1. Gout and pseudogout are types of crystal arthritis caused by sodium urate crystals or calcium pyrophosphate crystals respectively.
2. Gout prevalence is increasing, especially in developed countries, and affects men more than women. Risk factors include diet, medications, age, gender and medical conditions.
3. Pseudogout usually affects the knees and wrists of elderly women, causing painful flare ups that are treated similarly to gout.
lupus nephritis is a autoimmune disease, commonly seen in adult and child and the medical or nursing care is also very important for this type of disease condition.
lupus nephritis is a autoimmune disease, commonly seen in adult and child and the medical or nursing care is also very important for this type of disease condition.
This is a short presentation on gout and gouty arthritis. This also gives a brief idea about the causes of gout, its clinical features and investigations. This also provides basic information regarding management and prevention of gout and its associated complications
Dr.A.Mohan krishna
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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.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
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!
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.
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Gout
1. CRYSTAL ARTHRITIS
( gout and pseudogout )
Abdul Waris
Dept: internal medicine
2. DEFINITION/EPIDEMIOLOGY
Gout : is a painful and potentially destructive rheumatic disorder arising in the setting of
Hyperuricemia and sodium urate crystals.
3. DEFINITION/EPIDEMIOLOGY
GOUT
The prevalence of gout is increasing mainly in developed Countries
The prevalence is 1.4% in the UK and 2.7% in the USA.
their diet becomes moreWestern.
Gout develops in men more than women (10 : 1)
Some 85–90% of cases are idiopathic.
Asian populations are more at risk as
4. Urate is the end product of purine
metabolism that occurs in liver
5. URAT1 and GLUT9, are members
of the organic acid transporter
family and have predominant
effects on serum urate level.
11. INVESTIGATION
GOUT :
The clinical picture is often diagnostic.
1-
2-
3-
Joint fluid microscopy is the most specific and diagnostic test but is technically
Serum uric acid is usually raised (>600 μmol/L)
difficult.
Serum urea, creatinine and eGFR are monitored for signs of renal impairment.
Needle-shaped urate crystals
12. MANAGEMENT
The use of NSAIDs or coxibs in high doses rapidly reduces the pain and swelling. The first
dose should be taken at the first indication of an attack:
1-
2-
3-
4-
5-
Naproxen-750 mg immediately, then 500 mg every 8–12 hours
Diclofenac-75–100 mg immediately, then 50 mg every 6–8 hours
Indometacin-75 mg immediately, then 50 mg every 6–8 hours
Colchicine- 1000 μg immediately, then 500 μg every 6–12 hours
Corticosteroids- oral prednisolone or intramuscular or intra-articular depot
methylprednisolone.
Treatment with agents that reduce serum uric acid levels:
The aim of treatment is to reduce the uric acid level below the 360 μmol/L level; some
guidelines recommend below 300 μmol/L.
Allopurinol, Febuxostat , Pegloticase, Uricosuric agents, Losartan, Anakinra
13. Allopurinol:-
Should only be used when the attacks are frequent and severe , associated with renal
impairment or tophi, or when the patient finds NSAIDs or colchicine difficult to tolerate.
Allopurinol (300– 600 mg) blocks the enzyme xanthine oxidase, which converts
xanthine into uric acid .
It reduces serum uric acid levels rapidly and is relatively non-toxic but should
be used at low doses (50–100 mg) in renal impairment.
Skin rashes and gastrointestinal intolerance are the most common side-effects. A
hypersensitivity reaction is the most serious adverse event. This is rare, as is bone marrow
suppression.
14. Febuxostat (80–120 mg)
Is a non-purine analogue inhibitor of xanthine oxidase but not other enzymes in
the purine and pyrimidine pathway.
It is well tolerated and as effective as allopurinol in trials and is safer in renal
impairment as it is metabolized in the liver and not renally excreted.
It has been approved by the FDA and is helpful in patients who cannot tolerate
allopurinol but there are anxieties that it may increase cardiovascular risks.
At time of writing, most doctors advise trying allopurinol first unless there are
strong contraindications to its use.
15. Pegloticase
a pegylated recombinant uricase given intravenously, lowers urate levels
dramatically but its place in therapy is unclear.
16. Uricosuric agents
also lower the serum uric acid but their use is restricted throughout
Europe by the very rare occurrence of serious hepatotoxicity.
Benzbromarone acts on the
URAT-1 transporter and is well tolerated.
Sulphinpyrazone and probenecid are best avoided in renal impairment.
17. Losartan
is an angiotensin I-receptor antagonist and is uricosuric
in hypertensive patients with gout. I
t may reduce the risk of gout in patients with the
metabolic syndrome.
18. Anakinra
blocks IL-1β and canakinumab is a human monoclonal antibody with
specific cross-reactivity for IL-1β but not other members of the IL-1
family.
Their role in treatment-resistant gout is still subject to trials to
establish when their use is justified in gout which has not responded
to the more conventional agents.
19. Pseudogout
Precipitation of crystals of calcium pyrophosphate dihydrate (CPPD) in
connective tissues which may be asymptomatic or may be associated
with several clinical syndromes
20. CLINICAL MANIFESTATIONS
Pseudogout (pyrophosphate arthropathy)
Calcium pyrophosphate deposits in hyaline and fibrocartilage produce the radiological appearance of
chondrocalcinosis.
Shedding of crystals into a joint precipitates acute synovitis which resembles gout, except that it is more
common in elderly women and usually affects the knee or wrist.
The attacks are often very painful.
In young people it may be associated with haemochromatosis, hyperparathyroidism, or Wilson's disease.
21.
22.
23. INVESTIGATION
PSEUDOGOUT
Central investigations for diagnosis are
1-
fluid and tissue analysis for
2-
plain radiographs.
the presence of CPP crystals
Rhomboid shaped crystal
24. Treatment
Aspiration of the joint reduces the pain dramatically but it is usually
necessary to use an NSAID or colchicine, as for gout.
If infection can be excluded, an intra-articular injection of a corticosteroid
helps.
25. REFERENCES
Kumar & Clark’s clinical medicine 8th edition
Harrison, Tinsley Randolph, and Anthony S. Fauci. Harrison's principles of internal medicine. 14th ed.
New York: McGraw-Hill, Health Professions Division, 1998. Print.
Hochberg, Marc C.. Rheumatology. 5th ed. Philadelphia: Mosby/Elsevier, 2011. Print.