Decompensated undiagnosed liver disease 2ry to brucellosis
Lever involvement in brucellosis :
Brucellosis involves the liver in varying ways, ranging from benign subclinical increases in serum aminotransferase levels to chronic suppurative disease
A 59-year-old diabetic male presented to the emergency department with left-sided abdominal pain, abdominal distension, and decreased urine output over two days. Imaging revealed gas in the left renal calyces and retroperitoneal spaces, consistent with emphysematous pyelonephritis. The patient was admitted to the ICU for IV fluids, antibiotics, and glycemic control. A nephrostomy tube was placed and aspirated pus and air. Antibiotics were adjusted based on culture results identifying E. coli. The patient's condition improved with treatment and he was later discharged.
Celiac common presentation of a uncommon disease saved with dateMuhammad Arshad
A 38-year-old female presented with abdominal distention, leg edema, and loose motions for 4-6 months. Her history revealed multiple hospital admissions for anemia. Testing showed liver cirrhosis, hypothyroidism, and iron deficiency anemia. Upper endoscopy found flattened duodenal folds and villous atrophy. Biopsy revealed celiac disease. She was started on a gluten-free diet with improvement in symptoms. Celiac disease causes villous atrophy and malabsorption from intolerance to gluten, presenting variably from anemia to osteoporosis. Diagnosis requires biopsy showing villous atrophy after gluten exposure.
This case presentation describes a 39-year-old female with primary sclerosing cholangitis (PSC) who underwent deceased donor liver transplantation in 2017 and was subsequently diagnosed with systemic lupus erythematosus (SLE). She presented with fever, chest pain, and shortness of breath. Testing revealed pleural effusions, cytopenias, elevated inflammatory markers, and positive autoimmune markers. She was started on steroids and hydroxychloroquine for SLE. The document discusses associations between SLE and liver disease, patterns of liver dysfunction in SLE, challenges in immunosuppression for transplant patients with autoimmune conditions, and the importance of monitoring liver tests in SLE patients.
This document presents a case report of a 20-year-old female student who presented with abdominal distention, jaundice, and pain while urinating. Various tests were performed, including bloodwork, ultrasound, and biopsy. The final diagnosis was portal vein and splenic vein thrombosis due to a hypercoagulable state from essential thrombocythemia, exacerbated by oral contraceptive use. The document also reviews several other case reports and discusses vascular diseases of the liver like Budd-Chiari syndrome.
- The patient presented with abdominal distension, leg swelling, and shortness of breath. Examination found ascites and signs of liver disease.
- Investigations showed abnormal liver function, renal cysts, para-aortic lymphadenopathy, and chylous ascites. A cervical lymph node biopsy found small cell lymphoma.
- The final diagnosis was small cell lymphoma infiltrating the liver and causing portal hypertension, chylous ascites, and possibly autoimmune hemolytic anemia. The patient deteriorated and died before chemotherapy could be started.
This document summarizes a clinical meeting presentation about a 5-year-old female patient named Jannat. She presented with generalized swelling, scanty urination, and white urine precipitate. Her history revealed previous similar illnesses treated with steroids. On examination, she had puffy face and edema. Tests showed nephrotic syndrome with urine infection. She was diagnosed with infrequent relapse nephrotic syndrome and urine infection. She was treated with antibiotics, steroids, diet restrictions, and monitoring.
This document provides information on ascites including its definition, causes, diagnosis, and management. Ascites is defined as the accumulation of free fluid in the peritoneal cavity, most often caused by liver cirrhosis (75% of cases), malignancy, or heart failure. Diagnosis involves history, physical exam finding shifting dullness or fluid wave, and abdominal ultrasound or paracentesis. Initial ascites management consists of sodium restriction, diuretics, and large volume paracentesis for refractory ascites.
A 59-year-old diabetic male presented to the emergency department with left-sided abdominal pain, abdominal distension, and decreased urine output over two days. Imaging revealed gas in the left renal calyces and retroperitoneal spaces, consistent with emphysematous pyelonephritis. The patient was admitted to the ICU for IV fluids, antibiotics, and glycemic control. A nephrostomy tube was placed and aspirated pus and air. Antibiotics were adjusted based on culture results identifying E. coli. The patient's condition improved with treatment and he was later discharged.
