Sandbox:dina

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Dina Elantably, MD, MSc[1]

Huda A. Karman, M.D.

Dina Elantably, MD, MSc[2]

• CVS
• VSD

AF

Atrial fibrillation

Functions

1. Bind insulin receptors
   1. inducing glucose uptake into insulin dependent tissue
   2. gene transcription

glucose is the major regulator of insulin release to incretins.

Diabetes mellitus It could be due to genetic , enviromental or immune defects.

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Regulation of insulin

“

glucose is the main substrate for the brain

”

Thyroid disorders

Findings	hypothyroidism	Hyperthyroidism

proinsulin and c-peptide

Complications of diabetes:

1. Major complications
2. Minor complications
3. Emergency situations

11 β- hydroxylase deficiency

21 α-hydroxylase deficiency

1. redirectDiabetes Mellitus

The pathogenesis of chronic recalcitrant hand eczema and its dramatic response to alitretinoin is not yet known.

References

The 2012 Chapel Hill Consensus Conference (CHCC) classified the vasculitides as follows:

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

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))

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.