Hemoptysis is defined as coughing up blood originating below the vocal cords. It can range from blood-streaked sputum to coughing up pure blood. The document discusses the definition, causes, differential diagnosis, diagnosis and treatment of hemoptysis. The main causes discussed are tracheobronchial diseases like bronchitis and tumors, as well as cardiovascular issues. Diagnosis involves history, examination, labs, chest imaging like CXR, CT, and procedures like bronchoscopy.
Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles. Or •Bronchiectasis is characterized by permanent, abnormal dilation of one or more large bronchBronchiectasis.
Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles. Or •Bronchiectasis is characterized by permanent, abnormal dilation of one or more large bronchBronchiectasis.
Interstitial lung disease is a general category that includes many different lung conditions. All interstitial lung diseases affect the interstitium, a part of the lungs' anatomic structure.
Some of the types of interstitial lung disease include:
Interstitial pneumonia: Bacteria, viruses, or fungi may infect the interstitium of the lung. A bacterium called Mycoplasma pneumonia is the most common cause.
Idiopathic pulmonary fibrosis : A chronic, progressive form of fibrosis (scarring) of the interstitium. Its cause is unknown.
Nonspecific interstitial pneumonitis: Interstitial lung disease that's often present with autoimmune conditions (such as rheumatoid arthritis or scleroderma).
Interstitial lung disease is a general category that includes many different lung conditions. All interstitial lung diseases affect the interstitium, a part of the lungs' anatomic structure.
Some of the types of interstitial lung disease include:
Interstitial pneumonia: Bacteria, viruses, or fungi may infect the interstitium of the lung. A bacterium called Mycoplasma pneumonia is the most common cause.
Idiopathic pulmonary fibrosis : A chronic, progressive form of fibrosis (scarring) of the interstitium. Its cause is unknown.
Nonspecific interstitial pneumonitis: Interstitial lung disease that's often present with autoimmune conditions (such as rheumatoid arthritis or scleroderma).
Respiratory Tract Infections- A Pharmacotherapeutic ApproachDr. Ankit Gaur
In this presentation I have tried to explain the types, etiology, pathophysiology of respiratory tract infections such as bronchitis, pnemonia, otitis media, sinusitis, pharyngitis, and their treatment
Nutraceutical market, scope and growth: Herbal drug technologyLokesh Patil
As consumer awareness of health and wellness rises, the nutraceutical market—which includes goods like functional meals, drinks, and dietary supplements that provide health advantages beyond basic nutrition—is growing significantly. As healthcare expenses rise, the population ages, and people want natural and preventative health solutions more and more, this industry is increasing quickly. Further driving market expansion are product formulation innovations and the use of cutting-edge technology for customized nutrition. With its worldwide reach, the nutraceutical industry is expected to keep growing and provide significant chances for research and investment in a number of categories, including vitamins, minerals, probiotics, and herbal supplements.
Professional air quality monitoring systems provide immediate, on-site data for analysis, compliance, and decision-making.
Monitor common gases, weather parameters, particulates.
Richard's aventures in two entangled wonderlandsRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
Introduction:
RNA interference (RNAi) or Post-Transcriptional Gene Silencing (PTGS) is an important biological process for modulating eukaryotic gene expression.
It is highly conserved process of posttranscriptional gene silencing by which double stranded RNA (dsRNA) causes sequence-specific degradation of mRNA sequences.
dsRNA-induced gene silencing (RNAi) is reported in a wide range of eukaryotes ranging from worms, insects, mammals and plants.
This process mediates resistance to both endogenous parasitic and exogenous pathogenic nucleic acids, and regulates the expression of protein-coding genes.
What are small ncRNAs?
micro RNA (miRNA)
short interfering RNA (siRNA)
Properties of small non-coding RNA:
Involved in silencing mRNA transcripts.
Called “small” because they are usually only about 21-24 nucleotides long.
Synthesized by first cutting up longer precursor sequences (like the 61nt one that Lee discovered).
Silence an mRNA by base pairing with some sequence on the mRNA.
Discovery of siRNA?
The first small RNA:
In 1993 Rosalind Lee (Victor Ambros lab) was studying a non- coding gene in C. elegans, lin-4, that was involved in silencing of another gene, lin-14, at the appropriate time in the
development of the worm C. elegans.