Celiac common presentation of a uncommon disease saved with dateMuhammad Arshad
A 38-year-old female presented with abdominal distention, leg edema, and loose motions for 4-6 months. Her history revealed multiple hospital admissions for anemia. Testing showed liver cirrhosis, hypothyroidism, and iron deficiency anemia. Upper endoscopy found flattened duodenal folds and villous atrophy. Biopsy revealed celiac disease. She was started on a gluten-free diet with improvement in symptoms. Celiac disease causes villous atrophy and malabsorption from intolerance to gluten, presenting variably from anemia to osteoporosis. Diagnosis requires biopsy showing villous atrophy after gluten exposure.
This case presentation describes a 39-year-old female with primary sclerosing cholangitis (PSC) who underwent deceased donor liver transplantation in 2017 and was subsequently diagnosed with systemic lupus erythematosus (SLE). She presented with fever, chest pain, and shortness of breath. Testing revealed pleural effusions, cytopenias, elevated inflammatory markers, and positive autoimmune markers. She was started on steroids and hydroxychloroquine for SLE. The document discusses associations between SLE and liver disease, patterns of liver dysfunction in SLE, challenges in immunosuppression for transplant patients with autoimmune conditions, and the importance of monitoring liver tests in SLE patients.
This document presents a case report of a 20-year-old female student who presented with abdominal distention, jaundice, and pain while urinating. Various tests were performed, including bloodwork, ultrasound, and biopsy. The final diagnosis was portal vein and splenic vein thrombosis due to a hypercoagulable state from essential thrombocythemia, exacerbated by oral contraceptive use. The document also reviews several other case reports and discusses vascular diseases of the liver like Budd-Chiari syndrome.
- The patient presented with abdominal distension, leg swelling, and shortness of breath. Examination found ascites and signs of liver disease.
- Investigations showed abnormal liver function, renal cysts, para-aortic lymphadenopathy, and chylous ascites. A cervical lymph node biopsy found small cell lymphoma.
- The final diagnosis was small cell lymphoma infiltrating the liver and causing portal hypertension, chylous ascites, and possibly autoimmune hemolytic anemia. The patient deteriorated and died before chemotherapy could be started.
This document summarizes a clinical meeting presentation about a 5-year-old female patient named Jannat. She presented with generalized swelling, scanty urination, and white urine precipitate. Her history revealed previous similar illnesses treated with steroids. On examination, she had puffy face and edema. Tests showed nephrotic syndrome with urine infection. She was diagnosed with infrequent relapse nephrotic syndrome and urine infection. She was treated with antibiotics, steroids, diet restrictions, and monitoring.
This document provides information on ascites including its definition, causes, diagnosis, and management. Ascites is defined as the accumulation of free fluid in the peritoneal cavity, most often caused by liver cirrhosis (75% of cases), malignancy, or heart failure. Diagnosis involves history, physical exam finding shifting dullness or fluid wave, and abdominal ultrasound or paracentesis. Initial ascites management consists of sodium restriction, diuretics, and large volume paracentesis for refractory ascites.
This 52-year-old male with HIV presented with proximal tubulopathy. He has been on antiretroviral therapy since the 1980s, including regimens containing tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF). His current regimen of dolutegravir, rilpivirine, TAF and emtricitabine was associated with elevated creatinine, low bicarbonate, phosphate and urine glucose. Proximal tubulopathy can occur with both TDF and TAF-containing antiretroviral regimens due to accumulation of tenofovir in renal proximal tubules.
This document describes the case of a 24-year-old intravenous drug user who presented with a 15-day history of fever, malaise, and shortness of breath for 7 days. On examination, he was found to be pale with a heart murmur. Investigations showed anemia, hepatitis C, and HIV positivity. Echocardiography revealed vegetation on the tricuspid valve. He was diagnosed with right-sided infective endocarditis and treated with antibiotics.
This document discusses hepatocellular carcinoma (HCC). It begins with a case presentation of a 24-year-old male patient admitted with right hypochondriac pain, fever, weight loss, and vomiting who was initially diagnosed with liver abscess. Laboratory tests revealed elevated liver enzymes and AFP level over 1000 ng/L. Imaging showed multiple hypodense hepatic lesions. The patient was diagnosed with HCC.
