Vasculitis syndrome an approach -and-basic principles of treatmentSachin Verma
Vasculitides are a hetrogenous group of conditions characterized by inflammation and necrosis of blood vessels.
A broad group of syndromes may result from this process,since any type,size, and location of vessel may be involved.
Vasculitis syndrome an approach -and-basic principles of treatmentSachin Verma
Vasculitides are a hetrogenous group of conditions characterized by inflammation and necrosis of blood vessels.
A broad group of syndromes may result from this process,since any type,size, and location of vessel may be involved.
Vasculitis
pathology
Define and classify vasculitis.
Describe the cause, pathogenesis, morphology, and clinical presentation of various types of vasculitis.
A detailed description of sarcoidosis, pulmonary in specific but also covering the other systems. a rare entity in india or a better way to say, often an overlooked disease.
Vasculitis
pathology
Define and classify vasculitis.
Describe the cause, pathogenesis, morphology, and clinical presentation of various types of vasculitis.
A detailed description of sarcoidosis, pulmonary in specific but also covering the other systems. a rare entity in india or a better way to say, often an overlooked disease.
This presentation is about pulmonary manifestations of systemic vasculitis,in it m discussing about WEGNER,S GRANULOMATOSIS, churg-strauss syndrome and MPA
download link : https://www.dropbox.com/s/5c69pkpkass8sk1/Vasculitides%20AND%20ANTI-GBM.ppt?m
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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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
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. Introduction
• Vasculitis- Inflammation of blood vessels
characterised by leucocytic infiltration of the
vessel walls
• Different patterns of vessels’ involvement in
different entities
• Vessel lumen compromisedischemia of the
corresponding organ
3. Pathogenesis
• 3 main groups of pathogenetic mechanisms
behind vasculitis-
1.Immune complex formation
2.ANCA mediated
3.T lymphocyte mediated with Granuloma
formation
4. Immune complex formation
• Henoch Schonlein purpura- IgA mediated
• SLE & other collagen vascular diseases-
ANA
• Serum sickness
• Polyarteritis Nodosa- Hepatitis B ag
• Essential Mixed Cryoglobinemia- Hepatitis
C virion
*deposition of immune complexes in the
blood vesselsactivation of
complementsdestruction of vessel wall
(acute & chronic inflammation)
5. ANCA
• P-ANCA (anti-proteinase 3)- Wegener’s
• C-ANCA (anti-MPO)
- Churg Strauss vasculitis
- Microscopic Polyangiitis
- Wegener’s granulomatosis
* Aberrant expression of proteinase 3 and MPO
over the surface of the neutrophilsformation
of antibodiesdestruction of
neutrophilsvessel wall damage
6.
7. Granuloma formation
(T lymphocyte mediated)
• Giant cell arteritis
• Takayasu’s arteritis
• Wegener’s granulomatosis
• Churg Strauss vasculitis
*classical granuloma formation (giant cells and
epitheloid cells in a backround of fibrinoid
necrosis) can be demonstrated in the
corresponding vessel biopsy
23. Small vessel Vasculitis
Pauci-immune (ANCA mediated)
Wegener’s Granulomatosis
Churg Strauss vasculitis
Microscopic Polyangiitis
Immune complex mediated
Henoch Schonlein Purpura
Essential Mixed Cryoglobulinemia
SLE and other collagen c=vascular diseases
related vascultis
24. Other primary vasculitides
• Thromb Angiitis Obliterans
• Behcet’s disease
• Idiopathic Cutaneous vasculitis
• Isolated Vasculitis of CNS
• Relapsing Polychondritis
• Polyangiitis overlap syndromes (features of
more than 1 vasculitis)
25. STEP 4
Learn the characteristic presentations of each vasculitis !!!
26. Giant cell arteritis
• Temporal arteritis
• Elderly persons more than 50 yrs. of age
• Non specific symptoms, Headache, Elevated
ESR
• BLINDNESS-most serious complication
• Jaw claudication, Scalp pain, Scalp Tenderness
• Polymyalgia Rheumatica- different end of the
spectrum of Giant Cell Arteritis
27.
