Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome, is a rare systemic vasculitis characterized by eosinophilia, asthma, and small vessel vasculitis. It can affect multiple organ systems including the lungs, heart, skin, gastrointestinal tract, and nerves. Diagnosis is based on clinical criteria of asthma, eosinophilia, vasculitic manifestations, and tissue biopsy showing eosinophilic inflammation. Treatment involves glucocorticoids and immunosuppressants. Prognosis is generally good but relapses are common if treatment is stopped early.
Churg-Strauss syndrome is a disorder marked by blood vessel inflammation. This condition is also known as eosinophilic granulomatosis with polyangiitis (EGPA).
Austin Arthritis is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Arthritis.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances & happenings in all areas of Arthritis. Austin Arthritis accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Arthritis.
Austin Arthritis strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
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
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.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
- 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
2. Eosinophilic granulomatosis with polyangiitis
(EGPA)
• 1951,scientists Jacob Churg and Lotte Strauss, a syndrome characterized by
asthma, fever, eosinophilia, as well as symptoms of heart failure, kidney
damage, and peripheral neuropathy resulting from a vascular compromise in
different organs and systems.
• The histology, tissue eosinophilia, granulomatous, and necrotizing vascular
lesions and extravascular granulomas in most organs.
• 2012, Eosinophilic granulomatosis with polyangiitis (EGPA).
3. Epidemiology
• EGPA is a rare disease.
• annual incidence of 0.5–4.2 cases/1,000,000 inhabitants,
increase to 11–14 cases/1,000,000 inhabitants.
• 40 and 60 years of age, with a mean age onset of 49 years.
• Male= female.
• Familial clustering.
4. Pathogenesis:
• Immunogenetic factors:
The HLA-DRB1 *04 and *07 alleles and the HLADRB4 gene.
ANCA-negative EGPA, IL10.2 of the IL-10 promoter polymorphism.
• Environmental factor:
Silica exposure, infections, vaccines, and medications ( macrolide,
leukotriene receptor antagonists (LRAs)).
Vaglio et al 2013
5.
6. Clinical picture:
• A systemic disease and typically evolves in prodromal phases, the allergic
phase, the eosinophilic phase , and the vasculitis phase.
• These phases partially overlap and do not appear in a defined order.
Sinusitis 2016, 1, 24-43;doi:10.3390/sinusitis1010024
7. Specific organs:
• “limited” forms of EGPA; individual organ, diagnosis by histology.
• Allergic phase:
Upper Airways
• (Allergic rhinitis, chronic rhinosinusitis, and nasal polyps).
• Nasal polyps affect about 50%, recur after surgery if not received
medical treatment.
• Chronic rhinosinusitis 75% , as allergic manifestation or
granulomatous inflammation.
• Advanced stages of the disease; chronic ear drainage, serous otitis
media, sensorineural hearing loss, and facial nerve palsy.
8. Lower airways
• Asthma ;
95%–100%, precede the systemic manifestation.
Arises in adulthood with different levels of severity.
Unlike extrinsic asthma, seasonal exacerbations are not observed.
• The eosinophilic phase: lung, cardiac and GIT.
• Lung affection:
The pulmonary parenchyma, 2/3 patients.
chest X-ray, Migratory peripheral infiltrates.
High-resolution CT, ground-glass opacities, consolidation areas, thickening
of the bronchial wall and small centrilobular nodules.
Alveolar haemorrhage 3%–8% of patients.
Pleuritis and Pleural effusion secondary to eosinophilic.
9. • Cardiac involvement:
Symptomatic cardiac involvement (MRI and histological finding) has poor
prognostic factor.
Peripheral eosinophilia is higher in patient with cardiac involvement who have
initial lesions with eosinophilic infiltration
Complicated by restrictive cardiomyopathy secondary to fibrotic changes.
Endomyocardial infiltration (dominant) > pericarditis, vasculitis, valvular heart
disease.
Increased risk of venous thromboembolic events, DVT and pulmonary embolism.
• Gastrointestinal involvement;
Eosinophilic infiltration of GIT mucosa, the small bowel.
Presented with abdominal pain,GIT bleeding, cholecystitis (rare).
10. The vasculitic phase;
• General symptoms (fever, fatigue, weight loss).
• Paradoxical improvement of asthma.
• Peripheral neuropathy is a cardinal feature
70% of patients.
Affecting the peroneal, tibial, ulnar, and median nerves.