It then discusses HCC including risk factors like hepatitis B and C infection, cirrhosis from any cause. Pathogenesis involves chronic liver injury leading to cell regeneration and metabolic dysfunction increasing cancer risk. Symptoms include weakness, abdominal pain, and weight loss. Diagnosis is made through clinical presentation,
This document presents the case of a 29-year-old pregnant female who presented with epigastric pain, vomiting, diarrhea and later coughing up blood and nosebleeds. Investigations showed leukocytosis, low blood pH, high blood sugar, and sepsis. She had a spontaneous abortion due to sepsis and developed disseminated intravascular coagulation (DIC) and bilateral pulmonary embolism. Her condition improved with treatment but she was found to have a protein C deficiency, which can cause hypercoagulability and venous thromboembolism. The document provides details on her hospital course and explains DIC, its causes, diagnosis, and inherited and acquired hypercoagulable states.
This document summarizes the case of a 25-year-old Somali woman who presented with jaundice for 1 month associated with fever and rigor. Her past medical history was benign. On examination, she was deeply jaundiced but otherwise stable. Laboratory tests showed elevated liver enzymes. She was treated conservatively but deteriorated with hepatic encephalopathy. Despite treatment, her condition worsened and she suffered cardiorespiratory arrest. Investigation results received after her death showed a positive ANA and negative HCV RNA.
Intestinal bowel obstruction case .pptxAsifAhmed307
This case study presents a 73-year-old Thai male with small bowel obstruction. He presented with 10 hours of lower abdominal pain and distension. Imaging showed dilated small bowel with air-fluid levels, and a CT scan identified a transition point, confirming small bowel obstruction. The patient underwent exploratory laparotomy which revealed lysis of adhesions as the cause. He was treated conservatively with NG decompression and IV fluids initially, and then surgically with laparotomy for adhesion lysis and decompression of the small bowel.
This case presentation discusses a 47-year old male patient who was referred for abdominal pain, nausea, vomiting and significant weight loss. Investigations revealed jejunization of the ileum on CT scan and villous atrophy on biopsy. The patient was initially treated for Crohn's disease but did not improve. Further histopathology found a thick collagenous band suggestive of collagenous sprue. The patient was started on a gluten-free diet, steroids, total parenteral nutrition, and anti-TNF therapy, leading to improved symptoms. Collagenous sprue is a rare malabsorptive disorder characterized by villous atrophy and thick subepithelial collagen deposits. Treatment is challenging but may include steroids
This document presents a case report of a 62-year-old female patient who presented with abdominal pain and decreased appetite for two months. On examination, she was found to have pallor and edema, and a 7x5 cm lump in her right lower abdomen. Imaging found thickening of the ascending colon, cecum, and terminal ileum, with mesenteric stranding and a 4.5x4.5x5 cm lesion in her liver. Provisional diagnoses included ascending colon cancer or appendicular lump. Further tests found her CEA level to be elevated, and CT showed mural thickening of the terminal ileum, cecum and ascending colon consistent with possible infection or inflammation.
A 42-year-old male farmer presented with abdominal distension, pain, decreased urine output, and weight loss over the past two weeks. His history revealed chronic alcohol use over 30 years consuming 4.5-5.6 units daily. Examination found ascites and coagulopathy. Tests showed renal failure, cirrhosis, and transudative ascites. He was diagnosed with alcoholic liver disease complicated by ascites and hepatorenal syndrome due to chronic alcohol-induced cirrhosis. Management involved lifestyle changes including abstaining from alcohol and nutritional support.
Kshamendra, a 22-year-old male, presented with fever, rash, joint pains, fatigue, and cough for several weeks. He was initially diagnosed with typhoid fever but developed a drug reaction. Examination found a vesicular rash, joint pain, and pneumonia. Tests showed pancytopenia, positive ANA and anti-Ro/La antibodies. A diagnosis of Rowell's syndrome was made based on meeting the criteria of lupus erythematosus, ANA positivity, erythema multiforme-like lesions, and a positive anti-Ro antibody.
Alfi, a 10-year old boy, presented with sudden onset of severe pallor, dark colored urine, and jaundice. Examination found severe pallor, jaundice, splenomegaly, and otherwise normal vital signs. Initial workup showed features of hemolysis, positive direct Coombs test, and elevated bilirubin and LDH. The provisional diagnosis was autoimmune hemolytic anemia, which was confirmed. Treatment with steroids led to improvement in symptoms and laboratory values over subsequent follow ups.
