This document discusses rheumatoid arthritis and gout. It provides information on the pathogenesis, clinical presentation, diagnosis and management of these conditions. It lists various disease-modifying antirheumatic drugs and biological agents used to treat rheumatoid arthritis, along with their mechanisms of action, dosing and side effects. It also discusses the evaluation and treatment of acute and chronic gout, including use of colchicine, NSAIDs, allopurinol and febuxostat.
Biological therapy in rheumatic diseasesSamar Tharwat
Dr.Samar Tharwat ,Lecturer of Internal Medicine (Rheumatology & Immunology)represents a lecture on biological Therapy and its role in various rheumatic diseases.
Immunosupressants and Immunostimulants their pharmacology, uses etc. Basics of immunology, innate immune response, acquired immune response, role of complement in innate immune response. Major histocompatibility complex, antibody structure. classification of immunosupressants, their mechanism of action, uses and adverse effects.
Gouty Arthritis/Gout is a type of crystal arthropathy characterized by recurrent attacks of acute arthritis.
Pathophysiology, clinical features, investigations, treatments modalities and complications
Biological therapy in rheumatic diseasesSamar Tharwat
Dr.Samar Tharwat ,Lecturer of Internal Medicine (Rheumatology & Immunology)represents a lecture on biological Therapy and its role in various rheumatic diseases.
Immunosupressants and Immunostimulants their pharmacology, uses etc. Basics of immunology, innate immune response, acquired immune response, role of complement in innate immune response. Major histocompatibility complex, antibody structure. classification of immunosupressants, their mechanism of action, uses and adverse effects.
Gouty Arthritis/Gout is a type of crystal arthropathy characterized by recurrent attacks of acute arthritis.
Pathophysiology, clinical features, investigations, treatments modalities and complications
Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease, which means that your immune system attacks healthy cells in your body by mistake, causing inflammation (painful swelling) in the affected parts of the body. RA mainly attacks the joints, usually many joints at once.
A proper description about Rheumatic arthritis. It containts DEFINITION, EPIDEMIOLOGY, ETIOLOGY, RISK FACTORS, PATHOPHYSILOGY, SIGN & SYMPTOMS, DIAGNOSIS, TREATMENT & DIFFERENCES BETWEEN RA & OA
Rheumatoid arthritis (RA) is a chronic, progressive inflammatory disorder of unknown etiology characterized by polyarticular symmetric joint involvement and systemic manifestations.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
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.
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
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.
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
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
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Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
10. DMARDs
Conventional
Methotrexate
Hydrochloroquine
Sulfasalazine
Leflunomide
Gold
Azathioprine
Minocycline
Cyclophasphamide –
severe RA
Biologicals
Etanercept
Infliximab
Anakinra
Adalimumab
Abatacept
Rituximab
Prosorba column-
severe RA,Psoriatic A
11. DMARDS Mechanism AE & Risk Approximate
time to
benefit
Month/weak
Dose Comments/
MCQ
Diet Glucosemene
& condrotin
Pain relief
Methotrexate Antimetobolite
DNA Synthsis
