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.
Recent advances in diagnosis & management of SLEShadab Ahmad
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.
IgA nephropathy is a condition characterized by deposition of IgA immunoglobulins in glomeruli. This condition is fairly common in Western countries. The scope of the disease is wide and case by case. Cases of IgA nephropathy are rare. Our case report is of a young man who developed rapid onset IgA nephropathy leading to end stage renal disease ESRD . This case report describes a 26 years age young man who presented and eventually presented with microscopic hematuria and severe proteinuria. Hemodialysis for his burned out IgA nephropathy. Dr. Thenmozhi. P | Yuvaraj. B "IgA Nephropathy (Burger's Disease): Case Report" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-1 , February 2023, URL: https://www.ijtsrd.com/papers/ijtsrd52706.pdf Paper URL: https://www.ijtsrd.com/medicine/other/52706/iga-nephropathy-burgers-disease-case-report/dr-thenmozhi-p
Recent advances in diagnosis & management of SLEShadab Ahmad
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.
IgA nephropathy is a condition characterized by deposition of IgA immunoglobulins in glomeruli. This condition is fairly common in Western countries. The scope of the disease is wide and case by case. Cases of IgA nephropathy are rare. Our case report is of a young man who developed rapid onset IgA nephropathy leading to end stage renal disease ESRD . This case report describes a 26 years age young man who presented and eventually presented with microscopic hematuria and severe proteinuria. Hemodialysis for his burned out IgA nephropathy. Dr. Thenmozhi. P | Yuvaraj. B "IgA Nephropathy (Burger's Disease): Case Report" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-1 , February 2023, URL: https://www.ijtsrd.com/papers/ijtsrd52706.pdf Paper URL: https://www.ijtsrd.com/medicine/other/52706/iga-nephropathy-burgers-disease-case-report/dr-thenmozhi-p
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
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.
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
- 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
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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.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
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!
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.
2. Case Presentation
A 30 year old female Known/Case of SLE with lupus nephritis since July 2021
and Post cholecystectomy since 2017 complained of loose stools with fresh
blood dripping on toilet 3 episodes per day,perianal pain,
vomiting 1-2 episodes, for 3 days. Patient also complained of 35 kg
weight loss in last 2 years .On further exploring patient also complaint of loose
stools on and off for last 4 years which are not associated with any Abdominal
pain, Fever , blood , fat or mucus in it.
3. She complained of odynophagia and dysphagia to both solids and liquids.
Patient denies any joint pain , rash, Dry eyes ,Dry mouth
Patient complained of oral ulcers , photosensitivity and raynaud
phenomenon on and off
> Hospital stay
Patient developed Right knee pain during hospital stay
O/E
Pallor + Pedal edema++. white coated tongue
GCS 15/15. CVS S1+S2+0. RESP NVB+0. ABDOMIN SNT
Power 5/5 in all limbs with b/L downgoing plantars
MSK examination shows no tenderness, swelling , warmth , movement
limitation in any joints .
4. Past medical Hx. Past Surgical Hx
SLE since july 2021
Lupus Nephritis in Oct 2021
Patient was taking HCQ OD ,
Sunblock cream TDS, CAC 1000 OD ,
Vitamin D3 Monthly
,INOGRAF 0.5mg BD' Zeegap 25mg
HS,Sangobion OD and Deltacortril
5mg OD
Cholecystectomy 2017
6. ANA + Homogenous pattern. Titre 1:320. July 2021
Serum Anti dsDNA IgG positive. July 2021
Serum Antitransglutaminase IgA Neg- July 2021
ENA Profile Negative. OCT 2021
C3 53. C4 24. OCT 2021
SPOT URINE PROTEIN 213
SPOT URINE CREATININE 149
P:C RATIO 1.4. OCT 2021
Creatinine1.0. OCT 2021
11. Definition. Pathogenesis
SLE is an inflammatory
autoimmune disorder character-
ized by autoantibodies to nuclear
antigens. It can affect multiple
organ systems
>Trapping of antigen-antibody
complexes in capillaries of visceral
structures
>Autoantibody-mediated
destruction of host cells (eg,
thrombocytopenia).