A 15-year-old male presented with altered mental status and abdominal pain. His mother reported he had diabetes and had missed insulin doses for 3 days. His blood sugar was very high. Examination found signs of dehydration and neurological abnormalities. Testing showed diabetic ketoacidosis with high blood sugar and low bicarbonate. The leading diagnosis was Friedreich's ataxia given the neurological exam findings and family history was consistent with this diagnosis.
This case report describes an atypical case of Koch's abdomen in a 31-year-old woman. She presented with abdominal pain and swelling for 3 months. Investigations revealed a large subserosal fibroid, ascites, and left-sided pleural effusion. Further testing showed positive results for tuberculosis infection. She underwent surgery where a large subserosal myoma was removed. Her final diagnosis was subserosal leiomyoma with abdominal tuberculosis. Pseudomeigs' syndrome and Meigs' syndrome are discussed, which present with similar symptoms of ascites and pleural effusion but differ in their associated ovarian tumors.
This document presents a case study of a 43-year-old man presenting with vomiting and abdominal pain. Through examination and investigations, he was found to have chronic liver disease complicated by cirrhosis and hepatorenal syndrome. He was treated with antibiotics and medications for his liver conditions. Literature review discussed decompensated liver disease including definition, epidemiology, etiology, pathophysiology, clinical features, investigations and management. The case study followed the patient's hospital course and changing diagnosis and treatment over time.
This document summarizes the medical history and examination of a 56-year-old female patient presenting with an abdominopelvic mass. Key details include:
- The patient has a history of 5 pregnancies and 4 deliveries, with her last delivery in 2001.
- Ultrasound showed a myoma uteri and right ovarian mass with benign features measuring 16.8 x 13.7 cm.
- On examination, the patient had a globularly enlarged abdomen with a cystic mass measuring 21 x 26 cm that was movable and non-tender.
A 24-year-old male student with known sickle cell anemia presented with 4 days of generalized body pain, 2 days of fever, and 1 day of loss of consciousness. On examination, he was unconscious and tachycardic. Investigations showed anemia, leukocytosis, and thrombocytopenia. He was admitted to the ICU and treated for possible vaso-occlusive crisis or chest syndrome based on his history and exam findings. Brain CT was normal. He received blood transfusions and IV fluids and antibiotics, and was evaluated by neurology with no focal deficits found.
A 24-year-old male student with known sickle cell anemia presented with 4 days of generalized body pain, 2 days of fever, and 1 day of loss of consciousness. On examination, he was unconscious and tachycardic. Investigations showed anemia, leukocytosis, and thrombocytopenia. He received blood transfusions and antibiotics. Brain CT was normal but he remained hypotonic on one side. The differential diagnosis included acute stroke versus chest syndrome complications.
A 24-year-old male student with known sickle cell anemia presented with 4 days of generalized body pain, 2 days of fever, and 1 day of loss of consciousness. On examination, he was unconscious and tachycardic. Investigations showed anemia, leukocytosis, and thrombocytopenia. He received blood transfusions and antibiotics. Brain CT was normal but he remained confused. The differential diagnosis included vaso-occlusive crisis, sepsis, or stroke in the setting of sickle cell anemia.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
This 52-year-old male with HIV presented with proximal tubulopathy. He has been on antiretroviral therapy since the 1980s, including regimens containing tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF). His current regimen of dolutegravir, rilpivirine, TAF and emtricitabine was associated with elevated creatinine, low bicarbonate, phosphate and urine glucose. Proximal tubulopathy can occur with both TDF and TAF-containing antiretroviral regimens due to accumulation of tenofovir in renal proximal tubules.
This document describes the case of a 24-year-old intravenous drug user who presented with a 15-day history of fever, malaise, and shortness of breath for 7 days. On examination, he was found to be pale with a heart murmur. Investigations showed anemia, hepatitis C, and HIV positivity. Echocardiography revealed vegetation on the tricuspid valve. He was diagnosed with right-sided infective endocarditis and treated with antibiotics.
