The document summarizes Wegener's granulomatosis (WG), a rare necrotizing vasculitis that commonly involves the respiratory tract and kidneys. It describes the pathogenesis as a type III hypersensitivity reaction mediated by immune complexes. Treatment typically involves cyclophosphamide and glucocorticoids to induce remission, followed by azathioprine or methotrexate as maintenance therapy to sustain remission for 12-18 months. Complications can include rapidly progressive glomerulonephritis, renal failure, and other organ involvement.
Al finalizar este 2014, hemos atendido en nuestro Servicio de Endocrinología Clínica San Felipe de Lima 6 pacientes con Osteogénesis Imperfecta , en el Perú no tenemos la data exacta de esta patología pero en nuestra caminar haciendo medicina siempre la encontramos ,por eso el afán de renovar y estar atentos en los últimos adelantos de esta enfermedad
Al finalizar este 2014, hemos atendido en nuestro Servicio de Endocrinología Clínica San Felipe de Lima 6 pacientes con Osteogénesis Imperfecta , en el Perú no tenemos la data exacta de esta patología pero en nuestra caminar haciendo medicina siempre la encontramos ,por eso el afán de renovar y estar atentos en los últimos adelantos de esta enfermedad
Acometimentos Pulpares - Diferenças Entre Pulpite Aguda e Crônica - Arriba De...André Milioli Martins
Slides da minha aula postada no Youtube sobre acometimentos pulpares.
Nesta vídeo aula de endodontia, explico tudo sobre os principais tipos de pulpite, que são cobrados frequentemente em provas de concurso público para dentistas.
Por isso, nessa aula falo sobre Pulpite Aguda Reversível, Pulpite Aguda Irreversível, Pulpite Crônica Ulcerativa e Pulpite Crônica Hiperplásica.
Para assistir a vídeo aula completa acesse: https://youtu.be/TQnsEFJF0zM
Cistos e tumores odontológicos. Principais cistos e tumores apresentados na disciplina de Patologia bucal. Imagens, conceitos, etiopatogenia, principais tratamentos.
Tem como objetivo o conhecimento do periodonto de proteção e sustentação dos dentes, mostrando suas peculiaridades e componentes, bem como suas funções e sua importância para a saúde periodontal.
LESÕES FUNDAMENTAIS- SEMIOLOGIA E PROCESSOS PATOLÓGICOS
-Classificação das Lesões Fundamentais
-Mácula e Mancha
-Pápula e Nódulo
-Vesícula e Bolha
-Pústula e Abcesso
-Fístula
-Fissura
-Placa e Pseudoplaca
-Ulcera e Ulceração
-Crosta
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Acometimentos Pulpares - Diferenças Entre Pulpite Aguda e Crônica - Arriba De...André Milioli Martins
Slides da minha aula postada no Youtube sobre acometimentos pulpares.
Nesta vídeo aula de endodontia, explico tudo sobre os principais tipos de pulpite, que são cobrados frequentemente em provas de concurso público para dentistas.
Por isso, nessa aula falo sobre Pulpite Aguda Reversível, Pulpite Aguda Irreversível, Pulpite Crônica Ulcerativa e Pulpite Crônica Hiperplásica.
Para assistir a vídeo aula completa acesse: https://youtu.be/TQnsEFJF0zM
Cistos e tumores odontológicos. Principais cistos e tumores apresentados na disciplina de Patologia bucal. Imagens, conceitos, etiopatogenia, principais tratamentos.
Tem como objetivo o conhecimento do periodonto de proteção e sustentação dos dentes, mostrando suas peculiaridades e componentes, bem como suas funções e sua importância para a saúde periodontal.
LESÕES FUNDAMENTAIS- SEMIOLOGIA E PROCESSOS PATOLÓGICOS
-Classificação das Lesões Fundamentais
-Mácula e Mancha
-Pápula e Nódulo
-Vesícula e Bolha
-Pústula e Abcesso
-Fístula
-Fissura
-Placa e Pseudoplaca
-Ulcera e Ulceração
-Crosta
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
VASCULITIS INTRODUCTION.