28. Takayasu’s Arteritis
• Pulseless Disease
• Middle aged females
• Aorta and its branches mainly involved
• Subclavian vessels, Carotid vessels, Mesentric
vessels
• Chronic and Relapsing course
29.
30. Poly Arteritis Nodosa
• Renal arteries most commonly involved
leading to renovascular hypertension
• Pulmonary vessels NEVER involved
• Association with patients of
o Hepatitis B
o Hairy cell leukemia
31. Kawasaki’s Vasculitis
• MucoCutaneous Lymph node syndrome
• Children < 5 years of age mostly
• Desquamative erythematous rashes involving
the skin, mucus membranes, cervical
lymphadenopathy
• 25 % develop coronary artery aneurysms in
the convalescent stage of the illness
32.
33.
34. Pauci immune Vasculitis
Usually Pulmonary capillaritis PLUS
Glomerulonephritis
•Granulomas +, Asthma + Churg Strauss
•Granulomas +, NO asthma Wegener’s
•NO granulomas, NO asthma Microscopic
Polyangiitis
35. Wegener’s Granulomatosis
• Classical triad URT + LRT + renal
• Chronis sinusitis, Pulmonary nodules,
Pulmonary cavities, Rapidly Progressive
Glomerulonephritis
• Cutaneous vasculitis, Eye lesions may be
present
• Non specific symptoms may predominate
36.
37. Churg Strauss Vasculitis
• Asthma, Eosinophilia with pulmonary infiltrates ,
glomerulonephritis
• Myocardial involvement most common cause
of death
Microscopic Polyangiitis
• Pulmonary alveolar capillariitis,
glomerulonephritis
38. Henoch Schonlein Purpura
• 2nd decade
• Palpable purpura over lower limbs,
• Gastrointestinal complaints (abd.colicky pain,
blood in stools),
• Fever, polyarthralgia
• Increased IgA levels in blood
39.
40. Essential Mixed Cryoglobulinemia
• 5 % of Chronic Hepatits C pts. Have EMC
• Cryoglobulins formed agianst HCV RNA
• Pulmonary, renal ( MPGN ), cutaneous
vasculitis
Thromb Angiitis Obliterans
• Chronic heavy Smokers
• Inflammation of arteries, veins, nerves
• Upper and lower limb gangrene, Instep
claudication, rest pain
41. Other primary vasculitides
• Behcet’s disease (Recurrent OculoOroGenital
ulcerations with vasculitis)
• Idiopathic Cutaneous vasculitis
• Isolated Vasculitis of CNS
• Relapsing Polychondritis
• Polyangiitis overlap syndromes (features of
more than 1 vasculitis)
42. Summary of 4 steps
• Step 1- Recognise vasculitis
• Step 2- Rule out Sec. Vasculitis
• Step 3- Study the pattern of vessels involved
in the patient
• Step 4- Remember the characteristic
presentations of each primary vasculitis
44. Common Blood Counts
• Mild Anemia – Anemia of Chronic Disease
• Differential Leucocyte Count:
Predominant eosinophils- Churg Strauss, HSP
ESR
• Non specific
• But useful test to suggest presence of
underlying inflammatory process
45. • Acute Phase Reactants
Highly sensitive C reactive Protein, Alpha 2
globulin
• Chest X ray / HRCT thorax:
-Pulmonary infiltrates- small vessel vasculitis
-Pulmonary cavities- Wegener’s granulomatosis
• Xray Para Nasal Sinuses
-Sinusitis of Wegener’s
46.
