This document discusses nerve biopsy interpretation. It begins by describing nerve anatomy and indications for biopsy such as vasculitis and neuropathy. The sural nerve is preferred for biopsy due to its sensory function and distal location. Processing involves formalin, glutaraldehyde and cryosectioning. Stains identify morphology, myelin, and amyloid. Features to examine include vasculature, demyelination, regeneration, and inflammation. Common neuropathies discussed are diabetic, inflammatory, leprosy, vasculitic and amyloid. Biopsy can reveal axonal damage or demyelination.
A brief coverage of all IIM, including major junk of #Polymyositis, #Dermatomyositis #InclusionBodyMyositis and other IIM's.
Includes classification, characteristic features of all and specific features of each of them with diagnosing and approach to management.
NB: This presentation is equipped with animations, which might not work on slideshare
A brief coverage of all IIM, including major junk of #Polymyositis, #Dermatomyositis #InclusionBodyMyositis and other IIM's.
Includes classification, characteristic features of all and specific features of each of them with diagnosing and approach to management.
NB: This presentation is equipped with animations, which might not work on slideshare
about nerve fibers
It is the structural and the functional unit of nervous system.
The human nervous system contains approximate 1012 neurons.
A nerve fiber is a thread like extension of a nerve cell and consists of an axon and myelin sheath (if present) in the nervous system.
In peripheral nervous system it is formed by
schwann’s cell. While in case of central nervous system it is formed by oligodendroglia.
The places ,where myelin sheath is absent are called node of ranvier(2-3µm) and these are present once about 1-3 mm distance along the myelin sheath.
IT PREVENTS LEAKAGE OF IONS BY 5000 FOLDS.
IT INCREASES VELOCITY OF CONDUCTION BY 5-50 FOLDS DUE TO
SALTATORY CONDUCTION i.e. ABOUT 100 m/s IN CASE OF
MYELINATED NERVE FIBERS WHILE IN NONMYELINATED
IT IS ABOUT 0.25 m/s.
SALTATORY CONDUCTION CONSERVES ENERGY BECAUSE ONLY NODES OF RANVIER GET DEPOLARISED.
These are α type motor nerve fibers.
The neurotransmitter released at the neuron endings is acetylcholine(Ach).
It always leads to muscles excitation . Inhibition takes place centrally due to participation of interneurons.
they innervate smooth muscles , cardiac muscles and glands.
Their main work is to maintain homeostasis with the help of autonomic nervous system.
they can lead to either excitation or inhibition of effector organs
Erlanger and Grasser studied the action potential of mixed nerve trunk by means of cathode ray oscilloscope and they obtained the compounded spike. So they divided nerve fibers into 3 groups. They observed that the main cause of difference in nerve fibers is diameter
AS Diameter increases
Velocity of conduction increases.
Magnitude of electrical response increases.
Threshold of excitation decreases.
Duration of response decreases.
Refractory period decreases.
Factors associated with developing esophageal adenocarcinoma in Barett's esop...Dr Sayan Das
Based on the study “Rates and predictors of progression to esophageal carcinoma in a large population-based Barrett’s esophagus cohort” by Krishnamoorthi R et al published in “HHS Public Access” on 2016 July
Ground water Arsenic Contamination in IndiaDr Sayan Das
Extent, related research and remedication meassures
Chemistry of arsenic, Use of arsenic, reference value , Oxidation method, Ion exchange method, Membrane method
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
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
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.
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
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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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.
Evaluation of antidepressant activity of clitoris ternatea in animals
Peripheral nerve biopsy
1. Interpretation of Nerve Biopsy
by Dr. Sweta Biswas Das
3rd year PGT student
Department of Pathology
2. INTRODUCTION
Each peripheral nerve
composed of one or more
bundles (fascicles)
Each nerve fibre
surrounded by loose
vascular supporting tissue
endoneurium
Each fascicle surrounded
by condensed
collagenous tissue
perineurium
All fascicles are
surrounded by loose
collagenous tissue
epineurium
5. SELECTING THE NERVE FOR BIOPSY
Distal lower limbs –Sural nerve or superficial peroneal
nerve
Upper limbs-Superficial radial nerve or a branch of ulnar
nerve
Progressive optic neuropathy-Optic nerve biopsy
6. SURAL NERVE BIOPSY
Easily identifiable .
Purely sensory – No motor
deficit occur following biopsy.
Liable to be affected by
neuropathy
distal branch of a long nerve.
