Immune Modulation for Prevention of Type 1 Diabetes

Immune Modulation for Prevention of Type 1 Diabetes
Presentation by: Peter A. Gottlieb, MD
Barbara Davis Center
University of Colorado Health Sciences Center Denver, CO


Main Points

* Type 1 diabetes is an autoimmune disease
* It is a predictable disease with different phases
* Approaches to prevention and cure are possible.
* New insulins, medications and devices will improve therapy in the coming decade.

Regulatory Cells
Cellular Mechanics of Autoimmune Type 1 Diabetes
Progression to Diabetes vs Number of Autoantibodies
Type 1a Diabetes: An Autoimmune Disorder
Prevention of Type 1 diabetes
Secondary Prevention
EDIC: Long Term Benefit of Intensive Treatment
Diabetes Control and Complications Trial
Past Trials in New Onset Type 1
Metabolic Effects of AZA and Prednisone at 1 year in New Onset T1DM
Ongoing and Proposed Non-antigen Specific Immunotherapy Trials in New Onset Type 1 DM
Preservation of Pancreatic Production of Insulin (POPPI) study
(Mycophenolate Mofetil and Zenapax)
Mycophenolate Mofetil (MMF)
MMF (CellCept)
MMF Toxicities
Activated T cell
POPPI Study
Potential Benefits of the Study
Control Group
Before treatment
1 wk after treatment
Induction of IL-10+CD4+ cells in vivo following
Treatment with hOKT3g1(Ala-Ala)
Antigen Specific Therapy
Insulin
Altered Peptide Ligand
Recent and Ongoing Antigen-specific Immunotherapy Trials in T1DM
Prediabetes
Primary Prevention
Rationale for Oral Insulin
Oral Antigen Protocol
Nutritional Intervention to Prevent
Mechanistic Studies
Key Elements of Successful Clinical Trials

Immune Modulation for Prevention of Type 1 Diabetes.ppt

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Pregnancy & Renal Transplantation

Pregnancy & Renal Transplantation
Presentation by:Alicia Notkin

Case Study:

A 30 year old female w/ ESRD, s/p LDRT from her mother 3 years prior, comes to clinic for f/u. She is fully compliant with her regimen of prednisone 5mg daily, tacro 3mg q12h, and MMF 1g q12h. Her renal function has been stable, with a Cr ~ 1.2 mg/dl and a negative UA. She wishes to become pregnant. How should she be advised & managed?


Outline

* Pregnancy in patients with chronic kidney disease
* Pregnancy in patients on dialysis
* Pregnancy in renal transplant patients
* Transplantation medications in pregnancy
* Recommendations
* Other issues: graft dysfunction in pregnancy, donor & pregnancy, male fertility

Pregnancy in patients with chronic kidney disease: patient considerations
Pregnancy in patients with chronic kidney disease: other patient considerations
Pregnancy in patients with chronic kidney disease: fetal outcomes
Pregnancy in patients on dialysis
Pregnancy in renal transplant patients: outcomes
Transplant medications: steroids
Transplant medications: cyclosporine
Transplant medications: tacrolimus
Transplant medications: sirolimus
Transplant medications: mycophenolate mofetil
Transplant medications: azathioprine
AST Consensus Conference on Reproductive Issues & Transplantation 2005
Recommendations: key points
Graft dysfunction in pregnancy
OK to biopsy??
Issues for donor & male recipient

References

Pregnancy & Renal Transplantation.ppt

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RBC Disorders

RBC Disorders
Presentation by: Joyce Smith RN, BSN

* Decreased Production of RBC
* Iron Deficiency Anemia
* Vitamin B12 Deficiency Anemia
* Folic Acid Deficiency Anemia
* Aplastic Anemia

Fe Deficiency Anemia
* Common world wide
* Affects 10-30% of population in US
* Common in premenapausal woman, infants, children, adolescents, & elderly
* Develops slowly

A&P

* Occurs when supply of Fe is too low for optimal RBC formation
* Iron RDA
* 10mg/d M,
* F 12-49 15 mg
* Typical American diet provides 10 to 20 mg/d
* Many woman consume only 12.4mg/d

Cause of Development

* Inadequate absorption or excess Fe loss
* Inadequate dietary intake of foods high in Fe
* Principal cause in adults acute or chronic bleeding
* Secondary to trauma
* Excessive menses
* GI bleeding
* Blood donation

Diagnostics

* Hgb Panic value < 5g/dl
* Hgb level can drop to 3.6g/dl
* Total RBC count rarely below 3 million/dl
* MCH < 27 pg
* MCHC 20 to 30 g/dl
* Serum Fe as low as 10mcg./dl
* HCT < 47 ml/dl M
* HCT < 42 ml/dl F
* Fe binding capacity 
* Serum ferritin level 
* Bone marrow may also be indicated

Symptoms

* Pallor, glossitis
* Dizziness, irritability, numbness & tingling in limbs, fatigue, decreased concentrated & HA
* Tachycardia & dyspnea on exertion
* Sensitivity to cold, brittle hair & nails
* Atrophic glossitis, stomatitis, dysphagia

Treatment
Nursing Care
Folic Acid Deficiency
Food Sources
Clinical Manifestations
Treatment
Aplastic Anemia
Clinical manifestations
Treatment of Aplastic Anemia
Treatment
RBC Disorders
Polycythemia
Clinical Manifestations
Diagnostic Tests
Management

Hematology.ppt

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