This document provides information on cystic fibrosis including its clinical presentation, pathophysiology, gross and microscopic findings, and differential diagnosis. Key points:
- Cystic fibrosis is an autosomal recessive disorder caused by mutations in the CFTR gene resulting in defective ion transport in exocrine glands.
- Clinical manifestations include recurrent respiratory infections, pancreatic insufficiency, liver disease, and male infertility. Severity depends on mutation type.
- Pathophysiology involves defective CFTR chloride channel function leading to dehydrated secretions in the lungs, pancreas and other organs.
- Gross findings include bronchiectasis, pancreatic cysts and cirrhosis. Microscopy shows features of infection
An approach to Interstitial Lung Disease / Diffuse Parenchymal Lung DiseaseThomas Kurian
YouTube link: https://youtu.be/gPr31qrivUc
An approach to Diffuse Parenchymal Lung disease / Interstitial Lung disease with emphasis on the idiopathic causes.
An approach to Interstitial Lung Disease / Diffuse Parenchymal Lung DiseaseThomas Kurian
YouTube link: https://youtu.be/gPr31qrivUc
An approach to Diffuse Parenchymal Lung disease / Interstitial Lung disease with emphasis on the idiopathic causes.
Latest GINA guidelines for Asthma & COVIDGaurav Gupta
What are the changes from 2019 onwards till 2022, in the GINA guidelines for developing countries like India.
Includes COVID guidelines and also a FUN QUIZ !
Talk about why these guidelines have changed - use of ICS - formoterol combination for treating even intermittent asthma
THIS PRESENTATION INCLUDES DEFINITION, OVERVIEW, PATHOLOGY, CLINICAL FEATURES, ASSESSMENT AND PT MANAGEMENT OF CYSTIC FIBROSIS. THIS PPT WILL BE VERY USEFUL FOR FINAL YEAR BPT STUDENTS. IT COVERS BASIC KNOWLEDGE REGARDING THE DISEASE AND ALLOWS BETTER UNDERSTANDING. IT IS MADE ONLY FOR LEARNING AND EXAM PURPOSE.
Latest GINA guidelines for Asthma & COVIDGaurav Gupta
What are the changes from 2019 onwards till 2022, in the GINA guidelines for developing countries like India.
Includes COVID guidelines and also a FUN QUIZ !
Talk about why these guidelines have changed - use of ICS - formoterol combination for treating even intermittent asthma
THIS PRESENTATION INCLUDES DEFINITION, OVERVIEW, PATHOLOGY, CLINICAL FEATURES, ASSESSMENT AND PT MANAGEMENT OF CYSTIC FIBROSIS. THIS PPT WILL BE VERY USEFUL FOR FINAL YEAR BPT STUDENTS. IT COVERS BASIC KNOWLEDGE REGARDING THE DISEASE AND ALLOWS BETTER UNDERSTANDING. IT IS MADE ONLY FOR LEARNING AND EXAM PURPOSE.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
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This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
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Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
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.
3. CLINICAL
• Autosomal recessive disorder of ion transport that affects fluid secretion in
exocrine glands and in the epithelial lining of the respiratory, gastrointestinal,
and reproductive tracts.