7. PROCESSING OF NERVE BIOPSY
1.5 2 1.5 5 cm
Neutral-buffered formalin 4 % Glutaraldehyde -180°C liquid Nitrogen
Paraffin section Semithin section
Thin section for EM
Frozen section
H&E
Modified trichrome
Congo red
Toluidine blue
Toluidine blue and
basic fuchsin
H&E
Modified trichrome
Congo red
Cresyl-fast-violet
8. Advantages and Disadvantages of tissue Sections
Frozen section Rapid diagnosis
Immunofluorescent studies
Relative ease for preserving
the longitudinal section for
segmental demyelination
Detail of the cells are not
clear
Paraffin section Details of cell and
anatomical structure
Artifact is unavoidable
Semithin section Detection thinly myelinated
fibers
Detection of onion bulb
Detection clustering of
regenerated fibers
Special training
EM section
The only test for the
unmyelineated fibers
Special training
9. STANING
Different stains Staining for
H&E Morphology, Vasculitis, Inflammation,
Myelin ovoids, axonal degeneration
Masson's Trichrome Fibrosis, Hyalinisation,Vessels
Luxol fast blue Myelin
Toluidine Myelin
Congo red Amyloid
IHC EMA ,S100,MBP,PMP22
13. WHAT TO LOOK FOR
Status of the epineurium including the blood vessels
Alterations in the perineurium
Endoneurium oedema
Density of the large and small myelinated nerve fibers
Extent of axonal degeneration and atrophy
Frequency of bands of Bungner and Myelin
degeneration
Number of macrophages cluster
Onion bulb formation
Inflammatory infiltrates
Presence/absence of amyloid
14. Wallerian degeneration
Degeneration of axon
distally following its
interruption
Distal to injury the axon
disintegrates and the myelin
breaks up into globules
Macrophages participate in
the removal of axonal and
myelin debris
Approximation of nerve
ends result in regeneration,
the basement membrane
of the schwann cell survives
and acts as skeleton along
which the axon regrows
15. SEGMENTAL DEMYELINATION
Scattered destruction
of the myelin sheath
occurs without axonal
damage
The primary lesion
affects the schwann
cell. Prognosis for
recovery is good
because the muscle is
not denervated
17. ONION BULB FORMATION
Refers to the concentric laminated layers surrounding
the nerve fibre.
Best detected in the semithin section
Pathogenetically , onion bulb formation is indication of
repeated demyelination and remyelination
19. INFLAMMATORY DEMYELINATING
POLYNEUROPATHY
Acute- Guillain Barré Syndrome
Acute onset immune mediated demyelinating
neuropathy
Weakness beginning in the distal limbs and rapidly
advances to affect proximal muscle function(ascending
paralysis)
Prior history of viral infection
Hallmark of inflammatory neuropathy- presence of
inflammatory cells in the endoneural space of the nerve
Inflammatory cells are primarily responsible for the
macrophage induced demyelination in these neuropathy
20. Chronic inflammatory Demyelinating Poly
radiculoneuropathy
Symmetrical mixed sensorimotor polyneuropathy that
persists for more than 2 months
Evidence of recurrent demyelination and remyelination
associated with proliferation of Schwann cells
,formation of onion bulbs
INFLAMMATORY DEMYELINATING
POLYNEUROPATHY
22. LEPROSY
M. leprae is the bacterium that invades peripheral
nerve
Common nerves are
Ulnar nerve at the elbow
Deep peroneal branch at the ankle
23. TUBERCULOID LEPROSY
Pathological hallmark is an intense inflammatory
granulomatous lesion that severely damages the neural
architecture
Axon ,schwann cells and myelin lost
Granulomas in the epineural and perineural spaces &
edoneural space.
Bacilli are scanty ,
Localized nerve involvement
Healing –fibrosis and hyalization in the endoneurium
and thick perineurial and epineurial sheaths
25. LEPROMATOUS LEPROSY
Perineural and endoneural infiltration of enlarged
macrophages and Schwann cells with M leprae bacilli
and inflammatory cells.
In severe cases the epineurium may be infiltrated by
huge numbers of foamy cells especially around blood
vessels.
Granulomatous inflammatory response minimal.
Segmental demyelination and remyelination and loss of
both myelinated and unmyelinated axon
Symmetric polyneuropathy
27. DIABETIC NEUROPATHY
Ascending distal symmetric sensorimotor
polyneuropathy
Patients may be both type 1 and type 2
Nerve biopsy show reduced numbers of axons,
degenerating myelin sheaths and regenerative axonal
clusters,
Endoneurial arterioles show thickening ,hyalinization
33. AMYLOID NEUROPATHY
Neuropathies are usually distally accentuated and
symmetrical, and multiple mono neuropathies may
occur
Predominantly of axonal type
Amyloid may be deposited within endoneurium ,and
epineurial vasculature
Stain-Congo red and Thioflavin S or T