This case report describes a 43-year-old woman with multiple sclerosis who developed severe colitis after receiving two doses of ocrelizumab (an anti-CD20 monoclonal antibody). She was initially treated with antibiotics for suspected Clostridium difficile infection but did not improve. Further investigation found extensive inflammation throughout her colon. She failed treatment with steroids and underwent a total colectomy. The report discusses how ocrelizumab depletion of B-cells may disrupt the gastrointestinal immune system and presents a rare case of fulminant colitis requiring surgery after only two doses of the drug.
This document provides an overview of inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease. It discusses the classifications, clinical features, diagnosis, management, and conclusions regarding IBD. Key points include that IBD is characterized by chronic inflammation in the gastrointestinal tract. Ulcerative colitis only affects the colon while Crohn's disease can affect any part of the GI tract. Diagnosis involves ruling out other conditions through history, physical exam, labs, imaging and endoscopy. Management includes medications like 5-aminosalicylates, corticosteroids, immunosuppressants, biologics and surgery for severe cases.
LOWER GI HEMORRHAGE- PLAYLIST OF 6 VIDEOS
Dear Viewers,
Greetings from “Surgical Educator”.
I have made a playlist for Lower GI Hemorrhage which consists of six videos on various causes of Lower GI Hemorrhage. They are Introduction, diverticular disease, haemorrhoids, fissure-in-ano, colorectal carcinoma and inflammatory bowel disease. If you watch all these videos together you will become confident to tackle the clinical problem of Lower GI Hemorrhage. You can watch these videos in the following link: https://www.youtube.com/playlist…
Thank you for watching the videos.
This clinical trial demonstrated persistent graft function and regulated insulin secretion in a patient with type 1 diabetes who received an allogeneic islet transplant using a novel oxygenated chamber system without immunosuppression. The patient showed basal C-peptide production and stimulated insulin response over 10 months. The chamber protected the islets from immune rejection while continuously supplying oxygen. This approach may enable widespread application of islet and other cell-based therapies by overcoming limitations of donor availability and need for immunosuppression.
A rare co-occurrence of Ulcerative Colitis and Celiac Disease.pdfmerdaci dhia elhak
A 43-year-old woman presented with chronic bloody diarrhea, weight loss, and anemia. Laboratory tests revealed celiac disease and ulcerative colitis. Upper endoscopy found villous atrophy consistent with celiac disease, and lower endoscopy revealed erythematous lesions and crypt abnormalities consistent with ulcerative colitis. She was treated with a gluten-free diet and corticosteroids/mesalamine, which resolved her symptoms. This case report discusses the rare co-occurrence of celiac disease and ulcerative colitis, which can be difficult to distinguish but require different treatment approaches.
Eosinophilic Enterocolitis: A Rare Nosological Entitynavasreni
Eosinophilic enterocolitis is an exceptionally rare disease with few cases described in the literature. It is the least frequent manifestation of the broad spectrum of gastrointestinal eosinophilic diseases. We describe a case of a female patient presenting with a form of the disease manifested by Koenig’s syndrome and diarrhea.
Eosinophilic Enterocolitis: A Rare Nosological Entitypateldrona
Eosinophilic enterocolitis is an exceptionally rare disease with few cases described in the literature. It is the least frequent manifestation of the broad spectrum of gastrointestinal eosinophilic diseases. We describe a case of a female patient presenting with a form of the disease manifested by Koenig’s syndrome and diarrhea.
This document provides an overview of inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease. It discusses the classifications, clinical features, diagnosis, management, and conclusions regarding IBD. Key points include that IBD is characterized by chronic inflammation in the gastrointestinal tract. Ulcerative colitis only affects the colon while Crohn's disease can affect any part of the GI tract. Diagnosis involves ruling out other conditions through history, physical exam, labs, imaging and endoscopy. Management includes medications like 5-aminosalicylates, corticosteroids, immunosuppressants, biologics and surgery for severe cases.
LOWER GI HEMORRHAGE- PLAYLIST OF 6 VIDEOS
Dear Viewers,
Greetings from “Surgical Educator”.