Typical multiplex mononeuritis with asymmetric drop of wrist or foot, but can be symmetric or asymmetric
polyneuropathy.
NCS; axonal damage.
• Skin lesion;
Purpura 25% patients, involve lower limbs.
Nodules, urticaria, livedo and skin ulcer.
• Renal manifestation;
25% of patients.
isolated urinary abnormalities (microscopic hematuria, proteinuria) to rapidly progressive glomerulonephritis.
Histology; pauci-immune focal and segmental necrotizing glomerulonephritis, with or without crescents..
11. Sinusitis 2016, 1, 24-43;doi:10.3390/sinusitis1010024
At least 4 of 6 criteria.
Sensitivity 85%, Specificity 99.7%
12. Diagnosis
I-Blood Cells and Biomarkers:
• CBC; eosinophilia (>1500 cells/μL or > 10%).
Eosinophilia correlates with disease activity and relapses.
• Acute phase reactant; C-reactive protein (CRP, ESR); higher in the active phase.
• Serum total IgE level; elevated in most patient, non specific.
• Serum IgG4 levels; high in 75% of patients, active EGPA.
• ANCA appear several years before the onset of vasculitis , (p-ANCA) in 74%–90%.
• New biomarker; eotaxin-3, a chemokine, induces eosinophil chemo-attraction.
Serum levels were significantly higher in active EGPA than other DD.
Sensitivity and specificity; 87.5% and 98.6%.
13. ? ANCA has role in development of vasculitis in EGPA.
? prognostic role of ANCA
? whether ANCA has role in follow up
14. Diagnosis
II-Histopathology;
• More accessible affected tissue; nasal polyps, skin, lung, kidney, or nerves.
• Eosinophilic tissue infiltration and/or necrotizing vasculitis and/or extravascular eosinophilic
granulomas.
III-Imaging;
• Chest Radiography and CT Scan;
Lobar or segmental opacity, diffuse interstitial or mi liar patterns, migratory infiltrates
of the lower lobe or subpleural.
Hilar, or mediastinal lymphadenopathy.
Pleural effusion, and pulmonary haemorrhage, ground glass opacity and hyperinflation
• Sino nasal CT Scan; imaging of choice, pneumatic bone, solid bone, and soft
tissue.
• Sin nasal Plain X-rays; non specific but low cost.
15.
16. Diagnosis:
IV-Lung Function;
• An obstructive or restrictive pattern according to airway or parenchyma
involvement.
V-Bronchoscopy;
• Eosinophilic infiltration.
17. Differential Diagnosis:
• Eosinophilic Lung Diseases
Acute and chronic eosinophilic pneumonia
Allergic bronchopulmonary aspergillosis
Broncho centric granulomatosis
Loffler’s syndrome
Idiopathic hyper eosinophilic syndrome
• Small and MediumVesselVasculitis
Granulomatosis with polyangiitis
Polyarteritis nodosa
Microscopic polyangiitis
18. Therapeutic Options:
• “Five Factors Score” (FFS) as prognostic index for EGPA;
1. Cardiomyopathy
2. Gastrointestinal involvement
3. Central nervous system involvement
4. Proteinuria (>1 g/24 h)
5. Serum creatinine (>150 mmol/L)
• (FFS = 0) = Glucocorticoids alone, relapse high, azathioprine or cyclophosphamide as
adjuvant therapy.
• One or more risk factors (FFS ≥ 1) , a worse prognosis = glucocorticoids and
immunosuppressants.
• Moosig et al 2013. chose the medication according to the activity and extent of the
disease.
Guillevin, L etal2011
19. • Corticosteroids reduce eosinophil burden in blood and tissues and inhibit the
prolongation of eosinophil survival in extravascular tissues, 93% remission.
• Cyclophosphamide used for induction of remission, based on the FFS.
six or 12 pulses of cyclophosphamide were equally effective for inducing remission, but
relapse high in the six-pulse group.
• Methotrexate used for induction, 73% remission.
• High doses of intravenous immunoglobulin is effective in in neuropathy or
cardiomyopathy refractory to conventional therapy.
• Plasma exchange is effective rapidly progressive glomerulonephritis or alveolar
haemorrhage.
• Interferon-alpha, failed to achieve remission with high adverse effect.
Therapeutic Options:
20. BiologicalTherapies
(Monoclonal Antibodies)
Mepolizumab
• Anti-IL-5 antibodies.
• >50% complete remission, > 75% reduction of glucocorticoids (<7.5mg/day).