• Common disease in Caucasian
– 1 in 2500 live births have disease
– 1 in 20 are carriers
• Much lower incidence in other ethnic groups
• Usually manifests in Children and Adolescents
4. CLINICAL
Clinical picture:
• Respiratory:
– Recurrent infections
– COPD “Bronchiectasis”
• GIT, Liver & Pancreas:
– Pancreatic insufficiency “Steatorrhea, malnutrition”
– Hepatobiliary disease and cirrhosis
– Meconium ileus
• Genitourinary:
– Congenital bilateral absence of the vas deferens “Infertility”
Note that the severity of clinical picture “phenotype”
depends on the type of the mutation
(See Later)
5. CLINICAL
Common associated respiratory infections:
• Allergic bronchopulmonary aspergillosis
• Pseudomonas aeruginosa
• Hemophilus influenza
• Mycobacteria (atypical)
• Staphylococcus aureus
Two unique organisms for cystic fibrosis:
• Burkholderia cepacia
• Stenotrophomonus maltophilia
• Both are aggressive
• Both are treated with trimethoprim-sulfamethoxazole
6. CLINICAL
• Treatment:
– Antibiotics for respiratory infections
– Postural drainage and chest physiotherapy for airway clearance
– Lung transplant for end-stage lung disease
– Pancreatic enzyme replacement therapy and supplemental feedings
• Remember “Fibrosing Colonopathy”
– Colonic strictures due to submucosal fibrosis seen in children with CF receiving high-
strength pancreatic supplements
– Oral ursodiol for biliary buildup/obstruction
– Assisted reproductive technologies for infertility
7. PATHOPHYSIOLOGY
CFTR:
• Cystic Fibrosis Transmembrane conductance
Regulator
• Gene location: chromosome 7 (at 7q31)
• Function:
– Regulate epithelial Chloride channel
– Also regulate other ion channels
• E.g., Sodium, Potassium, and Bicarbonate ions
• Components: Five domains
– Two trans-membrane domains
– Two cytoplasmic nucleotide-binding domains (NBDs)
– One regulatory (R) domain
• Activation:
Agonists (e.g., acetylcholine) Increase cAMP Activates protein kinase A
Phosphorylating the CFTR at the R domain (using ATP bound to NBDs) CFTR Activation
8. PATHOPHYSIOLOGY
CFTR function is Tissue-specific (differ from site to another)
• Sweat gland ducts:
– Normal CFTR increases the reabsorption of Chloride ion and augments the reabsorption
of Sodium ions “via regulation of epithelial Na channel = ENaC”
– Mutated CFTR decreases the reabsorption of Sodium chloride
• Hypertonic “Salty” sweat
9. PATHOPHYSIOLOGY
• Lung / GIT / Pancreas:
– Normal CFTR increases the secretion of Chloride ion and reduces the reabsorption of
Sodium ions “via regulation of epithelial Na channel = ENaC”
– Mutated CFTR decreases the secretion of Chloride ion and augments the reabsorption of
Sodium ion (with passive Water reabsorption)
• Hyperconcentrated “dehydrated” viscid secretions
10. PATHOPHYSIOLOGY
• As regards the Bicarbonate ion:
– Normal CFTR increases the concentration of Bicarbonate ion into the lumen “via
regulation of anion exchangers = SLC26”
• Normal Alkaline secretion
– Mutated CFTR decreases the concentration of Bicarbonate ion into the lumen
• Acidic secretion increased mucin precipitation and plugging, increase bacterial
activity
11. GROSS
• Nose:
– Nasal polyps
• Single or Multiple polypoid masses
• Soft and edematous
• Lung:
– Bronchiectasis
• Enlarged, dilated bronchi
– Diameter of the bronchus should exceed the diameter of the accompanying bronchial artery
• Dilated bronchi are extending to pleural surface
• Filled with yellow-green mucopurulent secretions
12. GROSS
• Pancreas:
– Cystic changes “2ry to ductal obstruction”
• Multiple, small cysts (1-3 mm in diameter)
• Filled with thick, tenacious secretions
• Hepatobiliary:
– Bile duct obstruction
• Enlarged, dilated bile ducts
• filled with thick, tenacious secretions
– End-stage: Cirrhosis
14. MICROSCOPY
• Lung:
– Bronchiectasis
• Wall:
– Ectatic, dilated airways
– Chronic inflammatory cells and fibrosis
• Mucosa:
– Ulceration
– Squamous metaplasia
– Follicular bronchiolitis
• Lymphoid hyperplasia with germinal centers
– Pneumonia
• Acute or Organizing
• Features of causative organisms (if any)
15. MICROSCOPY
• Pancreas:
– Cystic changes
• Ectatic, dilated ducts filled with eosinophilic material
• Obstruction-related changes:
– Exocrine acinar atrophy
– Replacement of atrophic lobules by interstitial fibrosis
– Scattered islets of Langerhans could be seen
– Grading:
• Grade I: accumulation of secretion
• Grade II: exocrine atrophy
• Grade III: atrophy with lipomatosis
• Grade IV: fibrosis with total obliteration of the
exocrine glands and ducts with scattered islets
16. MICROSCOPY
• Hepatobiliary:
– Ductular reaction “2ry to Bile duct obstruction”
• Portal tracts expansion by inflammation and increased numbers of bile ductules
• Bile ductules are dilated and contain plugs of a light eosinophilic material
– Portal fibrosis, bridging fibrosis and cirrhosis
17. SPECIAL STUDIES
Laboratory tests:
• Elevated sweat chloride (>60 mEql/L)
– Remember that sweat glands are morphologically unaffected.