TYPES OF VASCULITIS
DIAGNOSING CRIERIA
TREATMENT AND GUIDELINES
DRUGS USED IN BURGER'S DISEASE
A CASE ON VASCULITIS
APPROACH OF TREATMENT
PATIENT COUNSELLING FOR THE PARTICULAR PATIENT
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!
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.
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
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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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.
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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
2. 1.- Inflamacion granulomatosa de tracto
respiratorio
2.- glomerulonefritis progresiva
3.- vasculitis necrotizante de arterias y venas de
mediano y pequeño calibre
6. PATOGENESIS
Inmunidad tipo III hipersensibilidad
mediada por inmunmocomplejos
Vasculitis necrotizante de arterias y venas de
mediano y pequeño calibre
Matriz de metaloproteinasas (MMPs) y sus
inhibidores endogenos han sido sugeridos en
rol patologico
Infeccion con Staphylococcus pueden
provocar recaidas
10. DIAGNOSTICO
1.-Nasal or oral inflammation (painful or
painless oral ulcers or purulent or bloody
nasal discharge)
2.-Abnormal chest radiograph showing
nodules, fixed infiltrates, or cavities
3.-Abnormal urinary sediment (microscopic
hematuria with or without red cell casts)
4.- Granulomatous inflammation on biopsy of
an artery or perivascular area
American College of Rheumatology
Arthritis Rheum 2009 Aug;33(8):1101
11. PRUEBAS A CONSIDERAR
Hematometría ,creatinina sérica
Examen completo de orina
Factor reumatoideo
ANA
hepatitis serología
(ANCA) anti-neutrophil cytoplasmic antibody
biopsia
Piel (> rendim), anormalidades en uro análisis
Biopsia de nervio sural
Biopsia nasal (vasculitis and inflamación granulomatosa)
Radiografía de tórax
Angiografía
Ecocardiografía
Mayo Clin Proc 2005 Nov;80(11):1435
12.
13. PRUEBAS SEROLOGICAS
ANCA – C 90 % G W alta
sensibilidad y especificidad (1,3)
ANCA – p negativo (1, 5)
ANCA –c
81% sensitivity, 98%
specificity, 54% VPP and 99% VPN ;
(2,3,4)
ELISA para ANCA –PR3 (5)
Ann Intern Med 1997 Jun 1;126(11):866
Journal Club on the Web 1997 Jun 10)
Arthritis Rheum 1998 Sep;41(9):1521
Arch Intern Med 2002 Jul 8;162(13):1509
(Ann Rheum Dis 2009 Feb;68(2):228 (5)
14.
15. ANATOMIA PATOLOGICA
PULMON : vasculitis granulomatosa
, necrotizante (fibrinoide) , granulomas no
caseificantes
RIÑÓN : GMN focal y segmentaria con
progresión a medias lunas GMN necrotizante
VASOS : infiltrado inflamatorio y fibrosis
ARTERITIS GRANULOMATOSA :
predominantemente infiltrado monocítico
con cell gigantes y formación de granuloma
Koderisch, J, et al. Wegener's granulomatosis with renal involvement: Patient
survival and correlations between initial renal function, renal histology, therapy
and renal outcome. Clin Nephrol 2007; 35:139.
16. EULAR CLASSIFICATION
classification of ANCA-associated vasculitis
1.-Localized — Upper and/or lower respiratory tract
disease without any other systemic involvement or
constitutional symptoms.
2.-Early systemic — Any, without organ-threatening or
life-threatening disease.
3.-Generalized — Renal or other organ-threatening
disease, serum creatinine ≤ 5.6 mg/dL (500
micromol/L).
4.-Severe — Renal or other vital organ failure, serum
creatinine ≥ 5.7 mg/dL (500 micromol/L)
5.-Refractory — Progressive disease unresponsive to
glucocorticoids and cyclophosphamide.
European League Against Rheumatism (EULAR) 2008
EULAR recommendation for the management of
primary small vessel vasculitis. Ann Rheum Dis 2008
17.