• Safety and tolerance good but relapse is high after stoppage.
Rituximab
• B-cell depletion, a chimeric anti-CD20 monoclonal antibody.
• Effectively induces remission in AAV.
• Induce clinical remission and eosinophil count normalization and IL-5 reduction.
Omalizumab
• Recombinant humanized monoclonal anti-IV Ig E antibody, in refractory EGPA.
21. Chronic Rhinosinusitis with Nasal Polyps
• Aim;
Eradicate polyps.
Reduce sino nasal inflammation.
Eliminate symptoms.
Prevent recurrences.
• Treatment:
Corticosteroids is the first line, most effective.
Saline nasal irrigation and antihistamines.
Anti-leukotrienes, aspirin desensitization.
Biological products such as anti-ige and anti-il-5,
immunosuppressants.
Endoscopic surgery after with nasal and oral corticosteroid
22.
23. Pearls :
• Churg-Strauss syndrome or eosinophilic granulomatosis with polyangiitis is
thus a pleiotropic systemic vasculitis with a dual face of manifestations- based
on eosinophilic damage orANCA associated small and medium vessel injury.
• The dichotomy has made it challenging to identify a gold standard for
diagnosis and has also made prognosis somewhat variable.
• Treatment with immunomodulators with the use of plasma exchange or
IVIG is reserved for more refractory cases.
• It responds well to treatment and characterized by a high remission rate.
• Characterized by a lingering persistence of difficult to control asthma and
systemic manifestations affecting the quality of life
24. Prognosis:
• EGPA has a favourable prognosis with a 5-year survival of 90%.
• Risk factors for relapse :
The sudden rise in eosinophil count
Persistent ANCA positivity
Gastrointestinal tract (GI) involvement
The rise in ANCA titres.
• (Guillevin et al.2007): 5 factor associated with high mortality;
1. Proteinuria (greater than 1 gm per day)
2. Renal insufficiency (Cr greater than 1.58 mg/dl)
3. Cardiomyopathy
4. GI tract involvement
5. CNS involvement
25. Reference:
• Guillevin, L.; Pagnoux, C.; Seror, R.; Mahr, A.; Mouthon, L.; leToumelin, P.The five-factor score revisited: Assessment of prognoses
of systemic necrotizing vasculitides based on the FrenchVasculitis Study Group (FVSG) cohort. Medicine 2011, 90, 19–27.
• Moosig, F.; Bremer, J.P.; Hellmich, B.; Holle, J.U.; Holl-Ulrich, K.; Laudien, M.; Matthis, C.; Metzler, C.; Nölle, B.; Richardt, G.; et al. A
vasculitis centre based management strategy leads to improved outcome in eosinophilic granulomatosis and polyangiitis (Churg-
Strauss, EGPA): Monocentric experiences in 150 patients. Ann. Rheum. Dis. 2013, 72, 1011–1017.
• Ribi C, Cohen P, Pagnoux C, Mahr A, Arène JP, Lauque D, Puéchal X, Letellier P, Delaval P, Cordier JF, Guillevin L., FrenchVasculitis
Study Group.Treatment of Churg-Strauss syndrome without poor-prognosis factors: a multicenter, prospective, randomized,
open-label study of seventy-two patients. Arthritis Rheum. 2008 Feb;58(2):586-94
• Cohen P, Pagnoux C, Mahr A, Arène JP, Mouthon L, Le GuernV, André MH, Gayraud M, Jayne D, Blöckmans D, Cordier JF, Guillevin
L., FrenchVasculitis Study Group. Churg-Strauss syndrome with poor-prognosis factors: A prospective multicenter trial comparing
glucocorticoids and six or twelve cyclophosphamide pulses in forty-eight patients. Arthritis Rheum. 2007 May 15;57(4):686-93.
• Ruppert AM, Averous G, Stanciu D, Deroide N, Riehm S, PoindronV, Pauli G, Debry C, de Blay F. Development of Churg-Strauss
syndrome with controlled asthma during omalizumab treatment. J Allergy Clin Immunol. 2008 Jan;121(1):253-4.
• Mahr A, Moosig F, NeumannT, SzczeklikW,Taillé C,Vaglio A, Zwerina J. Eosinophilic granulomatosis with polyangiitis (Churg-
Strauss): evolutions in classification, etiopathogenesis, assessment and management. Curr Opin Rheumatol. 2014 Jan;26(1):16-23