Autoimmune encephalitis is caused by antibodies targeting neuronal cell surface or synaptic proteins. It accounts for around 20% of encephalitis cases without an identifiable infection. Key symptoms include seizures, altered mental status, and movement disorders. Diagnosis involves detecting antibodies in serum or CSF using live or fixed cell-based assays. Treatment aims to remove or suppress antibodies through immunotherapies like steroids, IVIG, and plasma exchange. Prompt treatment often leads to recovery, though some deficits may persist. Outcomes depend on the specific antibody and targeted brain regions.
Anti-NMDA receptor encephalitis: Psychiatric presentation and diagnostic chal...Pawan Sharma
Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, only recently first described, is an increasingly well-recognized inflammatory encephalitis that is seen in children and adults. The highlights: Pychiatric manifestations in encephalitis and the need for the psychiatrist to a have high index of suspicion when atypical symptoms (e.g., dyskinesia, seizure, fever etc.) present in acutely psychotic patients.
Movement disorders are not only realm of chronic disorders that are treated without requiring emergent intervention, but also they can present acutely with more aggressive forms
Anti-NMDA receptor encephalitis: Psychiatric presentation and diagnostic chal...Pawan Sharma
Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, only recently first described, is an increasingly well-recognized inflammatory encephalitis that is seen in children and adults. The highlights: Pychiatric manifestations in encephalitis and the need for the psychiatrist to a have high index of suspicion when atypical symptoms (e.g., dyskinesia, seizure, fever etc.) present in acutely psychotic patients.
Movement disorders are not only realm of chronic disorders that are treated without requiring emergent intervention, but also they can present acutely with more aggressive forms
Introduction of Autoimmune encephalitis for Non medical professionals and mental health professionals work in neurology. Reference provided in last slide and prepared of self learning purpose not for any commercial purpose.
covering the topic of chronic immune mediated demyelinating neuropathies with a detailed focus on the typical form of chronic inflammatory demyelinating polyradiculoneuropathy (Typical CIDP).
a presentation on autoimmune encephalitis, paraneoplastic syndrome. their types and various imaging and lab finding
their differential diagnosis
acute and long term management plans
This presentation describes a few cases of stroke that presented within golden period but could not be thrombolysed. It is a case based discussion on when not to thrombolyse
Chikungunya- a short PPT.
This tells in brief about the infection.
The neurological complications is the main focus.
The management and other related issues are also discussed.
This presentation describes the common conditions, anatomy and the ideal ways to do and perform nerve conduction studies in lower limbs. It is nicely depicted with self explanatory pictures.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
3. • The immune reactions in brain depends on
the interaction between the immune system,
innate (glial cells) or adaptive (lymphocytes),
and nervous tissue and is modified by blood
brain barrier.
• This interaction is seen in many diseases of
the nervous system like the multiple sclerosis
or neurodegenerative diseases
4. • A more specific form of autoimmunity in CNS is
now recognized in the form of antibodies that
bind to neuronal cell surface/synaptic receptors
or ion channel related proteins.
• These antibodies are detected in adults as well
as the children.
• The antigens, essential for cellular function and
neurotransmission, are expressed to different
extent in the CNS.
• The clinical signs may depend on the extent of
brain regions targeted by the antibodies.
• The effects may be reversible and the patient may
frequently recover.
5. • Some of these disorders may be paraneoplastic.
These disorders are often known to be associated
with cancer.
• They however differ from paraneoplastic
encephalitis because in the latter, the antibodies
affect the intracellular proteins such as Hu or
CRMP5, and the T cell mechanisms lead to
irreversible neuronal dysfunction.
• In contrast to classical paraneoplastic syndromes,
these conditions respond to immunotherapy.
6. WHY IS IT IMPORTANT TO KNOW
ABOUT AUTOIMMUNE ENCEPHALITIS
7. • Large multicentre trials e.g. UK encephalitis
study and California Encephalitis project, have
demonstrated that almost one fifths of the
acute or subacute encephalitis patients who
are not detected to have an infection may be
autoimmune encephalitis.