I have made a playlist for Lower GI Hemorrhage which consists of six videos on various causes of Lower GI Hemorrhage. They are Introduction, diverticular disease, haemorrhoids, fissure-in-ano, colorectal carcinoma and inflammatory bowel disease. If you watch all these videos together you will become confident to tackle the clinical problem of Lower GI Hemorrhage. You can watch these videos in the following link: https://www.youtube.com/playlist…
Thank you for watching the videos.
This clinical trial demonstrated persistent graft function and regulated insulin secretion in a patient with type 1 diabetes who received an allogeneic islet transplant using a novel oxygenated chamber system without immunosuppression. The patient showed basal C-peptide production and stimulated insulin response over 10 months. The chamber protected the islets from immune rejection while continuously supplying oxygen. This approach may enable widespread application of islet and other cell-based therapies by overcoming limitations of donor availability and need for immunosuppression.
A rare co-occurrence of Ulcerative Colitis and Celiac Disease.pdfmerdaci dhia elhak
A 43-year-old woman presented with chronic bloody diarrhea, weight loss, and anemia. Laboratory tests revealed celiac disease and ulcerative colitis. Upper endoscopy found villous atrophy consistent with celiac disease, and lower endoscopy revealed erythematous lesions and crypt abnormalities consistent with ulcerative colitis. She was treated with a gluten-free diet and corticosteroids/mesalamine, which resolved her symptoms. This case report discusses the rare co-occurrence of celiac disease and ulcerative colitis, which can be difficult to distinguish but require different treatment approaches.
Eosinophilic Enterocolitis: A Rare Nosological Entitynavasreni
Eosinophilic enterocolitis is an exceptionally rare disease with few cases described in the literature. It is the least frequent manifestation of the broad spectrum of gastrointestinal eosinophilic diseases. We describe a case of a female patient presenting with a form of the disease manifested by Koenig’s syndrome and diarrhea.
Eosinophilic Enterocolitis: A Rare Nosological Entitypateldrona
Eosinophilic enterocolitis is an exceptionally rare disease with few cases described in the literature. It is the least frequent manifestation of the broad spectrum of gastrointestinal eosinophilic diseases. We describe a case of a female patient presenting with a form of the disease manifested by Koenig’s syndrome and diarrhea.
Eosinophilic Enterocolitis: A Rare Nosological Entitykomalicarol
Eosinophilic enterocolitis is an exceptionally rare disease with few
cases described in the literature. It is the least frequent manifestation of the broad spectrum of gastrointestinal eosinophilic diseases. We describe a case of a female patient presenting with a form
of the disease manifested by Koenig's syndrome and diarrhea. This
posed a diagnostic challenge for us due to its non-specific symptoms, associated with the absence of standardized histological criteria, hence the need for a high level of suspicion. There is also
no consensus regarding the treatment. It should be individualized
according to the age of the patient and the severity of symptoms
Pathophysiology of Hepatobiliary Menifestation of IBD.pptxDr. Awadhesh
This document discusses the pathophysiological relationship between the gut and liver in inflammatory bowel disease (IBD) and hepatobiliary manifestations of IBD. It notes the tight embryological, anatomical, and physiological connection between the two organs. When the gut barrier is compromised, microbial products can translocate to the liver, triggering an immune response. The liver's Kupffer cells and bile duct MAIT cells normally maintain tolerance to these microbial antigens. Primary sclerosing cholangitis is discussed as a prototypical gut-liver axis disease associated with IBD. Risk factors, potential roles of the microbiome and immune therapies are summarized.
The document provides information on inflammatory bowel disease (IBD), including its classification into ulcerative colitis and Crohn's disease. It discusses the epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, treatment goals, and pharmacological and non-pharmacological treatment approaches for IBD. The major drug therapy types used for IBD include aminosalicylates, corticosteroids, immunosuppressants, TNF inhibitors, and antimicrobials. Surgery may be required for severe cases or complications that do not respond to medical management.
