Myasthenia Gravis is an autoimmune neuromuscular disorder characterized by muscle weakness and fatigability. It is caused by antibodies that block acetylcholine receptors at the neuromuscular junction, preventing muscle contraction. Symptoms vary widely and can include weakness of the eye muscles, facial muscles, limbs, and respiratory muscles. Diagnosis involves physical exams, blood tests to detect antibodies, and electrodiagnostic tests. Treatment options include acetylcholinesterase inhibitors, immunosuppressants, plasmapheresis, intravenous immunoglobulin, and thymectomy.
Disorders of the neuromuscular junction include Myasthenia gravis, Lambert-Eaton myasthenic syndrome, Botulism, Tetanus, Strychnine intoxication, Organophosphates poisoning and neuromyotonia. Pharmacology of the NMJ is also reviewed in brief.
Myasthenia gravis (MG) is a neuromuscular disorder characterized by weakness and fatigability of skeletal muscles.
The underlying defect is a decrease in the number of available acetylcholine receptors (AChRs) at neuromuscular junctions due to an antibody-mediated autoimmune attack
Bell’s palsy
Trigeminal Neuralgia ( Tic Douloreux)
Cranial & spinal neuropathies
Bell’s palsy (facial paralysis) is due to unilateral inflammation of the ( CN VII Facial nerve) seventh cranial nerve, which results in weakness or paralysis of the facial muscles on the affected side.
Disorders of the neuromuscular junction include Myasthenia gravis, Lambert-Eaton myasthenic syndrome, Botulism, Tetanus, Strychnine intoxication, Organophosphates poisoning and neuromyotonia. Pharmacology of the NMJ is also reviewed in brief.
Myasthenia gravis (MG) is a neuromuscular disorder characterized by weakness and fatigability of skeletal muscles.
The underlying defect is a decrease in the number of available acetylcholine receptors (AChRs) at neuromuscular junctions due to an antibody-mediated autoimmune attack
Bell’s palsy
Trigeminal Neuralgia ( Tic Douloreux)
Cranial & spinal neuropathies
Bell’s palsy (facial paralysis) is due to unilateral inflammation of the ( CN VII Facial nerve) seventh cranial nerve, which results in weakness or paralysis of the facial muscles on the affected side.
Myasthenia Gravis is a neuromuscular disorder primarily characterized by muscle weakness and muscle fatigue. Although the disorder usually becomes apparent during adulthood, symptom onset may occur at any age.
Myasthenia gravis (MG) is a long-term neuromuscular disease that leads to varying degrees of skeletal muscle weakness. The most commonly affected muscles are those of the eyes, face, and swallowing. It can result in double vision, drooping eyelids, trouble talking, and trouble walking.
Guillain Barre Syndrome (GBS) is a serious disorder that occurs when the body’s defense (immune) system mistakenly attacks part of the nervous system i.e Autoimmune Disorder.
Myasthenia Gravis is a neuromuscular disorder primarily characterized by muscle weakness and muscle fatigue. Although the disorder usually becomes apparent during adulthood, symptom onset may occur at any age.
Myasthenia gravis (MG) is a long-term neuromuscular disease that leads to varying degrees of skeletal muscle weakness. The most commonly affected muscles are those of the eyes, face, and swallowing. It can result in double vision, drooping eyelids, trouble talking, and trouble walking.
Guillain Barre Syndrome (GBS) is a serious disorder that occurs when the body’s defense (immune) system mistakenly attacks part of the nervous system i.e Autoimmune Disorder.
myasthenia gravis , a neurological disorder, causes skeletal muscle weakness. There are classification according to american clinical classification of myasthenia gravis.Risk factors and causes of myasthenia gravis with animated gif shown in ppt. Types of muscle weakness and pathophysiology of myasthenia gravis explained. Clinical manifestation explained through animated gif. Important diagnostic test explained through pictures. Medical management, surgical management, nursing management explain in detail of myasthenia gravis. Excercise goals and rehablitation management of myasthenia gravis is explained. Types of rehablitation excercise for myasthenia gravis explained. Complications of myasthenia gravis and research article of myasthenia gravis is included in ppt. Summary and conclusion is also included in ppt.