Cell division
Hepatoxicity,
Myelotoxioity
fibrosing
alveolitis
1-2M 5-
25mg/
wk
Ist line
Sulfasalazine Antimetabolite
& Antimalarial
Hepatoxicity,
myelotoxicity
Hypersensitivi
ty reactions
1-3M 2-
4g/day
Oligospermia,
Pro drug
12. DMARDS AE & Risk Appoxim
ate time
to benefit
Month/w
eak
Dose Comment/
MCQ
Antimalarial
(Hydrochloro
quine)
Interfere
with Antigen
processing
Retinopathy Macular
damage (HCQ)
2-6 M 200-400
mg/day
Leflunamide Blocks T- Cell
division
Hepatotoxicity,
Myelotoxicity,
Hypertension
4-12 wk 10-
20mg/day
Gold salt
(Parentral)
unknown Hypersensitivity,
Nephritis fibrosing
alveolitis
3-6M 50mg/mon
th
1m
Auranofin
(Oral Gold)
unknown Diarrhoea,
Hypersencentivity
reaction
4-6m 3mg twice
a day
Cyclosporin T-cell activity
intibitor
Nephrotoxicity,
Hypertension
6-12wk 150-
300mg/day
Severe
active RA
not
responde
MTX
13. DMARDS AE & Risk Appoximate
time to
benefit
Month/wea
k
Doge MCQ
Azathioprime Cytostatic Hapatotoxicity,
Myelotoxicle
Gastrointestinal
2-3m 50-
150mg/
day
Not1st
line,
active RA,
with SLA
Bucillamine Proteinuria,
Hepatotoxic,
Mylosupression
1-3m 100-
200mg/
day
Tacrolimus Renal insuff, HT,
Anemia, Impaired
glucose tolerance
6-12 wk 3mg/da
y
D-
Penicillamine
Unknown
alter T-cell
function
Myelosuph,
proteinurea,
Nephrotoxic
3-6m 250-
750mg/
day
Persistent
active
disease
Minocycline Hyperpigmintation,
dizziness,vaginal
yeast infection
1-3m 100mg
BD
14. Biological DMARDS
Anti – TNFx Dose Command Structure Use Anti
TNFx
SE
Etanercept
Infliximab
Adalimumab
Certolizumab
Golimumab
50mg/wk/sc
3mg/kg/8wk
40mg/2wk sc
200 mg/2wk
sc
50mg/4wk sc
Decoy (R) for
TNFx
RA & Crohns
dz antibody to
TNF given
with MTX
Human
fusion
protein
Mouse/hum
an MaB
Fully human
MaB
RA, JRA,
Psoritic
arthritis
ankylosing
spondelyti
s crohns
disease
Infection CHF
Neurological
Malignancy
Autoimmunity
Hematological
Hypersencitivity
Anti-B-cell
therapy
Rituximab
1000mg/repea
t after 2 wk
Premedication
Methylprednis
olone
Chlorphenara
mine
PCM
15. Biological DMARDSAnti – TNFx Dose Command Structure
Inhibitory of T-cell
activation abatacept
125mg sc/wk Favorable safety
profile
Anti-1L6
Tocilizumab
8mg/kg/4wk More effective
than anti TNF in
MTx intolerant
patients
Anti 1L-1 blocking
agent
Anakinra
IL-1 trap
100 mg /sc /daily
Phase I
Less effective Recombinant form of
human 1L-1 Ra
33. Estimation of 24-hr Urinary
Uric Acid
Indications: Gout in
–men less than 25 years
–premenopausal women
34. Urate Lowering Therapy: Indications…
>3 attacks per year
2/yr if disabling, prolonged, interferes with ADL
Clinical or radiographic signs of chronic gouty joint disease
Gout with renal insufficiency
Urinary uric acid excretion >1100 mg/day (6.5 mmol)
35. Urate Lowering Therapy: Indications
Serum uric acid persistently >10.1
Tophi in soft tissues or subchondral bone
Recurrent urate urolithiasis
? Strong family history of gout
36. Goals of Therapy
Serum urate <6 mg/dL (<357 µmol/L)
<5 mg/dL (<297 µmol/L) in patients
with tophi
A fall of <0.6 mg/mo ensures
recurrence free achievement of
target
37. General Principles
Should not be initiated during an attack
Conventional interval: 4 wk
Exceptions:
Inter-critical interval <4 wk
Chronic tophaceous gout
Titrated against serum urate at 3 to 4 wks
Treatment should be
Continuous
Duration: indefinite
39. Allopurinol
Urate-lowering drug of general choice
Particularly suitable for overproducers
Started with 100 mg/day single dose
after meals with plenty of fluid
Doses >300 mg divided
Increased at 2 to 3 wks by 100 mg till target reached
