mortalitätsverteilung bei Eintreten.Therapeutisch eingesetzte Antimykotika.Erhöhte Sterblichkeit bei Venenkatheter und Beatmung
Signifikante Verschiebung des Erregerspektrums.Rückgang der Sterblichkeit während Hospitalisierung von 47% auf 22% .Candida albicans bleibt die bei weitem häufigste Spezies.C. glabrata belegt mit 20-25% den zweiten Rang. Eine zunehmende Bedeutung der non-albicans Candida spp. ist keineswegs generell zu beobachten.C. parapsilosis kommt vor allem bei Kindern vor und ist deshalb statistisch mit einer niedrigeren Letalität assoziiert.Sterblichkeit 29% ohne signifikante Speziesdifferenz (p = 0,32) Fluconazol-Resistenz bei C. glabrata 15%.Adäquate antimykotische Primärtherapie nur in 65% der Fälle vorausgegangen.Bedeutung der sofortigen ZVK-Entfernung bei Nachweis dort.
Patientencharakteristika:Parenterale Ernährung 75:Organtransplantation 26 Sensitivität und negativer prädiktiver Wert bei PCR höher,akkerdings etwas naiv, da Spezifität und positiver prädiktiver Wert bei Mikroskopie: fast 100%.eine alleinige PCR-Positivität beweist noch keine Pneumocystis-Pneumonie, sondern ist häufig – in Abhängigkeit von der Prätest-Wahrscheinlichkeit – falsch positiv.CDC-Leitlinien empfehlen das Tragen dicht sitzender FFP2- bzw. N95-Masken für Patienten mit schwerer Neutropenie oder nach allogener Stammzelltransplantation Maligne Erkrankung 20 Neutropenie 8. Antimykotische Vorbehandlung 43. Hier bestätigt sich, dass die Schwere der Grunderkrankung für die Prognose bei Candidämie entscheidend ist.Durch rasche Einleitung einer adäquaten antimykotischen Therapie und prompte Entfernung des Venenkatheters lässt sich jedoch die Sterblichkeit vermindern – wie es in aktuellen Leitlinien auch empfohlen wird.Resultat der Wirksamkeit von Mundschutz hier:
In beiden Gruppen je 8 invasive Pilzinfektionen. Kein erkennbarer Effekt der Mundschutzmasken.Auch Pilzvermehrung auf Mundschutz.Ein Nutzen der weit verbreitete Verwendung von FFP2-Mundschutzmasken lässt sich mit dem Ergebnis dieser bislang einzigen randomisierten Studie nicht untermauern.Eine größere Zahl eingeschlossener Patienten hätte die Aussagekraft dieser Studie zweifellos noch erhöht.
Neue Antimykotika wurden auch gut vertragen.Ergebnisse zu Caspofungin bei Stammzelltransplantation.
Hydatid cysts are most commonly found in the liver and lungs, although they may also occur in other organs, bones and muscles. The cysts can increase in size to 5 – 10 cm or more and may survive for decades. Non-specific signs include loss of appetite, weight loss and weakness
Echinococcus granulosus sensu lato occurs practically worldwide, and more frequently in rural, grazing areas where dogs ingest organs from
diagnosis
epidemiology
managment
The document discusses the anatomy, development, function, and clinical presentation of appendicitis of the appendix. It describes the appendix as a thin tube located in the lower right abdomen that develops from the cecum and contains lymphoid tissue. While its function was originally unknown, it is now believed to play a role in immune function as lymphoid tissue accumulates after birth, exposing white blood cells to antigens from the gastrointestinal tract. Acute appendicitis occurs when the appendix becomes blocked and infected, most commonly from lymphoid hyperplasia or fecaliths. Clinical features include abdominal pain that localizes to the right lower quadrant along with nausea, vomiting, and fever. Diagnosis involves examination
The document discusses the anatomy, development, and functions of the appendix. It begins by describing how the appendix was first described in 1889 and its typical location in the lower right abdomen attached to the cecum. It then discusses how the appendix acts as lymphoid tissue and may help the immune system by exposing white blood cells to antigens in the gastrointestinal tract. The document also covers acute appendicitis, including symptoms, investigations, and treatments like appendectomy. It notes the appendix's role may decrease with age after the third decade.