Myasthenia gravis is caused by an abnormal immune reaction (antibody-mediated autoimmune response) in which the body's immune defenses (i.e., antibodies) inappropriately attack certain proteins in muscles that receive nerve impulses.
A Clinical Case wherein patient presented with signs & symptoms of Fanconi Syndrome, on further evaluating the history; it was found that he matched the clinical criteria for Lowe Syndrome
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.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
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
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.
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!
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
- 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
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. Myasthenia Gravis (MG) is a neuromuscular disorder
characterized by weakness and fatigability of skeletal
muscles.
Key Concept :-
It is due to the decrease in the number of available
acetylcholine receptors (AchRs) at neuromuscular junctions
due to antibody mediated autoimmune attack.
5. Highest prevalence rate is 20.4 per 100,000
population.1
Prevalence of disease is increasing since 1950s.
2,3
Improved recognition
High sensitivity & specificity of the test.
Longer life-span due to effective treatment
More people in the ‘at risk’ group due to increased
life expectancy.
6. Currently, there are 60,000 patients with myasthenia
gravis in Unites States.2
The incidence & prevalence increases substantially
after the age of 55 years.4,5
The chances of “only ocular disease” increases after
the age of 55 years.6
Atypical presentation :-
Weakness in the distal extremity.
Different immunological & electrophysiological findings.
Prevalence 7% of patients.7
7. Autoimmune channelopathy
Genetic predisposition:
HLA B8 & DR3
DR1 specific for ocular myasthenia
75% patients have abnormality of thymus
10% have thymoma.
8. Autoantibodies against nicotinic
acetylcholinrereceptors (nAchRs)
These antibodies prevent binding of Ach to its
receptors
Other action:
Destruction of receptors
By complement activation
Elimination by endocytosis
9. AchR antigenic peptide fragment
+ TCR (T- Cell receptor)
Activation of T-Helper cells
B- cells converts to plasma cells
Production of antibodies
SYMPTOMS
12. Fluctuation weakness increasing trough the day &
relieved by rest.
Extra ocular muscle weakness
Present in 50% of patients initially.
Present in 90% of patients during the course of disease.
Disease remains ocular in 16% of patients.
13. Usually affects one extra ocular muscle
Ptosis
Not limited by innervations of one cranial nerve
Limited adduction of one eye with nystagmus of the
abducting eye on attempted lateral gaze
Diplopia common.
Sclera below limbus may be visible due to weak
lower eyelid.
15. Weakness of intercostal muscles and diaphragm
may lead to CO2 retention
Weakness of pharyngeal muscles may collapse the
airway.
O2 saturation can be normal while CO2 is retained.
So, pulse oximetry is not reliable to detect the
amount of paralysis.
16. Palatal muscle weakness
Nasal voice
Nasal regurgitation
Swallowing may be difficult & regurgitation of
foods can occur.
Coughing & choking while drinking.
Limb weakness can also be present
Initially proximal but may follow distal muscles also.
17. Hyperthyroidism
Weakness may not improve simply by treatment of
patients with MG; with co-existing hyperthyroidism.
Rheumatoid arthritis
Scleroderma
Lupus
18. NEONATAL: In 12% of the pregnancies with a mother with
MG, she passes the antibodies to the infant through the
placenta, causing neonatal myasthenia gravis. The symptoms
will start in the first two days and disappear within a few
weeks after birth. With the mother, it is not uncommon for the
symptoms to even improve during pregnancy, but they might
worsen after labor.
CONGENITAL: Children of a healthy mother can, very rarely,
develop myasthenic symptoms beginning at birth, congenital
myasthenic syndrome or CMS. Other than myasthenia gravis,
CMS is not caused by an autoimmune process, but due to
synaptic malformation, which in turn is caused by genetic
mutations. Thus, CMS is a hereditary disease. More than 11
different mutations have been identified, and the inheritance
pattern is typically autosomal recessive.
JUVENILE: myasthenia occurring in childhood, but after the
peripartum period
19. Physical examination
Blood tests
Neurophysiology
Edrophonium test
Imaging techniques
Pulmonary function tests
20. Looking upwards & sidewards for 30 seconds
For diplopia & ptosis
Looking at the feet while lying on the back for 30
seconds
Keeping arms stretched forward for 60 seconds
Ten deep knee bends
Wallking 30 steps on both the toes & heels
“Peek Sign” – After initial apposition of lid margins,
they quickly start to separate (in 30 seconds) & the
sclera start to show.