The document provides information on inflammatory bowel disease (IBD), including its classification into ulcerative colitis and Crohn's disease. It discusses the epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, treatment goals, and pharmacological and non-pharmacological treatment approaches for IBD. The major drug therapy types used for IBD include aminosalicylates, corticosteroids, immunosuppressants, TNF inhibitors, and antimicrobials. Surgery may be required for severe cases or complications that do not respond to medical management.
Inflammatory bowel disease (IBD) includes two major entities: Crohn's disease and ulcerative colitis. Crohn's disease can involve any part of the gastrointestinal tract and is transmural, while ulcerative colitis is limited to the colon and mucosa. The exact causes of IBD are unknown but likely involve genetic, immunological, environmental, and bacterial factors. The main differences between the two conditions are the locations they affect and their morphological expression.
Polymyositis as an Extra-Intestinal Manifestation of Ulcerative Colitis in a ...merdaci dhia elhak
A 28-year-old woman with a history of ulcerative colitis presented with muscle weakness, myalgias, and constitutional symptoms. Tests found elevated muscle enzymes and inflammation on muscle biopsy. She was diagnosed with polymyositis, a rare extra-intestinal manifestation of ulcerative colitis. Treatment with steroids and azathioprine improved her symptoms. While disease activity is not required, extra-intestinal manifestations like polymyositis should be considered in ulcerative colitis patients with muscle symptoms. Both conditions responded well to immunosuppressive therapy.
This document discusses inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis. IBD is a chronic condition characterized by inflammation in the gastrointestinal tract that causes symptoms like abdominal pain, diarrhea, and weight loss. While the exact cause is unknown, IBD is thought to be due to genetic factors combined with environmental triggers that cause an abnormal immune response in the gastrointestinal tract. It most commonly affects individuals of European descent between the ages of 15-30. Developed countries have higher rates of IBD than developing nations.
Introduction: Diffuse Large B Cell Lymphoma (DLBCL), as a set of heterogeneous aggressive lymphoma, most commonly originated in the germinal center B lymphocytes. Rare cases were from peripheral blood B cell (outside germinal center) or from the inert lymphoma development and transformation. And such tumor with originality outside germinal center was seldom seen in the literature. Even the tumor in combination with chronic gastritis has not been reported before.
Inflammatory bowel disease (IBD) represents a group of chronic disorders that cause prolonged inflammation of the digestive tract. The two main types are ulcerative colitis, which causes inflammation and ulcers in the lining of the large intestine, and Crohn's disease, which is a chronic inflammatory disease that can affect any part of the gastrointestinal tract from mouth to anus. IBD is treated through a combination of medications, dietary changes, and sometimes surgery, with the goals of inducing and maintaining remission of symptoms, preventing complications, and avoiding surgery if possible. Treatments include aminosalicylates, corticosteroids, immunosuppressants, biologics that target tumor necrosis factor, and antimicrobial agents.
This document discusses inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. It covers the classifications, clinical features, diagnosis, management, and surgical indications for IBD. The key points are that IBD is characterized by chronic inflammation of the gastrointestinal tract, Crohn's disease can affect any part of the GI tract while ulcerative colitis only involves the colon, and treatment involves medications to induce and maintain remission such as 5-aminosalicylates, corticosteroids, immunosuppressants, and anti-TNF therapies, with surgery indicated for complications or severe cases refractory to medical management.
This document provides information on Inflammatory Bowel Disease (IBD), including ulcerative colitis and Crohn's disease. It covers the etiology, pathophysiology, clinical manifestations, diagnostic evaluation, and treatment of IBD. The major causes of IBD involve genetic, infectious, and immunological factors. Ulcerative colitis affects the large intestine while Crohn's disease can involve any part of the gastrointestinal tract. Treatment involves medications to induce and maintain remission such as aminosalicylates, corticosteroids, immunomodulators, biologics, and antibiotics in some cases. Nutritional support and surgery may also be used in severe cases that do not respond to medical management.