This document summarizes the pathogenesis of antineutrophil cytoplasmic autoantibody (ANCA)-mediated disease. It discusses how ANCAs are associated with and likely cause a distinct form of vasculitis. The leading theory is that circulating primed neutrophils and monocytes display ANCA antigens on their surface. When ANCAs interact with these antigens, it activates the neutrophils and initiates vascular inflammation. This involves neutrophil respiratory burst, degranulation, and necrosis, which damages vessel walls. Neutrophil activation also activates the alternative complement pathway, amplifying inflammation. Extravascular granulomatosis may result from ANCA activation of primed neutrophils in tissues, causing necrosis and a granulo
Standard approach for focal disease
(<25% bowel involved)
Bowel resection with
primary anastomosis
For:
Case series showing feasibility and
safety in selected patients31–34
This document summarizes a systematic review of acute colonic pseudo-obstruction (ACPO). ACPO is the clinical syndrome of acute large bowel dilatation without mechanical obstruction that is an important cause of morbidity and mortality. It occurs in hospitalized or institutionalized patients with serious underlying medical conditions. The pathogenesis is not fully understood but likely involves an imbalance in autonomic regulation of colonic motor function from various metabolic, pharmacological, or traumatic factors. Early recognition and treatment are important to minimize complications. Supportive care is initially recommended, while neostigmine or colonoscopic decompression are effective first-line interventions for patients not improving or with more severe presentations. Surgery is reserved for complications like perforation.
This document discusses necrotizing enterocolitis (NEC), a life-threatening disease that affects the intestines of premature infants. It provides details on the etiology, pathology, clinical manifestations, diagnosis, treatment, monitoring, indications for surgery, prognosis, and prevention of NEC. NEC is most common in very premature infants and can range from mild to severe, with severe cases resulting in intestinal perforation and death. Treatment involves cessation of feeding, antibiotics, and potentially surgery for perforation. Prevention strategies include exclusive breastfeeding and minimizing aggressive enteral feeding in premature infants.
Hydronephrosis is the dilation of the renal pelvis and calyces, which can be caused by obstruction of urine flow. It is commonly detected during prenatal ultrasound screening. Common causes in neonates include ureteropelvic junction obstruction, posterior urethral valves, and vesicoureteral reflux. Treatment depends on the severity and includes antibiotics, surgery to repair obstructions, and management of any associated renal issues.
Necrotizing enterocolitis (NEC) is a life-threatening condition that affects the intestines of premature infants. It results from necrosis of the intestinal tissue and can range from mild to severe. Risk factors include prematurity, formula feeding, and bacterial or viral infections. Symptoms may include abdominal distension, vomiting, and bloody stools. Diagnosis is confirmed through x-ray evidence of pneumatosis intestinalis or portal venous gas. Treatment involves gut rest, antibiotics, surgery for perforation or failure to improve. Despite advances, NEC remains a major cause of death in preterm neonates.
Necrotizing enterocolitis (NEC) is a life-threatening condition that affects the intestines of premature infants. It results from necrosis of the intestinal tissue and can range from mild to severe. Risk factors include prematurity, formula feeding, and bacterial or viral infections. Symptoms may include abdominal distension, bloody stools, and temperature instability. Diagnosis involves x-rays showing pneumatosis intestinalis or portal venous gas. Treatment focuses on gut rest, broad-spectrum antibiotics, surgery for perforation or failure to improve, and careful feeding advancement after recovery. Outcomes depend on severity but may include strictures, adhesions, or short bowel syndrome.
This document discusses gluten sensitivity and its neurological manifestations. It notes that:
1) Gluten sensitivity can present with diverse neurological symptoms rather than just gastrointestinal issues.
2) Studies have found the prevalence of neurological issues among those with celiac disease is 10-22.5%, though numbers are uncertain due to referral biases.
3) Diagnosing neurological gluten sensitivity is challenging as patients often lack gastrointestinal symptoms, but serological testing and small intestine biopsies can provide evidence of gluten sensitivity and help guide treatment.
Esophageal atresia is a birth defect where the esophagus fails to develop properly, resulting in an abnormal connection or closure. It occurs in about 1 in 3,000-4,500 births. Types include atresia without a fistula, or with a proximal or distal fistula. Associated anomalies are present in 25% of cases. Prenatal ultrasound may detect polyhydramnios or an absence of stomach bubbles. After birth, signs include frothy mucus in the mouth or nose and coughing/choking during feeding. Treatment involves stabilizing the infant, then surgical repair of the esophagus. Long term follow up is needed to monitor for complications.
Wilson's disease is an autosomal recessive disease causing progressive
copper overload. It is an initially hepatic affection which can evolve
towards a multi-systemic attack with an accumulation of copper in
the brain, the eye, the kidney, the heart. The diagnosis is carried out
on a bundle of clinical, biological and radiological findings. Treatments associate a diet low in copper, copper chelators or zinc salts.
