Aseptic abscesses (AAs) are neutrophilic infiltrative lesions that often coincide with systemic inflammatory disorders such as inflammatory bowel diseases (IBD). According to recent literature, medical therapies in IBD with AAs include corticosteroid, immunosuppressants and anti-TNFα biologics.
Diagnostics in Inflammatory Bowel Disease (IBD): UltrasoundAbhineet Dey
Intestinal ultrasound has a good accuracy in the diagnosis of Crohn's disease, as well as in the assessment of disease activity, extent, and evaluating disease-related complications, namely strictures, fistulae, and abscesses.
Even though not fully validated, several scores have been developed to assess disease activity using ultrasound. Importantly, intestinal ultrasound can also be used to assess response to treatment. Changes in ultrasonographic parameters are observed as early as 4 weeks after treatment initiation and persist during short- and long-term follow-up. Additionally, Crohn's disease patients with no ultrasound improvement seem to be at a higher risk of therapy intensification, need for steroids, hospitalisation, or even surgery.
Similarly to Crohn's disease, intestinal ultrasound has a good performance in the diagnosis, activity, and disease extent assessment in ulcerative colitis patients. In fact, in patients with severe acute colitis, higher bowel wall thickness at admission is associated with the need for salvage therapy and the absence of a significant decrease in this parameter may predict the need for colectomy.
Short-term data also evidence the role of intestinal ultrasound in evaluating therapy response, with ultrasound changes observed after 2 weeks of treatment and significant improvement after 12 weeks of follow-up in ulcerative colitis.
Introduction: Diffuse Large B Cell Lymphoma (DLBCL), as a set of heterogeneous aggressive lymphoma, most commonly originated in the germinal center B lymphocytes. Rare cases were from peripheral blood B cell (outside germinal center) or from the inert lymphoma development and transformation. And such tumor with originality outside germinal center was seldom seen in the literature. Even the tumor in combination with chronic gastritis has not been reported before.
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Austin Surgery Case Reports is an open access, peer review journal publishing case reports covering all fields of surgery. We follow double blind review process & the published case reports can be accessed by readers across the world without subscription and registration.
Austin Publishing Group's mission to facilitate immediate access to scientific data through an Open Access platform is greatly supported by invaluable contributions from the strong editorial and advisory boards.
Austin Publishing Group is moving ahead with a vision to develop an optimized knowledge sharing platform and an enlightening interactive network for researchers all over the world through its scientific publications and meetings.
Eosinophilic Enterocolitis: A Rare Nosological Entitynavasreni
Eosinophilic enterocolitis is an exceptionally rare disease with few cases described in the literature. It is the least frequent manifestation of the broad spectrum of gastrointestinal eosinophilic diseases. We describe a case of a female patient presenting with a form of the disease manifested by Koenig’s syndrome and diarrhea.
Eosinophilic Enterocolitis: A Rare Nosological Entitypateldrona
Eosinophilic enterocolitis is an exceptionally rare disease with few cases described in the literature. It is the least frequent manifestation of the broad spectrum of gastrointestinal eosinophilic diseases. We describe a case of a female patient presenting with a form of the disease manifested by Koenig’s syndrome and diarrhea.
Eosinophilic Enterocolitis: A Rare Nosological Entitykomalicarol
Eosinophilic enterocolitis is an exceptionally rare disease with few
cases described in the literature. It is the least frequent manifestation of the broad spectrum of gastrointestinal eosinophilic diseases. We describe a case of a female patient presenting with a form
of the disease manifested by Koenig's syndrome and diarrhea. This
posed a diagnostic challenge for us due to its non-specific symptoms, associated with the absence of standardized histological criteria, hence the need for a high level of suspicion. There is also
no consensus regarding the treatment. It should be individualized
according to the age of the patient and the severity of symptoms
Diagnostics in Inflammatory Bowel Disease (IBD): UltrasoundAbhineet Dey
Intestinal ultrasound has a good accuracy in the diagnosis of Crohn's disease, as well as in the assessment of disease activity, extent, and evaluating disease-related complications, namely strictures, fistulae, and abscesses.