Achalasia cardia is an uncommon disorder with an incidence of 1.6 per 100,000 people [1]. Pseudoachalasia is even more infrequent. Its prevalence is estimated at 2.4 to 4% amongst patients diagnosed with achalasia. Pseudoachalasia refers to the dilatation of the oesophagus mimicking achalasia - due to narrowing of the distal oesophagus but from reasons other than primary denervation. Th e most common cause of pseuodachalasia is malignant involvement of the lower esophageal sphincter of which 53.9% are primary malignancies and 14.9% are secondary [2].
Acute cholecystitis:Severity assessment and managementKETAN VAGHOLKAR
This document discusses acute cholecystitis, including its etiology, clinical presentation, diagnosis, severity assessment, and treatment approaches. It provides details on evaluating the severity of acute cholecystitis using the Tokyo Guidelines, which classify it as mild, moderate, or severe based on clinical, laboratory, and imaging criteria. Treatment involves initial conservative management with antibiotics and supportive care, followed by early laparoscopic cholecystectomy within 72 hours for most patients, unless their age, comorbidities, or the severity of inflammation and organ dysfunction make surgery too risky.
This document discusses the management of fulminant ulcerative colitis, a potentially life-threatening condition. It describes:
1) Initial evaluation involves a thorough history, physical exam, and tests like bloodwork and imaging to assess severity and rule out complications.
2) Medical management begins with IV corticosteroids, and if that fails within 5-7 days, cyclosporine therapy is considered.
3) Surgery is indicated if medical therapies are not effective or complications develop. The staged or "all-at-once" surgical approach depends on the patient's condition and experience of the surgical team.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
Communicating effectively and consistently with students can help them feel at ease during their learning experience and provide the instructor with a communication trail to track the course's progress. This workshop will take you through constructing an engaging course container to facilitate effective communication.
Eosinophilic Enterocolitis: A Rare Nosological Entitykomalicarol
Eosinophilic enterocolitis is an exceptionally rare disease with few
cases described in the literature. It is the least frequent manifestation of the broad spectrum of gastrointestinal eosinophilic diseases. We describe a case of a female patient presenting with a form
of the disease manifested by Koenig's syndrome and diarrhea. This
posed a diagnostic challenge for us due to its non-specific symptoms, associated with the absence of standardized histological criteria, hence the need for a high level of suspicion. There is also
no consensus regarding the treatment. It should be individualized
according to the age of the patient and the severity of symptoms
Pathophysiology of Hepatobiliary Menifestation of IBD.pptxDr. Awadhesh
This document discusses the pathophysiological relationship between the gut and liver in inflammatory bowel disease (IBD) and hepatobiliary manifestations of IBD. It notes the tight embryological, anatomical, and physiological connection between the two organs. When the gut barrier is compromised, microbial products can translocate to the liver, triggering an immune response. The liver's Kupffer cells and bile duct MAIT cells normally maintain tolerance to these microbial antigens. Primary sclerosing cholangitis is discussed as a prototypical gut-liver axis disease associated with IBD. Risk factors, potential roles of the microbiome and immune therapies are summarized.
The document provides information on inflammatory bowel disease (IBD), including its classification into ulcerative colitis and Crohn's disease. It discusses the epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, treatment goals, and pharmacological and non-pharmacological treatment approaches for IBD. The major drug therapy types used for IBD include aminosalicylates, corticosteroids, immunosuppressants, TNF inhibitors, and antimicrobials. Surgery may be required for severe cases or complications that do not respond to medical management.
The document provides information on inflammatory bowel disease (IBD), including its classification into ulcerative colitis and Crohn's disease. It discusses the epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, treatment goals, and pharmacological and non-pharmacological treatment approaches for IBD. The major drug therapy types used for IBD include aminosalicylates, corticosteroids, immunosuppressants, TNF inhibitors, and antimicrobials. Surgery may be required for severe cases or complications that do not respond to medical management.
Inflammatory bowel disease (IBD) includes two major entities: Crohn's disease and ulcerative colitis. Crohn's disease can involve any part of the gastrointestinal tract and is transmural, while ulcerative colitis is limited to the colon and mucosa. The exact causes of IBD are unknown but likely involve genetic, immunological, environmental, and bacterial factors. The main differences between the two conditions are the locations they affect and their morphological expression.