Liver transplantation is the treatment for fulminant liver forms. This
rare genetic disease has a good prognosis if treatment is started early
and continued for life. It is therefore important to know the clinical manifestations of the disease and the diagnostic tests to evoke it
quickly in order to ensure regular clinical and biological monitoring
of patients. In this context, we report a familial case of Wilson's disease with its neurological, psychiatric, hepatic and ophthalmological
manifestations
This dissertation report submitted by Mr. Indorewala Moiz Hatim Tasneem studies autoimmune markers using an indirect immunofluorescence assay. The study analyzes samples from 50 individuals for markers like ANA, ANCA, ASMA, and anti-dsDNA. Results found 31 samples positive for ANA, 8 for ANCA, and 12 for autoimmune liver disease markers. Case studies discuss potential mechanisms for autoantibody presence in various conditions like brain injuries, connective tissue disorders, pregnancy complications, anemias, vasculitis, and liver diseases. The report concludes that autoantibodies can help define and classify diseases, as well as potentially predict disease onset through identification of preclinical autoimmune responses
This document provides an overview of renal vasculitis (AAV). It begins with the historical landmarks in recognizing and classifying different types of vasculitis. It then discusses ANCA-associated vasculitis in more detail, including the role of ANCA testing in diagnosis and monitoring disease. The clinical manifestations, pathology, treatment including induction and maintenance therapies, and prognosis of AAV are summarized. It also reviews recent insights into the genetics and environmental factors involved in AAV.
Vasculitis refers to inflammation of blood vessels. It is classified based on vessel size and pathology. The most common pediatric vasculitides are Henoch-Schonlein purpura and Kawasaki disease. Diagnosis involves evaluating symptoms, radiology like angiograms, histopathology of biopsied tissues, and serology tests like ANCA. Treatment depends on type and severity of vasculitis. Prognosis varies, with most children recovering fully from HSP or KD, while other types like AAV carry higher risks of organ damage and mortality if not properly treated.
This document provides background information and summarizes key principles regarding acute appendicitis. It begins by discussing the appendix's role in the digestive system and risk factors for appendicitis. The anatomy and pathophysiology of appendicitis are then described, noting that obstruction of the appendix is the underlying cause. Common presenting symptoms are reviewed, emphasizing that the classic presentation is seen in less than 50% of cases, making diagnosis challenging. Differential diagnoses and the role of laboratory tests, imaging, and clinical assessment in evaluation are also summarized. Throughout, it is stressed that diagnosis relies on integrating multiple factors rather than any single finding.
This document summarizes the pathogenesis of interstitial cystitis (IC). It discusses how IC was originally described in the 1800s and defines how it is currently classified. The pathogenesis is multifactorial and may involve infection, inflammation, autoimmunity, mast cell involvement, defects in the bladder surface, and neurobiological factors. The document also reviews diagnostic criteria, epidemiology, associated disorders, potential etiologies, and pathological findings of IC.
This document summarizes a lecture on acute rheumatic fever (ARF). It begins with definitions of ARF as an acute inflammatory disease affecting connective tissue and primarily the cardiovascular system, developing after a streptococcal infection in predisposed individuals. It then covers the epidemiology, etiology, pathogenesis, clinical manifestations including carditis, arthritis, chorea and others, diagnostic criteria, classification, treatment and prevention of ARF. The lecture traces the history of understanding and research on ARF and rheumatic heart disease. It emphasizes the role of streptococcal infection in causing ARF and discusses virulence factors and the immune response involved in its pathogenesis.
This document discusses different types of cystic diseases of the liver, including pyogenic liver abscess, amebic liver abscess, and hydatid liver cyst. It covers the etiology, risk factors, clinical presentation, diagnosis, and treatment of each condition. Pyogenic liver abscess was initially thought to be caused by appendicitis but is now understood to often have a biliary origin. Amebic liver abscess is caused by Entamoeba histolytica infection transmitted via contaminated food or water. Hydatid cyst results from Echinococcus granulosus infection through contact with dogs that are the definitive host.
Este documento contiene las preguntas de un examen de residencias médicas en la provincia de Córdoba, Argentina. Se enumeran 62 preguntas sobre diversos temas médicos como anatomía, enfermedades, síndromes y sus tratamientos. También se incluyen algunas referencias a sitios web relacionados con la medicina en Argentina.
This document is an upgraded edition of the Ultimate Guitar Chords reference guide. It contains enlarged chord diagrams for common guitar chords from A to G, organized by letter for easy reference. It also credits the original author and provides a website for additional guitar lessons and resources. The enlarged diagrams aim to make the chords easier to read compared to the original version.
