Rheumatological Urgencies

Rheumatological Urgencies
Presentation by: Rochella Ostrowski

Medical History
Physical Exam
DDX

* Crystal induced arthritis (Gout, pseudogout)
* Septic arthritis
X ray L foot
Arthrocentesis
Polarizing Microscopy
Synovial Fluid
Gout
Gout Treatment
Indications for Chronic therapy of Gout
Which diagnostic tests would you order next?
Septic Arthritis
Gonococcal vs Non-gonococcal
Organisms in Septic Arthritis
Mechanisms of Joint infection
Conditions That Predispose a Patient to Joint Infections
Septic Arthritis Therapy
Giant Cell Arteritis
GCA Clinical Findings
Treatment of GCA
Most reasonable diagnoses?

* Giant Cell Arteritis
* Rheumatoid arthritis
* Polymyositis
* Dermatomyositis
* Sjogren’s syndrome
* Ankylosing spondylitis
* Primary Raynaud’s
* Scleroderma
* Systemic lupus erythematosus

Scleroderma
Periungual Erythema
Nailfold Capillaroscopy
Scleroderma Diagnosis and Treatment
Scleroderma Renal Crisis
Manifestations of Scleroderma Renal Crisis
SRC Risk Factors
SRC Therapy
Diagnostic Tests

Rheumatological Urgencies.ppt

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Newer Anticoagulant Therapies

Newer Anticoagulant Therapies
Presentation by:Chris Ferrell MT(ASCP), CLS/H(NCA)

Special Coagulation Lead
Harborview Medical Center
University of Washington

Heparin Therapy
Lupus Anticoagulant and PTT
Monitoring Heparin Therapy in Patients with LA
Warfarin Therapy
Lupus Anticoagulant and Protime
Monitoring Coumadin Therapy in Patients with LA
Low Molecular Weight Heparin
Antithrombin
Thrombin
Unfractionated Heparin
Pentasaccharide
Antithrombin
Factor Xa
Pentasaccharide
LMWH Comparisons
Tinzaparin
Reviparin
Nadroparin
Enoxaparin
Dalteparin
Ardeparin
Advantages
FDA Approved Indications of LMWHs
Total knee replacement
Total hip replacement
General surgery
LMWH Administration
PTT and LWMH
LMWH Comparisons
Low Molecular Weight Heparin
Other Tests to Monitor Heparin
Problems with Monitoring Heparin Therapy with PTT’s
Why Use LMWH vs. UFH?
Heparin Induced Thrombocytopenia
What Is It?
Heparin Induced Thrombocytopenia
HIT Testing
How Do You Diagnose It?
HIT Testing by Aggregometry
Light source
Positive HIT Test
Patient Plasma
Heparin Induced Thrombocytopenia
Advances in Anticoagulation
Direct Thrombin Inhibitors
Hirudin and Derivatives
Thrombin and Hirudin
Direct Thrombin Inhibitors
Hirudin and Derivatives
Direct Thrombin Inhibitors Hirudin and Derivatives
Direct Thrombin Inhibitors
Clinical Trials of Direct Thrombin Inhibitors
Direct Thrombin Inhibitors
Effect on Laboratory Testing
Low Molecular Weight Heparin
Fondaparinux
Inhibition of VIIa/TF
Tissue Factor Pathway Inhibitor
Enhanced Protein C Pathway
Enhancement of the fibrinolysis
Advances in Anticoagulation
Platelet Function Inhibitors
Ideal Anticoagulant

Newer Anticoagulant Therapies,ppt

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Ion Channels in the Cardiovascular System in Health and Disease

Ion Channels in the Cardiovascular System in Health and Disease
Presentation by: William A. Coetzee

Hearts are Composed of Cells
The Cardiac Myocyte
Cells Have Membranes
Patch Clamping
Ion Channels - Gating
Inward Currents
Outward Currents
Ion Channels

* Na+ channels
* Ca2+ channels
* K+ channels
* Exchangers
* Pumps

Na+-Channels: Genetic Disorders
Na+ Channels - Pharmacology
Ca2+ Channels: Electrophysiology
Ca2+ Channel a-Subunits
Molecular Composition
Ca2+ Channel a-Subunits
Structural elements of function
Hyperkalemic periodic paralysis
Malignant hyperthermia
Functional Diversity of K+ Channels in the Heart
Voltage-activated K+ Channels
Inward Rectifier K+ Channels
Leak K+ Channels
Plateau (IKP) K+ channels
K+ Channels - Structure
K+ Channel Principal and Auxiliary Subunits
Voltage-gated K+ channels
Ca2+-activated K+ channels
Voltage-activated K+ Channels
Transient Outward K+ Channels
Delayed Rectifier Currents
Two Types of Delayed Rectifiers
Compounds Blocking Delayed Rectifiers
K+ Channel a-Subunits
Molecular determinants of gating
N-type inactivation
Kvb Subunits Accelerate Inactivation of Kv Channels
Enhanced Surface Expression
Kvb Subunits as Molecular Chaperones
3-Dimensional Structure of Kvb2
Kvb Confers Hypoxia-Sensitivity to Kv4 Channels
Identification of Frequenin as a Putative Kv4 b-subunit
Effects of Frequenin on Kv4.2 Currents
Delayed Rectifier K+ Channels
Molecular Composition
Voltage-activated K+ Channels Pharmacology
Mechanisms of Arrhythmias
Triggered Activity
Early Afterdepolarizations
Factors Promoting EADs
Inward Rectifier K+ Channels
Voltage-activated
Inward Rectifier K+ Channels
Electrophysiology
K+ Channel Principal Subunits
Voltage-gated K+ channels
Ca2+-activated K+ channels
K+ Channel Principal and Auxiliary Subunits
Voltage-gated K+ channels
Ca2+-activated K+ channels
Inward Rectifier K+ Channels
Genetic Disorders
Bartter’s syndrome
K+ Channel Principal and Auxiliary Subunits
Role of the KATP Channel
Secretory Mechanisms
Mechanism of Insulin Release
Glibenclamide Blocks KATP Channels

Ion Channels in the Cardiovascular System in Health and Disease.ppt

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