12. Incidence
It is affected by many factors
>Sex
MORE COMMON IN FEMALES
85% Of the Patients are females
>Race
MORE ,COMMON IN BLACK FEMALES THAN WHITE
SLE occurs in 1:1000 White women but in 1:250 Black women
>Genetic Inheritance
Familial occurrence of SLE has been repeatedly documented, and the
disorder is concordant in 25–70% of identical twins
14. SLICC CRITERIA
Presence of any four criteria (must
have at least 1 in each category)
qualifies patient to be classified as
having SLE
15. EULAR/ACR Updated
Criteria
It consists of seven clinical
domains and three immunologic
domains. Each criterion is
assigned points, ranging from 2
to 10.
16. Patients with ANA titre greater
than1:80 , at least one clinical
criterion and 10 or more points
are classified as having SLE.
Interpretation
19. Non specific symptoms
> Fever
> malaise
> Anorexia
> Weight loss
> Alopecia
> Raynand Phenomenon
20. Musculoskeletal
Joint symptoms, with or without active synovitis, occur in over 90% of
patients and are often the earliest manifestation. The arthritis can lead
to reversible swan-neck deformities, but radiographic erosions and
subcutaneous nodules are rare
21. Cutaneous
Most patients have skin lesions at some time;
the characteristic “butterfly” (malar) rash affects less than half of
patients. Other cutaneous manifestations are panniculitis (lupus
profundus), discoid lupus and typical fingertip lesions (periungual
erythema, nail fold infarcts, and splinter hemorrhages)
23. Pulmonary
Pleurisy and pleural effusion are common.
Pneumonitis, interstitial lung dis-ease, and pulmonary hypertension can
rarely occur.
Alveolar hemorrhage is uncommon but life-threatening
24. Ocular
Ocular manifestations include keratoconjunctivitis sicca and retinal
vasculopathy (cotton-wool spots, episcleritis, scleritis and optic
neuropathy)
25. Cardiac
The pericardium is affected in the majority of patients. Heart failure may
result from myocarditis and hypertension. Cardiac arrhythmias are
common. Atypical verrucous endocarditis of Libman-Sacks is usually
clinically silent but occasionally can produce acute or chronic valvular
regurgitation(most commonly mitral regurgitation)
26. Vascular
The prevalence of transient ischemic attacks, strokes, and myocardial
infarctions is increased in patients with SLE. These vascular events are
increased in, but not exclusive to, SLE patients with antibodies to
phospholipids (antiphospholipid antibodies), which are associated with
hypercoagulability and acute thrombotic events
27. Neurological
Neurologic complications of SLE include psychosis, cognitive
impairment, seizures, peripheral and cranial neuropathies, transverse
myelitis, and strokes
28. Renal
Several forms of glomerulonephritis may occur, including mesangial,
focal proliferative, diffuse proliferative, and membranous .Some
patients may also have interstitial nephritis. With appropriate therapy,
the survival rate even for patients with serious kidney disease
(proliferative glomerulonephritis) is favorable, a sub-stantial portion of
patients with severe lupus nephritis develop end-stage kidney disease
30. Gastroenterology
Nausea, sometimes with vomiting, and diarrhea can be manifestations
of an SLE flare Increases in serum aspartate aminotransferase (AST)
and alanine aminotransferase (ALT) are common when SLE is active.
Occasionally, abdominal pain in active SLE may be directly related to
active lupus, including peritonitis, pancreatitis, mesenteric vasculitis,
and bowel infarction. Rarely, lupus enteritis may be the initial
manifestation of SLE. ]Jaundice due to autoimmune hepatobiliary
disease may also occur.
Mouth ulcers are also common
31. Investigations
Antinuclear antibody (ANA) tests
based on immunofluorescence
assays nearly 100% SENSITIVE for
SLE but not specific
Antibodies to double-stranded
DNA and to Sm are SPECIFIC for
SLE but not sensitive, since they
are present in only 60% and 30% of
patients, respectively.