22. Detection of acetylcholine receptor antibodies.
Sensitivity of 80-96%
50% of patients with only ocular disease may lack in these
antibodies
In some cases, anti-MuSK protein antibodies.
Antibodies against voltage-gated calcium channels
to differenciate from Lambert-Eaton Myasthenic
Syndrome (LEMS).
24. More used to differenciate myasthenic crises from cholinergic crises.
Paralysed Muscle
Myasthenic Crises Temporary Improvement
Edrophonium
Chloride
Cholinergic Crises No improvement
25.
26. Chest X-Ray
Detection of thymoma.
To detect lung cancer for alternate diagnoses i.e. lambert-
Eaton Syndrome.
CT-Scan
MRI Scan
29. Forced Vital Capacity is monitored to detect any
gradual loss of respiratory functions.
Negative inspiratory force is useful to detect
adequacy of ventilation.
30. To detect IgG antibodies against neuromuscular
junction.
31. Class I: Any eye muscle weakness, possible ptosis, no other
evidence of muscle weakness elsewhere
Class II: Eye muscle weakness of any severity, mild weakness of
other muscles
Class IIa: Predominantly limb or axial muscles
Class IIb: Predominantly bulbar and/or respiratory muscles
Class III: Eye muscle weakness of any severity, moderate
weakness of other muscles
Class IIIa: Predominantly limb or axial muscles
Class IIIb: Predominantly bulbar and/or respiratory muscles
Class IV: Eye muscle weakness of any severity, severe weakness
of other muscles
Class IVa: Predominantly limb or axial muscles
Class IVb: Predominantly bulbar and/or respiratory muscles (Can also
include feeding tube without intubation)
Class V: Intubation needed to maintain airway
33. Pyridostigmine Bromide -
Starts in 30-60 mins & effect lasts 3-6 hours
Caution for cholinergic crises.
34. Most commonly used corticosteroid in US
Significant improvement is often seen after a
decreased antibody titer which is usually 1-4 months
No single dose regimen is accepted
Some start low and go high
Others start high dose to achieve a quicker response
Clearance may be decreased by estrogens or digoxin
Patients taking concurrent diuretics should be
monitored for hypokalemia
35. Drugs that alter the immune response can be used.
Commonly used drugs are
Azathioprine
Cyclosporine
Mycophenolate
36. Plasmapheresis
Filters out the antibodies from blood
Effect lasts only for a few weeks.
IV immuneglogulin
Provides body with antibodies
Binds to circulating antibodies.
38. Diet
Thickened liquids are preferred, when dysphagia arises to
counteract the fear of aspiration.
Asparagus should be taken as it contains steroid-like
substance.
Activity
Patients should be as active as possible but should take
rest in between.
Yoga exercises to stretch the weakened muscles should be
done.
This not only strengthens the muscles but also provides
oxygen & removes carbon dioxide from them.
39. 1. Isbister CM, Mackenzie PJ, Anderson D, et al. Co-occurrence of multiple sclerosis and
myasthenia gravis in British Columbia: a population-based study [abstract]. Neurology
2002;58(suppl 3):A185-A186
2. Phillips LH. The epidemiology of myasthenia gravis. Ann N Y Acad Sci 2003;998:407-412
3. Phillips LH, Torner JC. Epidemiologic evidence for a changing natural history of
myasthenia gravis. Neurology 1996;47:1233-1238
4. Kalb B, Matell G, Pirskanen R, Lambe M. Epidemiology of myasthenia gravis: a
population-based study in Stockholm, Sweden. Neuroepidemiology 2002;21:221-225
5. Phillips LH, Torner JC, Anderson MS, et al. The epidemiology of myasthenia gravis in
central and western Virginia. Neurology 1992;42:1888-1893
6. Jaretzke A, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis. Recommendations for
clinical research standards. Neurology 2000;55:16-23
7. Werner P, Kiechl S, Löscher S, et al. Distal myasthenia gravis: frequency and clinical
course in a large prospective series. Acta Neurol Scand 2003;108:209-210