Maximum: 900 mg/day
Monitoring parameters
CBC, serum uric acid, ALT, S Cr, at start of therapy
40. Allopurinol: Adverse Effects
Diarrhea, and drug fever
Rashes, rarely TEN and Steven Johnsons
Association: HLA- B*5801
Leukopenia or thrombocytopenia
Interstitial nephritis, vasculitis
Allopurinol hypersensitivity syndrome (AHS):
erythematous rash, fever, eosinophilia, hepatitis, and
acute renal failure
Rare but life-threatening, mortality 25%
41. Starting Dose and Titration of
Allopurinol on eGFR
eGFR Starting dose Titration
≥60 ml/min 100 mg/day 100 mg every 2-3 wk
30-59 ml/min 100 mg/day 50 mg every 2-3 wk
10-29 ml/min 50 mg/day 50 mg every 2-3 wk
42. Rational Treatment in Two Phases:Rational Treatment in Two Phases:
Phase I – control pain and inflammation:
NSAIDs (ibuprofen – may use indomethacin) or
colchicine
Phase II – decrease the serum urate (< 4.0 mg/dL)
> 800 mg in 24 hr urine suggests overproduction –
use allopurinol
< 500 mg in 24 hr urine suggests decreased renal
clearance – use probenecid
43. Febuxostat
investigational agent (NDA 12/2004)
oral xanthine oxidase inhibitor
chemically distinct from allopurinol
94% of patients reached urate < 6.0
mg/dl
minimal adverse events
can be used in patients with renal
disease
55. 9. Which of the following drugs is useful in
chronic gout but is NOT a uricosuric agent?
a. Probenecid
b. Phenylbutazone
c. Sulfinpyrazone
d. Allopurinol
(d)
57. 11. Rasburicase is a newer drug used in
gout. It act by
a. Decreasing urate synthesis
b. Increasing urate oxidation
c. Decreasing intestinal absorption of uric acid
d. Increasing renal excretion of uric acid
(b)
58. 12. A drug that is effective for rheumatoid
arthritis but is not appropriate for
osteoarthritis is
a. Acetaminophen
b. Infliximab
c. Keterolac
d. Rofecoxib
(b)
59. 13. Among NSAIDs aspirin is
unique because it
a. Irreversibly inhibits its target enzyme
b. Reduces the risk of colon cancer
c. Reduces fever
d. Selectively inhibits COX-2 enzyme
(a)
61. 15. A drug X is useful in the treatment of
rheumatoid arthritis. It is available only in
parenteral formulation and its mechanism of
action is antagonism of tumor necrosis factor.
Which of the following can be X?
a. Cyclosporine
b. Penicillamine
c. Phenylbutazone
d. Etanercept
(d)
62. 16. Which of the following
increases uric acid excretion?
a. Allopurinol
b. Aspirin
c. Colchicine
d. Probenecid
(d)
63. 17. True about COX-2 are all EXCEPT
a. Furosemide
b. Sulfinpyrazone
c. Allopurinol
d. Piroxicam
(d)
Rheumatoid arthritis (chronic progressive crippling dz) and gout
Small lumps, called rheumatoid nodules, may form under your skin at pressure points, and can occur at your elbows, hands, feet and Achilles tendons. Rheumatoid nodules may also occur elsewhere, including the back of your scalp, over your knee or even in your lungs. These nodules can range in size — from as small as a pea to as large as a walnut. Usually these lumps aren&apos;t painful.
A systemic autoimmune disease
of unknown cause with its primary manifestation in synovial tissues.
Synovial tissues proliferate in an uncontrolled fashion resulting in stretching of tendon and ligaments and erosions of bone.
Two to four times more common in women
Highest incidence in women of child-bearing age
‘Rare’ in men &lt; 45 years
Role of sex hormones…
Remission in pregnancy
Increased risk in postpartum
Oral contraceptives
Drugs that have the ability to slow or halt progression of RA; including radiographic progression