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PSC incidence ranges from 0.5 to 1.25 cases/100 000.
The prevalence of the disease ranges between six and 20 cases/100 000.
Men are more likely to be affected (70%).
Prevalence of PSC may be increased in first degree relatives of PSC patients
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Case presentation on SLE with Pleural effusion ,with typical SOAP format, Pharmaceutical care plan, pharmacist intervention & Critical appraisal of the laboratory datas compared with standard reference values.
A Case of Chronic Pancreatitis Due to Hyper ParathyroidismApollo Hospitals
Chronic pancreatitis is the progressive and permanent destruction of the pancreas resulting in exocrine and endocrine insufficiency and, often, chronic disabling pain. The etiology is multifactorial. 60 to 70% of patients with chronic pancreatitis have a long history of heavy consumption of alcohol before the onset of clinically apparent disease. Primary hyperparathyroidism is a rare cause of chronic pancreatitis and there is paucity of data on this interesting association. The relationship of cause and effect between the two diseases has been debated.
We present here a case of a 42-year-old non-alcoholic man, diagnosed to be suffering from chronic calcific pancreatitis, the cause of which was found to be hypercalcemia due to a solitary parathyroid adenoma.
An assignment to write a case study for medical terminology as if I were responsible for writing the patient\'s medical record. An assignment at Colorado Technical University online.
Polymyositis is an idiopathic inflammatory myopathy that causes symmetrical, proximal muscle weakness; elevated skeletal muscle enzyme levels; and characteristic electromyography (EMG) and muscle biopsy findings
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Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...
Case presentation fadl
1.
2. Female patient,22 years old , housewife , born and lives in
EL Mahmodia
Newly Married just 1 week ago
Patient neither diabetic nor hypertensive
She has no special habit of medical importance
1 year ago she said that she received steroids for 1 year
, after she consulted a nephrologist for puffy face and
lower limb edema
Family history is irrelevant
4. History of Present Illness
The condition started 3 days ago when the patient complained
of sudden sever generalized abdominal pain associated with
low grade fever and constipation
Patient received (nonspecific) treatment without improvement
She sought medical advice & was admitted at fever hospital for
1 day and investigations were done
While there ,she developed anuria & repeated vomiting
Then she was referred to us with elevated KFTs &anuria
5. Examination
Patient conscious, alert, oriented.
No special decubitus
weight: 69 kg
Heart rate: 80 Bpm, regular, equal on both sides
Blood pressure: 160/95
Respiratory rate: 20/minute
Temp: 37.5 ° C
There was pallor, no jaundice, no cyanosis.
15. Cont. present history
Patient developed compressing chest pain referred to left arm
ECG was done and revealed antero-lateral wall ischemia
Patient developed severe left hip joint pain with left leg
tenderness & limitation of movement .
Patient reported numbness of both hands
21. summary
22 years old female pt.
Not DM,not HTN
HBV +VE
C/O sudden sever abdominal pain
Renal impairment(AKI)
Normocytic normochromic anemia
Chest pain developed &ECG revealed Anterolateral
ischemia
Arthralgia of left hip joint
Renal biopsy>>focal ischemic cortical
necrosis&hyalinization with intimal thickening of bl.vs
24. Management …
Patient received 20 sessions of hemodialysis
Patient received pulse methylprednisolone 500 mg
IV/day for 3 days
Then continued on 60 mg prednisone/day orally for 4
weeks then tappred gradually
Antiviral agent was begun lamivudin 150 mg /day orally
25. Follow up
Now S.creatinine of the pateint ranges from 4.5-5.5
mg/dl without dialysis .