• This and the response to immunotherapy has
led to a paradigm shift in approach to
autoimmune encephalitis
9. • The key clinical features of the autoimmune
encephalopathy are
– seizures,
– altered mental state- confusion, disorientation,
– behavioral changes,
– cognitive impairment,
– movement disorders,
– autonomic dysfunctions and
– sleep disorders.
• There may be a preceding prodrome of headache
and fever suggesting a viral illness.
• The symptoms overlap and the cause may not be
apparent from history and examination.
10. • Seizures suggests a encephalitic process but
the inflammation may not be evident in the
radiological scans or cerebrospinal fluid.
Hence encephalopathy is a more apt term, but
may be used interchangeably with
autoimmune encephalitis.
11. • The most specific and appropriate tests are cell based
assays. These allow detection of antibodies binding
epitopes of neuronal surface antigens in a manner
similar to when the antigens are exposed in a
circulating fluids.
• The antigen is transfected to a suitable human cell line
and the mosaic of such fixed cells expressing different
antigens may be used commercially.
• Alternatively, live cell assays can be developed but are
much more time consuming.
• Both serum and csf may be used, however csf may
yield much more positive results (given the normal
ratio of serum to CSF immunoglobulin G levels of
around 400). Besides serum is more sticky.
12. • Other methods such as IHC, immunoblotting
and radioimmunoprecipitation assays can be
used but have individual limitations.
14. • Most clinicians rely on algorithm based parameters to
support autoimmune or immune causes.
• This is more so since the threshold for considering
immunotherapy becomes important.
• Autoimmune encephalitis should be considered in any
patient with a rapidly progressive encephalopathy of
unclear origin.
• Any immunological type of autoimmune encephalitis can
have a relapsing course and therefore the diagnosis of
these disorders should be considered in patients with a
past history of encephalitis or relapsing encephalopathy.
• The final diagnosis relies upon identification of neuronal
antibodies and/or positive response to immunotherapy.
• Attempts have been made to categorize the likelihood of
autoimmune cause to definite, probable, or possible.
16. • While the diagnosis is based on
demonstration of antibodies, the tests may be
negative frequently. One should consider the
follows in the situation-
17. 1. The samples are best taken when the patient is
symptomatic and maximally affected. Outside the
clinical event, the test may be negative. The tests may
be repeated on samples previously collected.
2. The immunotherapy, once initiated may influence the
results. Where plasmapheresis may result in false
tests, use of immunoglobulins may actually yield false
positive tests.
3. CSF samples yield a better report than the serum.
4. It is possible that the test is negative because the
precise antigenic target has yet to be identified. Thus
the absence on identification of a known antibody
should not exclude the diagnosis of autoimmune
encephalopathy or preclude initiation of treatment
18. CASE 1
• The patient a 26 year old female presented to
the hospital with a history of
– Altered speech and behavior,
– Gradually increasing drowsiness,
– Brief episode of mild fever,
– Gradually progressive deterioration of sensorium.
19. • On examination,
– Drowsy
– Arousable with difficulty
– Moving all 4 limb
– Sensory system and cerebellar system could’nt be
examined
– Reflexes were brisk.
20. • MRI Brain showed symmetrical T2/FLAIR
hyperintense signal involving bilateral medial
thalamus, caudate, putamen, external and
internal capsule, periaqueductal grey white
matter, dorsal midbrain, left frontal white matter
with patch DWI restriction with swelling of basa
ganglia and patchy minimalenhancement
suggestive of encephalitis.
• CSf was normal. An autoimmune panel was sent
that later came out negative.
21. • The patient was considered to have possible
autoimmune encephalitis.
• A course of steroids was initiated and her
sensorium showed improvement.
23. The treatment options include
1. Removal or suppression of circulating
antibodies via plasma exchange or IvIg.
2. Attenuate production of production of
autoimmune antibodies via steroids and
other immunosuppressive therapy.
24. • Concomitant and early use of intravenous
steroids and IVIGs and/or plasmapheresis are
often effective in achieving control of
symptoms and remission.
