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A new approach to disease-modifying drug trials in Parkinsonís disease

(2 hours)

 

I. Actuality of the theme: During pregnancy, many pathological changes occur in a pregnant woman, which have the influence on pregnancy and delivery, including cardiovascular, hematologic, metabolic, renal and respiratory changes that become very important in the event of complications. Prenatal care is important in screening for various complications of pregnancy and to educate the patient. Important issues of prenatal care include initial patient evaluation, routine patient evaluation, nutrition, disease states during the pregnancy, and preparing for the delivery.

 

II. Educational aims of the lesson:

A. Students must know (a-II):

1. Infectious diseases in pregnancy.

2. Effect of Syphilis on Pregnancy. Diagnosis. Evidence of syphilis in products of conception. Treatment.

3. Pulmonary tuberculosis with pregnancy. Effect of T.B. on pregnancy. Antenatal care, labor.

4. Viral infections during pregnancy. HIV.

5. Rubella. Clinical manifestations. Diagnosis. Complications.

6. Toxoplasmosis. Method of transmission. Clinical features. Complications.

7. Diseases of the alimentary tract.

8. Urinary tract infection in pregnancy.

9. Asymptomatic bacteriuria.

10. Pyelonephritis. Predisposing factors during pregnancy. Causative organisms. Diagnosis. Investigations.

11. Iron deficiency anemia. Megaloblastic anaemia. Hemolytic anemias.

12. Groups of increased risk of pregnant.

 

B. Students should be able (a-III):

∑ to take general and epidemiological history;

∑ to estimate complaints of women which are brought up due to pregnancy and medical illnesses during pregnancy;

∑ to provide general examination of pregnant women;

∑ to diagnose the discomfort states which are arise up during pregnancy;

∑ to differentiate physiological and pathological changes|changing| in the organism of mother during pregnancy|;

∑ to put a diagnosis and make a plan of additional examination;

∑ to estimate the results of basic and additional methods of research for diagnosis pathological states;

∑ to make a plan of antenatal care and plan of labor.

|luinIII. Interdisciplinary integration:

Ļ Disciplines To know To be able to
1. Previous disciplines:
1. Human anatomy   Anatomy of organs and systems of organism.  
2. Normal physiology Physiology of organs and systems.  
3. Internal medicine   Propedeutics of diseases of internal organs. Physiology parameters of the state of female organs and systems. Conduct system-based clinical examination  
2. Intradisciplinary integration:
1. Pregnancy and extragenital pathology   Physiological changes during pregnancy. Signs of somatic pathology during pregnancy. Complications of pregnancy which arise up as a background extragenital pathology. Diagnose somatic pathology during pregnancy.  

 

IV. Control materials of lesson.



4.1. Control questions:

1. What do physiological changes occur during pregnancy?

2. Infectious diseases in pregnancy.

3. Effect of Syphilis on Pregnancy. Diagnosis. Evidence of syphilis in products of conception. Treatment.

4. Pulmonary tuberculosis with pregnancy. Effect of T.B. on pregnancy. Antenatal care, labor.

5. Viral infections during pregnancy. HIV.

6. Rubella. Clinical manifestations. Diagnosis. Complications.

7. Toxoplasmosis. Method of transmission. Clinical features. Complications.

8. Diseases of the alimentary tract.

9. Urinary tract infection in pregnancy.

10. Asymptomatic bacteriuria.

11. Pyelonephritis. Predisposing factors during pregnancy. Causative organisms. Diagnosis. Investigations.

12. Iron deficiency anemia. Megaloblastic anaemia. Hemolytic anemias.

13. Groups of increased risk of pregnant.

14. What are the basic|main| principles and tasks|task| of prenatal care?

4.2. Practical skills:

∑ to take general history, define basic problems and complaints women experience during pregnancy;

∑ to conduct physical examination of a pregnant woman;

∑ to diagnose the discomfort states which show up during pregnancy;

∑ to differentiate physiological changes in the organism of mother during pregnancy with pathological on the basis of evaluation of the given laboratory results and other methods of investigation.

∑ to make a plan of antenatal care and plan of labor.

4.3. Clinical tasks and tests:

1. The basis of diagnostic of iron deficiency anemia:

ņ. Special complaints of pregnant woman.

¬. Laboratory results.

—. Appearance of heart diseases.