47. • Urine routine- RBCs with active sediments
suggest Glomerulonephritis (Renal
involvement of small vessel vasculitis)
• Viral Markers
- Hep. B Poly Arteritis Nodosa
- Hep.C Essential Mixed Cryoglobulinemia
48. • Immunoglogulin levels (IgG, M, A)
- Usually hyper gammaglobulinemia seen
- Elevated IgA levelsHenoch Sconlein Purpura
• Cryoglobulins- Essential Mixed Cryoglobulinemia
• Rheumatoid Factors
-To detect secondary vasculitisRheumatoid
Arthrits
-Significantly raised in Essential Mixed
Cryoglobulinemia also
49. • Complement levels (reduced in immune compex
mediated diseases)- EMC, HSP
• ANCA
P-ANCA: Wegener’s Granulomatosis
C-ANCA: Microscopic polyangiitis, Churg Strauss,
Wegener’s vasculitis
• ANA
-screening of SLE, collagen vascular disorders in
suspicion of secondary vasculitis
50. BIOPSY
• Renal Biopsy- to detect glomerulonephritis
especially in small vessel vasculitis
RPGN- seen in pauci immune vasculitis
MPGN- seen in EMC
• Skin Biopsy- to detect “leukocytoclasis” in
cutaneous vasculitis all small vessel and
secondary vasculitides
51. BIOPSY
• Temporal Artery Biopsy- Giant Cell Arteritis
• Pulmonary tissue Biopsy- Small vessel vascultides
• Upper Airway biopsies- Wegener’s Vasculitis
* Main purpose of biopsy is to study presence of
leukocytoclasis, characterisitc pathological
alterations in tissues, GRANULOMAS
* Immunofluorescence also helps to study immune
complex deposition, IgA deposition, Complement
deposition
52. ARTERIOGRAPHY
Helps specially in in arteries that cannot be
biopsied easily like Aorta, Coronary artery,
Mesentric vessels
Presence of vascular patency, Aneurysms
• Aortic Angiography- Takayasu’s
• Cerebral Angiography- Isolated CNS vascultis
• Renal Angiography- PAN
• Coronary Angiography- Kawasaki’s
• Lower limb arteriography-Buerger’s Disease
(TAO)
55. Principles of Treatment
• Immuno Suppression
Glucocorticoids- oral / IV methyl prednisolone
Cyclophosphamide
Methotrexate
Azathioprine
Cyclosporine
Rituximab- anti CD 20 ab
AntiTNF therapies- Infliximab, Adalimumab,
Etanacerpt, Certulizumab
56. Principles of Treatment
• Choice of therapy depends on
Severity of organ damage
Extent of Multi System Involvement
The vascular bed involved (renal, ocular,
coronary)
• Cyclophosphamide + Glucocorticoid therapy
preferred for severe / serious complications
• Glucocorticoids alone will suffice for isolated
mild vascultis like “idiopathic cutaneous
vascultis”
57. Principles of Treatment
• Wherever possible secondary causes
(infections, malignancies) should be sought
and treated
• Anti viral therapy (HCV, HBV)
• ASPIRIN therapy – Kawasaki’s, Giant cell
arteritis
• Intravenous Immunogloguloin Therapy-
Prevents coronary aneurysms in Kawasaki’s
58. Principles of Treatment
• Major toxic side effects of all prescribed drugs
need to be kept in mind
(Osteoporosis, growth retardation, bone
marrow suppression, hepatic toxicity, renal
toxicity, bladder cancer, cystitis …)
• Long term toxicities need to be prevented
• Long term prescription of a single group of
drug to be avoided change over to a drug
with lesser toxicity profile as soon as
symptoms are controlled
59. Principles of Treatment
• Regular Monitoring of Blood Counts, Renal
and hepatic functions
• Most of the Primary vasculitides have one
thing in common
“Chronic, Responsive to treatment, But
Notoriously Relapsing”
60. SUMMARY OF STEPS
• Step 1- Recognise vasculitis
• Step 2- Rule out Sec. Vasculitis
• Step 3- Study the pattern of vessels involved
in the patient
• Step 4- Remember the characteristic
presentations of each primary vasculitis
• Step 5- How to Diagnose
• Step 6- Principles of treatment