This document discusses gout, a disorder caused by high uric acid levels in the blood. It describes gout's causes such as diet, kidney disease, and certain drugs. The main symptoms are painful swelling in joints, especially the big toe joint. It explains the differences between primary gout caused by uric acid overproduction/under excretion and secondary gout caused by other conditions. Treatment involves lifestyle changes like diet, exercise and weight control. Medications are used to treat acute attacks with NSAIDs or colchicine and prevent chronic gout with uricosuric drugs like probenecid or allopurinol which inhibit uric acid synthesis.
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Gout is a type of inflammatory arthritis that causes permanent disability if left untreated. This presentation focuses on the important salient points we need to remember in Gout in all aspects - diagnosis, managment (both non-pharmacological and pharmacological approaches).
This presentation is useful to both MBBS and Postgraduate students of Pharmacology.
Pharmacotherapeutics of Gout
Definition of gout
Epidemiology in India
Etiology
Clinical Manifestations or signs and symptoms
Pathophysiology: normal physiology, overproduction of uric acids, under-secretion of uric acid
Diagnosis
Therapy of acute gouty arthritis and chronic gouty arthritis
Gout is a type of inflammatory arthritis that causes permanent disability if left untreated. This presentation focuses on the important salient points we need to remember in Gout in all aspects - diagnosis, managment (both non-pharmacological and pharmacological approaches).
This presentation is useful to both MBBS and Postgraduate students of Pharmacology.
Pharmacotherapeutics of Gout
Definition of gout
Epidemiology in India
Etiology
Clinical Manifestations or signs and symptoms
Pathophysiology: normal physiology, overproduction of uric acids, under-secretion of uric acid
Diagnosis
Therapy of acute gouty arthritis and chronic gouty arthritis
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
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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
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
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.
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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
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
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Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
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2. Introduction
• Gout is disorder of purine metabolism in which the blood
uric acid level is raised either due to over production or
impaired excretion.
• Normal plasma uric acid 3.4–7.2 mg/dl for men and for
female 2.4–6.1 mg/ dl).
• Uric acid, a product of purine metabolism, has low water
solubility, especially at low pH.
• When blood uric acid levels are high, it precipitates and
deposits in joints, kidney and subcutaneous tissue as
sodium urate, which causes pain and inflammation of such
parts.
• If not treated, it might cause permanent deformities of
joint aswell.
3. Etiology
• Hyperuricaemia
• Reason for hyperuricemia
– Consumption of high purine diet
– Impaired in excretion due to kidney disease
– Degradation of muscle
– Drug induced: Frusemide, levodopa, thiazide
– Obesity
4. TYPES OF GOUT
• Primary gout: It is usually due overproduction or under
excretion without any other secondary cause or disease
condition.
• Secondary gout: It occur due secondary disease or due to
use of medicines
a) Leukaemias, lymphomas, polycythaemia especially
when treated with chemotherapy or radiation: due to
enhanced nucleic acid metabolism and uric acid
production.
(b) Drug induced-thiazides, furosemide, pyrazinamide,
ethambutol, levodopa, reduce uric acid excretion by kidney
5. Types of gout according to onset
Acute Gout: Chronic Gout
6. Chronic gout
In chronic case tophi
(chalk-like Stones under
the skin in pinna, eyelids,
nose, joints and other
places) and urate stone in
kidney.
Chronic gouty arthritis
may cause progressive
disability and permanent
deformities.
9. Clinical features
Swollen and Inflammation of joint,
mainly monoarticular.
Intense pain and tender in joint
• Primarily affect metatarso
phalangeal joint of big toe
• Limited range of movement
• Crystal deposit on pinna, elbow,
knees
• Formation of Tophy
• Gouty nephrolithiasis/nephropathy
11. Pharmacological managment
Classification of medicines
1) Acute attack of gout:
– NSAIDs
– Colchicine
– Corticosteroids
2) For chronic gout and long term control.
– Uricosurics: Probenecid, Sulfinpyrazone
– Synthesis inhibitor: Allopurinol, Febuxostat
12. Medicine for acute attack
NSAID: Indomethacin, Diclofenac, naproxen, aceclofenac etc.
• But Aspirin is not used as it might decrease excretion of uric acid
Corticosteroid: Prednisolone, methylprednisolone,
• They are used due to strong anti-inflammatory and analgesic property.
• They are not recommended for long term use due to toxicity
Colchine: Dose: 0.25-1 mg
• It is an alkaloid derived from Colchicum autumnale.
• Colchicine does not have analgesic nor anti inflammatory as NSAID but
it specifically suppresses gouty inflammation.
• Chronic therapy might cause: aplastic anemia, agranulocytosis, hair
loss , myopathy, oligospermia, Azospermia
• Other: G.I irritation
•
13. Medicine for chronic use
Uricosuric agent:
• Probencid, Sulfinpyrazone
• These are the medicine which decrease the
uric acid by increasing its excretion.
• Dose of probencid: Dose: 0.25 gm- 0.5 gm
twice daily.
14. Uricosuric agent
• Adverse effects of probencid :
• Probenecid is generally well tolerated.
• Dyspepsia/indigestion t (up to 25% incidence with high
doses).
• It should be used cautiously in peptic ulcer patients.
• Rashes and other hypersensitivity phenomena are rare.
• Toxic doses cause convulsions and respiratory failure
15. Uricosuric agent
• Sulfinpyrazone.
• Pharmacological action is similar to probencid
• Pharmacokinetics:
• It is well absorbed orally and 98% plasma protein
bound.
• Excretion is fairly rapid, mainly by active secretion in
proximal tubule
• Dose: 100-200mg od/bd
• Adverse effects : Gastric irritation is most common so
contraindicated in peptic ulcer.
• Rarely: hypersensitivity reaction.
16. Uric acid synthesis inhibitors; Allopurinol
and febuxostat
These drug inhibit synthesis of uric acid.
Allopurinol:
Dose: Start with 100 mg OD,
gradually increase to maintenance
dose of 300 mg/day; maximum 600
mg/day
Adr: N/V, skin rashes
Febuxostat:
Dose: 40 mg/d - 80 mg/d; maximum
120 mg/d
Adverse effect:
Liver damage
Hypersensitivity reaction
Diarrhoea, nausea, headache
,Diet