Systemic lupus erythematosus (SLE) is an autoimmune disease in which organs and cells undergo damage mediated by tissue binding autoantibodies and immune complexes.
90 % of patients at diagnosis are women of childbearing age groups.
Highest prevalence is in black women and lowest is in white men.
Pathogenesis systemic lupus erythematosus by dr bashir ahmed dar associate pr...Prof Dr Bashir Ahmed Dar
Systemic lupus erythematosus is a chronic, multisystem, inflammatory disorder of autoimmune etiology, occurring predominantly in young women. Common manifestations may include arthralgias and arthritis; malar and other skin rashes; pleuritis or pericarditis; renal or CNS involvement; and hematologic cytopenias.
Meningococci are a type of bacteria that cause serious infections. The most common infection is meningitis, which is an inflammation of the thin tissue that surrounds the brain and spinal cord. Meningococci can also cause other problems, including a serious bloodstream infection called sepsis. In its early stages, you may have flu-like symptoms and a stiff neck. But the disease can progress quickly and can be fatal. Early diagnosis and treatment are extremely important. Lab tests on your blood and cerebrospinal fluid can tell if you have it. Treatment is with antibiotics. Since the infection spreads from person to person, family members may also need to be treated.
A vaccine can prevent meningococcal infections.
Non-typhoidal Salmonellosis, is one of the most common and widely distributed foodborne diseases, with tens of millions of human cases occurring worldwide every year.
In the United States, the incidence of NTS infection has doubled in the past 2 decades.
In 2009 there were 14 million cases of NTS.
Pathogenesis systemic lupus erythematosus by dr bashir ahmed dar associate pr...Prof Dr Bashir Ahmed Dar
Systemic lupus erythematosus is a chronic, multisystem, inflammatory disorder of autoimmune etiology, occurring predominantly in young women. Common manifestations may include arthralgias and arthritis; malar and other skin rashes; pleuritis or pericarditis; renal or CNS involvement; and hematologic cytopenias.
Meningococci are a type of bacteria that cause serious infections. The most common infection is meningitis, which is an inflammation of the thin tissue that surrounds the brain and spinal cord. Meningococci can also cause other problems, including a serious bloodstream infection called sepsis. In its early stages, you may have flu-like symptoms and a stiff neck. But the disease can progress quickly and can be fatal. Early diagnosis and treatment are extremely important. Lab tests on your blood and cerebrospinal fluid can tell if you have it. Treatment is with antibiotics. Since the infection spreads from person to person, family members may also need to be treated.
A vaccine can prevent meningococcal infections.
Non-typhoidal Salmonellosis, is one of the most common and widely distributed foodborne diseases, with tens of millions of human cases occurring worldwide every year.
In the United States, the incidence of NTS infection has doubled in the past 2 decades.
In 2009 there were 14 million cases of NTS.
Systemic Lupus erythematous , is world wide health problem
Here we talk about criteria for diagnosis investigation , Management and complication
With some scenarios to about disease and complication
Systemic Lupus-erythmatosus a detailed review.pdfUsamaSaleem91
Systemic lupus erythmatosus is an autoimmune disease affecting multiple organ systems. This presentation almost describes everything you need to know about this disease. A proper knowledge of this disease is necessary for healthcare professionals specially those related to medicine and rheumatology.
This presentation encompasses SLE as well Lupus nephritis,Antiphospholipid Syndrome and other special situation related to SLE such as SLE and Pregnancy.
Similar to Recent advances in diagnosis & management of SLE (20)
Clinical diagnosis of MI requires a syndrome indicative of myocardial ischemia with some combination of myocardial necrosis detected by biochemical, ECG, or imaging modalities
Rheumatic fever- a multifactorial disease that follows GAS pharyngitis in a susceptible individual who lives under deprived social conditions, characterized by acute inflammation of the heart, joints, skin, subcutaneous tissue & CNS, that gives rise to typical clinical feature including Arthritis, Carditis, Chorea, Subcutaneous nodules & Erythema marginatum.
Latent period of 2-3 weeks following GAS pharangitis.
Destructive effects on heart valves leads to RHD with serious hemodynamic disturbances causing HF, stroke & infective endocarditis.
