Πέτρος Καραγιάννης
Καθηγητής Μικροβιολογίας / Μοριακής Ιολογίας, Ιατρική Σχολή, Πανεπιστήμιο Λευκωσίας.
Νέες Εξελίξεις στη Θεραπεία της Χρόνιας Ηπατίτιδας Γ
Acyclovir Induced Acute Kidney Injury In Acute Meningitis Patient: A Case Rep...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
The views expressed in the presentations are that of the author and do not necessarily reflect the views of the Government of Canada. Presentations are shared in the original format received from the presenter.
Presentations given at the Conference to Develop a Federal Framework on Lyme Disease are the property of the author, unless otherwise cited. If you reference the author's work, you must give the author credit by naming the author and their work as well as the place and date it was presented.
For more information, contact the Lyme Disease Conference Secretariat at maladie_lyme_disease@phac-aspc.gc.ca
Edward R. Cachay, MD, MAS of UC San Diego Owen Clinic presents "When to Consider Neurosurgical Interventions for the Management of Complicated Cryptococcal Meningitis"
Critical Care physiology in resuscitation: Rinaldo BellomoSMACC Conference
Rinaldo Bellomo is here to cause some trouble! He says that critical care physiology in resuscitation has problems! Whilst the rest of the medical field has advanced and evolved over time (we no longer routinely prescribe oxygen for an acute myocardial infarction), critical care resuscitation still relies on malfunctioning physiological paradigms.
Critical care clinicians can change physiology with a number of tools. They can repeatedly, often, and mercilessly change physiological variables. Blood pressure, cardiac output, cardiac filling pressures, glucose levels, positive fluid balance and countless other physiological parameters can be increased and decreased at will.
This kind of “numerology” is attractive because the outcomes can be immediate, and clinicians feel powerful and effective. However, outside the obvious situations where physiology is so dangerously abnormal as to threaten life, such physiological manipulations have an unproven relationship with outcome.
Importantly, patients do not care whether their cardiac output has been increased from 5L/min to 6 L/min. They only care whether they live or die, get out of hospital intact and return to their previous life. Thus, physiological gain is not patient centred.
Moreover, all research focusing of the physiology of a specific intervention inevitably deals with the effect on a specific set of variables. For example, a fluid bolus may or may not increase cardiac output in the short term. However this effect is not sustained much past 20 minutes. Similarly, no studies examine the effect of such fluid bolus on anything other than haemodynamics. No one measures what the effect is on the immune system, cerebral oedema, the glycocalyx, interstitial oxygen gradient, pulmonary congestion, body temperature, haemoglobin, or white cell function. Thus, all physiological studies are “blind” to the broader effects of their intervention.
Rinaldo claims that in critical care resuscitation physiology, the measurable is made important but the important may not be measured. Clinicians need to reflect on this before they become seduced by physiological manipulation.
Rinaldo’s challenge to you? Look at the literature, consider biological plausibility, follow evaluated evidence, balanced, accept doubt with a smile and practice known medicine of the time whilst understanding that today’s medicine will be the source of derision in the future.
Πέτρος Καραγιάννης
Καθηγητής Μικροβιολογίας / Μοριακής Ιολογίας, Ιατρική Σχολή, Πανεπιστήμιο Λευκωσίας.
Νέες Εξελίξεις στη Θεραπεία της Χρόνιας Ηπατίτιδας Γ
Acyclovir Induced Acute Kidney Injury In Acute Meningitis Patient: A Case Rep...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
The views expressed in the presentations are that of the author and do not necessarily reflect the views of the Government of Canada. Presentations are shared in the original format received from the presenter.
Presentations given at the Conference to Develop a Federal Framework on Lyme Disease are the property of the author, unless otherwise cited. If you reference the author's work, you must give the author credit by naming the author and their work as well as the place and date it was presented.
For more information, contact the Lyme Disease Conference Secretariat at maladie_lyme_disease@phac-aspc.gc.ca
Edward R. Cachay, MD, MAS of UC San Diego Owen Clinic presents "When to Consider Neurosurgical Interventions for the Management of Complicated Cryptococcal Meningitis"
Critical Care physiology in resuscitation: Rinaldo BellomoSMACC Conference
Rinaldo Bellomo is here to cause some trouble! He says that critical care physiology in resuscitation has problems! Whilst the rest of the medical field has advanced and evolved over time (we no longer routinely prescribe oxygen for an acute myocardial infarction), critical care resuscitation still relies on malfunctioning physiological paradigms.