Este documento anuncia un taller de guitarra inicial gratuito que se llevará a cabo en mayo de 2012 en Córdoba, Argentina. El taller durará 8 semanas y será impartido por Jorge Ruiz. Los objetivos son que los asistentes conozcan las partes básicas de la guitarra, aprendan acordes, armonía y a tocar sus primeras canciones tanto en solitario como en grupo.
Programa Infectología Hospital Rawson, Córdoba - FCM - UNCMedicina Córdoba
Este documento presenta el programa de la materia Infectología del Hospital Rawson de la Universidad Nacional de Córdoba. El programa se divide en cinco partes que cubren temas de infectología básica, patologías endémicas, grandes síndromes infecciosos, situaciones especiales y conductas terapéuticas y preventivas. La primera parte cubre mecanismos de virulencia microbiana, microbiología clínica y epidemiología de enfermedades infecciosas. La segunda cubre patologías endémicas como brucelosis y
Programa Infectología Hospital Rawson, Córdoba - FCM - UNCMedicina Córdoba
El documento presenta el programa de la asignatura Infectología del Hospital Rawson de la Universidad Nacional de Córdoba. El programa consta de cinco partes que cubren aspectos básicos de infectología, patologías endémicas comunes en la región, grandes síndromes infecciosos, situaciones especiales como infecciones nosocomiales y conductas terapéuticas y preventivas.
1. La anestesia local produce parálisis sensitiva y motora en la zona inervada al bloquear los canales de sodio de las membranas de las neuronas.
2. Los anestésicos locales como la lidocaína, bupivacaína y mepivacaína interactúan con los canales de sodio de las neuronas para estabilizar su estado inactivo y bloquear la conducción del impulso nervioso.
3. Estos fármacos pueden causar efectos adversos como estimulación del SNC, arritmias cardíacas y
El documento presenta las guías del National Cholesterol Education Program de Estados Unidos para clasificar y tratar los niveles de colesterol total, LDL y HDL. Define categorías de riesgo y metas de LDL en función del riesgo cardiovascular. También resume los principales fármacos para tratar la hipercolesterolemia, incluyendo estatinas, resinas de intercambio iónico, fibratos, ezetimibe y ácido nicotínico, detallando sus mecanismos de acción, efectos, farmacocinética y contraindicaciones.
Este documento describe diferentes fármacos inmunomoduladores y su mecanismo de acción. Incluye agentes anti-TNF como etanercept, infliximab y adalimumab; bloqueantes de interleucina como anakinra; ciclosporina, que inhibe la calcineurina necesaria para la activación de linfocitos T; y metotrexato, un análogo del ácido fólico que inhibe la síntesis de purinas y timidilato. Estos fármacos se usan para tratar condiciones como artritis reum
Este documento trata sobre el sistema opioide endógeno y los analgésicos opiáceos. Describe las vías del dolor y los receptores opioides, así como los principales agonistas y antagonistas opioides como la morfina, la heroína, la metadona, la codeína, el fentanilo, la buprenorfina, la naloxona y la naltrexona. También resume los efectos fisiológicos y aplicaciones terapéuticas de los analgésicos opiáceos, incluida su utilización en la escala
Este documento resume las causas de la hiperuricemia, incluyendo un aumento en la producción o una disminución en la excreción de ácido úrico, así como factores iatrogénicos. Describe los tratamientos para la gota aguda, como la colchicina y los AINEs, y el tratamiento crónico con alopurinol u otros medicamentos uricosúricos. Finalmente, detalla la farmacodinamia y efectos adversos de fármacos comúnmente usados como la colchicina, alopurinol y uricosú
El resumen del documento es el siguiente:
1) Más de la mitad de los encuestados trabajan actualmente y casi el 40% tienen al menos un hijo.
2) Casi un tercio adeuda entre 1-3 materias y alrededor de un 20% adeuda entre 7-9 materias para recibirse.
3) La mayoría cree que separar los turnos de exámenes de 5to y 6to año en más de 72 horas les permitiría rendir más materias y recibirse antes.
