Selective immunoglobulin A deficiency (SIgAD) is a primary immunodeficiency disease and is the most common of the primary antibody deficiencies.[1] Total immunoglobulin A deficiency (IgAD) is defined as an undetectable serum immunoglobulin A (IgA) level at a value < 5 mg/dL (0.05 g/L) in humans. Partial IgAD refers to detectable but decreased IgA levels that are more than 2 standard deviations below normal age-adjusted means.[2, 3] IgAD is commonly associated with normal B lymphocytes in peripheral blood, normal CD4+ and CD8+ T cells, and, usually, normal neutrophil and lymphocyte counts. Anti-IgA autoantibodies of the IgG and/or IgE isotype may be present. Peripheral blood may also be affected by autoimmune cytopenias, eg, autoimmune thrombocytopenia,[4, 5] and patients may have other autoimmune phenomena. IgA was first identified by Graber and Williams in 1952; ten years later, the first patients with IgAD were described. IgAD is a heterogeneous disorder, and the results of intensive study are beginning to elucidate genetic loci and molecular pathogenesis that contribute to various subtypes of this disorder. Several lines of evidence suggest that, in many cases, IgAD and common variable immunodeficiency (CVID) have a common pathogenesis, which is discussed further in Pathophysiology. Other data indicate different genetic risk factors. Family studies show variable inheritance patterns. Familial inheritance of IgAD occurs in approximately 20% of cases,[6] and, within families, IgAD and CVID are associated.[7, 8] Many IgAD patients are asymptomatic (ie, "normal" blood donors) and are identified by finding a laboratory abnormality, without any apparent associated clinical disease. Some patients with IgAD may have the following associated conditions: (1) deficits in one or more immunoglobulin G (IgG) subclasses (this accounts for 20-30% of IgA-deficient patients, many of whom may have total IgG levels within the normal range) or (2) a deficient antibody response to pneumococcal immunization (specific polysaccharide antibody deficiency [SPAD]). Some patients with IgAD later develop CVID, and family members of patients with CVID may have only selective IgAD. Characterization of the receptor for the transmembrane activator and calcium-modulator and cyclophilin ligand interactor (TACI), encoded by the gene TNFRSF13B ( tumor necrosis factor receptor superfamily member 13B), suggests that people with the C104, A181E, and ins204A variants may be at risk for IgAD that progresses to CVID.[9] Primary IgAD is permanent, and below-normal levels have been noted to remain static and persist after 20 years of observation.[10] A recent report documents a rare case of reversion.[11] Environmental factors such as drugs or infections can cause IgAD, but this form is reversible in more than half the cases (see Causes). Although individuals with IgAD have largely been considered healthy, recent studies indicate a higher rate of symptoms. A 20-year follow-up study that compared 204 healthy blood donors with incidentally identified IgAD to 237 healthy subjects with normal IgA levels demonstrated that 80% of IgAD donors and 50% of control subjects had episodes of infections, drug allergy, or autoimmune or atopic disease. Severe respiratory tract infections occurred in 26% of IgAD subjects, in 24% of subjects with decreased IgA levels, and in 8% of control subjects; however, the incidence of life-threatening infections was not increased. IgAD is more common in adult patients with chronic lung disease than in healthy age-matched control subjects.[12] Patients with IgAD are at some increased risk of developing severe reactions after receiving blood products.[13, 14, 15] IgG anti-IgA antibodies may cause severe transfusion reactions if patients with IgAD are given whole blood; therefore, IgA-poor blood or washed red cells are preferred for those patients. IgA-deficient patients with immunoglobulin E (IgE)–class anti-IgA antibodies are at risk for anaphylaxis if they receive blood or intravenous immunoglobulin, but this situation is extremely rare. Individuals with such an unusual profile should receive only low IgA intravenous immunoglobulin preparations. However, caution must be used when administering IGIV to patients with IgAD if their anti-IgA status is unknown. A history devoid of previous blood product administration does not exclude the possibility of anti-IgA antibodies or adverse reactions. Fortunately, appropriate precautions can significantly reduce morbidity (see Treatment). Blood banks can use a simple ELISA screening approach to establish an IgAD blood donor poo

