Gouty Arthritis/Gout is a type of crystal arthropathy characterized by recurrent attacks of acute arthritis.
Pathophysiology, clinical features, investigations, treatments modalities and complications
Module: Pharmacotherapy III
Module Coordinator: Dr. Arwa M. Amin Mostafa
Academic Level: Postgraduate, Master of Pharmacy in Clinical Pharmacy
School: Dubai Pharmacy College
Year of first presented in Class: 2018
This presentation is for Educational purpose. It has no commercial value associated with it.
Gouty Arthritis/Gout is a type of crystal arthropathy characterized by recurrent attacks of acute arthritis.
Pathophysiology, clinical features, investigations, treatments modalities and complications
Module: Pharmacotherapy III
Module Coordinator: Dr. Arwa M. Amin Mostafa
Academic Level: Postgraduate, Master of Pharmacy in Clinical Pharmacy
School: Dubai Pharmacy College
Year of first presented in Class: 2018
This presentation is for Educational purpose. It has no commercial value associated with it.
Gout is a common, painful form of arthritis.
It causes swollen, red, hot and stiff joints. Gout occurs when uric acid builds
up in your blood. This happens if your body produces extra acid or does not
eliminate enough, or if you eat too many foods with purines, such as liver and
dried beans. Pseudogout has similar symptoms and is sometimes confused with
gout. However, it is caused by calcium phosphate, not uric acid.
Often, gout first attacks your big toe. It
can also attack ankles, heels, knees, wrists, fingers and elbows.
You are more likely to get gout if you:
Are a man
Have family
member with gout
Drink
alcohol
At first, gout attacks usually get better in
days. Eventually, attacks last longer and occur more often. Uric acid buildup
can lead to kidney stones.
Untreated gout can cause permanent joint and kidney damage. You can treat gout
with medicines.
I was asked by the organizers to review updates on the management of gout. I compared guideline recommendations from the 2008 Philippine CPG to the 2012 ACR Recommendations and the 2014 3E Initiative.
Crystal arthropathies gout & pseudogoutShinjan Patra
Gout is one of the most dangerous underrated acute emergency in rheumatological diseases. CPPD disease is an another entity which is very much under-diagnosed in respect t OA
Gout is a form of arthritis characterised by severe pain, redness and tenderness in joints.
What drug therapy options are available?
Whats the nursing responsibility?
All this and more are presented herein.
Gout is a common, painful form of arthritis.
It causes swollen, red, hot and stiff joints. Gout occurs when uric acid builds
up in your blood. This happens if your body produces extra acid or does not
eliminate enough, or if you eat too many foods with purines, such as liver and
dried beans. Pseudogout has similar symptoms and is sometimes confused with
gout. However, it is caused by calcium phosphate, not uric acid.
Often, gout first attacks your big toe. It
can also attack ankles, heels, knees, wrists, fingers and elbows.
You are more likely to get gout if you:
Are a man
Have family
member with gout
Drink
alcohol
At first, gout attacks usually get better in
days. Eventually, attacks last longer and occur more often. Uric acid buildup
can lead to kidney stones.
Untreated gout can cause permanent joint and kidney damage. You can treat gout
with medicines.
I was asked by the organizers to review updates on the management of gout. I compared guideline recommendations from the 2008 Philippine CPG to the 2012 ACR Recommendations and the 2014 3E Initiative.
Crystal arthropathies gout & pseudogoutShinjan Patra
Gout is one of the most dangerous underrated acute emergency in rheumatological diseases. CPPD disease is an another entity which is very much under-diagnosed in respect t OA
Gout is a form of arthritis characterised by severe pain, redness and tenderness in joints.
What drug therapy options are available?
Whats the nursing responsibility?
All this and more are presented herein.
Gout is a metabolic disorder manifesting in primary or secondary forms characterized by hyperuricemia & joint lesions .
A metabolic disease characterized by recurrent attack of acute inflammatory arthritis caused by elevated levels of uric acid in the blood (hyperuricemia).
Gout: Very painful form of arthritis characterized by the formation of uric acid crystals and severe inflammation.
Gout is a metabolic disorder of purine metabolism, characterized by intermittent attacks of acute pain, swelling and inflammation. • It always preceded by hyperuricemia
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
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
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
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.
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!
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
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.
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.
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
27. What you have to do for hyperuricemic patients :
Transplanted ?