This document discusses hepatocellular carcinoma (HCC). It begins with a case presentation of a 24-year-old male patient admitted with right hypochondriac pain, fever, weight loss, and vomiting who was initially diagnosed with liver abscess. Laboratory tests revealed elevated liver enzymes and AFP level over 1000 ng/L. Imaging showed multiple hypodense hepatic lesions. The patient was diagnosed with HCC.
It then discusses HCC including risk factors like hepatitis B and C infection, cirrhosis from any cause. Pathogenesis involves chronic liver injury leading to cell regeneration and metabolic dysfunction increasing cancer risk. Symptoms include weakness, abdominal pain, and weight loss. Diagnosis is made through clinical presentation,
This document presents the case of a 29-year-old pregnant female who presented with epigastric pain, vomiting, diarrhea and later coughing up blood and nosebleeds. Investigations showed leukocytosis, low blood pH, high blood sugar, and sepsis. She had a spontaneous abortion due to sepsis and developed disseminated intravascular coagulation (DIC) and bilateral pulmonary embolism. Her condition improved with treatment but she was found to have a protein C deficiency, which can cause hypercoagulability and venous thromboembolism. The document provides details on her hospital course and explains DIC, its causes, diagnosis, and inherited and acquired hypercoagulable states.
This document summarizes the case of a 25-year-old Somali woman who presented with jaundice for 1 month associated with fever and rigor. Her past medical history was benign. On examination, she was deeply jaundiced but otherwise stable. Laboratory tests showed elevated liver enzymes. She was treated conservatively but deteriorated with hepatic encephalopathy. Despite treatment, her condition worsened and she suffered cardiorespiratory arrest. Investigation results received after her death showed a positive ANA and negative HCV RNA.
Intestinal bowel obstruction case .pptxAsifAhmed307
This case study presents a 73-year-old Thai male with small bowel obstruction. He presented with 10 hours of lower abdominal pain and distension. Imaging showed dilated small bowel with air-fluid levels, and a CT scan identified a transition point, confirming small bowel obstruction. The patient underwent exploratory laparotomy which revealed lysis of adhesions as the cause. He was treated conservatively with NG decompression and IV fluids initially, and then surgically with laparotomy for adhesion lysis and decompression of the small bowel.
This case presentation discusses a 47-year old male patient who was referred for abdominal pain, nausea, vomiting and significant weight loss. Investigations revealed jejunization of the ileum on CT scan and villous atrophy on biopsy. The patient was initially treated for Crohn's disease but did not improve. Further histopathology found a thick collagenous band suggestive of collagenous sprue. The patient was started on a gluten-free diet, steroids, total parenteral nutrition, and anti-TNF therapy, leading to improved symptoms. Collagenous sprue is a rare malabsorptive disorder characterized by villous atrophy and thick subepithelial collagen deposits. Treatment is challenging but may include steroids
This document presents a case report of a 62-year-old female patient who presented with abdominal pain and decreased appetite for two months. On examination, she was found to have pallor and edema, and a 7x5 cm lump in her right lower abdomen. Imaging found thickening of the ascending colon, cecum, and terminal ileum, with mesenteric stranding and a 4.5x4.5x5 cm lesion in her liver. Provisional diagnoses included ascending colon cancer or appendicular lump. Further tests found her CEA level to be elevated, and CT showed mural thickening of the terminal ileum, cecum and ascending colon consistent with possible infection or inflammation.
A 42-year-old male farmer presented with abdominal distension, pain, decreased urine output, and weight loss over the past two weeks. His history revealed chronic alcohol use over 30 years consuming 4.5-5.6 units daily. Examination found ascites and coagulopathy. Tests showed renal failure, cirrhosis, and transudative ascites. He was diagnosed with alcoholic liver disease complicated by ascites and hepatorenal syndrome due to chronic alcohol-induced cirrhosis. Management involved lifestyle changes including abstaining from alcohol and nutritional support.
Kshamendra, a 22-year-old male, presented with fever, rash, joint pains, fatigue, and cough for several weeks. He was initially diagnosed with typhoid fever but developed a drug reaction. Examination found a vesicular rash, joint pain, and pneumonia. Tests showed pancytopenia, positive ANA and anti-Ro/La antibodies. A diagnosis of Rowell's syndrome was made based on meeting the criteria of lupus erythematosus, ANA positivity, erythema multiforme-like lesions, and a positive anti-Ro antibody.
