Sandbox:dina
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AF [2]
Atrial fibrillation
Insulin
Functions
- Bind insulin receptors
- inducing glucose uptake into insulin dependent tissue
- gene transcription
- glucose is the major regulator of insulin release to incretins.
Diabetes mellitus It could be due to genetic , enviromental or immune defects.
Regulation of insulin
| “ | glucose is the main substrate for the brain | ” |
| Findings | hypothyroidism | Hyperthyroidism |
|---|---|---|
proinsulin and c-peptide
Complications of diabetes:
- Major complications
- Minor complications
- Emergency situations
11 β- hydroxylase deficiency
21 α-hydroxylase deficiency
- redirectDiabetes Mellitus
The pathogenesis of chronic recalcitrant hand eczema and its dramatic response to alitretinoin is not yet known. [3]
References
- ↑ Spicer DE, Hsu HH, Co-Vu J, Anderson RH, Fricker FJ (2014). "Ventricular septal defect". Orphanet J Rare Dis. 9: 144. doi:10.1186/s13023-014-0144-2. PMC 4316658. PMID 25523232.
- ↑ Jennette JC, Falk RJ, Bacon PA et al (2013) 2012 Revised international Chapel Hill consensus conference nomenclature of vasculitides. Arthritis Rheum 65:1–11. https://doi.org/10.1002/art.37715
- ↑ Nada, Hanan Rabea; Rashed, Laila Ahmed; Elantably, Dina Mahmoud Mustafa; El Sharkawy, Dina Ahmed (2020). "Expression of retinoid receptors in hand eczema". International Journal of Dermatology. 59 (5): 576–581. doi:10.1111/ijd.14830. ISSN 0011-9059.
| Large Vessel Vasculitis |
|---|
| Takayasu arteritis |
| Giant cell arteritis |
| Medium vessel vasculitis |
| Polyarteritis nodosa |
| Kawasaki disease |
| Small vessel vasculitis |
| ANCA-associated vasculitis: Microscopic polyangiitis, Granulomatosis with polyangiitis (Wegener's), and Eosinophilic granulomatosis with polyangiitis (Churg-Strauss). |
| Immune complex small-vessel vasculitis: Anti-glomerular basement membrane disease, Cryoglobulinemic vasculitis, IgA vasculitis (Henoch-Schönlein), and Hypocomplementemic urticarial vasculitis (anti-C1q vasculitis) |
| Variable-vessel vasculitis |
| Behçet's syndrome |
| Cogan's syndrome |
| Single-organ vasculitis |
| Cutaneous leukocytoclastic angiitis |
| Cutaneous arteritis |
| Primary central nervous system vasculitis |
| Isolated aortitis |
| Vasculitis associated with systemic disease |
| Lupus vasculitis |
| Rheumatoid vasculitis |
| Sarcoid vasculitis |
| Others |
| Vasculitis associated with probable etiology |
| Hepatitis C virus-associated cryoglobulinemic vasculitis |
| Hepatitis B virus-associated vasculitis |
| Syphilis-associated aortitis |
| Drug-associated immune complex vasculitis |
| Drug-associated ANCA-associated vasculitis |
| Cancer-associated vasculitis |
| other |
Diagnosis of PSV is based on a combination of clinical, laboratory, histopathological and radiological features
| History suggestive of vasculitis | |||||||||||||||||||||||||||||||||||||||
| {{{ }}} | Clinical Findings | ||||||||||||||||||||||||||||||||||||||
| Laboratory tests C02= Additional tests | {{{ C02 }}} | ||||||||||||||||||||||||||||||||||||||
| Induction of Remission | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cyclophosphamide + Glucocorticoid | OR Rituximab + Glucocorticoid | No organ threatening involved: Mycophenolate Mofetyl or Methotrexate | Vital organ/life threatening/creatinine>500 mmol/L : Add Plasma exchange | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Disease control on Drug "Remission" | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Switch to Azathioprine or MTX & Taper Glucocorticoid | Disease control on Drug "Remission" | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| continue RTX & Taper Glucocorticoid | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Labs: To exclude vasculitis “mimics” and secondary causes Blood cultures
Echocardiogram
Hepatitis screen (B and C)
HIV test
Antiglomerular basement membrane antibody
Antiphospholipid antibodies
Antinuclear antibody
To assess extent of vasculitis Urine dipstick and microscopy (all patients)
Chest radiography (all patients)
Nerve conduction studies/electromyography/CK
To confirm diagnosis of vasculitis Biopsy and/or angiogram
To identify the specific type of vasculitis ANCA
Cryoglobulin
Complement levels
Eosinophil counts/IgE levels
Specific findings on biopsy (necrotising granulomatous inflammation, presence of IgA deposits, evidence of immune complex formation (or its absence)) [1]
Algorithm of small vs vasculitis dx: Bezerra, A. S., Polimanti, A. C., Fürst, R., & Corrêa, J. A. (2019). Algorithm for diagnosis of primary vasculitides. Jornal vascular brasileiro, 18, e20180092. https://doi.org/10.1590/1677-5449.009218
Algorithm for ttt of AAV: BSR and BHPR guideline for the management of adults with ANCA-associated vasculitis December 2014Rheumatology 53(12):2306-9 DOI:10.1093/rheumatology/ket445.
| A01 | |||||||||||||||||||||||||||||||||||
| B01 | |||||||||||||||||||||||||||||||||||
| C01 | C02 | C03 | C04 | ||||||||||||||||||||||||||||||||
| A01 | |||||||||||||||||||||||||||||||
| B01 | B02 | B03 | B04 | ||||||||||||||||||||||||||||
| C01 | C02 | ||||||||||||||||||||||||||||||
| D01 | D02 | ||||||||||||||||||||||||||||||
| E01 | E02 | ||||||||||||||||||||||||||||||
 |
Resident Survival Guide |
- ↑ Suresh E. (2006). Diagnostic approach to patients with suspected vasculitis. Postgraduate medical journal, 82(970), 483–488. https://doi.org/10.1136/pgmj.2005.042648