Este documento presenta una guía actualizada en 2010 para el diagnóstico, tratamiento y prevención de la enfermedad pulmonar obstructiva crónica (EPOC) dirigida a profesionales sanitarios. Describe los factores de riesgo, el diagnóstico mediante espirometría, y los cuatro componentes del tratamiento: valoración y supervisión, reducción de factores de riesgo, tratamiento de la EPOC estable e exacerbaciones. Recomienda un enfoque integral que incluye educación del paciente, tratamiento farmacoló
El resumen presenta los resultados preliminares de un censo virtual de estudiantes de medicina de la Universidad de Córdoba. Muestra que un 55% de los encuestados trabaja actualmente, un 35% tiene hijos, y un 75% pertenece al plan original de 1993. La mayoría fueron forzados a cambiar de plan o estuvieron mal informados. Más del 50% de los estudiantes tienen materias pendientes, principalmente de 6to año, y se estima que necesitarán varios turnos de examen para recibirse. Casi todos los encuestados se s
El resumen del documento es el siguiente:
1) La mayoría de los encuestados deben más de 5 materias para recibirse y necesitarán más de 5 turnos de examen.
2) Casi todos los encuestados deben materias de 5to año y más de la mitad deben materias como alumnos libres.
3) La mayoría estaría de acuerdo con una Práctica Final Obligatoria acortada de 2 meses para poder recibirse.
Guía práctica de Hepatitis C 2011
Journal of Hepatology
EASL (European Association for the study of the Liver)
MEDICINA CORDOBA WEB
www.plan93.com
www.medicinacordoba.com.ar
El documento presenta un calendario de vacunación para el año 2011. Recomienda vacunas para bebés, niños y adolescentes contra enfermedades como poliomielitis, sarampión, rubéola, paperas, hepatitis B y más. Además incluye información sobre dosis y edades apropiadas para cada vacuna.
Este resumen proporciona información sobre 10 casos médicos. Los casos involucran una variedad de presentaciones como erupciones cutáneas, dolor abdominal, fiebre y más. Cada caso presenta una pregunta sobre el diagnóstico o manejo más probable y señala a una página para obtener más detalles.
Este documento proporciona criterios para la vigilancia de trabajadores expuestos a sustancias químicas peligrosas. Se divide en 8 secciones que cubren una variedad de sustancias químicas como metales, derivados del petróleo, irritantes respiratorios, gases asfixiantes y sensibilizantes. Cada sección describe las características de toxicidad de las sustancias y provee indicaciones para la vigilancia médica de los trabajadores expuestos incluyendo exámenes clínicos periódicos y monitoreo bioló
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
2. Mini-Reviews and Perspectives continued
tropin (ACTH) insensitivity. Achalasia can be caused by include slow eating, stereotactic movements with eating,
infiltration of the esophagus and LES in amyloidosis or and avoidance of social functions that involve meals.
owing to extrinsic compression of the gastroesophageal With these self-taught accommodating techniques, the
junction, as may occur with tight fundoplication during onset of symptoms in patients can be slow in progression
antireflux procedures19 or laparoscopic adjustable gastric and many patients experience symptoms for years before
banding.20 Achalasia is known to occur after infection by coming to medical attention.21 Patients with achalasia
Trypanosoma cruzi, also known as Chagas disease. Pa- may also present with heartburn owing to bacterial fer-
tients with this infection often have other features of mentation, and thus acidification, of food products
diffuse enteric myenteric destruction, including megaco- within the esophagus. As a result, reflux symptoms un-
lon, heart disease, and neurologic disorders, although the responsive to reflux therapy may suggest achalasia.
phenotypic manifestations are linked to geographic vari-
ation in endemic countries. Diagnosis
The most common cause of secondary achalasia is Patients who have a history that suggests achala-
malignancy through one of several mechanisms. Tumors sia commonly require at least 2, and sometimes 3, mo-
that infiltrate the gastroesophageal junction may cause dalities for diagnosis.22 Barium esophagram is often the
an achalasia-like picture from extrinsic pressure or direct first study performed for patients with dysphagia. In
tumor invasion of the myenteric plexus. This is most patients with achalasia with severe symptoms, there is
commonly described with adenocarcinoma of the gastro- typically a dilated esophagus, absence of peristalsis, and
esophageal junction or proximal stomach, but may occur narrowing of the distal esophagus in a typical “bird’s
with pancreatic, breast, lung, or hepatocellular cancers. beak” appearance but the radiographic appearance of
Cancer, most commonly small cell lung cancer, may pro- achalasia can be variable (Figure 1). The number and
duce achalasia through a paraneoplastic effect by secre- severity of findings on esophagram often do not correlate
tion of an antineuronal antibody. with the degree of symptoms a patient with achalasia has,
but at least 1 of these features is present in virtually all
Clinical Presentation cases of achalasia.23 This study alone may be diagnostic,
Most patients with achalasia present with esoph- particularly in advanced cases.