PCI is one of the most common procedures in the US, and remain a cornerstone in the management of ischemic heart disease.
Historically, a large proportion of PCI procedures were performed during inpatient hospitalization, allowing for a significant amount of time for monitoring postprocedure to ensure procedural success & identify bleeding or vascular complications, as well as for initiating secondary prevention.
However, technological pharmacological and procedural innovations, as well as payer expectations and cost considerations, have led to a shorter length of stay postprocedure and obviate hospital admission.
Most non-acute MI PCIs performed in the US now are performed under an outpatient designation.
Acute chest pain is one of the most common reason for seeking care in the emergency department (10% of all visits)
Only 10-15% of patients with chest pain actually have ACS.
Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Liver Dis...Shadab Ahmad
Guidelines for the treatment of nonvalvular atrial fibrillation (AF) recommend oral anticoagulation (OAC) for stroke prevention with either warfarin or direct oral anticoagulants (DOACs), with a stronger recommendation for DOACs in the general population.
Advanced liver disease is known to increase the risk for bleeding and affects the hepatic clearance and metabolism of drugs.
Even so, OAC is associated with a lower risk for ischemic stroke and no difference in bleeding, including intracranial hemorrhage (ICH), in patients with AF and liver cirrhosis, and thus OAC should still be considered in this population.
Residual Inflammatory Risk in Patients With Low LDL Cholesterol Levels Underg...Shadab Ahmad
Patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) are at high risk of future adverse ischemic events.
Indeed, increased inflammatory status pre- and post-PCI has also been associated with poor prognosis, and control of the residual inflammatory risk (RIR) in the CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) trial has recently opened new perspectives in the field of secondary prevention.
Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low...Shadab Ahmad
The role of transcatheter aortic valve replacement (TAVR) in the treatment of patients with severe, symptomatic aortic stenosis has evolved on the basis of evidence from clinical trials.
Previous randomized trials of TAVR with both balloon-expandable valves and self-expanding valves showed that, in patients who were at intermediate or high risk for death with surgery, TAVR was either superior or noninferior to standard therapies, including surgical aortic-valve replacement.
However, most patients with severe aortic stenosis are at low surgical risk, and there is insufficient evidence regarding the comparison of TAVR with surgery in such patients.
Infusion Needle Radiofrequency Ablation for Treatment of Refractory Ventricul...Shadab Ahmad
Catheter ablation is an important therapy to prevent and reduce recurrent episodes of ventricular tachycardia (VT) in patients who have implanted defibrillators (ICDs) and premature ventricular beats and nonsustained VT causing significant symptoms or contributing to depressed ventricular function.
Following enhancements to the catheter design, this U.S. Food and Drug Administration investigational device exemption trial was initiated to assess the safety and outcome of RF needle infusion ablation in patients with recurrent ventricular arrhythmias that had failed control with conventional irrigated RF ablation and antiarrhythmic drug therapy.
Percutaneous Transcatheter Mitral Valve ReplacementShadab Ahmad
Symptomatic mitral regurgitation (MR) conveys significant morbidity and mortality. However, many patients with severe MR are not treated with surgery due to advanced age, left ventricular (LV) dysfunction, or other comorbidities. This unmet clinical need has driven the development of safer, catheter-based treatments for mitral valve disease.
Transcatheter mitral valve repair can be safe and effective in patients with suitable anatomy.
Long-Term Durability of Transcatheter Aortic Valve ProsthesesShadab Ahmad
Assessments of valve function in the early randomized trial cohorts and registries have consistently shown preserved valve function up to 5 years after TAVR. However, it is well recognized that structural valve degeneration (SVD) with surgical aortic valve bioprostheses is usually not seen until 5 to 10 years post-procedure, and data in this time frame following TAVR are very sparse
Cardiac Troponin Elevation in Patients Without a Specific DiagnosisShadab Ahmad
Measurement of cardiac troponin (cTn) levels is a cornerstone in the assessment of patients with acute chest pain.
An elevation in the cTn level together with a significant change in the setting of coronary ischemia indicates myocardial infarction (MI).
However, even other cardiac and noncardiac conditions may result in acute cTn increases (e.g., arrhythmias, severe hyper- or hypotension, pulmonary embolism, neurologic events, or endurance efforts).