• Abnormal nasal trans-epithelial potential difference
– Useful in cases with low sweat chloride
“Milder CFTR mutations“
• Azoospermia on semen analysis
– Obstructive type (due to structural abnormalities of the vas deferens)
18. SPECIAL STUDIES
Molecular studies: CFTR gene mutation
More than 1800 mutations, classified into Six groups:
Class Defect Result
I Defective protein synthesis No CFTR protein synthesis from the start
II
Defective protein folding and glycosylation
(in Golgi/endoplasmic reticulum)
CFTR protein is synthesized, but it is
degraded before reached the cell surface
III
Defective ATP binding
(to NBDs)
CFTR protein reaches the cell surface in
normal amount, but it is Nonfunctioning
IV
Defective chloride ion transport/conductance
(through transmembrane domains)
CFTR protein reaches the cell surface in
normal amount, but with reduced
function
V
Defective introns’ splicing
(within the gene)
CFTR protein reaches the cell surface in
reduced amount
VI
Defective regulatory role on other ion
channels
(e.g., Na, K, HCO3)
CFTR protein reaches the cell surface in
normal amount, but with altered function
19. SPECIAL STUDIES
Class I, II, and III Total loss of function (Severe clinical picture “phenotype”)
– I.e., Bronchiectasis, pancreatic insufficiency, male infertility, hepatic cirrhosis
Examples
• ΔF508 deletion
– Class II “Defective protein folding”
– The most common mutation in Caucasian
• W1282X nonsense mutation
– Class I “Defective protein synthesis”
– The most common mutation in Ashkenazi Jews
Class IV, V, and VI Reduced function (Milder clinical picture “phenotype”)
– I.e., Congenital bilateral absence of vas deference and infertility
Example R117H missense mutation (in trans with 5T allele)
– Class V “Defective chloride ion transport/conductance”
• 5T allele modifies Poly-T tract in intron 8 and reduces its splicing efficacy
20. SPECIAL STUDIES
• Remember that cystic fibrosis is an autosomal recessive disease
– Mutation of one allele carrier
– Mutation of both alleles disease
• Also the type of mutation plays a role in the overall phenotype
– If two “severe” mutations (e.g. class I, II, III) severe clinical picture
– If one “severe” + one “mild” mutation (e.g. class IV, V, VI) less severe
– If two “mild” mutations very mild
21. DIFFERENTIAL DIAGNOSIS
L u n g :
“ O t h e r c o n g e n i t a l / c y s t i c l u n g d i s e a s e s ”
• Congenital:
– Bronchogenic cysts
– Congenital pulmonary cysts
– Congenital pulmonary airway malformation
– Congenital lobar emphysema
– Pulmonary sequestration
• Acquired:
– Emphysema
– Healed abscess
– Honeycombing
22. DIFFERENTIAL DIAGNOSIS
Also:
“ O t h er c a u ses of p a n creat ic i n s u ffi cien cy, c h ron i c p a n creat itis “
“ O t h er c a u ses of b i l e d u c t u lar re acti on , c i r r h osi s “
“ O t h er c a u ses of n a sal p o l yps ”
23. DIFFERENTIAL DIAGNOSIS
Primary cilia dyskinesis:
• Immotile cilia, Kartagener syndrome, Young syndrome, secondary cilia
dyskinesis
• Ultrastructural abnormalities affect virtually all cilia and are
characterized by:
– Loss of dynein arms
– Absence of radial spokes
– Transposition or absence of microtubules
– Compound or disorientated cilia