Burkkit's Lymphoma

 

Rapid Notes for Management of Acute Ischemic Stroke

 

Normal Laboratory Values

 

Antibiotics Families and Spectrums

 

Causes of Oedema

 

Liddle's Syndrome

 

• it's inherited form of hypertension

• it's inherited in the form of Autosomal dominant pattern
• it's caused by mutation in the  SCNN1A, SCNN1B, SCNN1G genes
• these genes provide instruction for making subunit of protein complex called epithelial sodium channel ( ENaC ) may found on surface of kidney cells

• Normally ENaC open in response to signals that Na level in the blood is too low, which allow reabsorption of Na back to the bloodstream

• if mutations occure, the ENaC will increase on cell surface leading to increase Na reabsorption and K exceartion

Features :- 

• Begins usually early in life often in the childhood, some people aren't diagnosed until adulthood

• may be no additional signs or symptoms, but overtime if untreated, may develop heart disease or cerebrovascular accidents

• may suffer from signs and symptoms of hypokalemia as

                                      * muscle weakness

                                      * fatigue

                                      * constipation

                                      * heart palpitations

                                     * metabolic alkalosis
                           

Differential diagnosis of Hematuria

 

Scheme of Thyroid Activities

 

Brugada Syndrome

 

• it's channelopathy disorder in the form of reduce sodium current
• inherited in the form of Autosomal dominant, typically in young, male, and othewise healthy normal
• it's a cause of polymorphic ventricular tachycardia which can develop to ventricular fibrillation leading to sudden death
• syncope and cardiac arrest are the most common clinical presentations
• nightmares may be found
• may subtle abnormality in right ventricle reported
• if you suspect Brugada syndrome do :- 

             * 12-lead ECG in all patient 
             * Drug challengewith sodium channel blocker if syncope with                          obvious cause

             * Electrophysiologic study

             * Serum K, Ca, CK-MB

             * Genetic test for mutation in SCN5A

Feature on ECG :- 

• incomplete RBBB
• ST elevation in anterior leads

three types of Brugada

• Type 1 .... pronounced elevation of j point ( coved st ) and inverted t wave 
• Type 2 .... saddleback st elevated by more than 1mm
• Type 3 .... st elevated less than 1mm

Treatment :- 

the only treatment is implantable cardioversion defibrillator  ICD.    

                

Endothelin ... ET

 

• Family of 21 amino acids vasoconstrictors peptides

• three isoforms  ET-1   ET-2    ET-3
• mediate their actions via two receptors  ET-A  ET-B
• ET-1 id the most potent 
• ET-1 .....the major source is enfothelial cells then macrophages, fibroblast, cardiac myocyte, and neurons
• ET-2 ......Expressed in intestinal cells and at lower level in the heart
• ET-3 .....Expressed in brain neurons, kidney, and intestinal epithelial cells
• ET-2 & ET-3 differ from ET-1 in two and six amino acid repectively
• endothelin show very close structral and functional relationship to the snake venom peptide
• endothelins are released in the form of preproendothelin then undergone sequential prolytic processing by endothelin converting enzyme ECE
• ET-1 & ET-2 have the same affinity to ET-A but duffer to ET-B
• ET-3 binds to ET-B receptor so hence can be considered selective ET-B

Catecholaminergic polymorphic ventricular tachycardia ( CPVT )

 It abnormal heart rythm in response to physical activity or emotional stress

• episodes of VT can cause light headedness, dizzeness, and syncope
• episodes begin in childhood
• if not recognized and treated, it may cause cardiac arrest leading to sudden death

Etiology

inherited disease

• If mutation in RYR2 gene, will inherited in the form of Autosomal dominant and it occure in 50% of cases
• If mutation in CASQ2 gene, will inherited in the form of Autosomal ressissive and occure in 5% of cases
• the both genes provide instructions for making protein that help in maintain normal heart beat by controlling calcium movement within myocytes

Arrhythmogenic Right Ventricular Cardiomyopathy ( ARVC )

 primay disease of heart muscles 

• occure in the form of fibrofatty changes in right ventricule and subepicardial space in left ventricle 
• However its name, it's biventricular involvment and more common in left ventricle 
• in left ventricle  changes are related more to fibrosis than to fat or fibrofatty infiltration
• This condition causes part of the myocardium to break down over time, increasing the risk of an abnormal heartbeat (arrhythmia) and sudden death.

Etiology 

unknown but ....

• prescence of inflammatory infiltartion suggest resolving myocarditis
• families has phenotyping alteration 
• Gene mutations have been found in about 60 percent of people with ARVC. Mutations in a desmosomal gene called PKP2 appear to be most common.
• Mutations in desmosomal genes impair the function of desmosomes. Without normal desmosomes, cells of the myocardium detach from one another and die, particularly when the heart muscle is placed under stress (such as during vigorous exercise). These changes primarily affect the myocardium surrounding the right ventricle, one of the two lower chambers of the heart. The damaged myocardium is gradually replaced by fat and scar tissue. As this abnormal tissue builds up, the walls of the right ventricle become stretched out, preventing the heart from pumping blood effectively. These changes also disrupt the electrical signals that control the heartbeat, which can lead to arrhythmia.

findings 

• symtoms and signs related to arrhythmia and conduction disturbance
• Arrhythmia and cardiac arrest are common presentation then cardiac arrest
• Autopasy is the only diagnostic test 

under microscope

• moth eaten appearance
• destruction of normal myocytes via inflammatory scaring and fat replacement

Drug-induced liver injury...... ( DILI )

Drug-induced liver injury (DILI) is an injury of the liver that may occur when you take certain medicines.

Examples :- 

• • Amiodarone
  • Anabolic steroids
  • Birth control pills
  • Chlorpromazine
  • Erythromycin
  • Halothane (a type of anesthesia)
  • Methyldopa
  • Isoniazid
  • Methotrexate
  • Statins
  • Sulfa drugs
  • Tetracyclines
  • Amoxicillin-clavulanate

  Some anti-seizure medicines

findings :-

• Abdominal pain
• Dark urine
• Diarrhea
• Fatigue
• Fever
• Headache
• Jaundice
• Loss of appetite
• Nausea and vomiting
• Rash
• White or clay-colored stools
• elevated liver enzymes 
• enlaged liver and right hypochonderial tenderness

Treatment :-

• The only specific treatment for most cases of liver damage caused by taking a drug is to stop taking the drug that caused the problem.

• However, if you took high doses of acetaminophen, you should get treated for liver injury in the emergency department or other acute treatment setting as soon as possible.

• If symptoms are severe, you should rest and avoid heavy exercise, alcohol, acetaminophen, and any other substances that might harm the liver. You may need to get fluids through a vein if nausea and vomiting are severe.

N.B:-  rarely complicated by liver failure