28.
29. What you have to do for hyperuricemic patients :
Anuria ?
30.
31. What you have to do for hyperuricemic patients :
Lysis Syndrome ?
32. Olecranon bursitis secondary to gout in a 50-year-old man.
(a) Transverse US image shows a complex hypoechoic fluid collection ( * ) with
synovial thickening (arrowheads) and cortical irregularity with hyperechoic
foci (arrows), which are consistent with osseous erosions and crystalline
deposition from gout.
b) Color Doppler image shows hyperemic synovium. * = complex hypoechoic fluid
collection, arrows = osseous erosions and crystalline de position from gout.
33. What you have to do for hyperuricemic patients :
Excess urinary excretion ?
36. Gout in the Wrist
Gout is a type of arthritis that is caused by excess uric acid build-up in the joints. Most gout patients report swelling and discomfort in the foot or big toe. However, gout-
related wrist pain can be a sign of polyarticular gout, or gout that affects multiple joints. Since this is less common, gout in the wrist can be difficult to recognize. If you
have a history of gout and are also suffering from wrist pain, you should ask your physician about it during your next visit.
Gout that is isolated to the wrist is extremely rare, but pseudogout can affect large joints
37. What you have to do for hyperuricemic > 13 mg / dl ?
38.
39. What you have to do for hyperuricemic > 20 mg / dl ?
40. Gouty
Panniculitis
E : Severe ulnar
deformity along with
multiple gouty tophi in
both hands.
A : Presence of 2 tophi in the nose dorsum; aspiration of the
lesion confirmed birefringent crystals.
B : two gouty tophi in the
ear.
C and D :
Gouty Tophi in forearms,
elbows, and feet, some of
them ulcerated. tophi in
legs and pretibial area.
41. What you have to do for hyperuricemic > 80 mg / dl ?
44. A uric acid deposit in the Prepatellar Bursa of the
right knee in a patient with tophaceous gout.
The patient also has a large effusion in the
suprapatellar pouch.
46. A , Dorsal digits of the hand of a patient with tophaceous gout.
The involvement of the third distal interphalangeal joint has an appearance
similar to inflammatory osteoarthritis or psoriatic arthritis in the appropriate clinical setting.
B, Palmar view of the same hand revealing obvious “studding” of uric acid deposits.
54. Fusiform tophus of the Achilles tendon above the insertion on the calcaneus
55. A Tophus in the helix of the ear
in a patient with Chronic
Gout
56.
57. Is it right to give Prophylactic Colchicine without controlling
Hyperuricemia ?
58.
59. Digital images showing complete resolution of tophi in two patients who
received pegloticase biweekly.
A, Baseline tophus on the
medial aspect of the right third distal interphalangeal (DIP) joint in
patient 1.
B, Complete resolution of target tophus at week 13 in patient 1.
Note also the reduction in the area of a large tophus on the 3rd PIP
C, Baseline tophi on the right thumb; on the 2md, 3rd, & 4th DIP
joints with ulcerations; and on the 5th PIT joint of patient 2 after 6
months of treatment with placebo in randomized
controlled trials.
D, Complete resolution of target tophi on four digits in patient 2 after
25 weeks of treatment with twice-monthly pegloticase in an open-label
extension study.
(From Baraf HS, Becker MA, Gutierrez-Urena SR, et al: Tophus burden reduction with
burden reduction with pegloticase: results from phase 3 randomized
randomized
trials and open-label extension in patients with chronic gout refractory to conventional therapy.
refractory to conventional therapy. Arthritis Res Ther 15:R137, 2013.)
60. What are the Diseases should be treated before ULT ?
What are the Medications should be optimized before ULT ?
What are the Foods should be Reduced before ULT ?
What are the Foods should be Restricted OR avoided ?
What are Foods should be Encouraged ?
What is the disease that causing
Overproduction & Underexcretion of urates ?
61. Eltroxin may help ULT ?
Vitamin-D analogue may help
Uricosurics for Sarcoidosis but not Psoriasis ( XOIs )
Hyperuricemia may be Fatal for pregnant with Toxemia
To avoid low dose of aspirin : 350 mg weekly
Dehydration causing Hyperuricemia &
Fasting triggering acute attack of Gout ?
What is wonderful :
62. Is gout still disease of the kings & king of the diseases ?
90. What you have to do for hyperuricemic patients :
Transplanted ?