Polymyositis as an Extra-Intestinal Manifestation of Ulcerative Colitis in a ...merdaci dhia elhak
A 28-year-old woman with a history of ulcerative colitis presented with muscle weakness, myalgias, and constitutional symptoms. Tests found elevated muscle enzymes and inflammation on muscle biopsy. She was diagnosed with polymyositis, a rare extra-intestinal manifestation of ulcerative colitis. Treatment with steroids and azathioprine improved her symptoms. While disease activity is not required, extra-intestinal manifestations like polymyositis should be considered in ulcerative colitis patients with muscle symptoms. Both conditions responded well to immunosuppressive therapy.
This document discusses inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis. IBD is a chronic condition characterized by inflammation in the gastrointestinal tract that causes symptoms like abdominal pain, diarrhea, and weight loss. While the exact cause is unknown, IBD is thought to be due to genetic factors combined with environmental triggers that cause an abnormal immune response in the gastrointestinal tract. It most commonly affects individuals of European descent between the ages of 15-30. Developed countries have higher rates of IBD than developing nations.
Introduction: Diffuse Large B Cell Lymphoma (DLBCL), as a set of heterogeneous aggressive lymphoma, most commonly originated in the germinal center B lymphocytes. Rare cases were from peripheral blood B cell (outside germinal center) or from the inert lymphoma development and transformation. And such tumor with originality outside germinal center was seldom seen in the literature. Even the tumor in combination with chronic gastritis has not been reported before.
Inflammatory bowel disease (IBD) represents a group of chronic disorders that cause prolonged inflammation of the digestive tract. The two main types are ulcerative colitis, which causes inflammation and ulcers in the lining of the large intestine, and Crohn's disease, which is a chronic inflammatory disease that can affect any part of the gastrointestinal tract from mouth to anus. IBD is treated through a combination of medications, dietary changes, and sometimes surgery, with the goals of inducing and maintaining remission of symptoms, preventing complications, and avoiding surgery if possible. Treatments include aminosalicylates, corticosteroids, immunosuppressants, biologics that target tumor necrosis factor, and antimicrobial agents.
This document discusses inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. It covers the classifications, clinical features, diagnosis, management, and surgical indications for IBD. The key points are that IBD is characterized by chronic inflammation of the gastrointestinal tract, Crohn's disease can affect any part of the GI tract while ulcerative colitis only involves the colon, and treatment involves medications to induce and maintain remission such as 5-aminosalicylates, corticosteroids, immunosuppressants, and anti-TNF therapies, with surgery indicated for complications or severe cases refractory to medical management.
This document provides information on Inflammatory Bowel Disease (IBD), including ulcerative colitis and Crohn's disease. It covers the etiology, pathophysiology, clinical manifestations, diagnostic evaluation, and treatment of IBD. The major causes of IBD involve genetic, infectious, and immunological factors. Ulcerative colitis affects the large intestine while Crohn's disease can involve any part of the gastrointestinal tract. Treatment involves medications to induce and maintain remission such as aminosalicylates, corticosteroids, immunomodulators, biologics, and antibiotics in some cases. Nutritional support and surgery may also be used in severe cases that do not respond to medical management.
Achalasia cardia is an uncommon disorder with an incidence of 1.6 per 100,000 people [1]. Pseudoachalasia is even more infrequent. Its prevalence is estimated at 2.4 to 4% amongst patients diagnosed with achalasia. Pseudoachalasia refers to the dilatation of the oesophagus mimicking achalasia - due to narrowing of the distal oesophagus but from reasons other than primary denervation. Th e most common cause of pseuodachalasia is malignant involvement of the lower esophageal sphincter of which 53.9% are primary malignancies and 14.9% are secondary [2].