Critical care clinicians can change physiology with a number of tools. They can repeatedly, often, and mercilessly change physiological variables. Blood pressure, cardiac output, cardiac filling pressures, glucose levels, positive fluid balance and countless other physiological parameters can be increased and decreased at will.
This kind of “numerology” is attractive because the outcomes can be immediate, and clinicians feel powerful and effective. However, outside the obvious situations where physiology is so dangerously abnormal as to threaten life, such physiological manipulations have an unproven relationship with outcome.
Importantly, patients do not care whether their cardiac output has been increased from 5L/min to 6 L/min. They only care whether they live or die, get out of hospital intact and return to their previous life. Thus, physiological gain is not patient centred.
Moreover, all research focusing of the physiology of a specific intervention inevitably deals with the effect on a specific set of variables. For example, a fluid bolus may or may not increase cardiac output in the short term. However this effect is not sustained much past 20 minutes. Similarly, no studies examine the effect of such fluid bolus on anything other than haemodynamics. No one measures what the effect is on the immune system, cerebral oedema, the glycocalyx, interstitial oxygen gradient, pulmonary congestion, body temperature, haemoglobin, or white cell function. Thus, all physiological studies are “blind” to the broader effects of their intervention.
Rinaldo claims that in critical care resuscitation physiology, the measurable is made important but the important may not be measured. Clinicians need to reflect on this before they become seduced by physiological manipulation.
Rinaldo’s challenge to you? Look at the literature, consider biological plausibility, follow evaluated evidence, balanced, accept doubt with a smile and practice known medicine of the time whilst understanding that today’s medicine will be the source of derision in the future.
The study to measure the level of serum annexin V in patients with renal hype...inventionjournals
ABSTRACT : Renovascular hypertension reflects the causal relation between anatomically evident arterial occlusive disease and elevated blood pressure. The coexistence of renal arterial vascular disease and hypertension roughly defines this type of nonessential hypertension. The aim of this study was to measure the level of serum Anti-Annexin V antibodies in patients with renal hypertension. Methods. This study was conducted on 115 patients, diagnosed with renal hypertension and hypertension. Informed consents were obtained from the patients and the study was approved by the Kharkiv National Medical University ethics committee. Ten healthy age and sex matched volunteers were included as a control group. All patients and controls were subjected to the following full history taking and thorough clinical examination. Routine laboratory testing included a complete blood count, and erythrocyte sedimentation rate (ESR) and kidney function tests (blood urea nitrogen and serum creatinine). Immunological tests for antinuclear antibody (ANA) and anticentromere antibodies (ACA) was performed by the indirect immunofluorescence technique. AntiScl-70 (anti-topoisomerase antibodies) and anticardiolipin antibodies (ACA: IgG and IgM) were tested using the ELISA technique. The anti-annexin V antibodies titre used the ZYMUTEST anti-Annexin IgG ELISA kit. [Hyphen-BioMed, France.]: to measure the IgG isotype of auto-antibodies to annexin V in human serum. Results. Anti-annexin V antibodies were present in 75% of patients (mean 83.46 ± 22.44 AU/mL) vs. 0% in the controls (mean 3.94 ± 4.5 AU/mL). Comparison between patients and controls as regards levels of anti-annexin V showed a highly significant difference (P < 0.001). Furthermore, correlation of anti-annexin V titres with the disease activity score in the patient group showed a statistically significant positive correlation (r = 0.51, P < 0.05).In addition, the anti-annexin V antibody titres in this study showed a highly significant positive correlation with ACL antibodies (r = 0.74, P < 0.001). Patients with antiphospholipid syndrome (APS) have been known to have a higher frequency of anti-annexin V antibodies, and thrombotic events have been reported more frequently in patients with positive anti-annexin V antibodies. Furthermore, inhibition of annexin V binding to negatively charged phospholipids may be an additional pathogenic mechanism of APS.