• There is no data supporting the use of IvIg
over plasma exchange.
25. • Second line therapy with immunosuppresants
may yield additional benefits when first line
therapy fails e.g. rituximab and/or
cyclophosphamide. Prompt initiation of
second line drugs is recommended if the first
line therapy fails.
• If the patient remains symptomatic despite
first- and second-line treatment, repeated and
combination therapeutics may help.
26. • Treatment of tumours, if associated, helps
recovery and reduces the risk of relapses
27. CASE2
• A previously healthy four year old girl presented with
– progressive gait instability of two weeks.
• She was clinically diagnosed as viral encephalitis and
empirically treated with acyclovir at a centre.
• MRI brain and cerebrospinal fluid (CSF) cell count,
biochemical analysis and bacterial culture were
normal.
• There was progression of her disease activity.
– developed generalized tonic clonic seizures,
– choreoathetoid movements, and
– aphasia over the next 2 weeks.
28. • On admission she was
– disoriented,
– Aphasic
– Glasgow coma scale was 8/15
– had choreoathtoid movements involving all the
limbs,
– hypotonia,
– quadriparesis
– brisk deep tendon reflexes and extensor plantar
response.
– had multiple episodes of generalized tonic clonic
seizures.
29. • Investigations showed
– liver and renal function test, serum electrolytes
were normal.
– Repeat MRI brain was normal
– CSF analysis showed normal protein, lymphocytic
pleocytosis, negative virology and bacterial
culture.
– CSF NMDAR antibody was positive confirming the
diagnosis of NMDAR encephalitis.
30. • She was treated with
– IV Immunoglobulin (2gm/kg),
– IV methyl prednisolone,
– anticonvulsants and
– supportive measures.
• Her involuntary movements decreased, though
she continued to be unresponsive to
surroundings with intermittent visual fixation and
following. She also started having stereotypic
movements.
– Given 8 doses of rituximab (375mg/m2) at weekly
intervals.
31. • Gradually,
– her sensorium improved,
– involuntary movements decreased in intensity and
– seizures were under control.
– Child was discharged after 2 months of hospital
stay.
• She was on immunosuppression with oral
prednisolone and at one month follow up,
child was seizure free with persisting
quadriparesis.
33. NMDA receptor encephalitis
• The patient presents
with
– psychiatric symptoms,
– seizures,
– memory deficits,
– altered sensorium,
– dyskinesias, and
– autonomic disturbances.
• It affects predominantly
the young adults and
teenagers with age
related association to
ovarian teratoma.
• The patients usually
recover well with
immunotherapy.
34. LIMBIC encephalitis
The syndrome shows antibodies to different targets
and the symptoms vary according to the site.
1.GABA B receptor.
• Patients have limbic encephalitis with
predominant seizures.
• The patients are usually of advanced age
(approximately 62 years)
• Associated SCLC or neuroendocrine tumors.
• As many as 75% patients show partial to full
recovery with immunotherapy.
35. 2.AMPA receptor.
• The patients show limbic encephalitis with
predominant psychiatric symptoms.
• They may have associated breast, lung or
thymus cancer.
• Almost 70% patients show recovery with
immunotherapy but relapses are frequent.
36. 3. LG1 receptor.
• These patients present with hyponatremia,
REM behavior disorders and seizures- tonic or
myoclonic.
• They are infrequently associated with
thymoma
• 80% patients recover with immunotherapy
but mild residual deficit may persist.
37. 4. mGluR5 and mGluR1 receptor.
• The patients are commonly found to have
association with Hodgkin's lymphoma
• Recover well with immunotherapy.
38. GABA A receptor encephalitis
• Rapidly progressive severe encephalopathy
with refractory seizures is a common
presentation of these patients
• Commonly associated with other autoimmune
conditions e.g. TPO and GAD antibodies.
• Patients have good response to treatment.
• Medical complications of the status
epilepticus is common and can be fatal.
39. CASPAR2 receptor encephalitis.
• The patients present with Morvan syndrome
and frequently have associated neuropathic
pain.
• 70% of the patients show a full or substantial
improvement.