A comparison between Nephritic and Nephrotic syndrome from Professor Hossam Mowafy Internal Medicine textbook nephrology section, Please inform me if there is any error or wrong information include.
A comparison between Nephritic and Nephrotic syndrome from Professor Hossam Mowafy Internal Medicine textbook nephrology section, Please inform me if there is any error or wrong information include.
Jock itch, also called tinea cruris or ringworm of the groin, is an infection of the groin area caused by fungus.
Medline Plus - National Institutes of Health:
Is a condition seen in some cases of AIDS or immunosuppression, in which the immune system begins to recover, but then responds to a previously acquired opportunistic infection with an overwhelming inflammatory response that paradoxically makes the symptoms of infection worse.
Fungal skin infections are commonly affect the outer layer of the skin, nails and hair. Most of the fungi causing infections are usually dermatophytes (tinea), yeast (candida) and molds
Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly
Jock itch, also called tinea cruris or ringworm of the groin, is an infection of the groin area caused by fungus.
Medline Plus - National Institutes of Health:
Is a condition seen in some cases of AIDS or immunosuppression, in which the immune system begins to recover, but then responds to a previously acquired opportunistic infection with an overwhelming inflammatory response that paradoxically makes the symptoms of infection worse.
Fungal skin infections are commonly affect the outer layer of the skin, nails and hair. Most of the fungi causing infections are usually dermatophytes (tinea), yeast (candida) and molds
Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly
For infectious diseases module as part of medical school studies.
By Robert Ferris and Krystyna Gelinski.
Sources for all imagery and sources listed in references section where possible. I do not claim ownership of any images or graphics. Slides for educational purposes only, and should not replace clinical judgement. No monetary gain was made for this work.
Rabies is a zoonotic disease caused by RNA viruses.
Virus is transmitted in the saliva of rabid mammals via a bite.
After entry to the central nervous system, these viruses cause an acute progressive encephalomyelitis.
The incubation period usually ranges from 1 to 3 months after exposure, but can range from days to years.
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.
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
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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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
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. A 20 year old , 24 weeks ANC was admitted on
14 /06/13 with chief c/o
1. Weakness of both lower limbs since 7 days
2. Fever since 2 days
3. Retension of urine since 2 day
4. Abnormal behavior since 1 day
No h/o headache /vomiting/convulsion
3. No h/o lm / vomiting
No back pain
No h/o trauma
No h/o vaccination
H/o dog bite lt leg 6 month before
Not received ARV/ARG
4. On examination
Not cooperative
Disoriented
Agitated
Febrile
Pulse =104/min
Resp =18/min thoracoabdominal
Bp =140/90 mmhg
No edema feet
No neck stiffness
Spine was normal
Hydrophobia +
Aerophobia +
Photophobia +
5. On examination
Patient catheterised (ub)
Power – gr ‘o” in both lower limb
moving upper limbs
DTR absent lower limbs ,normal upper limbs
Planters –absent
Sensory/ cerebellar can not be tested
P/A –uterus gravid , 24 weeks , FHS +
RS- wnl
CVS -wnl
14. Introduction
Rabies is an acute highly fatal viral disease caused by lyssavirus type
-1,belongs to family Rhabdoviridae .
Occurs in more than 100 countries and territories.
Australia,Taiwan, Cyprus, Iceland, Ireland, Japan, Malta, UK & Islands
of western pacific Norway ,Swedan are free from disease.
The annual number of human rabies deaths globally is estimated in
2010 to be from 26 400 to 61 000
15. In India
India is reported highest incidence globally.
A multicentre study in 2003 showed that 20 565 human deaths
annually
Disease occurs in all parts of country except Lakshadweep,Andaman
& Nicobar group of Islands.
Transmitted mainly by animal bite, particularly rabid Dog bites, licks
on abraded skin and mucosa.
Aerosols and man to man transmission although rare is possible
16. Clinical features
The clinical stages of rabies are:
Incubation,
Prodrome,
Acute neurological signs,
Coma, and
Death.
17. Clinical features
furious rabies: cardinal features are
o fluctuating consciousness,
o hydrophobia or aerophobia,
o inspiratory spasms,
o signs of autonomic dysfunction
They might not be evident at the same time, and disappear during
coma.
Comatose patients with furious rabies develop flaccid limb
weakness, which has been frequently misinterpreted as paralytic
rabies.
18. Clinical features
paralytic rabies
LMN type ascending weakness with only motor disturbance is
the initial manifestation
Consciousness is preserved until the preterminal phase
Atypical signs and symptoms of rabies associated with infection
with either bat or dog increasingly recognised.
Presentation of transverse myelitis as neuromyelitis optica or
tetanus-like symptoms , focal brainstem signs, myoclonus,
hemichorea, and Horner’s syndrome have been reported.
Excitation is less evident in paralytic rabies, and phobic spasms may
appear in only 50% of such patients.
Paralytic rabies, which resembles GBS, although progression to
coma, myoedema, and bladder clearly differentiate these two
disorders
19. Percussion myoedema
During the early stages of paralytic rabies,
notable signs may include myoedema at
percussion sites.