91.
92. What you have to do for hyperuricemic patients :
Anuria ?
93.
94. What you have to do for hyperuricemic patients :
Lysis Syndrome ?
95. Olecranon bursitis secondary to gout in a 50-year-old man.
(a) Transverse US image shows a complex hypoechoic fluid collection ( * ) with
synovial thickening (arrowheads) and cortical irregularity with hyperechoic
foci (arrows), which are consistent with osseous erosions and crystalline
deposition from gout.
b) Color Doppler image shows hyperemic synovium. * = complex hypoechoic fluid
collection, arrows = osseous erosions and crystalline de position from gout.
96. What you have to do for hyperuricemic patients :
Excess urinary excretion ?
99. Gout in the Wrist
Gout is a type of arthritis that is caused by excess uric acid build-up in the joints. Most gout patients report swelling and discomfort in the foot or big toe. However, gout-
related wrist pain can be a sign of polyarticular gout, or gout that affects multiple joints. Since this is less common, gout in the wrist can be difficult to recognize. If you
have a history of gout and are also suffering from wrist pain, you should ask your physician about it during your next visit.
Gout that is isolated to the wrist is extremely rare, but pseudogout can affect large joints
100. What you have to do for hyperuricemic > 13 mg / dl ?
101.
102. What you have to do for hyperuricemic > 20 mg / dl ?
103. Gouty
Panniculitis
E : Severe ulnar
deformity along with
multiple gouty tophi in
both hands.
A : Presence of 2 tophi in the nose dorsum; aspiration of the
lesion confirmed birefringent crystals.
B : two gouty tophi in the
ear.
C and D :
Gouty Tophi in forearms,
elbows, and feet, some of
them ulcerated. tophi in
legs and pretibial area.
104. What you have to do for hyperuricemic > 80 mg / dl ?
107. A uric acid deposit in the Prepatellar Bursa of the
right knee in a patient with tophaceous gout.
The patient also has a large effusion in the
suprapatellar pouch.
109. A , Dorsal digits of the hand of a patient with tophaceous gout.
The involvement of the third distal interphalangeal joint has an appearance
similar to inflammatory osteoarthritis or psoriatic arthritis in the appropriate clinical setting.
B, Palmar view of the same hand revealing obvious “studding” of uric acid deposits.
117. Fusiform tophus of the Achilles tendon above the insertion on the calcaneus
118. A Tophus in the helix of the ear
in a patient with Chronic
Gout
119.
120. Is it right to give Prophylactic Colchicine without controlling
Hyperuricemia ?
121.
122. Digital images showing complete resolution of tophi in two patients who
received pegloticase biweekly.
A, Baseline tophus on the
medial aspect of the right third distal interphalangeal (DIP) joint in
patient 1.
B, Complete resolution of target tophus at week 13 in patient 1.
Note also the reduction in the area of a large tophus on the 3rd PIP
C, Baseline tophi on the right thumb; on the 2md, 3rd, & 4th DIP
joints with ulcerations; and on the 5th PIT joint of patient 2 after 6
months of treatment with placebo in randomized
controlled trials.
D, Complete resolution of target tophi on four digits in patient 2 after
25 weeks of treatment with twice-monthly pegloticase in an open-label
extension study.
(From Baraf HS, Becker MA, Gutierrez-Urena SR, et al: Tophus burden reduction with
burden reduction with pegloticase: results from phase 3 randomized
randomized
trials and open-label extension in patients with chronic gout refractory to conventional therapy.
refractory to conventional therapy. Arthritis Res Ther 15:R137, 2013.)
123. What are the Diseases should be treated before ULT ?
What are the Medications should be optimized before ULT ?
What are the Foods should be Reduced before ULT ?
What are the Foods should be Restricted OR avoided ?
What are Foods should be Encouraged ?
What is the disease that causing
Overproduction & Underexcretion of urates ?
124. Eltroxin may help ULT ?
Vitamin-D analogue may help
Uricosurics for Sarcoidosis but not Psoriasis ( XOIs )
Hyperuricemia may be Fatal for pregnant with Toxemia
To avoid low dose of aspirin : 350 mg weekly
Dehydration causing Hyperuricemia &
Fasting triggering acute attack of Gout ?
What is wonderful :
125. Is gout still disease of the kings & king of the diseases ?