18. TRATAMIENTO
INDUCCION - REMISION
Típicamente altas dosis de esteroides y ciclophosphamide (
oral pulsos IV )
methotrexate (o azatioprina si cr > 2 mg/dL ciclofosfamida i
IV IG 2 g/kg
Mantenimiento de remisión
methotrexate 20-25 mg/sem o azathioprine 2 mg/kg/d x 12-
18 m (menos toxica q ciclofl )
trimethoprim-sulfamethoxazole 160/800 mg 2v/d x 24 m
reduce el promedio de recaída
19. SUMMARY AND RECOMMENDATIONS
— The treatment of Wegener's granulomatosis
usually begins with cyclophosphamide and
glucocorticoid therapy to induce remission.
Cyclophosphamide is discontinued one to
two months after complete remission is
achieved, which usually occurs 3 a 6 m.
After cyclophosphamide has been
discontinued: Maintenance therapy should
not be started until the white BCC is >4000 c
and the absolute neutrophil count is >1500 c .
Tatsis, E, et al. Therapy for the maintenance of remission in sixty-five patients
with generalized Wegener's granulomatosis. Arthritis Rheum 2003 ; 39:2052.
20. If these criteria are met, maintenance can be
begun within days after cessation of oral
cyclophosphamide and within two to four
weeks after the last monthly dose of
intravenous cyclophosphamide
Initiation of maintenance therapy with
methotrexate or azathioprine to sustain the
remission (Grade 1A)
Bacon, P. A randomized trial of maintenance therapy for vasculitis associated
with antineutrophil cytoplasmic autoantibodies. N Engl J Med 2003; 349:36.
21. azathioprine rather than methotrexate for initial
maintenance therapy GFR < 50 mL/´ (Grade 2B).
- Azathioprine : initial dose of 2 mg/kg x d The dose
can be lowered to 1.5 mg/kg x d at one year from the time
of initiation of induction therapy
- methotrexate : initial dose 0.3 mg/kg 1 v/sem (max 15
mg) increased by 2.5 mg x sem - max dose of 25 mg 1 v
/sem + folic acid (1 to 2 mg/day) or folinic acid (2.5 to 5
mg/week, 24 hours after methotrexate)
Maintenance immunosuppressive therapy should be
continued for 12 to 18 ms.
Longer term or indefinite maintenance therapy may be
warranted in patients with multiple relapses.
glucocorticoid therapy (prednisone or equivalent), using
the lowest dose required for control of extrarenal
symptoms (Grade 1C).
Bacon, P. A randomized trial of maintenance therapy for vasculitis associated
with antineutrophil cytoplasmic autoantibodies. N Engl J Med 2008; 349:36.
22. DIAGNOSTICO DIFERENCIAL
hypersensitivity vasculitis, septic arthritis
(fungal, tuberculosis), lymphomatoid granulomatosis
other causes of granulomatous arteritis - Churg-Strauss
vasculitis, temporal arteritis, Takayasu's arteritis, seronegative
spondylarthropathy (aortitis)
other vasculitis of small-to-medium arteries - polyarteritis
nodosa, inflammatory rheumatic diseases, HBV, HCV, HIV infection
embolic disease - endocarditis (septic, marantic), atrial
myxoma, cholesterol embolization
vessel stenosis or spasm - atherosclerosis, fibromuscular dysplasia, drug-
induced vasospasm
(ergotamines, cocaine, phenylpropanolamine), intravascular lymphoma
vessel thrombosis - disseminated intravascular coagulation
(DIC), thrombotic thrombocytopenic purpura (TTP), coumadin-associated
necrosis, antiphospholipid antibody syndrome
similar syndrome described in 5 adults with autosomal recessive defective
surface expression of HLA class-I molecules.
cocaine-induced pseudovasculitis described in case report
Mayo Clin Proc 2005 May;80(5):671
Lancet 1999 Nov 6;354(9190):1598
25. RESISTENCIA A LA CICLOFOSFAMIDA
the first step is to ensure that the
cyclophosphamide regimen has been
optimized and, if indicated, plasma exchange
has been administered.
Mycophenolate mofetil or rituximab (Grade
2C).
mycophenolate mofetil 500 mg 2v/d which is
increased, if there is no response, by 250 mg
2v/d c/2 sem to a max dose 500 mg 2v/d
rituximab : 375 mg/m2 weekly for 4 weeks.