Pulmonary vasculitis refers to inflammation of blood vessels in the lungs which can be caused by various autoimmune disorders. The document discusses several types of pulmonary vasculitis including Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA), and Eosinophilic Granulomatosis with Polyangiitis (EGPA). GPA is characterized by necrotizing granulomatous inflammation and vasculitis primarily affecting the lungs and kidneys. MPA clinically resembles GPA but without granulomatous lesions. EGPA involves asthma, eosinophilia, and necrotizing vasculitis. Treatment involves inducing remission using glucocorticoids
This presentation is about pulmonary manifestations of systemic vasculitis,in it m discussing about WEGNER,S GRANULOMATOSIS, churg-strauss syndrome and MPA
This presentation is about pulmonary manifestations of systemic vasculitis,in it m discussing about WEGNER,S GRANULOMATOSIS, churg-strauss syndrome and MPA
New technology called Electromagnetic Navigation Bronchoscopy® (ENB) that uses virtual bronchoscopy and real time 3-dimensional CT images that enable me to localize these peripheral lung nodules for diagnosis and treatment. This outpatient procedure is minimally invasive and therefore has a small risk of pneumothorax (2-3%) and its published diagnostic yield rates range from 67% - 86%
Practical approach to interstitial lung diseases Hamdi Turkey
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
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Bronchial Thermoplasty (BT) Novel Treatment for Patients with Severe AsthmaBassel Ericsoussi, MD
Do our Asthma Patients Know What They Are Missing?Now, A Revolutionary Procedure Can Help Them Lead A Fuller Life.
Bronchial Thermoplasty (BT) Novel Treatment For Patients With Severe Asthma
New technology called Electromagnetic Navigation Bronchoscopy® (ENB) that uses virtual bronchoscopy and real time 3-dimensional CT images that enable me to localize these peripheral lung nodules for diagnosis and treatment. This outpatient procedure is minimally invasive and therefore has a small risk of pneumothorax (2-3%) and its published diagnostic yield rates range from 67% - 86%
Practical approach to interstitial lung diseases Hamdi Turkey
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
Do Not Forget To Visit Our Pages On Facebook on the following Links:
https://www.facebook.com/groups/569435236444761/
AND
https://www.facebook.com/groups/690331650977113/
Bronchial Thermoplasty (BT) Novel Treatment for Patients with Severe AsthmaBassel Ericsoussi, MD
Do our Asthma Patients Know What They Are Missing?Now, A Revolutionary Procedure Can Help Them Lead A Fuller Life.
Bronchial Thermoplasty (BT) Novel Treatment For Patients With Severe Asthma
Surgery before anesthesia and antibiotics was fast and invariably fatal. It involved potential risk of more damage than benefits. We still have many surgeons, managing benefits to some patients.
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
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.
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
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
- 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
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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
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.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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
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.
2. Introduction
• Usually a manifestation of a systemic disorder
• Inflammation of vessels of different sizes by a
variety of immunological mechanisms
• Types- primary and secondary
4. ANCA = Anti-Neutrophil Cytoplasmic Antibodies
• Proteinase 3 (PR3) and Myeloperoxidase (MPO) are
present in granules of neutrophils/monocytes.