D. Presence of trophic disorders.

Ň. Disturbance of intrauterine fetal development.

 

2. Direct diagnostic methods of intrauterine infections are the following except:

ņ. Chorion villous samples.

¬. Investigation of amniotic fluid.

—. Investigation of fetal blood.

D. Investigation of pharyngeal aspirate in moment of fetal birth.

Ň. Identification of microorganisms in cervical and vaginal discharges of pregnant woman.

 

3. Method of delivery by pyelonephritis is:

ņ. Plan cesarean section.

¬. Cesarean section in labor.

—. Vaginal delivery without shorten of the II period.

D. Vaginal delivery with shorten of the II period of labor by perineotomy..

Ň. Forceps delivery.

 

4. A 30 years old woman delivered at 32 weeks of pregnancy a death baby with numerous defects of brain, eyes, heart. In anamnesis: 2 spontaneous abortions, premature labor by death baby. During the last pregnancy: prolong subfebrile condition, sings of chronic hepatitis. What is necessary for diagnose?

ņ. Inoculation from cervix.

¬. Complement fixation Toxoplasma reaction.

—. Urine inoculation for determination of sterility.

D. Wasserman reaction.

Ň. Mantoux reaction.

4.4. Table.

  Virus Complications
Abortion Stillbirth Low birth weight Main congenital anomalies
Rubella + + + Cataract, deafness, cardiac, hepatosplenomegaly, psychomotor retardation.
Cytomegalovirus ? + + Microcephaly, deafness, hepatosplenomegaly, psychomotor retardation.
Herpes hominis - - + Microcephaly, psychomotor retardation, chorioretinitis.
Varicella zoster ? ? + Hypoplasia of limb, rudimentary digits.
Mumps + + - Endocardial fibro-elastosis.
Influenza + + - Following 1st trimester illness.
Smallpox + + ? Foetal smallpox.
Hepatitis B - - - Hepatosplenomegaly, chronic cirrhosis.
Measles + + - Nil Proven.
Polio virus + + + Paralysis.

 

V. Literature:

1. Khmil S.V., Kuchma Z.M., Romanchuk L.I. Gynecology: T., Ukrmedknyga, 2003.

2. Obstetrics and gynecology. Williams & Wilkins Waverly Company. Ė Third Edition Ė 1998.

3. Tamara L.Callahan, Aaron B.Caughey. Blueprints Obstetrics and gynecology. Ė Lippincott Williams & Wilkins Ė Fourth edition Ė 2007.

 

Head of department of Obstetrics and Gynecology

doctor of medical sciences, professor Genik N.I.

 

A new approach to disease-modifying drug trials in Parkinsonís disease

Roger A. Barker,1 Mark Stacy,2 and Patrik Brundin3,4

Go to:

Abstract

Translating new findings in the laboratory into therapies for patients is a slow and expensive process. The development of therapies for neurodegenerative diseases is further complicated by the difficulty in determining whether the drug truly retards the slow degenerative process or provides only symptomatic benefit. In this issue, Aviles-Olmos et al. describe a first in Parkinsonís disease (PD) patient study using a drug previously approved for diabetes treatment. In addition to suggesting that the drug may indeed be disease modifying in PD, their innovative approach suggests there may be more rapid and inexpensive avenues for testing novel therapies in PD.

Taking new potentially disease-modifying therapies from studies in experimental animals to the clinic in patients with chronic neurodegenerative disorders requires a balance between optimal trial design and expense, and new methods are desperately needed. In this issue, Aviles-Olmos and colleagues describe a novel approach toward exploring the potential for disease-modifying effects in patients with Parkinsonís disease (PD) using a drug approved for the treatment of type 2 diabetes (1). They examined the drug exenatide, a glucagon-like peptideĖ1 (GLP-1) receptor agonist that has demonstrated promise in several animal models of PD (2). This work is remarkable not only because it is an attempt to examine the effectiveness of repurposing a drug that is already in clinical use, but also because it represents a cost-effective method. This is important because the clinical research community faces a challenge in developing proof of concept studies in a way that gives confidence to proceed to the necessary ó and markedly more costly ó double-blind, placebo-controlled trials.


Date: 2014-12-21; view: 1264


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Topic: Diseases of the alimentary tract, urinary tract, hematologic disorders, sexually transmitted diseases. HIV | Targeting the dopaminergic pathway in PD
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