A case of severe autoimmune haemolytic anaemia due to clinically significant ...Apollo Hospitals
Anti N antibody belongs to the MNS blood group system. Usually, anti N antibodies are naturally occurring, cold agglutinins. Clinically significant anti N antibodies have also been reported. We report here a case of autoantibody with anti N specificity presenting with severe autoimmune haemolytic anaemia.
Ebell MH, Afonso AM, Gonzales R, Stein J, Genton B, Senn N. Development and validation of a clinical decision rule for the diagnosis of influenza. J Am Board Fam Med. 2012;25:55–62. によるインフルエンザ予測スコアをまとめました。
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
- 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
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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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
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.
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.
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.
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
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
3. ヘルペス脳炎疑い患者
脳⽣検後にビダラビン開始
脳⽣検でHSV陽性ならビダラビン継続,陰性なら終了
England Journal of Medicine
March 31, 2016. For personal use only. No other uses without permission.
2010 Massachusetts Medical Society. All rights reserved.
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on these 75 patients with similar data obtained from
18 vidarabine recipients and 10 placebo recipients
studied previously.' The mortality rate in herpes sim-
plex encephalitis in the present study was 33 per
cent one month after treatment and 39 per cent six
and 12 months after treatment. In the prior study,
mortality rates with therapy were not notably differ-
ent (28 per cent and 44 per cent at one month and six
months, respectively) from those in the current study.
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Days After Enrollment
Figure 1. Survival of Patients with Biopsy-Proved Herpes
Simplex Encephalitis.
A follow-up evaluation of patients treated with vidarabine
(squares) demonstrated a survival rate of 61 per cent. The
survival rates in the treated group (triangles) and placebo
group (circles) from the previously reported trial1 were 56 per
cent and 30 per cent, respectively.
・132例中75例で脳⽣検でHSV陽性
・■が本研究のHSV陽性,ビダラビン治療群
・▲はNEJM. 1977;297:289‒94. のビダラビン群
・●はNEJM. 1977;297:289‒94.のプラセボ群
New England Journal of Medicine. 1981;304:313–8.
11. ビダラビンは海外では使用されなくなった
• “As vidarabine is no longer available in any form, having been
replaced by aciclovir and other potent antiviral drugs active
against herpesviruses”
Grayson, M L. Kucers' The Use of Antibiotics Sixth Edition, 6th Edition. CRC Press.
15. HSV脳炎の治療期間は現在は14-21⽇間が
推奨されているが・・・
• 2008年のIDSAガイドラインでは14-21⽇間治療を推奨
Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL, et al. The Management of
Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America.
CLIN INFECT DIS. 2008;47:303‒27.
• 14⽇間治療で再燃
Yamada S, Kameyama T, Nagaya S, Hashizume Y, Yoshida M. Relapsing herpes simplex
encephalitis: pathological confirmation of viral reactivation. J Neurol Neurosurg Psychiatr.
2003;74:262‒4.
• 15⽇間,20⽇間,21⽇間治療で1例ずつ再燃例の報告
Sköldenberg B, Aurelius E, Hjalmarsson A, Sabri F, Forsgren M, Andersson B, et al.
Incidence and pathogenesis of clinical relapse after herpes simplex encephalitis in adults.
J Neurol. 2006;253:163‒70.
• 治療終了前に髄液のHSV-PCR陰性化を確認した⽅がよいかも
Herpes. 2004;11 Suppl 2:57A‒64A.
CLIN INFECT DIS. 2008;47:303‒27.
17. アシクロビル耐性HSVの脳炎?
• アシクロビル耐性HSVはAIDS患者で粘膜病変を繰り返す⼈で出
現することはあるが,免疫正常者では⾮常に稀
Chaudhuri A, Kennedy PGE. Diagnosis and treatment of viral encephalitis.
Postgraduate medical journal. 2002;78(924):575‒83.
• 2010年に免疫正常でアシクロビル投与歴のない⼈でアシクロビ
ル耐性HSVによる脳炎が初めて報告
Schepers K, Hernandez A, Andrei G, Gillemot S, Fiten P, Opdenakker G, et al.
Acyclovir-resistant herpes simplex encephalitis in a patient treated with anti-tumor
necrosis factor-α monoclonal antibodies. J Clin Virol. 2014;59:67‒70.