Alfi, a 10-year old boy, presented with sudden onset of severe pallor, dark colored urine, and jaundice. Examination found severe pallor, jaundice, splenomegaly, and otherwise normal vital signs. Initial workup showed features of hemolysis, positive direct Coombs test, and elevated bilirubin and LDH. The provisional diagnosis was autoimmune hemolytic anemia, which was confirmed. Treatment with steroids led to improvement in symptoms and laboratory values over subsequent follow ups.
A 15-year-old male presented with altered mental status and abdominal pain. His mother reported he had diabetes and had missed insulin doses for 3 days. His blood sugar was very high. Examination found signs of dehydration and neurological abnormalities. Testing showed diabetic ketoacidosis with high blood sugar and low bicarbonate. The leading diagnosis was Friedreich's ataxia given the neurological exam findings and family history was consistent with this diagnosis.
This case report describes an atypical case of Koch's abdomen in a 31-year-old woman. She presented with abdominal pain and swelling for 3 months. Investigations revealed a large subserosal fibroid, ascites, and left-sided pleural effusion. Further testing showed positive results for tuberculosis infection. She underwent surgery where a large subserosal myoma was removed. Her final diagnosis was subserosal leiomyoma with abdominal tuberculosis. Pseudomeigs' syndrome and Meigs' syndrome are discussed, which present with similar symptoms of ascites and pleural effusion but differ in their associated ovarian tumors.
This document presents a case study of a 43-year-old man presenting with vomiting and abdominal pain. Through examination and investigations, he was found to have chronic liver disease complicated by cirrhosis and hepatorenal syndrome. He was treated with antibiotics and medications for his liver conditions. Literature review discussed decompensated liver disease including definition, epidemiology, etiology, pathophysiology, clinical features, investigations and management. The case study followed the patient's hospital course and changing diagnosis and treatment over time.
This document summarizes the medical history and examination of a 56-year-old female patient presenting with an abdominopelvic mass. Key details include:
- The patient has a history of 5 pregnancies and 4 deliveries, with her last delivery in 2001.
- Ultrasound showed a myoma uteri and right ovarian mass with benign features measuring 16.8 x 13.7 cm.
- On examination, the patient had a globularly enlarged abdomen with a cystic mass measuring 21 x 26 cm that was movable and non-tender.
A 24-year-old male student with known sickle cell anemia presented with 4 days of generalized body pain, 2 days of fever, and 1 day of loss of consciousness. On examination, he was unconscious and tachycardic. Investigations showed anemia, leukocytosis, and thrombocytopenia. He was admitted to the ICU and treated for possible vaso-occlusive crisis or chest syndrome based on his history and exam findings. Brain CT was normal. He received blood transfusions and IV fluids and antibiotics, and was evaluated by neurology with no focal deficits found.
A 24-year-old male student with known sickle cell anemia presented with 4 days of generalized body pain, 2 days of fever, and 1 day of loss of consciousness. On examination, he was unconscious and tachycardic. Investigations showed anemia, leukocytosis, and thrombocytopenia. He received blood transfusions and antibiotics. Brain CT was normal but he remained hypotonic on one side. The differential diagnosis included acute stroke versus chest syndrome complications.
A 24-year-old male student with known sickle cell anemia presented with 4 days of generalized body pain, 2 days of fever, and 1 day of loss of consciousness. On examination, he was unconscious and tachycardic. Investigations showed anemia, leukocytosis, and thrombocytopenia. He received blood transfusions and antibiotics. Brain CT was normal but he remained confused. The differential diagnosis included vaso-occlusive crisis, sepsis, or stroke in the setting of sickle cell anemia.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
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4. ▹ 52 years old male K/C of :
-DM on oral hypoglycemic meds
▹ Patient came through ER C/O :
-Abdominal pain, fever for more than 2 weeks.
▹ And 1 day HX of abdominal distention.
5. Abdomenal pain = the pain was generalized vague in
nature intermittent started 2 weeks earlier not radiated
no food relation relieved with bascopan weak him up
from sleep.
Fever = mostly at night associated with sweating,
documented 38 /38.9 /39 Relived by fifadol
No other associations.
6. ▹ Yellowish discoloration of eye & dark urine
▹ Abdominal distention started the day of admission
noticed by family
▹ Patient have HX of wight loss more than 13 kg in
the last 2 months
▹ NO Hx contact with active pulmonary TB , or other
sick patient
▹ No HX of GI bleeding
▹ No HX of change of LOC
▹ NO similar complain in the past.