Two small transcripts of lin-4 (22nt and 61nt) were found to be complementary to a sequence in the 3' UTR of lin-14.
Because lin-4 encoded no protein, she deduced that it must be these transcripts that are causing the silencing by RNA-RNA interactions.
Types of RNAi ( non coding RNA)
MiRNA
Length (23-25 nt)
Trans acting
Binds with target MRNA in mismatch
Translation inhibition
Si RNA
Length 21 nt.
Cis acting
Bind with target Mrna in perfect complementary sequence
Piwi-RNA
Length ; 25 to 36 nt.
Expressed in Germ Cells
Regulates trnasposomes activity
MECHANISM OF RNAI:
First the double-stranded RNA teams up with a protein complex named Dicer, which cuts the long RNA into short pieces.
Then another protein complex called RISC (RNA-induced silencing complex) discards one of the two RNA strands.
The RISC-docked, single-stranded RNA then pairs with the homologous mRNA and destroys it.
THE RISC COMPLEX:
RISC is large(>500kD) RNA multi- protein Binding complex which triggers MRNA degradation in response to MRNA
Unwinding of double stranded Si RNA by ATP independent Helicase
Active component of RISC is Ago proteins( ENDONUCLEASE) which cleave target MRNA.
DICER: endonuclease (RNase Family III)
Argonaute: Central Component of the RNA-Induced Silencing Complex (RISC)
One strand of the dsRNA produced by Dicer is retained in the RISC complex in association with Argonaute
ARGONAUTE PROTEIN :
1.PAZ(PIWI/Argonaute/ Zwille)- Recognition of target MRNA
2.PIWI (p-element induced wimpy Testis)- breaks Phosphodiester bond of mRNA.)RNAse H activity.
MiRNA:
The Double-stranded RNAs are naturally produced in eukaryotic cells during development, and they have a key role in regulating gene expression .
(May 29th, 2024) Advancements in Intravital Microscopy- Insights for Preclini...Scintica Instrumentation
Intravital microscopy (IVM) is a powerful tool utilized to study cellular behavior over time and space in vivo. Much of our understanding of cell biology has been accomplished using various in vitro and ex vivo methods; however, these studies do not necessarily reflect the natural dynamics of biological processes. Unlike traditional cell culture or fixed tissue imaging, IVM allows for the ultra-fast high-resolution imaging of cellular processes over time and space and were studied in its natural environment. Real-time visualization of biological processes in the context of an intact organism helps maintain physiological relevance and provide insights into the progression of disease, response to treatments or developmental processes.
In this webinar we give an overview of advanced applications of the IVM system in preclinical research. IVIM technology is a provider of all-in-one intravital microscopy systems and solutions optimized for in vivo imaging of live animal models at sub-micron resolution. The system’s unique features and user-friendly software enables researchers to probe fast dynamic biological processes such as immune cell tracking, cell-cell interaction as well as vascularization and tumor metastasis with exceptional detail. This webinar will also give an overview of IVM being utilized in drug development, offering a view into the intricate interaction between drugs/nanoparticles and tissues in vivo and allows for the evaluation of therapeutic intervention in a variety of tissues and organs. This interdisciplinary collaboration continues to drive the advancements of novel therapeutic strategies.
Observation of Io’s Resurfacing via Plume Deposition Using Ground-based Adapt...Sérgio Sacani
Since volcanic activity was first discovered on Io from Voyager images in 1979, changes
on Io’s surface have been monitored from both spacecraft and ground-based telescopes.
Here, we present the highest spatial resolution images of Io ever obtained from a groundbased telescope. These images, acquired by the SHARK-VIS instrument on the Large
Binocular Telescope, show evidence of a major resurfacing event on Io’s trailing hemisphere. When compared to the most recent spacecraft images, the SHARK-VIS images
show that a plume deposit from a powerful eruption at Pillan Patera has covered part
of the long-lived Pele plume deposit. Although this type of resurfacing event may be common on Io, few have been detected due to the rarity of spacecraft visits and the previously low spatial resolution available from Earth-based telescopes. The SHARK-VIS instrument ushers in a new era of high resolution imaging of Io’s surface using adaptive
optics at visible wavelengths.