Even though not fully validated, several scores have been developed to assess disease activity using ultrasound. Importantly, intestinal ultrasound can also be used to assess response to treatment. Changes in ultrasonographic parameters are observed as early as 4 weeks after treatment initiation and persist during short- and long-term follow-up. Additionally, Crohn's disease patients with no ultrasound improvement seem to be at a higher risk of therapy intensification, need for steroids, hospitalisation, or even surgery.
Similarly to Crohn's disease, intestinal ultrasound has a good performance in the diagnosis, activity, and disease extent assessment in ulcerative colitis patients. In fact, in patients with severe acute colitis, higher bowel wall thickness at admission is associated with the need for salvage therapy and the absence of a significant decrease in this parameter may predict the need for colectomy.
Short-term data also evidence the role of intestinal ultrasound in evaluating therapy response, with ultrasound changes observed after 2 weeks of treatment and significant improvement after 12 weeks of follow-up in ulcerative colitis.
Introduction: Diffuse Large B Cell Lymphoma (DLBCL), as a set of heterogeneous aggressive lymphoma, most commonly originated in the germinal center B lymphocytes. Rare cases were from peripheral blood B cell (outside germinal center) or from the inert lymphoma development and transformation. And such tumor with originality outside germinal center was seldom seen in the literature. Even the tumor in combination with chronic gastritis has not been reported before.
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Austin Surgery Case Reports is an open access, peer review journal publishing case reports covering all fields of surgery. We follow double blind review process & the published case reports can be accessed by readers across the world without subscription and registration.
Austin Publishing Group's mission to facilitate immediate access to scientific data through an Open Access platform is greatly supported by invaluable contributions from the strong editorial and advisory boards.
Austin Publishing Group is moving ahead with a vision to develop an optimized knowledge sharing platform and an enlightening interactive network for researchers all over the world through its scientific publications and meetings.
Eosinophilic Enterocolitis: A Rare Nosological Entitynavasreni
Eosinophilic enterocolitis is an exceptionally rare disease with few cases described in the literature. It is the least frequent manifestation of the broad spectrum of gastrointestinal eosinophilic diseases. We describe a case of a female patient presenting with a form of the disease manifested by Koenig’s syndrome and diarrhea.
Eosinophilic Enterocolitis: A Rare Nosological Entitypateldrona
Eosinophilic enterocolitis is an exceptionally rare disease with few cases described in the literature. It is the least frequent manifestation of the broad spectrum of gastrointestinal eosinophilic diseases. We describe a case of a female patient presenting with a form of the disease manifested by Koenig’s syndrome and diarrhea.
Eosinophilic Enterocolitis: A Rare Nosological Entitykomalicarol
Eosinophilic enterocolitis is an exceptionally rare disease with few
cases described in the literature. It is the least frequent manifestation of the broad spectrum of gastrointestinal eosinophilic diseases. We describe a case of a female patient presenting with a form
of the disease manifested by Koenig's syndrome and diarrhea. This
posed a diagnostic challenge for us due to its non-specific symptoms, associated with the absence of standardized histological criteria, hence the need for a high level of suspicion. There is also
no consensus regarding the treatment. It should be individualized
according to the age of the patient and the severity of symptoms
Prevalence and Determinants of Distress Among Residents During COVID Crisisgeorgemarini
Residents are predisposed to develop distress, burnout, and depression. With COVID-19, new stressful working conditions were imposed. This study aims to assess the impact of COVID-19 on residents’ wellbeing in France.
A Road from Coronary to Pulmonary: A Rare Imaging Presentationgeorgemarini
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Its association with Pulmonary Atresia is considered to be the most severe form, the diagnosis of which plays an important role in determination of the treatment protocol. In such cases, systemic vascular channels called Major Aortopulmonary Collateral Arteries (MAPCA’s) develop from aorta and its major branches to supply and maintain the pulmonary circulation. Such patients commonly undergo a Cardiac CT as an imperative pre-operative investigation for detailed information of these collaterals which helps plan further management. Here, we present a Case Report of an adult female patient with Pentalogy of Fallot wherein, a Cardiac CT showed the presence of dilated coronary-to-pulmonary collateral circulation. i.e. CAPA apart from the normally visualized MAPCA’s, an extremely rare occurrence.
Patients with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection mainly present severe pneumonia associated with complications related to cytokine storm syndrome. So, it was associated with thrombotic incidents like acute limb ischemia and pulmonary embolism.