Acute but subtle increases in cTn levels may also be difficult to distinguish from chronic cTn elevation which is a common finding in the elderly, patients with renal failure, or patients with chronic cardiac conditions.
His Resynchronization Versus Biventricular Pacing in Patients With Heart Fail...Shadab Ahmad
This study tested the ability of HBP to deliver resynchronization and then compared the electromechanical effects of His resynchronization against conventional BVP, using high-precision hemodynamic assessment and noninvasive epicardial ventricular activation mapping
Alirocumab and Cardiovascular Outcomes after Acute Coronary SyndromeShadab Ahmad
Studies have shown that mutations conveying gain or loss of function of PCSK9 result in a higher or lower level of LDL cholesterol, respectively, which in turn is associated with a corresponding higher or lower risk of incident coronary heart disease. These findings have led to the development of monoclonal antibodies to PCSK9 that produce substantial reductions in LDL cholesterol when administered alone or with a statin
Angiotensin neprilysin inhibition in acute decompensated heart failureShadab Ahmad
Sacubitril–valsartan is an angiotensin receptor– neprilysin inhibitor that is indicated for the treatment of patients with symptomatic heart failure with reduced ejection fraction
Rivaroxaban for thromboprophylaxis after Hospitalization for Medical IllnessShadab Ahmad
Anticoagulant prophylaxis reduces the risk of in-hospital venous thromboembolism by 50 to 60% but is rarely continued after discharge in accordance with current guidelines
A Study of Chest X-Ray PA View & Lateral ViewsShadab Ahmad
X-ray is a form of electromagnetic radiation.
Frequencies in the range 30 petahertz to 30 exahertz (3×10^16 Hz to 3×10^19 Hz)
Energies in the range 100 eV to 100 keV.
It a type of ionizing radiation, and therefore harmful to living tissue.
A No-Prophylaxis Platelet-Transfusion Strategy for Hematologic CancersShadab Ahmad
The effectiveness of platelet transfusions to prevent bleeding in
patients with hematologic cancers remains unclear.
This trial assessed whether a policy of not giving prophylactic platelet
transfusions was as effective and safe as a policy of providing prophylaxis.
In patients with hematologic cancers, severe thrombocytopenia
frequently develops as a consequence of the disease or its treatment.
Probability of cancer in pulmonary nodules detected on first screening CT scanShadab Ahmad
More than 20% of participants in low-dose CT screening programs were found on their first scan to have one or more lung nodules that required further investigation.
Influence of the Timing of Malaria Infection during pregnancy on birth weight...Shadab Ahmad
Malaria infection during pregnancy is a significant cause of maternal, fetal, and infant mortality and morbidity.
Malaria in pregnancy is associated with maternal anemia, premature delivery, and intrauterine growth retardation.
The period of malaria infection during pregnancy, which has the highest impact for the mother and the baby, is still an open question.
Endocarditis in adults with bacterial meningitisShadab Ahmad
Bacterial meningitis is a life-threatening disease that is associated with considerable mortality and morbidity.
Currently, Streptococcus pneumoniae is responsible for 70% of the cases in Europe and the United States.
Bacterial meningitis is often related to other foci of infection outside the central nervous system such as pneumonia, sinusitis, or otitis.
An uncommon focus of bacterial meningitis is infective endocarditis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
- 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
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
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
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
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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Recent advances in diagnosis & management of SLE
1. Recent Advances in Diagnosis &
Management of SLE
Speaker- Dr. Shadab Ahmad
2. Definition
Systemic lupus erythematosus (SLE) is an autoimmune disease in which
organs and cells undergo damage mediated by tissue binding
autoantibodies and immune complexes.
• 90 % of patients at diagnosis are women of childbearing age groups.
• Highest prevalence is in black women and lowest is in white men.
3. Risk factors
• Female sex
• Black ethnic groups
• Exposure to UV light
• Epstein-Barr virus (EBV) infection
• Tobacco smoking
• Prolonged occupational exposure to silica
4. Female sex is permissive for SLE because
• Hormone effects
• Genes on X- chromosome
• Epigenetic differences between genders
• Estradiol binds to receptors on T and B lymphocytes, increasing
activation and survival of those cells, thus favoring prolonged immune
response.
