Lecture 49+50+DLA Flashcards
cell-mediated immunity to viral infection
intracellular
NK cells: These are cytotoxic for virus-infected cells and participate in antigen-dependent cell mediated cytotoxicity (ADCC)
Cytotoxic CD8+ T cells: Destroy cells with viral peptides presented on cell surface in association with class I MHC
humoral immunity to viruses
antibodies
interferons: alpha and beta (produced by virally infected cells; will inhibit transcription and translation in neighboring cells)
IFN-gamma = activates macrophages and NK cells
upregulate MHC I
how do viruses avoid immunity
antigenic shift and drift polymorphism latency modulation of MHC infection of the lymphocytes prevention of complement activation
cell mediated immunity for intracellular bacteria
cells infected can activate the NK cells
(cytotoxicity and activation of macrophages)
CD8 T cells will recognize MHC I and lyse
once lysed:
APC
Th1 cell
Bacteria antigen are processed and presented with
class II MHC molecules on the surface of APCs to
CD4+ T cells
humoral immunity for extracellular bacteria
the complement pathway
c3b = opsonin
c3a and c5a = recruit leukocytes
MAC: perforate the membrane of gram -
lysozyme: attack peptidoglycan
antibody: principle defense
how do bacteria avoid immunity
prevent phagocytosis (capsules)
killing phagocytes
neutralizing the ab’s
survival within the phagocyte
prevent complement activation
avoid recognition (polymorphism)
humoral immunity to protozoal infection
Complement and antibody are important during the
extracellular stage of infection.
Opsonizes the protozoa and cause lysis
cell-mediated immunity to protozoal infection
important during the intracellular phase
Phagocytosis: macrophages, monocytes and neutrophils
CD4+ T-cells are activated
Cytotoxic CD8+ T-cells: important in the intracellular
stage (e.g, sporozoite stage of Plasmodium falciparum,
which causes malaria)
NK cells
how protozoa avoid the immune system
escape into the cytoplasm following phagocytosis
prevention of the complement activation
antigen variation via gene switching
parasitic worms and immune response
process as an extracellular organism: antibodies (IgE) and complement are the most important attack mechanisms
Th2 cell-mediated production of IgE
immune response to fungi
innate immunity controls most fungal infection
phagocytosis by neutrophils
the alternative and lectin pathways
defective Th17
Defective Th17 cell differentiation has been linked to
recurrent filamentous fungi and the occurrence of
mucocutaneous candidiasis in patients with primary
immunodeficiencies
Physician Impairment
means a physical, mental, or substance-related disorder that interferes with a physician’s ability to undertake professional activities competently and safely
signs and symptoms of impairment
ataxic gait slurred speech tremor Disheveled Appearance weight change mood alcohol breath more absence from work more accidental injury
professional lapses
writing, requesting, and diverting narcotics, stimulants or sedatives for self-use
physician burnout
emotional exhaustion
depersonalization
reduced personal accomplishment
causes of burnout and complications
too many tasks
too many hours at work
debt
no meaning in work
comp:
poor healthcare
less patient safety
top 3 leading causes of death
heart disease
cancer
stroke
top 3 actual causes of death
tobacco
diet/activity
alcohol
information collected on the death certificate
identifying
demographic
place of death
time and cause of death
what does the pronouncing physician fill out?
24-31
what does the certifying physician fill out?
32-37, 45-49
what is the importance of the death certificate?
burial permit settlement of deceased estate life insurance claim obtain death benefits termination of government services maybe.. closure
why are death certificates important for public health
Characterize and assess general health of
population, and differences within population
calculation of life expectancy
target and measures results of interventions
physicians responsibility regarding the death certificate
be familiar with state and local regulations regarding medical certifications
complete relevant portions of the certificate
deliver the paper to the funeral director; signed
answer questions
provide supplemental report if autopsy is different
ICD (international classification of diseases)
cause of death codes
published by WHO
every cause of death has a code
crude death rate
number of deaths in an area per 1000 population counted at mid year
equation:
total number of deaths from all causes in 1 year x 1000
/ number of persons in the pop. at mid year
disease specific death
total number of deaths due to a disease in an area during a certain period
equation:
total number of deaths due to a disease / mid year pop. x 1000
age specific death
total number of deaths in a specific age group / mid year pop. of that age group x 1000
neonatal mortality rate (NNMR)
number of deaths within the first 28 days of life per 1000 births
infant mortality rate (IMR)
number of deaths during the 1st year of life per 1000 births
under-five mortality rates
number of deaths during the first 5 years of life per 1000 births
maternal mortality rate
maternal deaths / woman of reproductive age
maternal mortality ratio
maternal deaths / live births
case fatality rate
number of people dying during a specific time after disease onset x 100 / number of people with that disease at that time
proportionate mortality rate
deaths from a certain cause in a given year and location / total deaths from all causes x 100