32. Frequency of autoantibodies in SLE
ANA by IF
Anti dsDNA
Anti Sm
RA Factor
Anti SSA
Anti SSB
95-100%
60%.
10-25%,
20%
15-20%
5-20%
34. CBC
Anemia (Hemolytic anemia,
anemia of chronic disease)
Leukopenia (WBC <4000/µL )
Thrombocytopenia(<100,000/μL)
Serum complement levels
Depressed
C3 and C4 suggests active disease
ESR and CRP
Durng disease flares, elevations
in the ESR are common, but the
serum CRP is usually normal
Liver function tests
ALT and AST may be raised in
acute SLE or in response to
therapies like NSAIDS or
Azathioprine
Albumin is usually low in case of
proteinuria
35. Urine complete
examination
Lupus nephritis shows hematuria
with or without casts, and
proteinuria (varying from mild to
nephrotic range) .
Creatinine usually deranged
in active lupus nephritis
P:C Ratio
Spot urine Protein and spot urine
creatinine is used to quantify
proteinuria
Renal biopsy helps to
identify the type of
glomerulonephritis.
it is recommended in all cases of
active Lupus Nephritis unless
there is any contraindications
36. Classification of Lupus Nephritis ISN/RPS
Class I: Minimal Mesangial Lupus Nephritis mesangial immune deposits by
immunofluorescence only
Class II: Mesangial Proliferative Lupus
Nephritis
mesangial hypercellularity or mesangial
matrix expansion by light microscopy,
Class III: Focal Lupus Nephritis focal, segmental or global
glomerulonephritis involving ≤50% of all
glomeruli,
Class IV: Diffuse Lupus Nephritis focal, segmental or global
glomerulonephritis involving >50% of all
glomeruli,
Class V: Membranous Lupus Nephritis Global or segmental subepithelial immune
deposits
Class VI: Advanced Sclerotic Lupus Nephritis ≥90% of glomeruli globally
sclerosed without residual activity.
37. Skin Biopsy
Lupus skin rash often
demonstrates inflammatory
infiltrates at the dermoepidermal
junction and vacuolar change in
the basal columnar cells
Arthrocentesis
joint effusions, which can be
inflammatory or noninflammatory.
The cell count may range from
less than 25% polymorphonuclear
neutrophils (PMNs) in
noninflammatory effusions to
more than 50% in inflammatory
effusions
38. Radiology
Joint radiography
periarticular osteopenia and soft-
tissue swelling without erosions
Chest X ray and HRCT
These modalities can be used to
monitor interstitial lung disease and to
assess for pneumonitis, pulmonary
emboli, and alveolar hemorrhage
Echocardiography
is used to assess for pericardial
effusion, pulmonary hypertension,
or verrucous Libman-Sacks
endocarditis
40. SLE activity often waxes and
wanes, the intensity of drug
therapy used
must be tailored to match
disease severity.
Since the various
manifestations of SLE
affect prognosis differently
drug therapy is chosen
accordingly to induce
remission
GOAL OF THERAPY
41. NON-LIFE-THREATENING DISEASE
Antimalarials (hydroxychloroquine, )
often reduce dermatitis, arthritis, and
fatigue. They also reduce the incidence
of disease flares and prolong survival in
SLE.
NSAIDs are useful analgesics/
anti-inflammatories, particularly
for arthritis/arthralgias
Patients should be cautioned against sun
exposure and should apply broad-spectrum UVA/
UVB sunscreen while outdoors. Milder skin
lesions often respond to the topical
administration of corticosteroids
Skin and joint symptoms
42. Systemic Corticosteroids
Corticosteroids are required for the control of certain
complications.