Acute cholecystitis:Severity assessment and managementKETAN VAGHOLKAR
This document discusses acute cholecystitis, including its etiology, clinical presentation, diagnosis, severity assessment, and treatment approaches. It provides details on evaluating the severity of acute cholecystitis using the Tokyo Guidelines, which classify it as mild, moderate, or severe based on clinical, laboratory, and imaging criteria. Treatment involves initial conservative management with antibiotics and supportive care, followed by early laparoscopic cholecystectomy within 72 hours for most patients, unless their age, comorbidities, or the severity of inflammation and organ dysfunction make surgery too risky.
This document discusses the management of fulminant ulcerative colitis, a potentially life-threatening condition. It describes:
1) Initial evaluation involves a thorough history, physical exam, and tests like bloodwork and imaging to assess severity and rule out complications.
2) Medical management begins with IV corticosteroids, and if that fails within 5-7 days, cyclosporine therapy is considered.
3) Surgery is indicated if medical therapies are not effective or complications develop. The staged or "all-at-once" surgical approach depends on the patient's condition and experience of the surgical team.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
Communicating effectively and consistently with students can help them feel at ease during their learning experience and provide the instructor with a communication trail to track the course's progress. This workshop will take you through constructing an engaging course container to facilitate effective communication.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
2. hydrocortisone. Her CRP was downtrending on hydro-
cortisone. However, serial abdominal X-rays demonstrated
ongoing gaseous distension, and she continued having
watery bowel motions. The patient was referred to a tertiary
hospital and colorectal surgeons for medication-resistant
biological medication-induced colitis. She subsequently
underwent a total colectomy and ileostomy formation.
3. Discussion/Conclusion
We surmise that the most likely cause of colitis in this in-
stance is ocrelizumab, as evidenced by both the clinical
history and histopathological reports. Drug-induced colitis
is a relatively new clinically recognized phenomenon with
diagnosis increasing in alignment to the expansion of
Table 1: Laboratory results.
Laboratory tests Patient’s sample Normal values
Haemoglobin 172 115–160 g/L
White blood cells 15.2 4.00–11.0 ×109
/L
Platelets 160 140–400 ×109
/L
C-reactive protein (CRP) 187 <5.0 mg/L
Lipase 25 <60 U/L
Albumin 40 35–80 g/L
Lactate 4.0 0.6–1.8 mmol/L
Faecal calprotectin 3200 <50 µg/g
Stool culture Normal colonic bacterial flora
Clostridium difficile toxins Negative
Table 2: Imaging and procedural results.
Imaging and procedures Relevant findings
X-ray abdomen Dilated large bowels with thumbprinting sign
CT abdomen
Pronounced colitis primarily involving the transverse colon, splenic flexure, and descending colon
of the large bowel extending to involve the sigmoid colon
Flexible sigmoidoscopy
Decreased mucosa vascular pattern in the sigmoid colon
Nodular mucosa in the rectosigmoid colon and in the sigmoid colon
Congested, erythematous, inflamed, and vascular pattern decreased mucosa in the rectum.
Histology showed features of biological medication effect.
Laparoscopy converted to open total
colectomy
Widespread inflammatory adhesions with contact bleeding. Attempted laparoscopic resection
converted to open total colectomy due to disintegrating fulminant colitis of left colon and sigmoid
colon falling to pieces on retraction, contact bleeding, and massive distension of large bowel. Frank
pus from rectum during insertion of rectal catheter at the end of the case.
Histology of total colectomy
Mucosa in proximal colon appears normal. The rest of the colonic mucosa is completely ulcerated
without residual islands of intact mucosa. There is congestion, chronic inflammation, and
submucosal fibrosis. The ulceration is mostly superficial but does extend focally to the muscularis
propria. Focal areas of subserosal fibrosis are noted. The pathology features are compatible with the
clinical diagnosis of medication induced colitis.
Figure 1: Abdomen X-ray showing thumbprinting sign.
Figure 2: Distal sigmoid colon showing severe colitis.
2 Case Reports in Gastrointestinal Medicine
3. medications and novel therapy. However, to date, we are
aware of two other cases of de novo colitis associated with
ocrelizumab, with one of them requiring surgical resection
[2, 3].
