Medplexus

 CCR5  receptor antagonist  also known  as entry inhibitors Maraviroc :- Tablets  and oral solutions form   20-mg/ml oral solution 25-mg  tab. 75-mg  tab. 150-mg  tab. 300–mg  tab. Note : It should be taken with combination with others HIV medications. swallow the tablet whole not chew it. Take a missed dose  as soon as patient remember it and take next schedule dose as its regular time. Side effects:- Liver problems, skin  reactions, allergic reactions, vomiting ,abdominal pain. 2) HIV fusion inhibitor  Binds to gp41 preventing the creation of and entery pore for the capsid of virus, that’s keep it out of cell. Enfuvirtide :-  For adult - 90 mg SC twice  daily administered into upper arm, abdomen ,or anterior thigh. (6 yr-16 yr ) 2mg/kg SC twice daily administer into upper arm, abdomen ,or anterior thigh. Maximum dose 90 mg SC twice daily.  Side effects:- skin infections , or nerve irritation, Diarrhea, nausea, fatigue, wt. loss, cough, aches and pains, flue like symptoms. 3) Nuc

Chances of cancer occurrence in dermatomyositis  -  elder patient (more than 65 year) is about 48% and very low chance in young and middle age patient approximately 9%. Must common cancers associated with dermatomyositis are ovarian cancer, breast cancer, cervical cancer , lung cancer, bladder   cancer,   stomach cancer,   pancreas cancer, colorectal cancer and kidney cancer. highly incidence in male patient. Cancer  screening   in dermatomyositis  Patients include : Family / Medical History : Ask for autoimmune disease, relatives involvement . Physical exam : Examiner will take patient vitals, Auscultate heart and lung sound, inspect for swelling , tumor, skin color changes, scars,  palpation (superficial and deep) of abdomen, percuss and auscultate for bowel movement. Perform digital rectal examination to rule out colorectal cancer. Check for lymphadenopathy, Breast examination for lumps, inverted nipples and discharge of blood from nipples.  Breast MRI often used for women who ha

polymyositis (inflammation of many muscles) is slowly progressing symmetrical weakness of proximal muscle of limbs. Epidemiology: - can occurs at any age 30s, 40s, 50s  - women and black are more affected Cause: The cause of polymyositis is unknown but genetic, viral infection(retro virus, ) and autoimmune factor play key role in disease initiation. Pathogenesis: Humoral attack against the muscle capillaries and arterioles of endomycium which cause inflammation and infiltration. Clinical feature: myalgia weakness of muscles i.e shoulder girdle, pelvic girdle cause difficult to raise from seated position, difficult to climb stairs, early fatigue while walking. Constitutional symptoms like fever, fatigue, weight loss, anorexia. Rheumatic - arthritis/ arthralgia occurs in 20-70% cases GI tract - dysmotility of esophagus(dysphasia)  occurs in 10-30% cases, constipation Cardiac - arrhythmia , conduction block Skin- livedo raticularis(net like appearance of skin) Pulmonary - dyspnoea, it c

Dermatomyositis(DM) is a  rare connective-tissue disease  which is an idiopathic , autoimmune and chronic inflammatory mostly involved skin and muscles. It’s  a systemic disorders  that can also  affect the joints, the oesophagus, the lungs, the kidney ,the heart ,etc. It’s more common in elderly  people (over 40 yrs).In children most often appears between 5 and 15 years. Female to male ratio is 2:1. Black more affected. Causes: Idiopathic , but can be result from viral infections or cancer, that might cause autoimmune response. Inherited, and  HLA subtypes (HLA-DE3,HLA-DR52,HLA-DR6). Environmental factors Certain drugs like statins. Certain Autoimmune diseases Risk factors: Genetic UV rays exposure(sun) Certain drugs eg: statins Environmental factors Viral and parasitic infections Epidemiological  factors Pathophysiology: Dermatomyositis occurs as a result of a humoral attack against the muscle capillaries and small arterioles.the disease starts when putativ

Written by Dr. PAWAN TIWARI Polyarteritis Nodosa(PAN) or Panarteritis nodosa or periarteritis nodosa or Kussmaul diseases or Kussmaul-Maier Auto-immune inflammatory systemic disease of medium  or small size vessels, particular those in muscles. It’s mainly affect middle age (30-45 yr),more common in male . No association with ANCA. Etiology:   Idiopathic, infections, reaction to medications, also associated with hepatitis B and C. Pathogenesis : Immunecomplex deposition(e.g. HBsAg/anti-HBsAg) PAN can involve any organs system  of our body some listed below: Skin : vesicular rash, papule , petechial  purpura, livedoreticularis ,nodules under the skin. Muscles and bone : joint and muscles syndrome or arthritis, arthralgia myesthenic syndrome with myalgia. Peripheral nervous system : asymmetrical polyneuropathy ,crania l nerve damage ,elbow nerve damage ,etc. CNS : stroke,psychosis Kidney : vesicular kidney pathology with chronic kidney failure very rare with  GN. Heart  and  vessels sys