• So, women exposed to estrogen containing OCPs and hormone
replacement therapy have an increased risk of developing SLE.
• People with more X- chromosome (XXY karyotype, Klinefelter’s
syndrome) have a significantly increased risk for SLE.
6. Autoantibodies in SLE
Antibodies Antigen Recognized
ANA Multiple nuclear antigens
Anti-dsDNA dsDNA
Anti-Sm Protein complexed to 6 species of nuclear U1 RNA
Anti-RNP Protein complexed to U1 RNA-gamma
Anti-Ro (SS-A) Protein complexed to hY RNA (60 kDa, 52 kDa)
Anti La (SS-B) Protein complexed to hY RNA (47 kDa)
Anti-histone Histone associated with DNA(in nucleosome, chromatin)
Antiphospholipid Phospholipids, beta-2 glycoprotein 1 cofactor,
prothrombin
Antierythrocyte Erythrocyte membrane
Antiplatelet Surface and altered cytoplasmic antigens on platelets
Antineuronal (anti-glutamate receptors) Neuronal and lymphocyte surface antigens
Antiribosomal P Protein on ribosomes
7. New Antibodies
Antibodies Used as marker of Role in SLE
Anti-nucleosome antibodies Disease activity and organ
involvement
Drug induced lupus, lupus
nephritis, lupus flares
Anti-C-1q antibodies Disease activity and organ
involvement
Nephritic flares
NMDA receptor antibody Neuronal damage Neuropsychiatric disease
Anti-Alpha actinin antibody Disease activity, renal involvement Lupus nephritis
9. ACR Criteria
Malar rash Fixed erythema, flat or raised, over malar eminence
Discoid rash Erythematous circular raised patches with adherent keratotic scaling and follicular
plugging; atrophic scarring may occur
Photosensitivity Exposure to ultraviolet light causes rashes
Oral ulcers Includes oral and nasopharyngeal ulcers, observed by physician
Arthritis Nonerosive arthritis of two or more peripheral joints, with tenderness, swelling, or
effusion
Serositis Pleuritis or pericarditis documented by ECG or rub or evidence of effusion
Renal disorder Proteinuria >0.5 g/d or 3+, or cellular casts
Neurologic disorder Seizures or psychosis without other causes
Hematologic disorders Hemolytic anemia or leukopenia (<4000/dl) or lymphopenia (<1500/dl) or
thrombocytopenia (<1,00,000/dl) in absence of offendidng drugs
Immunologic disorder Anti-dsDNA, anti-Sm, and/or anti-phospholipid
Antinuclear antibodies An abnormal titer of ANA by immunofluorescence or an equivalent assay at any point
in time in the absence of drugs known to induce ANAs
Sensitivity is – 75%
Specificity is – 95%
10. SLICC criteria
(Systemic Lupus International Collaborating Clinics Classification 2012 )
Clinical Criteria
Acute Cutaneous lupus Lupus malar rash, bullous lupus, toxic epidermal necrolysis variant of SLE, maculopapular lupus
rash, photosensitivity lupus rash (in absence of dermatomyositis)
Chronic Cutaneous lupus Classic discoid rash localized (above the neck) or generalized (above and below neck),
hypertrophic (verrucous) lupus, lupus panniculitis (profundus), mucosal lupus, chilblains lupus,
discoid lupus/lichen planus overlap
Oral Ulcers or Nasal
Ulcers
Oral: palate, buccal, tongue, nasal ulcers. In the absence of other causes, such as vasculitis,
Behcet’s disease, infection, inflammatory bowel disease, reactive arthritis, and acidic foods
Non-scarring alopecia Diffuse thinning or hair fragility with visible broken hairs, in the absence of other causes such as
alopecia areata, drugs, iron deficiency, and androgenic alopecia
Synovitis involving 2 or
more joints
Characterized by swelling or effusion or tenderness in 2 or more joints and at least 30 minutes
of morning stiffness
Serositis Typical pleurisy for more than 1 day or pleural effusion or pleural rub. Typical pericardial pain
(pain with recumbency improved by sitting forward) for more than 1 day or pericardial effusion
or pericardial rub or pericarditis by electrocardiography
11. SLICC criteria cont…
Clinical Criteria cont..