Ocrelizumab is a humanized monoclonal antibody that
binds to the CD20 antigen on B-lymphocytes and has been
approved for the treatment of primary progressive multiple
sclerosis (PPMS) and relapsing multiple sclerosis (RMS) in
adults [1]. Ocrelizumab-induced colitis has been reported to
occur within a few weeks of initiation of therapy. In this case,
severe colitis involving a significant portion of the colon and
requiring total colectomy occurred after only two doses of
ocrelizumab. This may indicate either a cumulative effect
from ocrelizumab or a delayed presentation of worsening
colitis from commencement of the medication. Rituximab,
which is also a humanized anti-CD20 monoclonal antibody,
has been reported to be associated with colitis. However,
fulminant colitis is extremely rare [4].
Ocrelizumab is likely to play a role in the development of
autoimmunity resulting in severe pancolitis as described in
our case. The exact mechanism of anti-CD20-induced colitis
is not known, nor is the pathogenesis of ocrelizumab-in-
duced colitis. Since ocrelizumab depletes B cells, there could
be an association between colitis with the dysregulation of
the gastrointestinal immune system via B-cell depletion.
B cells play a vital role in the mucosal immune system by
producing secretory antibodies IgA and IgM which protects
the mucosal barrier [5]. B-cells also produce IL-10 which is
an anti-inflammatory and has been linked to inhibit Th1-
derived responses. Animal studies have shown that mice
with depleted B-cells and IL-10 have severe colitis likely
mediated by Th1 response profile [6]. Ocrelizumab-sup-
pressed B-cell levels have been shown to return to pre-
treatment levels at a median of 72 (27–175) weeks [7].
Therefore, the inflammatory process with T-cell dysfunction
may occur and persist for up to a year. Ocrelizumab could
potentially predispose patients to develop autoimmunity by
causing immune dysregulation. This process might continue
in the background until another immunological trigger or
disruption which leads to the development of autoimmune
process.
Risk factors for ocrelizumab-induced colitis remain
unclear. Several cumulative risk factors may have expo-
nentiated the presentation in this particular case. This pa-
tient had previously received teriflunomide and
alemtuzumab which may have altered her immune system
which concomitantly could have been affected by an already
proinflammatory state of multiple sclerosis. This is consis-
tent with literature [2, 3] describing other cases where pa-
tients received ocrelizumab after failing first-line therapy.
Whether this increased risk is due to a severe refractory
disease state or simply the alteration of the immune system
from multiple agents remains unknown.
Treatment of ocrelizumab-induced colitis is challenging
as this is extremely rare, and hence, therapeutic options are
limited. Immunosuppressants such glucocorticoids were
only effective in one case report but not effective in two
others, including our case, and surgical intervention was
needed for definitive management as a life-saving procedure
[2, 3]. More studies need to be done to explore other medical
therapies such as other immunosuppresants or immuno-
modulators which could be another option. It is unclear
what the best therapeutic options are due to the novelty of
this condition. However, medical management and the least
invasive management will likely produce the best outcome.
In conclusion, colitis may be a potential risk with ad-
ministration of ocrelizumab. Research is required to identify
patients at risk and devise strategies to monitor patients who
could potentially develop complications from ocrelizumab.
Ethical Approval
The publication was approved through the institution’s
governance processes.
Consent
Written informed consent was provided by the patient.
Conflicts of Interest
The authors have no conflicts of interest to declare.
Authors’ Contributions
Hsing Hwa Lee and Naveen Sritharan were responsible for
compiling case report details, manuscript preparation, and
literature search. Daniel Bermingham contributed to med-
ication review and literature search. Gabriela Strey con-
tributed to supervision and manuscript preparation.
Acknowledgments
The case study was performed under the guidance of the
Wide Bay Hospital and Health Service with specific funding
support for publication. The authors thank all medical teams
and staff involved in the care of this patient and Angela
Ratsch for your helpful comments on the preparation of the
manuscript.
Figure 3: Midsigmoid colon showing extension of the severe colitis
to the midsigmoid region.
Case Reports in Gastrointestinal Medicine 3
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4 Case Reports in Gastrointestinal Medicine