Leprosy, also known as Hansen's disease, is a chronic bacterial infection caused by Mycobacterium leprae. It primarily affects the skin and nerves. There are approximately 600,000 new cases detected worldwide each year. It is endemic in many developing countries. The disease presentation exists on a spectrum from tuberculoid leprosy to lepromatous leprosy depending on the immune response. Left untreated, leprosy can cause permanent nerve damage and deformities. Standard treatment involves multidrug therapy with dapsone, rifampin, and clofazimine over the course of months or years.
Erythroderma is defined as the scaling erythematous dermatitis involving 90% or more of the cutaneous surface.
Also known as exfoliative dermatitis
Idiopathic exfoliative dermatitis – also known as the “red man syndrome”, is characterized by marked palmoplantar keratoderma, dermatopathic lymphadenopathy,increased IgE.
Increased skin perfusion leads to
Temperature dysregulation >
Resulting in skin loss and hypothermia >
High output state >
Cardiac failure
BMR raises to compensate for heat loss
Increased dehydration due to transpiration (similar to burns)
All lead to negative nitrogen balance and characterized by edema, hypoalbuminemia, loss of muscle mass.
Erythroderma is defined as the scaling erythematous dermatitis involving 90% or more of the cutaneous surface.
Also known as exfoliative dermatitis
Idiopathic exfoliative dermatitis – also known as the “red man syndrome”, is characterized by marked palmoplantar keratoderma, dermatopathic lymphadenopathy,increased IgE.
Increased skin perfusion leads to
Temperature dysregulation >
Resulting in skin loss and hypothermia >
High output state >
Cardiac failure
BMR raises to compensate for heat loss
Increased dehydration due to transpiration (similar to burns)
All lead to negative nitrogen balance and characterized by edema, hypoalbuminemia, loss of muscle mass.
Cutaneous manifestations of hiv infectiontashagarwal
Dermatological problems occur in more than 90% of patients with human immunodeficiency virus (HIV) infection. In some patients, skin is the first organ affected. Skin diseases have proved to be sensitive and useful measures by which HIV progression can be monitored.
Cutaneous manifestations of hiv infectiontashagarwal
Dermatological problems occur in more than 90% of patients with human immunodeficiency virus (HIV) infection. In some patients, skin is the first organ affected. Skin diseases have proved to be sensitive and useful measures by which HIV progression can be monitored.
Key facts
Leprosy is a chronic infectious disease caused by a type of bacteria, Mycobacterium leprae.
The disease predominantly affects the skin and peripheral nerves. Left untreated, the disease may cause progressive and permanent disabilities.
The bacteria are transmitted via droplets from the nose and mouth during close and frequent contact with untreated cases.
Leprosy is curable with multidrug therapy (MDT).
Leprosy is reported from all the six WHO Regions; the majority of annual new case detections are from South-East Asia.
Overview
Leprosy is an age-old disease and is described in the literature of ancient civilizations. It is a chronic infectious disease which is caused by a type of bacteria called Mycobacterium leprae. The disease affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the eyes. Leprosy is curable and treatment in the early stages can prevent disability. Apart from the physical deformity, persons affected by leprosy also face stigmatization and discrimination.
Scope of the problem
Leprosy is a neglected tropical disease (NTD) which still occurs in more than 120 countries, with more than 200 000 new cases reported every year. Elimination of leprosy as a public health problem globally (defined as prevalence of less than 1 per 10 000 population) was achieved in 2000 (as per World Health Assembly resolution 44.9) and in most countries by 2010. The reduction in the number of new cases has been gradual, both globally and in the WHO regions. As per data of 2019, Brazil, India and Indonesia reported more than 10 000 new cases, while 13 other countries (Bangladesh, Democratic Republic of the Congo, Ethiopia, Madagascar, Mozambique, Myanmar, Nepal, Nigeria, Philippines, Somalia, South Sudan, Sri Lanka and the United Republic of Tanzania) each reported 1000–10 000 new cases. Forty-five countries reported 0 cases and 99 reported fewer than 1000 new cases.
Transmission
The disease is transmitted through droplets from the nose and mouth. Prolonged, close contact over months with someone with untreated leprosy is needed to catch the disease. The disease is not spread through casual contact with a person who has leprosy like shaking hands or hugging, sharing meals or sitting next to each other. Moreover, the patient stops transmitting the disease when they begin treatment.
Diagnosis
The diagnosis of leprosy is done clinically. Laboratory-based services may be required in cases that are difficult to diagnose.
The disease manifests commonly through skin lesion and peripheral nerve involvement. Leprosy is diagnosed by finding at least one of the following cardinal signs: (1) definite loss of sensation in a pale (hypopigmented) or reddish skin patch; (2) thickened or enlarged peripheral nerve, with loss of sensation and/or weakness of the muscles supplied by that nerve; (3) microscopic detection of bacilli in a slit-skin smear.
