Rheumatoid Arthritis (Nutshell)
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for education purpose of MBBS, BHMS and BAMS students. Rheumatoid Arthritis is a quite common and troublesome disease in the society. Plenty of patients present with RA in our clinics as well as family. This brief presentation tends to cover the basic pathology behind RA, easy to identify signs and symptoms and prompt management of the disease before the deformities set in. In case of doubts or feedbacks, feel free to contact me on WhatsApp 9409012212 or Email- dr.aakashnandu@gmail.com
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This document provides an overview of the approach to diagnosing and classifying muscle disorders. It discusses taking a clinical history and performing a physical exam to identify symptoms and patterns of weakness. Key investigations include blood tests of enzymes like CK, electromyography and muscle biopsy. Major classifications of myopathies covered are immune-mediated myopathies like dermatomyositis and polymyositis, necrotizing myopathies, inclusion body myositis, and others. Treatment typically involves immunosuppressants like corticosteroids and newer targeted immunotherapies depending on antibody status and subtype.
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This document provides an overview of pathology and cell injury. It begins with definitions of pathology and discusses its focus on etiology, pathogenesis, morphology, and manifestations of disease. It then covers cell injury, describing the process from normal cell to reversible and irreversible injury. Specific types of cell injury are outlined like cloudy swelling, fatty change, and hyaline degeneration. The document concludes with examples of intracellular accumulations seen in various disease states.
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9
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Chapter wise All Notes of First year Basic Civil Engineering.pptx
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Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
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Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
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● Types of event processing models in Mule 4
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For Upcoming Meetups Join Mysore Meetup Group - https://meetups.mulesoft.com/mysore/YouTube:- youtube.com/@mulesoftmysore
Mysore WhatsApp group:- https://chat.whatsapp.com/EhqtHtCC75vCAX7gaO842N
Speaker:-
Shivani Yasaswi - https://www.linkedin.com/in/shivaniyasaswi/
Organizers:-
Shubham Chaurasia - https://www.linkedin.com/in/shubhamchaurasia1/
Giridhar Meka - https://www.linkedin.com/in/giridharmeka
Priya Shaw - https://www.linkedin.com/in/priya-shaw
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Rheumatoid Arthritis (Nutshell)
- 1. Rheumatoid Arthritis Dr Aakash Nandu M.S. Orthopaedics Smit Orthopaedic Hospital
- 2. Introduction • MC cause of chronic inflammatory joint disorder. • Typical features – 1. Symmetrical polyarthritis 2. Morning stiffness 3. ESR and CRP elevated Systemic Autoimmune disorder Pt dies younger due to multiple organ involvement MC Ischaemic heart disease.
- 3. Definition • Auto-immune Chronic Inflammatory disorder which affects the joints and produces an inflammatory synovitis.
- 4. Pathophysiology Presentation of Antigen to T- cells B and T cell proliferation Angiogenesis in Synovium Neutrophilic infiltration & Synovitis Early Pannus Formation Sub chondral Bone erosion Pannus invasion of Cartilage Ligament Laxity Joint instability, Contractures, reduced ROM
- 5. Pannus • Pannus is a sheet of inflammatory granulation tissue that spreads from the synovial membrane and invades the joint
- 6. Etiology 1. Idiopathic 2. Positive Family History 3. Presence of inherited MHC Antigen 4. Smoking 5. Herpes Simplex / EBV infection 6. Bacterial / Fungal Infection
- 7. Signs and Symptoms • EARLY 1. Polyarthralgia • Pain in 2 or more joints at the same time • Most commonly involves PIP joints of fingers > toes. • Joints are red, swollen and tender
- 8. Swan neck Deformity Boutennaire Deformity Z-deformity of thumb
- 9. RA hands
- 10. Mallet Finger • Simple flexion deformity of distal interphalangeal joint preventing extension
- 11. • 2. Bilateral Symmetrical Polysynovitis • 3. Morning stiffness ( >30 min) • 4. Loss of mobility • 5. Constitutional Symptoms (LOA, LOW, Malaise, Low grade fever)
- 12. Late Features 1. Spread to larger joints (wrist, ankle, knee and shoulder in order of frequency) 2. Deformities set in Wrist – Volar and radial deviation Knee – flexion Elbow – flexion Shoulder- limited abduction Toes - Clawed 3. Activities of daily living are affected. Quality of life affected.
- 13. Diagnosis • 1. Clinical • 2. Lab Tests – ESR, CRP, RA factor, Anti-CCP • 2. Radiological (EULAR Criteria)
- 16. Treatment • No permanent Cure • Only delay the symptoms • Supportive and palliative
- 18. 1st Line of management • Ibuprofen, Indomethacin, Cox-2 inhibitors like Etoricoxib, Celecoxib and Polmacoxib reduce inflammation and relieves pain. • Steroids in low doses reduce pain and inflammation. • Opioids like morphine, buprenorphine and tramadol provide symptomatic relief.
- 19. DMARDS
- 20. Biological Response modifiers • These drugs directly modify the immune system by inhibiting proteins called cytokines – Eg. Infliximab, Adalimumab, Anakinra, Etanercept. • Cytokine inhibition leads to suppression of immunity. • Be careful !! Increased risk of infections…sometimes life threatening.
- 22. Protein A Immunoadsorption Therapy • This is not a drug. • It is a therapy • Dialysis to remove the antibodies and Immune complexes that promote the inflammation.
- 23. Surgeries 1. Osteotomy Extra articular procedure for even weight distribution Cannot be performed in active disease. 2. Arthroplasty ( Joint replacement) Replace the root cause of disease 3. Arthrodesis Fuse the joint in functional position
- 24. Arthrodesis
- 25. Complications 1. Deformities 2. Muscle weakness 3. Infection 4. Spinal Cord compression 5. Systemic Vasculitis 6. Amyloidosis – Renal Failure