Loop –Mediated Isothermal Amplification (LAMP) Based POINT-OF-CARE for Rapid ...georgemarini
Abstract Infectious diseases, including foodborne diseases, to this day remain a major health threat worldwide. Molecular diagnostics, based on nucleic acid (NA) amplification technologies, are in the forefront for the detection of pathogens. Polymerase chain reaction (PCR) is one of the most widely used methods for nucleic acid amplification in pathogen diagnostic.
Wen Dan Tang: A Potential Jing Fang Decoction for Headache Disordersgeorgemarini
Chinese herbal medicine is considered relatively safe, inexpensive, and easily accessible. Furthermore, it is becoming increasingly popular in the western countries. Wen Dan Tang, a Jing Fang ancient classical Chinese herbal formula, with a broad indication profile, has been used for several centuries in China to treat various illnesses.
Abstract Syringoma is a benign eccrine sweat gland tumor affecting mostly females at puberty projected with multiple soft papules usually 1-2 mm in diameter. During puberty, syringoma appears among females; it is presented as multiple soft papules, 1-2 mm in diameter, as a benign eccrine sweat gland tumor. The sites of predilection are lower eyelids, and cheeks. The regions of tendency are cheeks and lower eyelids. Syringoma of the vulvar is a rare disorder few cases of which have been reported in literature.
Rural Healthcare in Light of a Multinational Pandemic: A Global Perspectivegeorgemarini
Abstract Rural healthcare recently came into international spotlight, with recent reported influx of the COVID-19 into rural regions. This article focuses on susceptibilities of the rural population to pandemics and mitigating measures to prevent formation of disease epicentre. Rural Healthcare is by far one of the most neglected areas of medicine. The discrepancies in quality of rural healthcare has been evident for decades, yet no lasting measures have been able to bridge this gap till date. Lessons gleaned from the recent SARS and H1N1 pandemics has once again fallen through the cracks in a futile attempt to curb urban spread. http://dx.doi.org/10.47829/ACMCR.2021.61801
A Mild form of Familial Mediterranean Fever Associated with a Polymorphisms C...georgemarini
Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disease caused bymutation(s) in the Mediterranean fever (MEFV, pyrinmarenostrin) gene. FMF is characterized byrecurrent fever crisis combined with serosal, synovial, or cutìaneous inflammation
Portosystemic Shunt for Treatment of Symptomatic Varices in Polycythemia Vera...georgemarini
Myeloproliferative disorders are commonly associated with portal vein thrombosis, which can lead to extensive and symptomatic variceal disease due to the development of noncirrhotic portal hy- pertension. In severe cases, a decline in liver synthetic function may indicate the need for liver transplantation
A hookah (shisha, waterpipe) use may increase the risk of suffering from serious symptoms due to
COVID-19. Like smoking, hookahs may exacerbate the risk for severe COVID-19 through shared use
and being difficult-to-clean the long pipes and having a cold water reservoir. Social gatherings also
provide an opportunity for the virus to spread.
Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...georgemarini
The increasing interest in Lung Ultrasound (LUS) over the last years led to a great diffusion and better experience in using this technique, which became an essential tool for clinicians. During the current Coronavirus Disease 2019 (COVID-19) pandemic
Postpartum Meningitis by Enterococcus Faecalis Secondary to Neuraxial Anesthesiageorgemarini
Meningitis is an infrequent and serious cause of postpartum fever that requires early diagnosis and treatment to prevent serious complications and to reduce the high mortality rate. Neuraxial anesthesia is a frequently used technique in obstetrics. Meningitis is a very rare complication of neuraxial an- esthesia and enterococcus....
Advanced Esophagogastric Cancer after Bariatric Proceduregeorgemarini
A 74-year-old man, non-smoker or alcoholic, underwent gastric bypass with stapled division of the stomach and Roux-en-Y gastrojejunostomy 20 years ago. A band was used to limit the emptying of the gastric pouch. Follow up was abandoned there are ten years, and, three months ago,
Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report and Revi...georgemarini
Encephalitis caused by Herpes Simplex Virus (HSV) and medulloblastoma are both fairly rare disorders with relatively poor prognoses. We experienced a case of HSV encephalitis (HSE) in which the patient presented 1 year after surgical resection and radiation therapy and 1 month after chemotherapy....