Observation of Io’s Resurfacing via Plume Deposition Using Ground-based Adapt...
Hemoptysis
1. HEMOPTYSISHEMOPTYSIS
ByBy
Iman Galal, MDIman Galal, MD
Assistant Professor Pulmonary MedicineAssistant Professor Pulmonary Medicine
Ain Shams UniversityAin Shams University
E-mail: dr.imangalal@gmail.comE-mail: dr.imangalal@gmail.com
2. Definition of hemoptysisDefinition of hemoptysis
Causes of hemoptysisCauses of hemoptysis
Differential diagnosis of hemoptysisDifferential diagnosis of hemoptysis
Diagnosis of hemoptysisDiagnosis of hemoptysis
Treatment of hemoptysisTreatment of hemoptysis
ContentsContents
3. HemoptysisHemoptysis is defined as coughing of bloodis defined as coughing of blood
originating from below the vocal cords.originating from below the vocal cords.
The wordThe word "hemoptysis""hemoptysis" comes from the Greekcomes from the Greek
"haima""haima" meaning "blood“ &meaning "blood“ & "ptysis""ptysis" which means "awhich means "a
spitting".spitting".
HemoptysisHemoptysis can range fromcan range from blood-streakingblood-streaking ofof
sputum to the presence ofsputum to the presence of gross bloodgross blood in the absencein the absence
of any accompanying sputum.of any accompanying sputum.
DefinitionDefinition
4. Life threatening (or) Massive hemoptysisLife threatening (or) Massive hemoptysis isis
defined as coughing of blood > 150 ml/time (or) > 600defined as coughing of blood > 150 ml/time (or) > 600
ml/24 hours.ml/24 hours.
Only 5% of hemoptysis isOnly 5% of hemoptysis is massivemassive but mortality is 80%.but mortality is 80%.
DefinitionDefinition
9. Sources:Sources:
1.1. Bronchial circulation.Bronchial circulation.
2.2. Pulmonary circulation.Pulmonary circulation.
3.3. Anatomizes between pulmonary & bronchial circulation.Anatomizes between pulmonary & bronchial circulation.
Mechanisms:Mechanisms:
1.1. Vessel engorgement.Vessel engorgement.
2.2. Erosion (or) rupture of vessels.Erosion (or) rupture of vessels.
3.3. Mucosal ulceration.Mucosal ulceration.
4.4. Vascular granulation tissue.Vascular granulation tissue.
Mechanism & Sources of HemoptysisMechanism & Sources of Hemoptysis
10. Make sure that this isMake sure that this is True Hemoptysis.True Hemoptysis.
Identify theIdentify the SeveritySeverity of hemoptysis.of hemoptysis.
Clinical clues inClinical clues in HistoryHistory && Examination.Examination.
DiagnosticDiagnostic Investigations.Investigations.
AppropriateAppropriate Treatment.Treatment.