7. 7
▹ CVS
▹ Respiratory= mild cough 2-3 times a day
▹ Neurology
▹ Genitourinary/renal
▹ Musculoskeletal = back pain 2 month ago
▹ Psychiatry
8. ▹ Patient K/C of DM on glocophage 2 tabs BID
Fifadol , Panadol and baskopan for pain and fever
9. ▹ Family Hx:
NO HX of
liver disease
of Gi
Malegnancy
▹ Allergy:
NKA
▹ Past surgical
Hx:
▹ appendectomy
10 years ago
9
10. This is 52 years old male K/C of DM S/P appendectomy
Patient came to ER with fever & abdominal pain for 2
weeks abdominal distention started at the day of
admission.
10
Summary:
12. 12
Patient was laying down on bed GCS:15/15
Patient look pale and fatigued with jaundice.
Chest: equal air entry with normal breath sound.
CVS: s1+s2+0 with NO lower limb edema.
Abdomen: mild tenderness, distended with
-ive fluid thrills -ive shifting dullness.
CNS: NO weakness ,sensory intact.
✘ Physical examination
✘ upon presentation :
15. 15
✘ Tumor marker:
CA 19-9 = 17
PSA = 0.221
CEA= 5.3
HBsAg Result=-ive
HCV Antibody=-ive
AST= 188
GGT= 305
BLOOD CS : GRAM NEGATIVE COCCOBACILLARY, SUGGETIVE
OF BRUCELLA
- Other Liver cirrhosis & leishmania test still bending
16. 16
Findings:
1. Coarse heterogeneous liver parenchyma suggestive of underlying liver
parenchymal disease, for clinical correlation. No obvious focal hepatic lesion
could be seen.
2. Mild splenomegaly and mild ascites.
3. Reactive thick-walled edematous gall bladder likely related to underlying
ascites or liver parenchymal disease. NO gall stones
4. Right renal small nonobstructive stone.
18. 18
Findings:
The visualized parts of the thyroid gland appear within normal. There is a
cystic lesion located in the subcarinal area measuring about 2.2 x 1 cm. No
enlarged lymph nodes noted in the chest. There is a small hiatus hernia
noted. The vessels are all patent with no evidence of major pulmonary
embolism.
The tracheobronchial tree is patent. Small pleural effusion noted in the left
side.
19. 19
Con..
A large area of consolidation noted in the left lower lobe with air
bronchogram. The right lower lobe atelectatic changes noted.
The included cuts of the upper abdomen shows a large to the amount of
ascites.
A cirrhotic liver is noted with no suspicious liver lesions. The hepatic veins
and portal veins are patent. There is splenomegaly noted.
The visualized bones show no suspicious bony lesions or fractures. The
surrounding soft tissues appear within normal.
21. 21
Cirrhotic liver with secondary portal hypertension. No concerning hepatic
lesion. " Gallbladder wall thickening, likely reactive with no gallbladder stone.
22. 22
▹ the histologic findings are consistent with chronic
biliary disease, suggestive of sclerosing cholangitis;
however, drug-induced cholangiopathy should be
clinically excluded.
▹ The presence of lobular activity raises the
possibility of a concomitant infection.
▹ Clinical, serologic, radiologic, and microbiological
correlations are required to establish the underlying
etiology.
23. ▹ ESOPHAGUS : At least 5 cords of large esophageal
varices with high risk stigmata ( red wales and nipple
sign). 9 bands applied and hemosatsis achived.
▹ STOMACH : around 200cc of fresh blood seen.
Moderate portal gastropathy, No gastric ulcer or
mucosal bleeding seen. No fundal varices on
retroflextion.
▹ DOUDENUM : Normal 1st and 2nd part.
23
28. “
Lever involvement in
brucellosis :
Brucellosis involves the liver in
varying ways, ranging from benign
subclinical increases in serum
aminotransferase levels to chronic
suppurative disease
28
29. “
▹ Liver involvement in patients
with brucellosis: results of the
Marmara study
29
. This study included 325 brucellosis
patients with significant hepatobiliary
involvement identified with
microbiological analyses from 30
centers between 2000 and 2013.