Superior Mesenteric Artery Syndrome Treated by Laparoscopic Duodenojejunostomygeorgemarini
Superior Mesenteric Artery syndrome (SMA Sd) is a very rare disease. It is suspected in the case of intestinal obstruction in severely underweight patients
Colopleural Fistula. A Case Report and Review of Literaturegeorgemarini
The presence of a colopleural fistula is a rare event related to several factors, inadequate placement of drains, poor surgical technique, infection or dehiscence of a GI anastomosis
Atypical Presentation of Post-Kala Azar Dermal Leishmaniasis in Bhutangeorgemarini
This article describes an atypical case of post-kala azar dermal leishmaniasis associated with complications due to delayed diagnosis and poor case management. The grave consequences of the prolonged disease process, which included facial disfigurement
Cutaneous Larva Migrans: A Case Report in a Traveler Childgeorgemarini
Cutaneous Larva Migrans (CLM) is the most common skin disease of tropical origincaused by hookworms larvae, occurring in international travelers. Typical manifestations consist of erythematous, serpiginous slightly elevated linear cutaneous lesions
Since receiving unexplained pneumonia patients at the Jinyintan Hospital in Wu- han, China in December 2019, the new coronavirus (COVID-19) has rapidly spread in Wuhan, China and spread to the entire China and some neighboring countries.
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
Prevalence and Determinants of Distress Among Residents During COVID Crisisgeorgemarini
Residents are predisposed to develop distress, burnout, and depression. With COVID-19, new stressful working conditions were imposed. This study aims to assess the impact of COVID-19 on residents’ wellbeing in France.
A Road from Coronary to Pulmonary: A Rare Imaging Presentationgeorgemarini
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Its association with Pulmonary Atresia is considered to be the most severe form, the diagnosis of which plays an important role in determination of the treatment protocol. In such cases, systemic vascular channels called Major Aortopulmonary Collateral Arteries (MAPCA’s) develop from aorta and its major branches to supply and maintain the pulmonary circulation. Such patients commonly undergo a Cardiac CT as an imperative pre-operative investigation for detailed information of these collaterals which helps plan further management. Here, we present a Case Report of an adult female patient with Pentalogy of Fallot wherein, a Cardiac CT showed the presence of dilated coronary-to-pulmonary collateral circulation. i.e. CAPA apart from the normally visualized MAPCA’s, an extremely rare occurrence.
Patients with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection mainly present severe pneumonia associated with complications related to cytokine storm syndrome. So, it was associated with thrombotic incidents like acute limb ischemia and pulmonary embolism.
Loop –Mediated Isothermal Amplification (LAMP) Based POINT-OF-CARE for Rapid ...georgemarini
Abstract Infectious diseases, including foodborne diseases, to this day remain a major health threat worldwide. Molecular diagnostics, based on nucleic acid (NA) amplification technologies, are in the forefront for the detection of pathogens. Polymerase chain reaction (PCR) is one of the most widely used methods for nucleic acid amplification in pathogen diagnostic.
Wen Dan Tang: A Potential Jing Fang Decoction for Headache Disordersgeorgemarini
Chinese herbal medicine is considered relatively safe, inexpensive, and easily accessible. Furthermore, it is becoming increasingly popular in the western countries. Wen Dan Tang, a Jing Fang ancient classical Chinese herbal formula, with a broad indication profile, has been used for several centuries in China to treat various illnesses.
Abstract Syringoma is a benign eccrine sweat gland tumor affecting mostly females at puberty projected with multiple soft papules usually 1-2 mm in diameter. During puberty, syringoma appears among females; it is presented as multiple soft papules, 1-2 mm in diameter, as a benign eccrine sweat gland tumor. The sites of predilection are lower eyelids, and cheeks. The regions of tendency are cheeks and lower eyelids. Syringoma of the vulvar is a rare disorder few cases of which have been reported in literature.