A salivary gland stone -- also called salivary duct stone -- is a calcified structure that may form inside a salivary gland or duct. It can block the flow of saliva into the mouth. The majority of stones affect the submandibular glands located at the floor of the mouth. Less commonly, the stones affect the parotid glands, located on the inside of the cheeks, or the sublingual glands, which are under the tongue. Many people with the condition have multiple stones. Salivary Gland Stone Causes and Symptoms Salivary stones form when chemicals in the saliva accumulate in the duct or gland. They mostly contain calcium. The exact cause is not known. But factors contributing to less saliva production and/or thickened saliva may be risk factors for salivary stones. These factors include: dehydration, poor eating, and use of certain medications (such as antihistamines), blood pressure drugs, psychiatric drugs, and bladder control drugs. Trauma to the salivary glands may also raise the risk for salivary stones. The stones cause no symptoms as they form, but if they reach a size that blocks the duct, saliva backs up into the gland, causing pain and swelling. You may feel the pain off and on, and it may get progressively worse. Inflammation and infection within the affected gland may follow. Salivary Gland Stones Diagnosis and Treatments If you have symptoms of a salivary gland stone, your doctor will first check for stones with a physical exam. Sometimes tests may also be ordered, such as X-ray, CT scan, or ultrasound.

Skin changes are among the most visible signs of aging. Evidence of increasing age includes wrinkles and sagging skin. Whitening or graying of the hair is another obvious sign of aging. Your skin does many things. It: Contains nerve receptors that allow you to feel touch, pain, and pressure Helps control fluid and electrolyte balance Helps control your body temperature Protects you from the environment Although skin has many layers, it can generally be divided into three main parts: The outer part (epidermis) contains skin cells, pigment, and proteins. The middle part (dermis) contains blood vessels, nerves, hair follicles, and oil glands. The dermis provides nutrients to the epidermis. The inner layer under the dermis (the subcutaneous layer) contains sweat glands, some hair follicles, blood vessels, and fat. Each layer also contains connective tissue with collagen fibers to give support and elastin fibers to provide flexibility and strength.

Fainting occurs when the blood supply to your brain is momentarily inadequate, causing you to lose consciousness. This loss of consciousness is usually brief. Fainting can have no medical significance, or the cause can be a serious disorder. Therefore, treat loss of consciousness as a medical emergency until the signs and symptoms are relieved and the cause is known. Discuss recurrent fainting spells with your doctor. If you feel faint Lie down or sit down. To reduce the chance of fainting again, don't get up too quickly. Place your head between your knees if you sit down. If someone else faints Position the person on his or her back. If the person is breathing, restore blood flow to the brain by raising the person's legs above heart level — about 12 inches (30 centimeters) — if possible. Loosen belts, collars or other constrictive clothing. To reduce the chance of fainting again, don't get the person up too quickly. If the person doesn't regain consciousness within one minute, call 911 or your local emergency number. Check the person's airway to be sure it's clear. Watch for vomiting. Check for signs of circulation (breathing, coughing or movement). If absent, begin CPR. Call 911 or your local emergency number. Continue CPR until help arrives or the person responds and begins to breathe.

Watch that Above Knee Amputation Surgery video

Transvenous cardiac pace maker, also called endocardial pacing, is a potentially life saving intervention used primarily to correct profound bradycardia. It can be used to treat symptomatic bradycardias that do not respond to transcutaneous pacing or to drug therapy.

Epilepsy is a chronic disorder, the hallmark of which is recurrent, unprovoked seizures. Many people with epilepsy have more than one type of seizure and may have other symptoms of neurological problems as well. Sometimes EEG testing, clinical history, family history and outlook are similar among a group of people with epilepsy. In these situations, their condition can be defined as a specific epilepsy syndrome. The human brain is the source of human epilepsy. Although the symptoms of a seizure may affect any part of the body, the electrical events that produce the symptoms occur in the brain. The location of that event, how it spreads and how much of the brain is affected, and how long it lasts all have profound effects. These factors determine the character of a seizure and its impact on the individual. Esssentially, anything the brain can do, it can do in the form of a seizure. Having seizures and epilepsy can affect one's safety, relationships, work, driving and so much more. Public perception and treatment of people with epilepsy are often bigger problems than actual seizures.

