PANDAS is a hypothesized condition where symptoms of obsessive compulsive disorder (OCD) or tic disorders are exacerbated by group A streptococcal (GAS) infections in children. It is characterized by: 1) Abrupt onset and episodic course of OCD and/or tic symptoms, 2) Pediatric onset between ages 3-puberty, 3) Temporal association between GAS infection and symptom onset/exacerbation. Treatment involves antibiotics for GAS infections combined with standard neuropsychiatric treatments for OCD/tics. However, the association between PANDAS and GAS is controversial and more research is still needed.
This presentation consist information about unspoken and less well known variants of GBS as well as CIDP. Also it includes information about diagnosis and management.
ATAXIA IN CHILDREN -CAUSES, MANAGEMENT, INVESTIGATIONS, TYPES, COMMONEST ATAXIA IN CHILDREN IN DETAIL, HOW WILL YOU FIND OUT THE CAUSE FOR ATAXIA IN CHILDREN FLOWCHART, DEFINITION, TREATMENT
This presentation consist information about unspoken and less well known variants of GBS as well as CIDP. Also it includes information about diagnosis and management.
ATAXIA IN CHILDREN -CAUSES, MANAGEMENT, INVESTIGATIONS, TYPES, COMMONEST ATAXIA IN CHILDREN IN DETAIL, HOW WILL YOU FIND OUT THE CAUSE FOR ATAXIA IN CHILDREN FLOWCHART, DEFINITION, TREATMENT
PANDAS is short for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. A child may be diagnosed with PANDAS when: Obsessive-compulsive disorder (OCD), tic disorder, or both suddenly appear following a streptococcal (strep) infection, such as strep throat or scarlet fever.
Anti-NMDA receptor encephalitis: Psychiatric presentation and diagnostic chal...Pawan Sharma
Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, only recently first described, is an increasingly well-recognized inflammatory encephalitis that is seen in children and adults. The highlights: Pychiatric manifestations in encephalitis and the need for the psychiatrist to a have high index of suspicion when atypical symptoms (e.g., dyskinesia, seizure, fever etc.) present in acutely psychotic patients.
Presentation USAAA conference 2009 - supports fully why this is not Kanner Autism, not developmental, not a classical genetic or developmental disorder of any kind. Shows section of truly recovered children. Recovery like this can only happen with a medical disease, not from a developmental disorder. That is the key message for all. /mjg
Somatoform disorder include different entities. One of complex and difficult to treat ailment among the somatoform disorder is illness anxiety disorder, formerly known as hypochondriasis. My power point presentation is an attempt to simplify the mystery of this common psychiatric diagnosis. (Dr Satyajeet Singh, MD, Neuropsychiatrist, Aiims Patna)
Food allergy in adults-the experience of a center in the north of portugalNatacha Santos
Couto M, Coimbra A, Silva D, Santos N, Pereira A, Plácido JL. Food allergy in adults: the experience of a center in the north of Portugal. Clinical and Translational Allergy 2013, 3(Suppl 3):66.
- 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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
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
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
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
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. INTRODUCTION
Group of neuropsychiatric disorders that are proposed to have an
autoimmune basis and to be related to infection with group A
beta-hemolytic streptococci (GAS)
Neuropsychiatric disorders- obsessive–compulsive disorder
(OCD) and tic disorder or Tourette’s syndrome
Susan E. Swedo et.al - Clinical Description of the 50 Cases
Epidemiology- true incidence/prevalance not known, rare
disorder, 10 cases were identified among 30,000 throat
cultures positive for GAS
1.http://www.uptodate.com/contents/pandas-pediatric-autoimmune-neuropsychiatric-disorder-associated-with-group-a-streptococci
2. Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections: Clinical Description of the First 50 Cases.