Renal Urine protein to creatinine ratio (or 24 hour urine protein) representing 500 mg protein/24
hour or red blood cell casts.
Neurologic Seizure, psychosis, mononeuritis multiplex (in the absence of other known causes such
primary vasculitis), myelitis, peripheral or cranial neuropathy (in the absence of other
known causes such as primary vasculitis, infection, and diabetes mellitus), acute confusional
state (in the absence of other causes, including toxic/metabolic, uremia, drugs)
Hemolytic anemia
Leukopenia (<4000/mm3) OR At least once: In the absence of other causes such as Felty’s syndrome, drugs, and portal
hypertension
Lymphopenia (<1000/mm3) At least once: In the absence of other known causes such as corticosteroids, drugs, and
infection
Thrombocytopenia
(<100,000/mm3)
At least once in the absence of other known causes such as drugs, portal hypertension, and
thrombotic thrombocytopenic purpura
12. SLICC criteria cont…
Immunologic
Criteria
ANA Level above laboratory reference range
Anti-dsDNA Antibody level above laboratory reference range (or 2-fold if tested by ELISA)
Anti-Sm Presence of antibody to Sm nuclear antigen
Anti-phospholipid
antibody
Positivity, as determined by
Positive test for lupus anticoagulant
False-positive test result for rapid plasma regain
Medium-or high titer anticardiolipin antibody level (IgA, IgG, or IgM)
Positive test result for anti-2-glycoprotein I (IgA, IgG, or IgM)
Low complement (C3, C4, or CH50)
Direct Coomb’s
test
(In the absence of hemolytic anemia)
Sensitivity is – 94%
Specificity is – 92%
13. Classify a patient as having SLE if..
ACR criteria
If ≥4 of these criteria, well documented, are present at any time in a
patient’s history
SLICC criteria
The patient satisfies four of the criteria including at least one clinical
criterion and one immunologic criterion
OR
The patient has biopsy proven nephritis compatible with SLE and
with ANA or anti-dsDNA antibodies
14. Novel Biomarkers in SLE
Cellular markers Used as marker of Role in SLE
CD27 plasma cells Disease activity Distinguish a lupus flare up from infection
CD44v3/CD44v6-T cells Disease activity Lupus nephritis
CD4- CD8- (double
negative) t cells
Disease activity Lupus nephritis
Plasma MBL Disease activity Lupus nephritis (high level), Cutaneous lupus (low level)
Complement activation
products
Diagnosis or disease
activity
Diagnosis of SLE
Cytokines
IFN-𝛼, IFN-𝛾 Disease activity/flare Marker and potential predictive marker for anti-type I IFN therapy
MCP-1 Disease activity/flare
IL-2, IL-6, IL-10, IL-17, IL-23
TNF-𝛼, IFN-𝛼, TGF-B
Disease activity Diagnosis and progression of SLE
TWEAK Disease activity Lupus nephritis
15. Novel Biomarkers cont..
Genomic markers Used as marker of Role in SLE
Fc receptor gene polymorphism Disease susceptibility Diagnosis of SLE
DNA methylation markers (CD70,
CD154, Perforin)
Disease activity Diagnosis and monitoring
Micro RNAs Disease activity and effect of
treatment
Monitoring of SLE
New gene therapy strategies
16. Therapeutic classification
Mild Moderate
Muco-cutaneous
Butterfly rash
Photosensitivity
Maculopapular rash
Mild oral ulcer
Mild DLE
Severe oral ulcer
Severe DLE
Diffuse SCLE
Lupus profundus
Skin vasculitis
Articular Arthralgia
Mild polyarthritis
Disabiling polyarthritis
17. Cont…
Mild Moderate Severe
Renal Class I,II Class III,IV
LN
Neuropsychiatry Lupus headache Chorea
Peripheral neuropathy
Delirium
Encephalitis
Psychosis
Coma
Myelopathy
Hematological Platelet 30-100,000 Platelet 15-30,000
Hemolytic anemia
Leucopenia