Based on the above, the cases are classified into two types for treatment
Diffuse astrocytomas, also referred to as low-grade infiltrative astrocytomas, are designated as WHO II tumours of the brain.
The term diffuse infiltrating means there is no identifiable border between the tumour and normal brain tissue, even though the borders may appear well-marginated on imaging.
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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
- 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.
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
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
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
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
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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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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
2. • Leprosy (Hansen's disease) can be defined as a chronic
granulomatous infection and its sequelae, caused by
Mycobacterium leprae, and affecting primarily skin and
nerves.
• 600,000 new cases yearly, worldwide
• despite apparently curative antibacterial therapy, one-
quarter to one-third of all patients will have a
debilitating and permanent neurologic deficit.
Father Damien with leprosy patients he
ministered to in Hawaii during the 1870s;
he was later canonized by the Roman
Catholic Church.
3. EPIDEMIOLOGY
• Primarily a disease of developing countries, is
endemic in all continents, except Antarctica.
• The highest case detection rates are in India, Brazil,
Madagascar, Nepal, and Tanzania.
• More common in men than in women by a 2:1 ratio
• Predominantly a young person's disease, the
majority of cases occurring before age 35 years
4.
5. ETIOLOGY AND PATHOGENESIS
• M. leprae, the cause of leprosy, is a noncultivable,
gram-positive, obligate intracellular, acid-fast bacillus.
• Entry into nerves is mediated by the binding of the
species-specific trisaccharide in phenolic glycolipid I to
laminin-2 in the basal lamina of Schwann cell-axon
units, 11providing a rationale as to why M. leprae is
the only bacterium known to invade peripheral nerves.
6.
7.
8. Granulomatous Spectrum
• The most detailed description of the granulomatous
spectrum of leprosy came from Ridley and his
associates, integrating both clinical and histologic
changes.
TT (polar tuberculoid), BT (borderline tuberculoid), BB
(borderline), BL (borderline lepromatous), LLs (subpolar
lepromatous), and, finally, LLp (polar lepromatous)
9. Peripheral Nerve Changes
• Four types of peripheral nerve abnormalities are common in
leprosy:
(1) nerve enlargement (usually perceived as asymmetry),
particularly in those close to the skin, such as the great
auricular, ulnar, radial cutaneous, superficial peroneal, sural and
posterior tibial;
(2) sensory loss in skin lesions;
10. 3) nerve trunk palsies either with signs and symptoms of
inflammation or without such overt manifestations, that is,
silent neuropathy, usually with both sensory and motor loss
(weakness and/or atrophy) and, if long-standing, also with
contracture;
(4) acral distal symmetric anesthesia, a withering away, so to
speak, of the type C fibers, involving heat and cold
discrimination before loss of pain or light touch, beginning in
acral areas and, over time, extending centrally but sparing the
palms, at least for a while.
11. The most commonly affected
nerves in leprosy.
(From Sabin TD, Swift TR,
Jacobson RR: Leprosy. In: Dyck
PJ, Thomas PK, eds: Peripheral
Neuropathy. Philadelphia:
Elsevier Saunders. 2005, p
2089, Figure 91-4.)
12. POLAR TUBERCULOID LEPROSY
A solitary, anesthetic, and
annular lesion of polar
tuberculoid leprosy (TT),
which had been present for
3 months. Its sharp margins,
erythema, and scale are
more evident than its
elevation. The central red
dots are the sequelae or
“footprints” of testing for
pinprick perception when it
is absent. (If present, the
patient withdraws,
preventing
overtly purpuric
consequences.)
13. One of several lesions of
borderline tuberculoid
(BT), which had an
incompletely annular
configuration
with satellite papules.
Compared to the TT lesion,
there is less erythema, no
evident scales, but sharp
margination, and the
footprints of absent
pinprick perception are
also seen.
BORDERLINE TUBERCULOID LEPROSY
14. BORDERLINE LEPROSY
• BB is the immunologic midpoint or mid-zone of the granulomatous
spectrum, being its most unstable area, with patients quickly up- or
downgrading to a more stable granulomatous posture with or
without a clinical reaction.
• Characteristic skin changes are annular lesions with sharply
marginated interior and exterior margins, large plaques with
islands of clinically normal skin within the plaque, giving a
“Swiss cheese” appearance, or the classic dimorphic lesion.
• Because of instability, the BB posture is short-lived and such
patients are evidently rarely seen.
15. BORDERLINE LEPROMATOUS LEPROSY
A characteristic borderline or
dimorphic lesion, which is an
indurated and elevated
annular plaque that
has a well defined
“tuberculoid” interior
margin, but a poorly defined
“lepromatous” exterior
margin. Having both
morphologies, it is termed
“dimorphic.”