Clinical Approach for Management ofClinical Approach for Management of
HemoptysisHemoptysis
11. Important points to address in HistoryImportant points to address in History
Clinical CluesClinical Clues Suggested DiagnosisSuggested Diagnosis
Anticoagulant useAnticoagulant use Medication effect, coagulation disorderMedication effect, coagulation disorder
Association with mensesAssociation with menses Catamenial hemoptysisCatamenial hemoptysis
Dyspnea on exertion, fatigue, orthopnea,Dyspnea on exertion, fatigue, orthopnea,
PND, frothy pink sputumPND, frothy pink sputum
Congestive heart failure, Lt V. dysfunction, MSCongestive heart failure, Lt V. dysfunction, MS
Fever, productive coughFever, productive cough URTI, acute bronchitis, pneumonia, lung abscessURTI, acute bronchitis, pneumonia, lung abscess
History of breast, colon, or renal cancersHistory of breast, colon, or renal cancers Endobronchial metastatic lung diseaseEndobronchial metastatic lung disease
History of chronic lung disease, recurrentHistory of chronic lung disease, recurrent
LRTI, cough with copious purulent sputumLRTI, cough with copious purulent sputum
Bronchiectasis, lung abscessBronchiectasis, lung abscess
Melena, alcoholism, chronic use of NSAIDsMelena, alcoholism, chronic use of NSAIDs Gastritis, gastric or peptic ulcer, esophageal varicesGastritis, gastric or peptic ulcer, esophageal varices
Pleuritic chest pain, calf tendernessPleuritic chest pain, calf tenderness Pulmonary embolism or infarctionPulmonary embolism or infarction
Tobacco useTobacco use Acute bronchitis, chronic bronchitis, lung Ca, pneumoniaAcute bronchitis, chronic bronchitis, lung Ca, pneumonia
Toxic symptomsToxic symptoms TuberculosisTuberculosis
Weight lossWeight loss Emphysema, lung cancer, TB, bronchiectasis, lung abscessEmphysema, lung cancer, TB, bronchiectasis, lung abscess
12. True Hemoptysis VersusTrue Hemoptysis Versus
Spurious (False) HemoptysisSpurious (False) Hemoptysis
True hemoptysisTrue hemoptysis False hemoptysisFalse hemoptysis
Below vocal cordsBelow vocal cords Above vocal cordsAbove vocal cords
Persists as blood tinged sputumPersists as blood tinged sputum Does not persistDoes not persist
May be mixed with sputumMay be mixed with sputum Not mixed with sputumNot mixed with sputum
History of cardiopulmonary diseaseHistory of cardiopulmonary disease Obvious by ENT examinationObvious by ENT examination
CXR may be abnormalCXR may be abnormal Normal CXRNormal CXR
13. Hemoptysis Versus HematemsisHemoptysis Versus Hematemsis
HemoptysisHemoptysis HematemsisHematemsis
Coughing of bloodCoughing of blood Vomiting of bloodVomiting of blood
History of cardiopulmonary diseaseHistory of cardiopulmonary disease History of GIT diseaseHistory of GIT disease
Bright red in colorBright red in color Dark brown in colorDark brown in color
Sputum remains blood stainedSputum remains blood stained
after the attack for few daysafter the attack for few days
Usually followed by melenaUsually followed by melena
Mixed with sputumMixed with sputum Mixed with gastric contentsMixed with gastric contents
Blood is frothyBlood is frothy AirlessAirless
AlkalineAlkaline AcidicAcidic
Sputum contains hemosedrinSputum contains hemosedrin
laden macrophagesladen macrophages
NoNo
23. Advantages:Advantages:
1)1)Tomography is valuable in selected cases to better show theTomography is valuable in selected cases to better show the
presencepresence
of lung cavities, solid masses, and mediastinal & hilar LDN.of lung cavities, solid masses, and mediastinal & hilar LDN.
2)2)Its complementary use with FOB gives a greater positive yield ofIts complementary use with FOB gives a greater positive yield of
pathology & is useful for excluding malignancy in high-risk patients.pathology & is useful for excluding malignancy in high-risk patients.
3)3)Allows application of special imaging techniques: e.g.,Allows application of special imaging techniques: e.g.,
HRCT (1-3mm thickness section)HRCT (1-3mm thickness section) →→BronchiectasisBronchiectasis
Spiral CT with pulmonary angiographySpiral CT with pulmonary angiography →→PEPE
DiagnosisDiagnosis
Computed Tomographic Scan (CT)Computed Tomographic Scan (CT)
27. Advantages:Advantages:
1.1. It is diagnostic for central endobronchial lesions.It is diagnostic for central endobronchial lesions.
2.2. Allows direct visualization of the bleeding site.Allows direct visualization of the bleeding site.
3.3. Permits tissue biopsy, bronchial lavage, or brushings for pathologicPermits tissue biopsy, bronchial lavage, or brushings for pathologic
diagnosis.diagnosis.
4.4. FOB also can provide direct therapy in cases of non massiveFOB also can provide direct therapy in cases of non massive
hemoptysis:hemoptysis:
Instillation of diluted adrenaline.Instillation of diluted adrenaline.
Iced cooled saline.Iced cooled saline.