Know About Cardiothoracic Surgery in 60 Seconds About what cardiothoracic surgery is, why it is done and what is the result of such surgery. A Major Session on #cardiothoracic #surgery at #Congress #2018HCC 2018 Healthcare and Cardiology Conference #BANGKOK http://cosmicseries.org/cardiology-conferences/

arteriovenous hemodialysis access has been the "gold standard" for patients needing hemodialysis for the past 30 years. Despite the reported advantages of autologous access, the availability of prosthetic graft material, coupled with the challenging dialysis candidate, has led to a trend of primary prosthetic graft dialysis access in the 1980s and 1990s. In recognition of this unfortunate trend, the National Kidney Foundation Dialysis Outcomes Quality Initiative (DOQI) used evidence from published studies and summary articles to generate clinical practice guidelines, emphasizing a shift back to autologous arteriovenous fistula (AVF) as the key to long-term successful hemodialysis.[1,2] These initial guidelines proposed a goal of 50% autologous AVF as the initial access, with a 40% prevalence of autologous access for a given practice or unit.

Worlds Most Amazing Medical Case

Treatment consists of diet modifications and laxatives A high-fiber diet can be effective, along with over-the-counter medications, such as stool softeners. In some cases, a medical procedure to remove the hemorrhoid may be needed to provide relief.

Motivation for Medical Students!

Heart sounds are the noises generated by the beating heart and the resultant flow of blood through it. Specifically, the sounds reflect the turbulence created when the heart valves snap shut. In cardiac auscultation, an examiner may use a stethoscope to listen for these unique and distinct sounds that provide important auditory data regarding the condition of the heart. In healthy adults, there are two normal heart sounds often described as a lub and a dub (or dup), that occur in sequence with each heartbeat. These are the first heart sound (S1) and second heart sound (S2), produced by the closing of the atrioventricular valves and semilunar valves, respectively. In addition to these normal sounds, a variety of other sounds may be present including heart murmurs, adventitious sounds, and gallop rhythms S3 and S4.

Heart failure, sometimes known as congestive heart failure, occurs when your heart muscle doesn't pump blood as well as it should. Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently.

Acute intermittent porphyria (AIP) is a rare autosomal dominant metabolic disorder affecting the production of heme, the oxygen-binding prosthetic group of hemoglobin. It is characterized by a deficiency of the enzyme porphobilinogen deaminase.

Bleeding usually occurs from only one nostril. If the bleeding is heavy enough, the blood can fill up the nostril on the affected side and overflow within the nasopharynx (the area inside the nose where the two nostrils merge), spilling into the other nostril to cause bleeding from both sides. Blood can also drip back into the throat or down into the stomach, causing a person to spit or even vomit blood. Signs of excessive blood loss include dizziness, light-headedness, confusion, and fainting. Excessive blood loss from nosebleeds is rare. Additional bleeding from other parts of the body, such as bleeding gums when brushing teeth, blood in urine or bowel movements, or easy bruising may indicate an inability of the blood to clot. Additional bleeding or easy bruising can be a sign of a more significant medical problem.

The most frequent incision utilized to open the abdomen for liver surgery is called a chevron incision. In this incision a cut is made on the abdomen below the rib cage. The cut starts under the armpit below the ribs on the right side of the abdomen and continues all the way across the abdomen to the opposite arm pit thereby the whole width of the abdomen is cut to provide access to the liver. The average length of the incision is approximately 24 to 30 inches. This is one of the longest incisions is utilized in abdominal surgery. The incision is frequently associated with significant discomfort after the surgery and in some patients the discomfort can continue for many months, particularly when some of the nerves in the abdominal wall have been cut during the surgery. Laparoscopic surgery provides advantages over open surgery for the liver since the chevron incision is completely avoided and the surgery is performed through tiny incisions. As a consequence the duration of stay in hospital, the amount and duration of post operative discomfort, and the length of recovery is much shorter after the laparoscopic procedure compared to open surgery

Though you might think of your spinal cord as one single piece, it's actually a column of nerves protected by a sheath of myelin and then further secured by 31 butterfly-shaped vertebrae (singular: vertebra). Medical providers divide the spinal cord into four distinct regions. Knowing the region in which the injury is located is often the key to understanding diagnosis and treatment. The four spinal cord regions are: The cervical spinal cord: This is the topmost portion of the spinal cord, where the brain connects to the spinal cord, and the neck connects to the back. This region consists of eight vertebrae, commonly referred to as C1-C8. All spinal cord numbers are descending, so C1 is the highest vertebra, while C8 is the lowest in this region. The thoracic spinal cord: This section forms the middle of the spinal cord, containing twelve vertebrae numbered T1-T12.

Thanks to a new, state-of-the-art procedure for total knee replacement developed by surgeons at the Detroit Medical Center's Sinai-Grace Hospital, the rehabilitation time for patients has been reduced from six months to six weeks. ~ Detroit Medical Center