ageal dysphagia (present in up to 90% of patients), often Endoscopic evaluation of the esophagus and stomach
for both solids and liquids, a distinction from anatomic is recommended in every patient with achalasia to ensure
disorders of the esophagus. Other common symptoms that there is not a malignancy causing the disease or
include chest pain, heartburn, regurgitation, and weight esophageal squamous cell carcinoma complicating acha-
loss, all of which occur in up to 60% of patients. Patients lasia. At endoscopy, a dilated esophagus with a tight LES
with achalasia may also present with more subtle symp- that “pops” open with gentle pressure is often observed,
toms owing to accommodation. These symptoms might as is retained food and saliva. However, a normal esopha-
Figure 1. Barium esophagrams on achalasia patients
demonstrating a dilated esophagus and tapering of the
distal esophagus with the classic “bird’s beak” (A), dif-
fuse narrowing of the esophagus with a spastic appear-
ance often seen in “vigorous” achalasia and a large epi-
phrenic diverticulum (B), and a dilated and tortuous
esophagus with early “sigmoidization” of the esophagus
(because of its visual similarity to the sigmoid colon on
barium enema) observed in long standing achalasia ac-
companied by multiple pulsion diverticuli (C).
370
3. Mini-Reviews and Perspectives continued
Figure 2. High-resolution esophageal manometry with
impedance on an achalasia patient revealing aperistalsis
and incomplete bolus transit demonstrated by imped-
ance (A), isobaric simultaneous contractions (B), and a
hypertensive and poorly relaxing LES (C).
gogastroduodenoscopy should not dissuade a clinician with an esophageal pressurization 30 mm Hg, and type
from making the diagnosis because up to 40% of patients III (spastic achalasia) patients have 2 spastic contrac-
with achalasia will have a normal endoscopy.24 tions with or without a period of compartmentalized
Esophageal manometry is considered the gold stan- pressurization. These investigators used logistic regres-
dard diagnostic modality for achalasia. Manometrically, sion and found that type II achalasia patients were more
classic achalasia is defined by absence of peristalsis in the likely to have good symptom response and less likely to
esophageal body, a hypertensive LES (resting pressure require multiple treatments than the other 2 groups.
45 mm Hg) and a poorly relaxing LES, with a residual With reevaluation of the manometric criteria for acha-
pressure 8 mm Hg. However, it is well understood that lasia, some diseases may commonly be called achalasia
as many as 50% of patients that are given the clinical variants.28 For example, diffuse esophageal spasm, which
diagnosis of achalasia do not have a hypertensive LES,25 may be defined manometrically by a hypertensive LES
although the diagnosis does require aperistalsis and a and some simultaneous contractions, may progress to
poorly relaxing LES.26,27 achalasia. Indeed, some patients with insufficient mano-
High-resolution manometry and multichannel intralu- metric criteria undergo classic barium esophagograms
minal impedance with manometry have been applied to for achalasia. As a result, diagnosis of achalasia often
achalasia (Figure 2). Using high-resolution manometry, becomes a compilation of compatible clinical and objec-
achalasia has been divided into 3 subtypes based on the tive criteria rather than reliance on a single test.
function of the esophageal body with the notion that
different subtypes may respond to treatment in a variable
fashion. Type I (classic achalasia has no distal esophageal Treatment
pressurization 30 mm Hg); type II (achalasia with Therapy of achalasia focuses on relaxation or me-
esophageal compression) has 2 test swallows associated chanical disruption of the LES. Achalasia is rare so there
371
4. Mini-Reviews and Perspectives continued
are few randomized, controlled clinical trials that can Some investigators debate the role of injection of bot-
define the optimal strategy. The safety, effectiveness, and ulinum toxin injection versus pneumatic dilation. A re-
durability of current treatment options vary widely. cent Cochrane Review that included 6 randomized, con-
trolled trials with 178 patients evaluated symptom
Medications recurrence after esophageal dilation versus endoscopic
A number of medications have been used in acha- botulinum toxin injection at 1, 6, and 12 months after
lasia including nitrates,29 calcium channel blockers,30 and treatment. Thirty percent of patients undergoing dilation
nitric oxide donors (sildenafil)31 in an attempt to either experienced symptom recurrence and treatment failure at
facilitate LES relaxation and/or augment esophageal 12 months versus 74% of patients who received EBTI.43
peristalsis. Unfortunately, adverse side effects and a gen- Furthermore, a systematic review and meta-analysis of