Susan E. Swedo et.al. Am J Psychiatry 1998; 155:264–271
3. Perrin EM. Et.al. Arch Pediatr Adolesc Med 2004; 158:848
4. EVIDENCE
Presence of antineuronal antibodies among patients with
childhood-onset OCD and/or tic disorders
Animal studies suggest these antineuronal antibodies may play
an etiologic role in these neuropsychiatric disorders
Striking effectiveness of immunomodulatory therapies, such
as therapeutic plasma exchange and intravenous immunoglobulin
(IVIG) in the PANDAS subgroup
LA Snider and SE Swedo. PANDAS: current status and directions for research. Molecular Psychiatry (2004) 9, 900–907
5. Genetic predisposition- rates of tic disorders and OCD in firstdegree relatives of children in the PANDAS subgroup are higher
than those in the general population
MRI scans- enlargements of the caudate, putamen, and globus
pallidus, which points to regional inflammatory changes
LA Snider and SE Swedo. PANDAS: current status and directions for research. Molecular Psychiatry (2004) 9, 900–907
6. CLINICAL FEATURES
Clinical Description of the 50 Cases[Susan E. Swedo.et.al(1998) ]
Age
Prepubertal (3-11), 6.3 years for tics and 7.4 years for obsessivecompulsive symptoms, 3 years younger than that from other
childhood-onset OCD and tic disorders
Sex
M:F= 2.6:1
Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections: Clinical Description of the First 50 Cases.
Susan E. Swedo et.al. Am J Psychiatry 1998; 155:264–271
7. Symptoms
primary diagnosis of OCD (N=24, 48%) and those with primary
tic disorder(N=26, 52%)
43 (86%) of the children reported obsessive-compulsive
symptoms, and 40 (80%) of the children were found to have
motor tics
severity of the obsessive-compulsive symptoms as well as motor
and vocal tics was moderate, on average
8. Symptoms of OCD varied by primary diagnosis - Children with
primary OCD reported more washing and checking behaviors
than did children with a primary diagnosis of tic disorder
Psychiatric comorbidity was common for the children with
PANDAS- ADHD, affective disorders, and anxiety disorders
were most prevalent (40%,42%, and 32%, respectively)
Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections: Clinical Description of the First 50 Cases. Susan
E. Swedo et.al. Am J Psychiatry 1998; 155:264–271
12. DIAGNOSTIC CRITERIA
Presence of OCD and/or a tic disorder
Pediatric onset: Symptoms of the disorder first become evident
between 3 years of age and the beginning of puberty
Episodic course of symptom severity: Clinical course is
characterized by the abrupt onset of symptoms or by dramatic
symptom exacerbations
Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections: Clinical Description of the First 50 Cases. Susan E.
Swedo et.al. Am J Psychiatry 1998; 155:264–271
13. DIAGNOSTIC CRITERIA(contd..)
Association with GABHS infection: Symptom exacerbations
must be temporally related to GABHS infection, i.e., associated
with positive throat culture and/or elevated anti-GABHS antibody
titers
Association with neurological abnormalities- During symptom
exacerbations, patients will have abnormal results on neurological
examination. Motoric hyperactivity and adventitious movements
(including choreiform movements or tics) are particularly common
Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections: Clinical Description of the First 50 Cases. Susan E. Swedo
et.al. Am J Psychiatry 1998; 155:264–271
14. Sydenham Chorea Versus PANDAS
Feature
Sydenham chorea
PANDAS
Age at onset (yr)
5–15
6–9 years
Male:female
Close to 1:1 most studies
2.6:1
Typical duration
1–6 mths
Relapsing-remitting course
Time lag between inciting
infection/symptom
Longer
Shorter
Association with rheumatic fever
Characteristic. A ‘‘major’’ Jones
criterion
Rare
Association with carditis
Common (25–80%)
Rare
Association with arthritis
Common
Rare
Presence of chorea
Obligatory
Rare; mild if present
Presence of tics
Uncommon
Characteristic
Presence of OCD
Frequent
Characteristic
Clinical signs of motor
impairment (milkmaid’s
grisp, darting tongue)
Present
Present in 30–40% of cases
Antineuronal antibodies
Common; usually anti–basal
ganglia
Common; usually anti–basal
ganglia
Putative GABHS M-protein
subtypes involved
M6, lesser extent M5, M19
M12, lesser extent M3, 13, 11, 1
15. Evidence against
negative reports from investigators who were not able to induce
behavioral changes through an infusion
isolated group A b-hemolytic streptococcal infection is common
in children-GAS accounts for 15 to 30 percent of all cases of
pharyngitis in children between the ages of 5 and 15 years
Prospective surveillance identified GAS carriage in 2.5 percent
of well children and 4.4 percent of children with URI (including
a sore throat)
1.http://www.uptodate.com/contents/pandas-pediatric-autoimmune-neuropsychiatric-disorder-associated-with-group-a-streptococci
2. Piero Pavone et.al. J Child Neurol 2006;21:727–736
16. OCD occurs in 1 to 2 percent of school-age children and
transient motor tics in as many as 25 percent
Occurrence of OCD/Tics with GAS- coincidental
1.http://www.uptodate.com/contents/pandas-pediatric-autoimmune-neuropsychiatric-disorder-associated-with-group-a-streptococci
2. Piero Pavone et.al. J Child Neurol 2006;21:727–736
17. MANAGEMENT
Therapy for GAS infection
Therapy for OCD/Tic disorder
Immunomodulatory therapy ?