Rural Healthcare in Light of a Multinational Pandemic: A Global Perspectivegeorgemarini
Abstract Rural healthcare recently came into international spotlight, with recent reported influx of the COVID-19 into rural regions. This article focuses on susceptibilities of the rural population to pandemics and mitigating measures to prevent formation of disease epicentre. Rural Healthcare is by far one of the most neglected areas of medicine. The discrepancies in quality of rural healthcare has been evident for decades, yet no lasting measures have been able to bridge this gap till date. Lessons gleaned from the recent SARS and H1N1 pandemics has once again fallen through the cracks in a futile attempt to curb urban spread. http://dx.doi.org/10.47829/ACMCR.2021.61801
A Mild form of Familial Mediterranean Fever Associated with a Polymorphisms C...georgemarini
Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disease caused bymutation(s) in the Mediterranean fever (MEFV, pyrinmarenostrin) gene. FMF is characterized byrecurrent fever crisis combined with serosal, synovial, or cutìaneous inflammation
Portosystemic Shunt for Treatment of Symptomatic Varices in Polycythemia Vera...georgemarini
Myeloproliferative disorders are commonly associated with portal vein thrombosis, which can lead to extensive and symptomatic variceal disease due to the development of noncirrhotic portal hy- pertension. In severe cases, a decline in liver synthetic function may indicate the need for liver transplantation
A hookah (shisha, waterpipe) use may increase the risk of suffering from serious symptoms due to
COVID-19. Like smoking, hookahs may exacerbate the risk for severe COVID-19 through shared use
and being difficult-to-clean the long pipes and having a cold water reservoir. Social gatherings also
provide an opportunity for the virus to spread.
Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...georgemarini
The increasing interest in Lung Ultrasound (LUS) over the last years led to a great diffusion and better experience in using this technique, which became an essential tool for clinicians. During the current Coronavirus Disease 2019 (COVID-19) pandemic
Postpartum Meningitis by Enterococcus Faecalis Secondary to Neuraxial Anesthesiageorgemarini
Meningitis is an infrequent and serious cause of postpartum fever that requires early diagnosis and treatment to prevent serious complications and to reduce the high mortality rate. Neuraxial anesthesia is a frequently used technique in obstetrics. Meningitis is a very rare complication of neuraxial an- esthesia and enterococcus....
Advanced Esophagogastric Cancer after Bariatric Proceduregeorgemarini
A 74-year-old man, non-smoker or alcoholic, underwent gastric bypass with stapled division of the stomach and Roux-en-Y gastrojejunostomy 20 years ago. A band was used to limit the emptying of the gastric pouch. Follow up was abandoned there are ten years, and, three months ago,
Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report and Revi...georgemarini
Encephalitis caused by Herpes Simplex Virus (HSV) and medulloblastoma are both fairly rare disorders with relatively poor prognoses. We experienced a case of HSV encephalitis (HSE) in which the patient presented 1 year after surgical resection and radiation therapy and 1 month after chemotherapy....
Superior Mesenteric Artery Syndrome Treated by Laparoscopic Duodenojejunostomygeorgemarini
Superior Mesenteric Artery syndrome (SMA Sd) is a very rare disease. It is suspected in the case of intestinal obstruction in severely underweight patients
Colopleural Fistula. A Case Report and Review of Literaturegeorgemarini
The presence of a colopleural fistula is a rare event related to several factors, inadequate placement of drains, poor surgical technique, infection or dehiscence of a GI anastomosis
Atypical Presentation of Post-Kala Azar Dermal Leishmaniasis in Bhutangeorgemarini
This article describes an atypical case of post-kala azar dermal leishmaniasis associated with complications due to delayed diagnosis and poor case management. The grave consequences of the prolonged disease process, which included facial disfigurement
Cutaneous Larva Migrans: A Case Report in a Traveler Childgeorgemarini
Cutaneous Larva Migrans (CLM) is the most common skin disease of tropical origincaused by hookworms larvae, occurring in international travelers. Typical manifestations consist of erythematous, serpiginous slightly elevated linear cutaneous lesions
Since receiving unexplained pneumonia patients at the Jinyintan Hospital in Wu- han, China in December 2019, the new coronavirus (COVID-19) has rapidly spread in Wuhan, China and spread to the entire China and some neighboring countries.
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
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
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.