• ANCA are auto-antibodies against these antigens
C-ANCA: Diffuse, granular staining
PR3 Abs
P-ANCA: Perinuclear staining
MPO Abs
5. Granulomatosis with Polyangiitis
• Necrotizing granulomatous
inflammation+necrotizing vasculitis
• Most frequently involved sites-upper airways,
lungs, and kidneys
• Two forms- Limited or Severe
10. Histopathology
• Earliest lesion - Small necrotizing
microabscesses
• Necrotizing granulomatous inflammation +
small vessel vasculitis
• mixed cellular infiltrate containing
lymphocytes, plasma cells, scattered giant
cells, and eosinophils
11. Glomerulonephritis
• Kidneys are affected in 80% of
patients
• Microscopic hematuria and
red cell casts, proteinuria and
declining renal function
• Renal biopsy - segmental,
necrotizing inflammation and
cellular crescents
12. Microscopic Polyangiitis
• Histopathologically indistinguishable from GPA
• All organ systems may be involved
• Kidneys are most commonly affected (80%)
• Diffuse alveolar hemorrhage (10% to 30%)
• Most frequent cause of pulmonary renal
syndrome
13. Clinical presentation
• Palpable purpura
• Arthralgias and myalgias
• Gastrointestinal involvement occurs in about
1/3rd of patients – rarely seen in GPA
• Sinusitis and asthma are rarely found
14. Diagnosis
• 40% to 80% cases have p-ANCA
• Histopathological diagnosis may be necessary to
confirm the diagnosis
• Renal biopsy - pauci-immune focal segmental
necrotizing glomerulonephritis, with crescents
• Granulomatous inflammation is not a feature of MPA
15. Eosinophilic Granulomatosis with
Polyangiitis
• Necrotizing granulomatous inflammation and
vasculitis + Asthma + Eosinophilia
• Usually p-ANCA +
• ANCA status appears to correlate with disease
activity
16. Phases of the disease
PHASES CHARACTERISTIC
FEATURE
DURATION
1. Prodromal
allergic phase
Asthma Number of years
2. Eosinophilic
phase
Prominent
peripheral and
tissue
eosinophilia
Number of years
And the
manifestations
may remit and
recur
3. Vasculitic
phase
Systemic
vasculitis
Life threatening
Prognosis is better than that of GPA and MPA
Most deaths are secondary to cardiac involvement
17. Clinical presentation
• Pulmonary parenchymal involvement occurs in
38% of patients
• Alveolar hemorrhage is exceedingly rare
• Renal involvement is less prominent
• Peripheral nerve involvement, typically in the
form of mononeuritis multiplex, is more frequent
20. Pathophysiology of ANCA-Associated
Vasculitis
• Etiology of ANCA-associated vasculitis remains
unknown
• Causes of the production and persistence of ANCA
remain poorly understood
• ANCA production maybe the result of molecular
mimicry
• Many clinical observations suggest that the presence
and type of ANCA defines the disease phenotype
21. Goals of treatment in GPA/MPA
1. Induce early remission of active disease
2. Reduce disease relapse
3. Minimize therapeutic toxicity
4. Surgical interventions to repair damage
22. Remission Induction Therapy
• According to degree of disease severity, extent
and acuity.
1. Indolent GPA localized to the upper and/or
lower airways, ANCA negative –
Trimethoprim/Sulfamethoxazole at a dose of
160/800 mg twice daily
23. 2. Limited or non-severe or early-systemic –
• oral prednisone - 0.5 to 1 mg/kg per day
(generally not to exceed 80 mg/d)
• in combination with methotrexate with a
target dose of 20 to 25 mg once a week, orally
or subcutaneously
24. 3. Severe disease (generalized or organ-
threatening disease) –
a) oral prednisone in combination with oral
cyclophosphamide at a dose of 2 mg/kg daily
for 3 to 6 months
25. b) Rituximab - once-weekly doses (375 mg/m2
of body surface) for 18 months
c) daily oral cyclophosphamide followed by
azathioprine for 18 months
• 90% of patients attain remission with either of
these 3 regimens
26. 4. Rapidly progressive fulminant disease –
• Intravenous methy-lprednisolone, 1000
mg/day for 3 to 5 days
• Plasma exchange
27. Remission Maintenance Therapy
• Prednisone - tapered over 5-6 months with
the goal of complete discontinuation
• Limited disease -methotrexate
• Patients with cyclophosphamide for induction
should be switched to methotrexate or
azathioprine
28. • Azathioprine is preferred in patients with any
degree of renal insufficiency
• Alternative - Mycophenolate mofetil
• Duration of emission maintenance - at least 12
months, longer in relapse cases
• Early discontinuation of immunosuppressive
therapy is associated with an unduly high relapse
rate
29. Treatment of Patients Refractory to
Standard Therapy
• 10% cases are refractory
• Rituximab - standard of care for refractory
GPA
• Anti–TNF-α agents has been tried
30. Treatment of EGPA
• Systemic glucocorticoids are the cornerstone
of therapy
• Cyclophosphamide added to glucocorticoids
for remission induction
• Refractory disease - interferon-α therapy