Glomerulonephritis,
Hemolytic anemia,
Myocarditis,
Alveolar hemorrhage,
Central nervous system
involvement,
Severe thrombo-cytopenia
The mainstay of treatment for any inflammatory life-threatening
or organ-threatening manifestations of SLE is systemic
glucocorticoids
43. For serious manifestations, either methylprednisolone 250–1000 mg
given intrave-nously over 30 minutes daily for 3 days or prednisone
40–60 mg orally is needed initially
However, the lowest dose of corticosteroid that controls the
condition should be used over time to minimize adverse
effects
44. Immunosuppressive Agents
These are used for long term control of the
disease
Cyclophosphamide,
Mycophenolate mofetil,
Azathioprine,
Methotrexate
Tacrolimus
Belimumab, a monoclonal antibody that
inhibits the activity of a B-cell growth factor, is
FDA approved for treating SLE patients with
active disease who have not responded to
standard therapies (eg, NSAIDs, antimalarials,
or immunosuppressive therapies)
45. Lupus Nephritis
Lupus Nephritis
Induction Phase
Mycophenolate mofetil and cyclophosphamide are first-
line induction treatments for lupus nephritis and are
generally given with corticosteroids to achieve disease
control
Mycophenolate mofetil is gien 1000 mg or 1500
mg orally twice daily
Cyclophosphamide is usually administered using the
Euro-Lupus regimen (500 mg intravenously every 2 weeks for six doses)
National Institutes of Health regimen (3–6 monthly intravenous pulses [0.5–1 g/
m2] for induction followed by maintenance infusions every 3 months).
46. Maintenance Phase
Mycophenolate mofetil or azathioprine is typically used for
maintenance therapy for lupus nephritis
Studies shows that Tacrolimus is also an
effective drug for induction and maintenance
of lupus nephritis
47. SLE IN PREGNANCY
Active SLE in pregnant women should be controlled with
hydroxychloroquine and, if necessary, prednisone/
prednisolone at the lowest effective doses for the shortest
time required. Azathioprine may be added if these
treatments do not suppress disease activity
48. Lupus and Anti Phospholipid Syndrome
should be managed with long-term anticoagulation
. With warfarin, a target international normalized ratio (INR) of 2.0–2.5 is
recommended for patients with one episode of venous clotting; an INR of
3.0–3.5 is recommended for patients with recurring clots or arterial clotting,
49. MEDICATION DOSE RANGE ADVERSE EFFECTS
NSAIDs Acc to Salt GI distress
elevated liver enzymes,
decreased renal function,
Glucocorticoids
Oral
Prednisone, prednisolone:
0.5–1 mg/kg per day for
severe SLE 0.07–0.3 mg/kg
per day or qod for milder
disease
infection, hypertension,
hyperglycemia,
hypokalemia, acne, aseptic
necrosis of bone, cushingoid
changes, CHF, fragile skin,
insomnia, menstrual
irregularities, , osteoporosis,
psychosis
Methylprednisolone
sodium
Same
Cyclophosphamide
IV
500 mg every 2 weeks for 6
doses, then begin
maintenance with MMF or
AZA.
Infection, leukopenia,
anemia, thrombocytopenia, ,
, malignancy, alopecia,
cough, diarrhea, fever, GI
symptoms, , hypertension,
hypercholesterolemia,
For severe disease, 0.5-1 g
IV qd × 3 days
50. Medication Dose Adverse Effects
Mycophenolate
mofetil
2–3 g/d PO total given bid
for induction therapy, 1–2 g/
d total given bid for
maintenance therapy
Same as other
immunosuppressive agents
e.g Cyclophosphamide
Azathioprine 2–3 mg/kg per day PO for
induction;1–2 mg/kg per
day for maintenance;
Infection, VZV infection,
bone marrow suppression, ,
pancreatitis, hepatotoxicity,
malignancy, , fever, flulike
illness, GI symptoms
Belimumab 10 mg/kg IV wks 0, 2, and 4,
then monthly OR
subcutaneous 200mg each
week
Infusion reactions, allergy,
infections. Headache and
diffuse body aching.
Tacrolimus 1-2 mg bid Infection oppurtunistic,
nephrotoxicity, neural
toxicity
HCQ 200-400mg/day Retinopathy ,Myopathy
51. Patient Summary
Patient Summary
Patient developed different infections like
diarrhea and candidiasis because of prolonged
immunosuppressive medications like
Tacrolimus and steroids