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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
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2. http://www.acmcasereport.com/ 2
Volume 8 Issue 17 -2022 Case Report
side colon wall, multiple low enhanced lesions in liver and kidneys
and multiple newly appearing lymphadenopathies in mediastinal,
mesenteric and para-abdominal aortic areas with some particularly
enlarged abdominal lymph nodes that were up to 2-3cm diameters
with central liquefactive necrosis [Figure 2B]. Those image results
were confirmed by enhanced MR scan [Figure 2A]. Colonoscopy
demonstrated active ulcerative colitis that affected from the trans-
verse colon near the hepatic flexure to the descending colon [Fig-
ure 1A, 1B]. She was diagnosed as ulcerative colitis. Pathological
nature of the enlarged abdominal lymphadenopathies and hepatic
and renal lesions were considered including multi-organ infectious
lesions, which is reasonable considering her immunocompromised
status due to colitis and past history of using corticosteroid, and
lymphoma which have been reported repeatedly in patients of in-
flammatory bowel disease with lymphadenopathy. She was admin-
istrated with broad spectrum antibiotics for 3 weeks (Ertapenem 1g
every day for a week, Cefoperazone/Sulbactam 3g every 8 hours
with Ornidazole 0.5g every 12 hours for a week and levofloxacin
0.4g every day with Ornidazole 0.5g every 12 hours for a week).
Her peripheral white cell count was moderately improved. How-
ever, activity of bowel disease and other manifestations showed
much less alleviation. PET-CT scan was conducted that showed no
indication of lymphoma. We also performed endoscopic ultraso-
nography with fine needle aspiration [EUS-FNA]. Results of EUS
coincided with CT and MR scan and FNA acquired 2ml of puru-
lent fluid which was further sent to bacteria, fungi and tuberculo-
sis cultures, Next Generation Sequencing [NGS] for pathogens,
pathological examination and cytological smears [Figure 3]. Evi-
dence of infectious pathogen was negative and pathological exam
demonstrated necrotic tissue with neutrophils infiltration. Hip
joints MR scan was also performed with experienced rheumatolo-
gist’s evaluation that confirmed polyarthritis. We finally diagnosed
her as ulcerative colitis (chronic relapse, pancolitis, moderate to
severe activity), aseptic abscesses (mesenteric lymph nodes, liver
and kidneys), musculoskeletal manifestation (peripheral arthrop-
athy) and recommended vedolizumab for her. We then witnessed
a dramatic remission of her intestinal and articular symptoms and
improvement of her lymphatic enlargement, hepatic and renal le-
sions that were confirmed by colonoscopy and MR scan at the time
of 4-month follow-up [Figure 1C, 1D, 2C and 2D]. Her hemoglo-
bin and albumin levels gradually recovered to normal and inflam-
matory markers such as CRP decreased accordingly. Till the time
this report written, it has been 9 months since vedolizumab therapy
began, she came back to hospital periodically for continuous treat-
ment and surveillance, and there’s no sign of any sort of relapse.
Figure 1: Colonoscopy images of transverse colon and descending colon before and after 4 months of treatment.
Colonoscopy showed friable mucosa, diffused mucosal congestion and edema with flaky ulcers and erosions covered with mucopurulent secretions and
lack of vascular pattern in the descending colon (A) and transverse colon (B) at the time of admission and recovered mucosa with nascent granulation
tissue and inflammatory polyps in the descending colon (C) and transverse colon (D) 4 months after treated with vedolizumab.
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Volume 8 Issue 17 -2022 Case Report
Figure 2:Abdominal radiological images demonstrating hepatic and renal lesions and aseptic abscesses before and after 4 months of treatment.
MRI (A, C) and CT (B, D) scan of upper-abdomen showed multiple lesions in live and kidneys (green arrows) and enlarged abdominal lymph node
with central liquefactive necrosis (yellow arrows) at the time of admission (A, B). After treated with vedolizumab, the lesions decreased in sizes (B, D).
Figure 3: Endoscopic ultrasonography and fine needle aspiration (EUS-FNA) of the enlarged and necrotic lymph nodes.
EUS demonstrated abdominal enlarged lymph nodes with central liquefactive necrosis (A). Fine needle aspiration was performed and 2ml of purulent
fluid was acquired (B and C).
