This document presents the case of a 15-year-old female patient admitted with short stature, body aches, loss of appetite, and joint pain. Her examination revealed short stature, coarse facies, widened bones, and limited joint mobility. Skeletal survey showed narrow pelvis, short stubby bones, and irregular bone growth. Differential diagnoses included Mucopolysaccharidoses (MPS), Ehlers-Danlos syndrome, and Mucolipidoses. MPS Type IV was considered most likely given skeletal findings and enzyme deficiency causing lysosomal storage.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
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
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
2. HISTORY
15 years old BIBI KAFIA resident of Quetta
admitted through OPD with C/C
• Short stature
• Body aches
• Loss of appetite
• A/C to father her height normally attain at the
age of 3 years after that her height did not inc.
since then she is complaining of body aches,
fatigue, joint pain and morning stiffness but not
swelling of joint. As the time passed stiffness
relieve and she can perform her daily activity.
3. Conti..……..
• She is having on &off constipation and diarrhea.
She passed hard stool after 4-5 days by taking
skilax drops . When loose motion started its 5-6
episodes ,watery in nature and asso with
abdominal pain relived by taking antibiotics. No
Hx of melena .No Hx of jaundice.
• She is also having burning micturition on& off.
which is relived by taking treatment from local
GP. She notice puffiness of face early in morning
which resolves after 2-3 hours. No Hx of
hematuria & passage of sludge of stone.
4. Conti…….
• She is also having SOB when she walked after
taking 10-15 steps. No Hx of orthopnea and PND
and cyanosis.
• She have toothaches on & off ,swelling of gums . No
Hx of tooth extraction and dental caries.
• No Hx of blood transfusion.
• No Hx of fracture, alopecia, any lymphadenopathy
and visceromegaly.
• Hearing and vision normal.
• Menarche not be achieved yet.
5. • In ward child investigated as
• CBC ,urine DR, urea/creatinine
• Skeletal survey, vitamin D level, S/Calcium,
S/Phosphorus
• TSH,T3 , T4
• U/S Abdomen, Echocardiography
• Treatment given as stoss therapy and nutrition
rehabilitation.
6. PAST HISTORY;
• She admitted 6 years back in this ward with the
same complain for up to 1 month .she was
investigated in the form of skeletal survey then
she was diagnosed as a case of MPS.
• Hx of repeated chest infections once in a month
for which oral antibiotics and sometime
injectable were used.
• Hx of measles and chicken pox present.
• BIRTH History;
• Full term SVD with no any significant antenatal ,
natal and post natal Hx.
8. Feeding History
• Breast feed up to 2years . Weaning started at
1year of age in the form of family food. Now her
total calorie intake is 400-500 kcal/day.
• Vaccination ; not done.
• Developmentally ; normal, all milestone
achieved a/c to their ages.
9. Examinations
• A short stature child with coarse facies
• Broad nose, thick lips .
• Frontal and maxillary prominence.
• OFC=54cm
• Height=94cm
• Upper segment(US)=50cm
• Lower segment(LS)=44cm
• US:LS=1.1
• Arm span =94cm
• Arm touches mid of thigh , flat feet
10. A. General Physical Exam….
• Short stubby hand . widening of
metaphysis of long bone , wrist and
ankle joint.
• Knock knee with Waddling gait.
• Pigeon shape chest.
15. C.SYSTEMIC EXAMINATION
Abdomen; normal with no visceromegaly
Chest; Pectus carinatum, kyphosis, NVB
CVS; S1+S2+0
CNS; oriented to time , place and person .
Tone slightly inc.
Power 4/5
Reflexes normal
Babinski down going
17. Skeletal survey
• Narrow pelvis.
• Hand and feet
bone short and
stubby.
• Irregular
metaphysis.
• Flattening and
fragmentation
of radius ,ulna
& head of femur
25. Mucopolysaccharidoses(MPS)
• It is hereditary , progressive disease caused by
mutation of genes, coding for lysosomal enzymes
needed to degrade glycosaminoglycains (GAGs).
Major GAG s are
• Chondroitin sulfate
• Heparan sulfate
• Dermatan sulfate
• Keratan sulfate
37. 2.Ehler- Danlos syndrome
• It is a group of genetical disorders that affect
connective tissues supporting the skin, bones,
blood vessels, and many other organs and
tissues.
• Defects is a quantitative deficiency of fibrillar
collagen in connective tissues .
42. Ehlar – danlose syndrome
• Kyphoscoliosis type
(formerly type VI)
• Fragile globe of the eyes, significant skin and joint
laxity, and severe curvature of the spine (scoliosis)
are typical features. Its inheritance pattern is
autosomal recessive.
• Arthrochalsia (type VII)
• Patients are short in height and severely affected
by joint laxity and dislocations. Skin involvement is
variable. Both autosomal dominant and recessive
inheritance is possible. A skin biopsy can be used
to diagnose this disorder.
43. 3.MUCOLIPIDOSES(ML)
• It is a rare autosomal recessive disorder that
share common clinical feature of Hurler
syndrome.
• There is deficiency of N- acetyleglucosamine-
1-phosphotransferase which involve
phosphorylation of mannose residue in lysosome.
• Deficiency of enzyme lead to accumulation of
substance inside the lysosome.So classified as
lysosomal storage diseases.
44. Clinical features
• Presentation at birth
• Coarse facies,
• Restricted joint movement
• Hypotonia, short stature
• Mental retardation
• Kyphoscoliosis
• Congenital dislocation of hip
• Inguinal hernia
• Gum hypertrophy
• Death early childhood.