26. Effect of HBV on kidney
1) Most common lesion seen is Membranous Nephropathy(MN)
The lesion is a result of the deposition of IC HBe Ag-Ab complex in the B.M
(subepithelial)
2) Also it can cause MPGN
The HBs Ag-Ab complex is too large to filter through the B.M so it lodges in the
inner surface of the capillary wall (subendothlial)
3) Polyarteritis nodosa
Necrotizing vasculitis of medium sized vesseles that is not a direct form of
glomerulnephritis
3) IgA Nephropathy
In significant liver injury there is increase circulating IgA and may deposite in
the kidney
5)
FSGS: no immune complex & it may be due to deposition of HBV in the
renal tissues
27. Case Commentary
POLYARTERITIS NODOSA(PAN)
Polyarteritis nodosa is a rare autoimmune systemic
disease featuring spontaneous inflammation of
medium & small sized arteries
. The most common areas of involvement include the
muscles, joints, bowels, nerves, kidneys, and skin
28. causes and risk factors for
PAN
Polyarteritis nodosa is most common in middle-age
people.
Its cause is unknown, but it has been reported after
hepatitis B infection(30%)
29. Symptoms and Signs of PAN
The American College of Rheumatology established
criteria for the classification of PAN in 1990
Patient is said to have PAN if at least three of the
following 10 criteria are present:
30. Criteria of PAN
1)
Elevated kidney blood tests (BUN greater than 40 mg/dl or
creatinine greater than 1.5 mg/dl)
2)
Hepatitis B virus tests positive (for surface antigen or antibody)
3)
Arteriogram (angiogram) showing the arteries that are dilated
(aneurysms) or constricted by the blood vessel inflammation
4)
Biopsy of tissue showing the arteritis (typically inflamed
arteries)
5)
Livedo reticularis (a mottled purplish skin discoloration over the
extremities or torso)
31. Criteria of PAN
6)
Weight loss greater than or equal to 4 kg
7) Diastolic blood pressure greater than 90 mm Hg (high
blood pressure)
8) Testicular pain or tenderness (occasionally, a site
biopsied for diagnosis)
9)
Muscle pain, weakness, or leg tenderness
10) Nerve disease (either single or multiple)
32. Diagnosis:
There is no single diagnostic test for PAN
Tests that can confirm the diagnosis include:
Arteriogram
Tissue biopsy
Complete blood count (CBC)
Erythrocyte sedimentation rate (ESR) or C-reactive
protein (CRP)
33. Angiography
Conventional angiography is the preferred.
Positive findings include aneurysms and stenosis
of medium-sized vessels
Aneurysms are most commonly found in the
kidney, liver, and mesenteric arteries, and their
presence is associated with more severe and
extensive disease
34.
35. Biopsy
Most accessible sites for biopsy include the skin, sural
nerve, testes, and skeletal muscle
PAN typically affect medium sized or small arteries and
sparing arteriols , capillaries , venules & does not cause
glomerulonephritis but may cause ischemic renal injury
Granulomatous inflammation does not occur in PAN, and
its presence suggests other diagnoses
Kidney biopsy carries a risk of aneurysmal rupture and
bleeding
37. Cytotoxic drugs (cyclophosphamide)
with or against
Plasmapheresis
Role , regimen
steroid regimen
Antiviral drugs
which to give(interferon-α2b, lamivudine or entecavir)
& the regimen
38. Treatment
HBV-Related PAN
HBV-related PAN is a special situation. Standard therapies for
PAN, including glucocorticoids and
cyclophosphamide, enhance prognosis and control of the
polyarteritis.
Antiviral medications are essential in the treatment of these
patients
For hepatitis B–related PAN, treatment consists of
corticosteroids for early, initial control followed by
plasmapheresis and antiviral agents.
39. Treatment (cont.)
Stronger immunosuppression using a combinations
of steroids and cyclophosphamide is typically
avoided in these cases as it can enhance viral
replication
Plasma exchanges are used as adjunctive therapy??
with antivirals.
40. Treatment (cont.)
Prednisone (1 mg/kg/d) is administered for the first week.
Alternatively, methylprednisolone pulse (15 mg/kg/d for 1-3 d) is
used in severely ill patients. Steroids are then tapered rapidly and
withdrawn at the end of 2ndweek
Antiviral agents are begun after steroid withdrawal to enhance
immunologic clearance of HBV-infected hepatocytes and favor
seroconversion.
Agents studied included vidarabine, which was replaced by
interferon-α2b,and later by lamivudine and recently entecavir
It is recommended that lamivudine be continued for 6 months or
stopped at the time of seroconversion to hepatitis B surface
antibody