4. Discussion
To our knowledge, this is the first case of ulcerative colitis with
aseptic abscesses treated with vedolizumab that showed a prom-
ising result during at least 9 months follow-up. Aseptic abscesses
were first described in 1995 by Andre et al. in patients with ab-
scesses that could not be explained by infection because of un-
responsiveness to antibiotics and sensitivity to corticosteroid [2].
It often associates with systemic inflammatory conditions, mostly
IBD as one of extraintestinal manifestation [6, 7]. Similar to neu-
trophilic dermatosis such as Pyoderma Gangrenosum and Sweet’s
Syndrome which are two types of more often seen dermatological
manifestations of IBD, histopathological characteristics of AA is
sterile predominant neutrophils infiltration of the deep tissues [6].
There is currently no diagnostic criterion for AA. However, An-
dre and colleagues came up with a set of common characteristics
base on case series for clinicians to evaluate AA: (1) deep abscess-
es with neutrophilic features; (2) negative findings of causative
infectious pathogen from serological tests and cultures of blood
and aspiration sample; (3) failure of broad-spectrum antibiotics;
(4) clinical improvement on corticosteroid therapy with or without
additional immunosuppressant which is confirmed by radiologic
evidence [3]. According to the latest literature review by Yama-
guchi. Y and teammates, 43 patients of IBD-associated AA were
identified in MEDLINE from 1994 to 2020. Patients may present
with fever, abdominal pain, weight loss and diarrhea. Lesions may
be located at spleen, liver, lymph nodes, muscles, kidneys, sternum
and other locations in very rare cases. Patients may coincide with
other EIM of IBD such as arthritis, myalgia, neutrophilic dermato-
sis, aphthous ulcer, panniculitis and polyneuropathy. Several treat-
ments had been reported including corticosteroids which is most
often mentioned, cyclophosphamide, azathioprine, methotrexate,
granulocytapheresis, adalimumab, infliximab and surgical proce-
dures such as splenectomy, incision and drainage, laparoscopic
biopsy of lymph nodes [1]. In this case, we regarded this patient
as IBD-associated AAs according to results of pathogen tests, his-
topathological findings and therapeutic effect of broad-spectrum
antibiotics. However, other differential diagnoses such as oppor-
tunistic infection, lymphoma and tuberculosis infection couldn’t
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Volume 8 Issue 17 -2022 Case Report
be excluded. Thus, among several therapeutic options including
corticosteroid, anti-TNF biologics, and anti-Integrin biologics,
we deemed vedolizumab as the optimal choice for her from the
perspective of safety because of its intestinal selectivity. Outcome
of this treatment was inspiring for not only remission of colonic
mucosal inflammation but also alleviation of AAs and arthralgias.
Inflammatory bowel disease is not limited to the digestive tract
and is regarded as a systemic immune disorder with nearly one
half of patients experiencing extraintestinal manifestations which
involve multiple organs and systems including musculoskele-
tal system, skin, ocular organ and hepatobiliary tract and others
[8]. The pathophysiological mechanism of EIMs is unclear with
several hypotheses. Either they could be the result of intestinal
immune activation with inflammatory cells and cytokines subse-
quently trafficking or diffusing to extraintestinal target organs, or
they, together with gastrointestinal tract, could be simultaneously
involved by systemic immune disturbance [3]. Vedolizumab is a
gut-selective antibody to α4β7 integrin for treatment of moder-
ate-severe IBD. Studies have shown long-term effectiveness and
a favorable safety profile of vedolizumab with low incidence rates
of serious infections and malignancies at least partially due to its
selectivity [9, 10]. It is uncertain whether a gut-selective action is
suitable for controlling EIMs such as aseptic abscesses and mus-
culoskeletal manifestations. In a systemic review worked by Han-
zel. J and team, vedolizumab may be effective for musculoskeletal
EIMs associated with disease activity [3]. There were case reports
suggesting that vedolizumab could be effective for pyoderma gan-
grenosum according to Groudan K. et al., Fleisher M. et al. and
Shibuya T. et al. [11, 12, 13]. However, there were no randomized
controlled trials that specifically study the efficacy of vedolizumab
for IBD related EIMs especially aseptic abscesses and arthropathy,
and evidence from different observational studies are of modest
quality. Thus, large-scale well-designed prospective studies are
needed in the future in order to definitively answer such questions.
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