Wedging & temponadeWedging & temponade →→Fogarty catheter balloonFogarty catheter balloon
DiagnosisDiagnosis
Fiberoptic Bronchoscopy (FOB)Fiberoptic Bronchoscopy (FOB)
31. AngiographyAngiography
AdvantagesAdvantages::
1.1. Gold standard diagnostic tool for suspected PE.Gold standard diagnostic tool for suspected PE.
2.2. Diagnosis of arteriovenous malformation.Diagnosis of arteriovenous malformation.
3.3. Allows management of some cases of hemoptysis usingAllows management of some cases of hemoptysis using
endovascular embolization.endovascular embolization.
Disadvantages:Disadvantages:
1.1. Embolization of Spinal arteriesEmbolization of Spinal arteries →→ paraplegia.paraplegia.
2.2. Needs special skills.Needs special skills.
36. Management of HemoptysisManagement of Hemoptysis
GoalGoal::
1.1. Evaluate the severity of hemoptysis.Evaluate the severity of hemoptysis.
2.2. Airway protection & patency.Airway protection & patency.
3.3. Identify the site of bleeding.Identify the site of bleeding.
4.4. Protect the contralateral un involved lung.Protect the contralateral un involved lung.
5.5. Stop the bleeding.Stop the bleeding.
6.6. Treatment of the cause of bleeding.Treatment of the cause of bleeding.
37. Management of HemoptysisManagement of Hemoptysis
Non-MassiveNon-Massive MassiveMassive
Treatment of theTreatment of the
underlying causeunderlying cause
MedicalMedical
SurgicalSurgical
EndobronchialEndobronchial
EndovascularEndovascular
38. Management of MassiveManagement of Massive
HemoptysisHemoptysis
I.I. MedicalMedical::
Endotacheal tube (single wide bore (or) double lumen).Endotacheal tube (single wide bore (or) double lumen).
Position of the patient sitting (or) bleeding side downPosition of the patient sitting (or) bleeding side down
Large bore IV line fluids, blood transfusionLarge bore IV line fluids, blood transfusion (EXCEPT??)(EXCEPT??)
Supplemental Oxygen/ Mechanical ventilation.Supplemental Oxygen/ Mechanical ventilation.
Avoid cough suppressants (if necessary Benzodiazepine).Avoid cough suppressants (if necessary Benzodiazepine).
Pitressin (Vasopressin) 0.2-0.4 units/min. IV.Pitressin (Vasopressin) 0.2-0.4 units/min. IV.
39. Management of MassiveManagement of Massive
HemoptysisHemoptysis
II.II. SurgicalSurgical::
Emergency resection forEmergency resection for
bronchogenic mass.bronchogenic mass.
Resection of bronchogenicResection of bronchogenic
mass after patientmass after patient
stabilization.stabilization.
Surgical resection forSurgical resection for
aspergilloma.aspergilloma.
40. Management of MassiveManagement of Massive
HemoptysisHemoptysis
III.III.EndobronchialEndobronchial::
Identify:Identify: SSource,ource, RRate & toate & to SSlow (or)low (or) AArrest bleeding.rrest bleeding.
43. IV.IV.Endovascular:Endovascular:
First results of embolization were published in 1973First results of embolization were published in 1973..
In most patients the bleeding originates fromIn most patients the bleeding originates from
bronchial arteriesbronchial arteries rather than pulmonary arteriesrather than pulmonary arteries..
Transcatheter embolization is effective in immediateTranscatheter embolization is effective in immediate
control of massive hemoptysis (73% - 98%).control of massive hemoptysis (73% - 98%).
Recurrence may be caused by:Recurrence may be caused by:
Incomplete embolization of artery.Incomplete embolization of artery.
Recanalization of previously embolized artery.Recanalization of previously embolized artery.
Revascularization through collateral circulation.Revascularization through collateral circulation.
Progression of basic lung disease.Progression of basic lung disease.
Management of MassiveManagement of Massive
HemoptysisHemoptysis
44. Management of MassiveManagement of Massive
HemoptysisHemoptysis
ICU AdmissionICU Admission
Conservative Medical CareConservative Medical Care
Rigid BronchoscopeRigid Bronchoscope
Hemoptysis stopHemoptysis stop
Investigate the causeInvestigate the cause
Hemoptysis did not stopHemoptysis did not stop
Surgical/EmbolizationSurgical/Embolization