Rheumatoid arthritis is a chronic inflammatory disease that primarily affects the joints, causing swelling, warmth, pain, and stiffness. It results from an autoimmune reaction where the immune system mistakenly attacks healthy joint tissue. This leads to a proliferative synovitis that can cause cartilage and bone destruction over time. RA is characterized by symmetrical inflammation of multiple joints that typically involves the hands, feet, wrists, and knees. It has both articular and extra-articular effects and is associated with an increased risk of comorbidities such as lung or heart disease. The cause is unknown but involves genetic and environmental factors.
TREATMENT OF RHEUMATOID ARTHRITIS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR ...Prof Dr Bashir Ahmed Dar
Dr Bashir ahmed dar associate professor medicine chinkipora sopore kashmir presently working in medical college malaysia describes rheumatoid arthritis which is a autoimmune disorder in which Immune system identifies the synovial membrane as "foreign" and begins attacking it.
RHEUMATOID ARTHRITIS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPO...Prof Dr Bashir Ahmed Dar
Dr Bashir ahmed dar associate professor medicine chinkipora sopore kashmir presently working in medical college malaysia describes rheumatoid arthritis which is a autoimmune disorder in which Immune system identifies the synovial membrane as "foreign" and begins attacking it.
Similar to Pathophysiology of Rheumatoid Arthritis (20)
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.
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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
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.
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
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!
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
2. Rheumatoid arthritis (RA)
Chronic inflammatory disorder of autoimmune origin
principally attacks the joints, producing a nonsuppurative proliferative and
inflammatory synovitis
Articular lesions: destruction of the articular cartilage and, in some cases
ankylosis (adhesion) of the joints.
Extraarticular lesions: may occur in the skin, heart, blood vessels, and
lungs
Causes Symmetrical Polyarthritis: affects several joints in pairs on both
sides of your body
Epidemiology
• it is three times more common in women than in
men
• The peak incidence between the ages of 30 and
50 years
• There is an increased incidence in those with a
family history of RA
3. Etio-pathogenesis
Etiology:
Genetic predisposition: Human leucocyte antigen (HLA)-DR4 and HLA-DRB1*
0404/0401 alleles confer susceptibility to RA
Insults such as infection (including periodontitis) and smoking
Hormonal: Sex hormones In premenopausal women
Pathogenesis: as autoimmune diseases, genetic predisposition and
environmental factors contribute to the development, progression, and
chronicity of the disease
The pathologic changes are mediated by antibodies against self-antigens
(arthritogens: chemical or microbial modified self antigen)
and inflammation caused by cytokines, predominantly secreted by CD4+ T
cells
The T cells produce cytokines that stimulate other inflammatory cells to
effect tissue injury:
4. Pathogenesis continued
IFN-γ from TH1 cells activates
macrophages and synovial cells.
IL-17 from TH17 cells recruits
neutrophils and monocytes.
RANKL expressed on activated T
cells stimulates osteoclasts and
bone resorption
TNF and IL-1 from macrophages
stimulate resident synovial cells to
secrete proteases that destroy
hyaline cartilage.
Plasma cells produces Seum
antibodies against Citrullinated
peptides in which arginine residues
are posttranslationally converted to
citrulline
Ex. citrullinated fibrinogen, type II
collagen, α-enolase, and vimentin
deposit in the joints.
Serum antibodies are k/n as anti-
citrullinated protein antibodies
(ACPA)
Another antibodies About 80% of
patients have serum IgM or IgA
autoantibodies that bind to the Fc
portions of their own IgG. These
autoantibodies are called
Rheumatoid factor and may also
deposit in joints as immune
complexes
5. Pathogenesis continued
The inflammation localizes to the
joint, recruiting macrophages and
triggering activation and/or
proliferation of synovial cells,
chondrocytes, and fibroblasts.
The production of proteolytic
enzymes and cytokines contributes
to the destruction of cartilage and,
through increased osteoclast
activity, bone
6. Morphology
the synovium becomes
edematous, thickened, and
hyperplastic, transforming its
smooth contour to one covered by
delicate and bulbous villi
The characteristic histologic
features include:
(1) Synovial cell hyperplasia and
proliferation;
(2) dense inflammatory infiltrates of
CD4+ helper T cells, B cells, plasma
cells, dendritic cells, and
macrophages
(3) increased vascularity resulting
from angiogenesis;
(4) neutrophils and aggregates of
organizing fibrin on the synovial and
joint surfaces;
(5) Osteoclastic activity in underlying
bone, allowing the synovium to
penetrate into the bone, causing
periarticular erosions and
subchondral cysts.
Pannus Formation: a mass of
edematous synovium, inflammatory
cells, granulation tissue, and
fibroblasts that grows over the
articular cartilage and causes its
erosion
Pannus can lead to fibrous ankylosios
and bony ankylosis
7. Clinical Diagnosis:
ACPA and RF in blood and Radiographic findings
(x-rays)
Sign and symptoms
Early symptoms: malaise, fatigue, and
generalized musculoskeletal pain.
After several weeks to months the joint
become involved generally Symmetrical
Commonly joints of the hands and feet,
wrists, ankles, elbows, and knees
joints are swollen, warm, and painful
Stiffness of the joints when patient rises
in the morning or following inactivity
joint enlargement and decreased range
of motion
Inflammation in the tendons, ligaments,
and occasionally the adjacent skeletal
muscle
produces the characteristic ulnar
deviation of the fingers and flexion-
hyperextension of the fingers (swan-
neck deformity, boutonnière deformity).
Radiographic hallmarks are joint
effusions and juxtaarticular osteopenia
with erosions and narrowing of the joint
space and loss of articular cartilage
Joint effusion
8.
9. Extra-articular RA
•Systemic – Fever, Fatigue, Weight loss
•Eyes- Scleritis, Scleromalacia perforans (perforation of the eye)
•Neurological- Carpal tunnel syndrome, Atlanto-axial subluxation, Cord
compression
•Haematological-
• Felty’s syndrome (rheumatoid arthritis, splenomegaly, neutropenia),
• Anaemia (chronic disease, NSAID-induced, gastrointestinal blood loss, haemolysis,
hypersplenism),
• Thrombocytosis
Pulmonary - Pleural effusion, Lung fibrosis, Rheumatoid nodules,
Rheumatoid pneumoconiosis
Heart and peripheral vessels – Pericarditis, Pericardial effusion, Raynaud’s
syndrome
Vasculitis - Leg ulcers, Nail fold infarcts, Gangrene of fingers and toes
Kidneys - Amyloidosis causes the nephrotic syndrome and renal failure
10. Rheumatoid nodules
An infrequent manifestation of RA and
typically occur in subcutaneous tissue including the forearm, elbows,
occiput, and lumbosacral area.
Microscopically, they resemble necrotizing granulomas