• ⽇本での免疫正常でアシクロビル投与歴のない⼈のアシクロビ
ル耐性HSVによる脳炎の報告は⾒つけられず
18. アシクロビル耐性
HSV脳炎
• day 6の髄液HSV-PCRのtiter
がday2よりも増加していたこ
とから耐性が疑われた
Schepers K, Hernandez A, Andrei G, Gillemot S, Fiten P,
Opdenakker G, et al. Acyclovir-resistant herpes simplex
encephalitis in a patient treated with anti-tumor necrosis
factor-α monoclonal antibodies. J Clin Virol. 2014;59:67‒70.
19. アシクロビルで治療された35例のHSV脳炎
良好な転帰でも治療後の発熱期間は約7⽇間
literature, a marked decrease should make us consider other
diseases18
.
As was mentioned above, CSF PCR for HSV is the diagnostic
method of choice, with a sensitivity of 98% and a specificity
of 94%. However, negative PCR results should be interpreted in
keeping with clinical suspicion18
. False-negative PCR results can
encephalitis up to the start of treatment8,10,21
. Among all these
prognostic factors, the only one clinicians can influence is early
establishment of antiviral treatment. In our series, the majority of
patients started treatment with acyclovir on the first day after
admission, and it may be for this reason that a delay in starting
antiviral treatment did not have a significant influence on our
ARTICLE IN PRESS
Table 4
Univariate analysis of factors associated with the prognosis at 6 months
Good outcome (Rankin p2), n ¼ 25 (71%) Poor outcome (Rankin X3), n ¼ 10 (29%) pÃ
Age (years) 48.12717.68 68.4720.34 0.007
Duration of symptoms before admission (days) 4.9672.81 4.972.13 0.928
Duration of symptoms before treatment (days) 5.5673.03 5.472.72 0.872
Duration of fever after initiating treatment (days) 6.8474.69 14.1176.64 0.003
Sodium levels in serum at admission (mmol/l) 134.8874.9 136.475.34 0.418
Leukocyte count in serum at admission (cells/ml) 9232.472911.58 10270.0073299.835 0.46
Sex (males) 16 (64%) 6 (60%) 0.049
Debilitating diseases 4 (16%) 1 (10%) 0.553
Headache 20 (80%) 4 (40%) 0.021
Nausea and vomiting 10 (40%) 5 (50%) 0.292
Disorientation 14 (56%) 6 (60%) 0.567
Behavioral changes 13 (525) 6 (60%) 0.184
Seizures 10 (40%) 4 (40%) 0.652
Decreased level of consciousness 14 (56%) 2 (20%) 0.071
Neurological deficit 15 (60%) 3 (30%) 0.146
Treatment for cranial hypertension 7 (28%) 4 (40%) 0.689
Antiepileptic drugs 16 (64%) 7 (70%) 0.530
Serum hemoglobin levels at admission (g/dl) 12.971.4 13.5370.95 0.225
Serum albumin levels at admission (g/l) 36.8874.53 32.674.76 0.02
Values are expressed as the mean7standard deviation (SD).
à Univariate analyses were calculated using the Mann-Whitney U test, w2
or Fisher exact test, as appropriate.
A. Riera-Mestre et al. / Enferm Infecc Microbiol Clin. 2009;27(3):143–147146
Riera-Mestre A, Gubieras L, Martínez-Yelamos S, Cabellos C, Fernández-Viladrich P. Adult herpes simplex
encephalitis: fifteen years' experience. Enfermedades Infecciosas y Microbiología Clínica. 2009;27:143–7.
20. 予後不良因⼦
• 年齢が⾼いこと,発症時の意識レベルが悪いのは予後不良因⼦
New England Journal of Medicine. 1986;314:144‒9.
• 治療の遅れは予後不良因⼦
Hughes PS, Jackson AC. Delays in initiation of acyclovir therapy in herpes simplex
encephalitis. The Canadian journal of neurological sciences Le journal canadien des
sciences neurologiques. 2012;39:644‒8.
• 発症から受診までの時間が⻑いこと,MRIで病変が広範囲であ
ることは予後不良因⼦
Sili U, Kaya A, Mert A, HSV Encephalitis Study Group. Herpes simplex virus
encephalitis: clinical manifestations, diagnosis and outcome in 106 adult patients. J
Clin Virol. 2014;60:112‒8.