16. Multiple lesions in a patient
with borderline
lepromatous (BL) leprosy.
The annular lesions vary in
size
and are asymmetrically
distributed. In contrast, the
poorly defined papular and
nodular lesions are roughly
symmetric.
Loss of sensation was
present in most lesions.
17. LEPROMATOUS LEPROSY
Multiple skin-colored papular
and small nodular lesion in a
patient with polar lepromatous
(LLp)
leprosy. The margination of the
lesions is variable, some being
poorly defined. The absence of
clinical inflammation is
evident. Some distortion of the
normal helix is arising from
diffuse infiltration as well as
from the nodular lesions.
18. Multiple papular lesions,
which are solitary and
confluent, in a patient with
subpolar lepromatous (LLs)
leprosy.
These multiple, barely palpable, erythematous,
and asymptomatic lesions had been erupting
over the previous 2 months in a LLs patient.
With treatment, as lesions remitted they
became mildly hyperpigmented.
19. With progressive bacillary proliferation, further cellular
infiltration, and the consequent thickening of the dermis,
the skin is thrown into folds producing the leonine faces
often in conjunction with nodular lesions.
20. Systemic Associations
• Because of motor or sensory
changes in cranial nerve V, the
eye may be at risk in TT and BT
disease, as well as in BB, BL, and
LL leprosy.
• numerous changes in the cornea
and anterior chamber are
possible, iritis being a common
serious change.
• Corneal insensitivity is the
common, treatable change.
21. INDETERMINATE LEPROSY
• Indeterminate leprosy is a term with nearly as many meanings
as it has users:
- “designating an early lesion, appearing before the host
makes a definitive immunologic commitment to cure or to an
overt granulomatous response.”
• hypopigmented macule
• with or without a sensory deficit
• acid-fast bacilli, if found, are in very small numbers
• rare in clinic
22. Indeterminate leprosy, A solitary erythematous macule on
the face of a young family member of a patient with
lepromatous leprosy.
23. Variants: PREGNANCY AND POSTPARTUM
• Pregnancy is a precipitating factor for leprosy in 10 to 25
percent of women patients.
• Of the drugs used to treat leprosy, none have been proven to
be safe for the fetus and one is clearly contraindicated.
• Fetal damage attributable to dapsone evidently has not been
observed, hence continuation of dapsone in multibacillary
patients is usually recommended.
• The wishes of the patient should be carefully considered.
Untreated, lactating BL and LL patients have viable bacilli in
their milk, but no definable risk has been identified in infants
ingesting such bacilli.
24. LABORATORY FINDINGS
• Most laboratory changes occur in LL or extensive BL disease.
• Hyperglobulinemia -> increased sedimentation rate
• A biologic false-positive serologic test for syphilis, anemia of
chronic disease, and mild lymphopenia are also common
• Clinically insignificant antiphospholipid antibodies are present
in 50 percent of LL patients, and may give rise to a lupus
anticoagulant or agglutination of sheep erythrocytes (Rubino
factor).
• Elevated serum lysozyme and angiotensin-converting enzyme
• Proteinuria, not uncommon, is associated with a focal
glomerulonephritis
• High serumfollicle-stimulating hormone (FSH) and luteinizing
hormone (LH) values, but low testosterone levels
25. DIAGNOSIS
• A firm diagnosis of leprosy requires the satisfaction of one of
two criteria:
- a consistent peripheral nerve abnormality
- the demonstration of mycobacteria in tissues.
• Risk factors:
-(1) birth or residence in an endemic area, which is almost
sine qua non for the diagnosis
-(2) a blood relative with the disease, which could reflect
transmission, common genetic makeup, or common
environmental exposure
- (3) armadillo (seven-banded) exposure in North American.
26. • The possibility of leprosy also should be suggested by
particular clinical constellations such
- (1) simultaneous skin lesions and peripheral nerve
abnormalities
- (2) a differential diagnosis that includes granuloma, vasculitis,
or lymphoma
- (3) a peripheral neuropathy of unknown type in a patient in or
from an endemic area, the so called pure neuritic leprosy
- (4) simultaneous palsies of cranial nerves V and VII,
considered to be leprosy until proven otherwise.
27.
28. TREATMENT
• Medical management is directed at the infection itself, or if
present, at a reactional state.
- For paucibacillary disease (TTor BT) the World Health
Organization (WHO) recommends the combination of
unsupervised dapsone (bacteriostatic) 100 mg daily and
supervised rifampin (bactericidal) 600 mg monthly for a
duration of 6 months.
- For multibacillary disease (BB, BL, and LL) the WHO
recommends unsupervised dapsone 100 mg daily, supervised
rifampin 600 mg monthly and clofazimine 50 mg daily,
unsupervised, and 300 mg monthly supervised for a routine
duration of 2 years.