eral lack of efficacy have precluded common use of these 105 articles that reported on 7855 patients with achalasia
medications for achalasia. who underwent endoscopic treatment with esophageal
dilation or EBTI showed that symptom relief was better
Endoscopic Treatments for dilation than for EBTI and the necessity of further
procedures was reduced.44
Endoscopic botulinum toxin injection (EBTI) into
The role of pneumatic dilation in comparison to sur-
the LES inhibits the release of acetylcholine from nerve
gery is less clear. There has been a single randomized
endings thereby relaxing muscles. The injection of botu-
linum toxin into the LES is an appealing strategy; it is prospective trial examining esophagomyotomy versus
safe, easy to perform, inexpensive, and effective.32,33 A pneumatic dilation.45 This study showed equivalent re-
variety of studies have looked at the efficacy and dura- sults regarding effectiveness at relieving symptoms ini-
bility of botulinum toxin injection and have found excel- tially, but at follow-up showed that patients who had
lent short-term symptomatic improvement, although re- esophagomyotomy had fewer recurrent symptoms than
peat injections are commonly required.34 The long-term those who had pneumatic dilation. Some studies suggest
safety and efficacy are less certain.34,35 There is some that pneumatic dilation may achieve long-term relief of
evidence that injection of botulinum toxin into the LES symptoms,46 particularly in patients 50 or 60 years old
is associated with increased difficulty of performing or when compared retrospectively with myotomy and,
esophagomyotomy at a later date.36 For this reason, many consequently, should be offered as a treatment to pa-
clinicians reserve the use of botulinum toxin for patients tients with achalasia.
who are of extreme advanced age or who have severe
comorbidities that preclude treatment with pneumatic Surgery
balloon dilation or esophagomyotomy because of their Esophagomyotomy or Heller myotomy divides
associated risks. LES from serosa to mucosa, thereby completely disrupt-
Dilation of the LES in patients with achalasia should ing the muscular layers. A longitudinal incision is initi-
be aimed at fracturing the muscularis propria. Bougien- ated on the gastric side approximately 2 cm distal to the
age or standard balloon dilation are typically ineffective gastroesophageal junction and extended proximally 7 cm
in achalasia, but pneumatic balloon dilation with a rigid above the junction. Over the past 20 years, this procedure
balloon across the LES has been shown to be effective has been performed safely and successfully laparoscopi-
and inexpensive.37,38 It is typically performed using a cally47,48 and more recently with the assistance of com-
guidewire and fluoroscopy to position the balloon across puter guidance and a robotic arm.49 Long-term studies
the LES. Recently, investigators have performed pneu- show that surgical myotomy may result in symptomatic
matic dilation using direct visualization rather than flu- relief in 80% to 85% of patients when followed for 10
oroscopy to limit radiation exposure and to improve years.50,51 There is mounting evidence, however, that the
clinical remission and complications. Although this en- learning curve, particularly when performed laparoscopi-
doscopically guided dilation is as effective as the tradi- cally, is steep, requiring 200 procedures. This has been
tional fluoroscopically guided technique, it did not have shown to lead to fewer complications and a shorter
fewer complications or better response rates.39 The draw- duration of hospitalization.52
backs of pneumatic dilation are that there is an esopha- Heller myotomy is not effective in every case, and some
geal perforation rate between 2% and 6% (depending on patients require reoperation or esophagectomy. The best
the series and technique)40 and lack of durability com- predictor of patients who will require additional inter-
pared with operative treatment in most studies.41 Al- vention after Heller myotomy is esophageal dilation of
though patients who sustain perforation may have effec- 6 cm in diameter before surgery, a condition known as
tive completion myotomy emergently, experience with megaesophagus. Patients who have severe dilation of the
emergent laparoscopic repair is preliminary42 and often esophagus have a higher rate of reoperation with esoph-
necessitates open laparotomy. agectomy, although the majority of these patients
372
5. Mini-Reviews and Perspectives continued
( 90%) do not require esophagectomy.53,54 Most experts the more invasive nature of the laparoscopic procedure,
advocate that patients with megaesophagus be treated but differences in baseline patient characteristics and
with Heller myotomy initially. severity of the disease may have an impact on the results
Nearly 50% of patients who have a modified Heller of each method reported.