Percussion myoedema is most readily elicited on
the chest, deltoid, and thigh regions; it consists of
mounding of the muscle at the percussion site,
which then disappears over a few seconds.74
The reason why percussion myoedema is
associated with paralytic rabies is unknown, but
this sign is not observed in GBS or encephalitic
rabies, or in neuroparalytic accidents after
neural-tissue vaccination.
Has to be interpreted with caution, because it
can be found in extreme cachexia,
hyponatraemia, and the syndrome of
inappropriate secretion of antidiuretic hormone,
hypothyroidism, and renal failure usually in the
region of the chest, deltoid muscle and thigh,
piloerection and fasciculation.
20. Average survival with furious rabies and paralytic rabies after
infection 5.1 and 11 days respectively
Survival can be extended to 1 month or longer with intensive care
support.
21. Clinical case definition
a subject presenting with an acute neurological syndrome (i.e.
encephalitis) dominated by forms of hyperactivity (i.e. furious rabies) or
paralytic syndromes (i.e. dumb rabies) progressing towards coma and
death, usually by cardiac or respiratory failure, typically within 7–10 days
after the first sign, if no intensive care is instituted.
One or more of the following laboratory criteria should be used to
confirm a clinical case:
■■ presence of viral antigens;
■■ isolation of virus in cell culture or in laboratory animals;
■■ presence of viral-specific antibodies in the cerebrospinal fluid or
the serum of an unvaccinated person; or
presence of viral nucleic acids detected by molecular methods in
samples (e.g. brain biopsy, skin, saliva, concentrated urine) collected
post mortem or intra vitam
22. Clinical case definition
Cases of rabies are basically classified as follows:
■■ suspected: a case that is compatible with a clinical case
definition
■■ probable: a suspected case plus a reliable history of contact
with a
suspected rabid animal
■■ confirmed: a suspected or probable case that is laboratory-
confirmed.
In some situations, a clinical suspicion of encephalitis or a history of
animal exposure may be lacking; however, a case would still be
considered confirmed by appropriate laboratory diagnostic testing.
23. Sampling
For intra-vitam diagnosis in humans
Secretions, biological fluids (e.g. saliva, spinal fluid, tears) and tissues (skin biopsy
samples and hair follicles at the nape of the neck) can be used to diagnose
rabies during life
Three saliva samples taken at intervals of 3–6 h, skin and hair follicules are the
most sensitive samples.
Ideally, samples should be stored at –20 °C or less. Serum should be collected
from blood samples before freezing and stored at –20 °C or less.
For post-mortem diagnosis in humans
Brain tissue is the preferred specimen for post-mortem diagnosis in both
humans and other animals
If a brain biopsy cannot be performed, such as in field studies, tissue samples can be
collected via the trans-orbital or trans-foramen magnum route (1). Preservation
in glycerine (at +4 °C or –20 °C) or drying smears of brain tissue on filter paper
containing proper inactivating chemicals (at +30 °C) allows safe, stable
transport of infected material, but safe, effective viral inactivation must be
ensured before shipment
Other specimens, such as skin and hair follicles taken at the nape of the neck, are
also highly sensitive for post-mortem diagnosis
24. Techniques for intra-vitam diagnosis
1.Viral antigen detection
Direct fluorescent antibody test
Immunochromatographic methods
2.Viral antibody detection
Rapid fluorescent focus inhibition test
Fluorescent antibody virus neutralization test
3 .Viral RNA detection by RT-PCR
Post-mortem diagnosis of rabies BY
Direct fluorescent antibody technique
Enzyme linked immunosorbent assays (ELISAs) and
Direct rapid immunohistochemistry tests,
Virus isolation,Viral RNA detection
25. Neuroimaging
MRI abnormalities provide clues for differential diagnosis with
other encephalitides, in terms of preferential sites and extent of
involvement
Typically, MRI abnormalities are hypersignalT2 changes without
contrast enhancement involving the spinal cord, brainstem, thalamus,
limbic structures, and white matter during the non-comatose phase
Both clinical forms of rabies in man have similar MRI features Lesions
in the brachial plexus, spinal cord, and nerve roots are already seen at
the prodromal stage as signal intensity abnormalities or enhancement.
During the comatose phase, widespreadT2 hyperintense lesions in
the brainstem and forebrain can be seen; these are probably due to
virus-induced neuronal injury and superimposed hypoxic insult.
26.
27. Management
No proven standard treatment exists
Recovery after rabies, reported in four patients with bat RABV
variant rabies
Importantly, all four rabies survivors , had a vigorous and early
immune response, with autosterilisation (ie, no detected virus or
RNA in tissue or biological fluids) and rabies antibodies detected in
serum and CSF.
28. Management
The Milwaukee protocol
Initially aimed to induce coma with an electroencephalographic
stage of burst suppression.
Various sedatives (midazolam barbiturates,ketamine), amantadine,
which is supposed to reduce brain excitotoxicity, and ribavirin were
given to a patient who then recovered with minimal sequelae.
However, following the protocol did not save more than two dozen
fully alert, previously healthy, young, or middle-aged patients with
symptomatic rabies.
Current Milwaukee protocol consists of ketamineand midazolam,
similar to what is used by physicians in dog RABV variant endemic
countries to relieve suff ering and dysautonomia. Nimodipine has
also been added to the protocol to relieve vasospasm
Coma induction is no longer recommended in the protocol..