Prophylactic therapy ?
18. GAS infection
Children with positive culture or rapid antigen detection test for
GAS - antistreptococcal therapy ↓ incidence suppurative
complications, ↓ nonsuppurative complications, ↓ the risk of
transmission
no randomized controlled trials of antibiotic treatment of
children suspected of having PANDAS syndrome
http://www.uptodate.com/contents/pandas-pediatric-autoimmune-neuropsychiatric-disorder-associated-with-group-a-streptococci
19. Prospective study(Murphy. et.al., 2002)
Children with abrupt onset of neuropsychiatric symptoms and
evidence of recent GAS infection, antistreptococcal (penicillin or
cephalosporin) therapy was associated with prompt symptom
resolution in all cases
Antistreptococcal therapy also was associated with prompt
resolution of symptoms in patients who developed recurrent
symptoms associated with GAS infection
mean time to resolution of symptoms was shorter among
children treated with cephalosporin than with penicillin (14
versus 5 to 6 days)
Murphy ML et.al. Prospective identification and treatment of children with pediatric autoimmune neuropsychiatric disorder associated with group A
streptococcal infection (PANDAS). Arch Pediatr Adolesc Med 2002; 156:356.
20. Neuropsychiatric therapy
Manifestations respond to treatment with standard
pharmacologic and behaviour therapies
Evidence-based treatment for OCD
Pharmacological- SSRIs first-line pharmacological treatment,
Nonpharmacological interventions - cognitive behavioral
therapy (ie, exposure and response prevention) is considered
first- line nonpharmacological treatment
1.http://www.uptodate.com/contents/pandas-pediatric-autoimmune-neuropsychiatric-disorder-associated-with-group-a-streptococci
2. Vilma Gabbay et.al . Pediatrics 2008;122;273
22. Immune modulating therapy
Glucocorticoids, plasma exchange, and intravenous
immunoglobulin (IVIG)
Treatment of PANDAS with immune modulating therapies-not
recommended outside of the research setting
May be considered an alternative for severely ill patients who
have not responded to standard therapies
1.http://www.uptodate.com/contents/pandas-pediatric-autoimmune-neuropsychiatric-disorder-associated-with-group-a-streptococci
23. Prophylactic therapy
Prophylactic antibiotics to prevent recurrences of PANDAS- not
recommended
Prospective case-control study (Shulman ST et.al, 2009) continuous prophylaxis against GAS might prevent an average of
0.06 exacerbations per patient-year
Shulman ST et. al. Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS): update. Curr Opin Pediatr
2009; 21:127
24. PROGNOSIS
Long-term outcome of children who meet criteria for PANDAS
is not known
Unrecognized PANDAS and untreated PANDAS may result in
an increased risk of progression to lifelong OCD and tic
disorders
1.
2.
Dale RC, Heyman I, Giovannoni G, Church AW. Incidence of anti-brain antibodies in children with obsessive-compulsive disorder. Br J
Psychiatry 2005; 187:314
http://www.uptodate.com/contents/pandas-pediatric-autoimmune-neuropsychiatric-disorder-associated-with-group-a-streptococci
25. SUMMARY AND CONCLUSION
Subset of children whose symptoms of obsessive compulsive
disorder (OCD) or tic disorders are exacerbated by group A
streptococcal (GAS) infection- hypothesized association
between PANDAS and GAS is controversial
PANDAS, five working criteria
OCD and/or tic disorder
Pediatric onset (between three years and onset of puberty)
Abrupt onset and episodic course of symptoms
Temporal relation between GAS infection and onset and/or
exacerbation
Neurologic abnormalities or tics during exacerbations
26. Children who present with abrupt onset of OCD/tic disorder be
evaluated for GAS infection
Children with abrupt onset OCD and/or tic disorders and evidence
of GAS infection - be treated with antistreptococcal therapy
along with standard neuropsychiatric treatment for OCD/tic
disorder
Treatment with immune-modulating therapies outside of the
research setting not recommended
Use of prophylactic antibiotics to prevent recurrences of
PANDAS not recommended