myotomy progress to develop gastroesophageal reflux A decision analysis model has been pursued for the
disease,55 with some developing erosive esophagitis, stric- treatment of achalasia. They evaluated 4 strategies: (1)
ture, and Barrett’s esophagus. This has led to the com- Laparoscopic Heller myotomy and partial fundoplica-
mon practice of coupling the modified Heller myotomy tion, (2) pneumatic dilation, (3) botulinum toxin injec-
with a fundoplication in most centers. Initially, a tion, and (4) thoracoscopic Heller myotomy. Based on
“floppy” Nissen fundoplication was used, but more re- complications, need for repeated procedures, and overall
cently there has been widespread adoption of the Dor (or treatment cost, they found that laparoscopic Heller my-
anterior) fundoplication. Investigators have compared otomy with fundoplication was preferred treatment strat-
the 2 in reference to dysphagia and control of gastro- egy unless the patient’s risk of operative mortality was
esophageal reflux and have found that the Dor fundopli- 0.7%.62
cation is associated with good long-term control of gas- These authors recommend that those patients who
troesophageal reflux and less dysphagia than a Nissen meet criteria for achalasia (manometric, endoscopic, ra-
fundoplication.56 Furthermore, a prospective, random- diographic) and who are good surgical candidates should
ized clinical trial of myotomy with and without Dor be referred to an experienced center for minimally inva-
fundoplication showed that patients with the Dor pro- sive modified Heller myotomy. Patients who are not good
cedure had much less gastroesophageal reflux assessed by surgical candidates and cannot accept the risk of pneu-
24-hour esophageal pH testing than those without the matic dilation can be treated with endoscopically di-
fundoplication (9% vs 48%). Despite the theoretical con- rected botulinum toxin injection or medications.
cerns, dysphagia was not a long-term complication in
either group.57
Outcomes
New Treatments Patients who have had treatment for achalasia
The utility of self-expanding, 30-mm metallic typically have their response measured by amelioration of
stents for achalasia has been prospectively evaluated in their symptoms. Others suggest, however, that there
75 patients with achalasia at a single center over a 13-year should be more objective testing for response. Manomet-
period. The clinical success rate after 10 years of fol- rically, an LES pressure 10 mm Hg has been shown to
low-up after the stent was removed was high (83%). There be an accurate indicator of a complete myotomy.63 Rou-
were no perforations or mortality associated with the tine barium esophagram has been demonstrated to have
treatment, but stent migration occurred in 5% of pa- poor positive predictive value postmyotomy;64 however,
tients, reflux in 20% and chest pain in 38.7%.58 the use of timed barium study to assess esophageal emp-
Several centers are developing esophagomyotomy that tying correlates well with clinical outcome after myot-
is performed via the intestinal lumen. Pasricha et al omy.65 Some authors have voiced concern that some
reported a submucosal esophagomyotomy successfully patients may progress to advanced stages of achalasia
performed on porcine models endoscopically.59 Recently, with minimal symptoms until they present with a megae-
2 groups of investigators have performed peroral endo- sophagus. Once this stage is reached, complete esopha-
scopic myotomy. One group published its experience in 17 gectomy may be required, although myotomy is at-
patients, all of whom had good clinical response with no tempted initially. As a result, periodic timed barium
significant complications in short-term follow-up.60,61 swallows may be employed in patients after treatment.66
Several studies have reported long-term outcomes.
Overall, there is no difference in life expectancy or mor-
Treatment Recommendations tality in patients with treated achalasia versus the general
The appropriate treatment for any given patient population.67 Two decades after an esophagomyotomy
with achalasia depends on their willingness to undergo and anterior fundoplication is performed, there is even-
invasive procedures and on their physical ability to en- tual evidence of clinical deterioration after initial good
dure them. The perforation rate for endoscopic pneu- results owing primarily to an increase in acid reflux and
matic dilation with a rigid balloon is approximately 2%. A its associated complications.68 Symptoms may recur also
systematic review of the results of 3086 patients who owing to either initial incomplete myotomy, regrowth of
underwent a laparoscopic myotomy found that compli- muscle fibers, or stricturing. Finally, there is clear evi-
cations were reported in 6% and death in 0.1%.44 When dence that achalasia patients (treated or untreated) are at
comparing the overall complication rates of laparoscopic increased risk for esophageal squamous cell carcinoma.47
myotomy with dilation, differences are likely related to Although there is no consensus on screening we recom-
373
6. Mini-Reviews and Perspectives continued
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Supplementary Material Reprint requests
The first 5 references associated with this article are Address requests for reprints to: David A. Katzka, MD, Division of
available below in print. The remaining references accom- Gastroenterology and Hepatology, Mayo Clinic, 200 First Avenue
SW, Rochester, Minnesota 55905. e-mail: katzka.david@mayo.edu;
panying this article are available online only with the elec-
fax: (507) 266-9081.
tronic version of the article. To access the remaining refer-
ences, visit the online version of Gastroenterology at www. Conflicts of interest
gastrojournal.org, and at doi:10.1053/j.gastro.2010.06.024. The authors disclose no conflicts.
374
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