Lupus adenitis
Platelet <15,000
18. Cont…
Mild Moderate Severe
Cardiopulmonary Pleurisy Pleural effusion
Pneumonitis
Pericarditis
Mild myocarditis
Severe pneumonitis with
respiratory failure
Pulmonary hemorrhage
Cardiac temponade
Severe myocarditis
Gastro-intestinal Mild hepatitis Pancreatitis
Peritonitis
Severe hepatitis
Colitis
Protein losing
enteropathy
Mesenteric vasculitis
Miscellaneous Responsive fever
Fatigue
Myalgia
Refractory/high fever
20. Drugs for management of SLE
Medication Dose range Adverse effects
NSAISs Upper limit of recommended
range
Aseptic meningitis, decreased renal function, vasculitis of skin,
myocardial infarction, ototoxicity, GI irritation
Topical glucocorticoids Mid potency for face
High potency- other area
Atrophy of skin, contact dermatitis, folliculitis, infection,
hypopigmentation
Topical sunscreens SPF 15 at least
30+ preferred
Contact dermatitis
Hydroxychloroquine 200-400 mg OD Retinal damage, agranulocytosis, thrombocytopenia, aplastic
anemia, ataxia, cardiomyopathy, ototoxicity, neuropathy, seizures
DHEA
(dehydrepiandrosterone)
200 mg OD Acne, menstrual irregularity
Methotrexate 10-25 mg once a week with
folic acid
Anemia, bone marrow suppression, leukopenia, infection,
thrombocytopenia, hepatotoxicity, nephrotoxicity, neurotoxicity,
pulmonary fibrosis, pneumonitis, teratogenic
Oral glucocorticoids
(Prednisone)
0.5-1 mg/kg/d- severe SLE
0.07-0.3 mg/kg/d- milder SLE
Infection, hypertension, hyperglycemia, hypokalemia, aseptic
necrosis of bone, cushingoid changes, osteoporosis, psychosis
IV glucocorticoids
(Methylprednisolone)
1 g *IV*OD for 3 days As oral glucocorticoids
21. Cont…
Medication Dose range Adverse effects
Cyclophosphamide 7-25 mg/kg once a month
for 6 months
Infection, bone marrow suppression, leukopenia, anemia,
thrombocytopenia, hemorrhagic cystitis, carcinoma bladder,
alopecia, ovarian and testicular failure, teratogenic
Mycophenolate
mofetil
2-3 g/d Infection, leukopenia, anemia, thrombocytopenia, lymphoma,
malignancy, alopecia, GI symptoms, hypertension,
hypokalemia, tremor, teratogenic
Azathioprine 2-3 mg/kg/d Infection, bone marrow suppression, leukopenia, anemia,
thrombocytopenia, pancreatitis, hepatotoxicity, malignancy,
alopecia, GI symptoms
22. Targeted therapy in SLE
Target Agent Role in SLE
B Cell depletion
Anti-CD20 Rituximab Effective in refractory SLE, no benefit in proliferative lupus
nephritis
Anti-CD22 Epratuzumab Reduction in corticosteroid dose in SLE
Anti-CD11 Efalizumab Improvement in cutaneous SLE
B Cell activation
Anti-B Lys Antibody Belimumab Reduction in SLE activity, reduce flares
Anti-B Lys+APRIL Atacicept Decrease in SLE autoantibodies
B Cell tolerogens
B cell tolerogen Abetimus,
Edratide
No long term benefit in lupus nephritis
T-Cell target blockers
Anti-CD40 antibodies Toralizumab Unproven role
CTLA4-Ig Fusion protein Abatacept Improvement in non-life threatening SLE
Cell surface receptor
activation inhibition
Sirolimus Role in refractory SLE
23. Cont…
Target Agent Role in SLE
Cytokine inhibition
Anti-TNF-𝛼 Infliximab Doubtful efficacy in lupus nephritis
Anti-IFN-𝛼/-𝛾 Sifalimumab
Rontalizumab
No result released
Anti-IL-1 Anakinra Improvement in SLE arthritis
Anti-IL-6 Tocilizumab Clinical and serologic improvements in SLE
Anti-IL-10 B-N10 Improvement in disease activity
Other targets
Anti-C5 monoclonal
antibody
Eculizumab Improvement in SLE
Soluble recombinant
complement C3
inhibitor
sCR1 Improvement in disease activity
Chemokine inhibitor Bindarit Improvement in disease activity
