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8/18/2019 (Sun) 2-5pm with at in . Come down for – at Panca










RT : RT : Grab a pack of goat/toolo beef jollof for only GHc 15. Remember to place your order by 10pm today. Happy Wednesday. Swipe.




Un réveil tardif, s'attaquer à un pile de 🥞 et déjeuner dehors. J'ai pris 3 jours de repos et ils sentent bon les vacances!! J'ai enfin testé la recette des pancakes fluffy de et ils sont 👌. . Bonne journée mes petits 😘 .




Sopra (ma anche sotto) la ! Ecco il mood di questo venerdì… perché questo antico e semplice oggetto non passa mai di moda ed è capace di reinterpretarsi e di adattarsi a qualsiasi ambiente delle nostre case!



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年間新規患者数は 約100例 年間の医療施設受診者は、約1,800例と推定 治療により約90%の症例は6か月以内に寛解に至るが、継続加療を要する )陽性などが重要 引用元



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Ulteriore modifica al gommone:panca a poppa! Offre maggiore capienza al gommone poichè all'interno può contenere i vostri oggetti personali ed inoltre consente altre 2 comode sedute😉




Ulteriore modifica al gommone:panca a poppa! Offre maggiore capienza al gommone poichè all'interno può contenere i vostri oggetti personali ed inoltre consente altre 2 comode sedute😉




Me encanta el aguacate. 🥑 está deliciosa presentación es en Simplemente delicioso.







タピ活 なる言葉を 初めて聞きました。 なるほど。 婚活 就活 タピ活、って感じですね。
















An event-style pancake by Dancakes artist Lee ( ) that sort of explains itself 😂 . Want meme pancakes at your next event? Hire Dancakes by clicking the link in our bio! We go anywhere and will make any requests 🥞✨ .









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*Note that all disease entities shown may demonstrate either ANCA staining pattern with antibodies to either MPO or PR3 (or other proteins found in primary granules, as is common in ulcerative colitis and primary sclerosing cholangitis); this table shows the most common pattern and antigens and is what you would most likely see on boards.

I got this question and mixed up MPA and GPA. Ugh. MPA is p-ANCA + and GPA is c-ANCA +.

An elevated P-ANCA titer is a useful diagnostic marker in patients with microscopic polyangiitis (MPA). Although MPA has similar clinical features as granulomatosis with polyangiitis (GPA), including nonspecific systemic symptoms, pulmonary symptoms including hemoptysis and renal involvement characterized by pauci-immune glomerulonephritis, MPA typically lacks upper respiratory/ENT symptoms and granulomatous inflammation on tissue biopsy, which are common in GPA.

Microscopic polyangiitis (MPA) is an autoimmune necrotizing vasculitis of small vessels. Males are affected more frequently than females, with an average age of onset of 50 years. Clinical symptoms are similar to those seen in granulomatosis with polyangiitis (GPA), although the common ENT manifestations, such as chronic sinusitis, that are seen in GPA are frequently absent in patients with MPA. Nonspecific constitutional symptoms, such as weight loss, fatigue, fever, and arthralgias, are common. Pulmonary airway and parenchymal involvement, often with cough, dyspnea, hemoptysis, and pleuritic pain, are frequently seen. Renal involvement is also frequent; although less than 20% of patients have involvement at diagnosis, up to 85% will have necrotizing crescentic glomerulonephritis within 2 years of diagnosis.

Dermatologic symptoms including palpable purpura may be seen in 50% of patients, and peripheral nervous system findings are often present (but are rare in GPA). Patients with suspected MPA should undergo biopsy of involved tissue if possible. Renal biopsy and pulmonary biopsy are common and most frequently show pauci-immune glomerulonephritis, which is often diffuse and necrotizing with crescentic formation, and pulmonary capillaritis, respectively. Of note, MPA usually lacks granulomatous inflammation in the tissue surrounding the vasculitic small vessels. This is in opposition to GPA, in which granulomatous inflammation is a common finding.

Elevated antineutrophilic cytoplasmic autoantibodies (ANCA) titers may be found in both GPA and MPA, and testing for ANCA should be performed in all patients with suspected vasculitis. The antigens for these autoantibodies are found in the primary granules of neutrophils and macrophages. ANCA in MPA are most commonly against myeloperoxidase (MPO), whereas ANCA in GPA are most commonly against PR3. When fixed neutrophils are reacted in an immunofluorescent assay with patient serum, ANCA against MPO typically form a perinuclear staining pattern (termed P-ANCA), whereas ANCA against PR3 typically form a cytoplasmic staining pattern (termed C-ANCA). Thus, in this patient with symptoms of small vessel vasculitis characterized by sparing of the upper respiratory tract and with biopsy findings of vasculitis with absent granulomatous inflammation, the most likely diagnosis is MPA, and P-ANCA is the most useful marker for diagnosis. Immunosuppressive treatment is needed in almost all patients with both MPA and GPA and initially consists of glucocorticoids and either cyclophosphamide or rituximab. Therapeutic response/remission and disease monitoring is by assessment of clinical disease manifestations, including general symptoms such as arthralgias and fever, and involvement of the major organ systems.

ANCA was never really explained to us. It’s when after getting a negative immunofluorescence result, you put a neutrophil on a slide and put the pt’s serum on the same slide. The p-ANCA antibodies in the serum surround the nucleus of the neutrophil (hence the name “p-ANCA,” which is “perinuclear anti-neutrophil cytoplasmic antibody”). If the antibodies bind in the cytoplasm, then they’re c-ANCA (cytoplasmic anti-neutrophil antibody).

Approximately 80% of patients with primary sclerosing cholangitis (PSC) are positive for p-ANCA (antineutrophil cytoplasmic antibodies), although this is not a specific finding. The majority of patients with PSC are asymptomatic upon diagnosis, but manifestations often include fatigue, pruritus, fevers, chills, night sweats, and right upper quadrant (RUQ) pain. Diagnosis is confirmed by demonstrating multifocal stricturing and dilation of intrahepatic and/or extrahepatic bile ducts on cholangiography. Major complications include cholestasis, cholelithiasis, cholangitis, gallbladder/colon cancer, and cholangiocarcinoma.

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Thought I posted about this, but I can’t find it.

GN = Glomerulonephritis
Wegener’s granulomatosis is a spectrum. Wegener’s is associated with presence of c-ANCA, which is correlated with anti-proteinase 3 antibodies.

Another condition similar to Wegener’s granulomatosis is microscopic polyangiits, which is associated with presence of p-ANCA, which is correlated with Abs against MPO.

“P” in “p-ANCA” is a peri-nuclear distribution. “C” in “c-ANCA” is for diffuse cytoplasm distribution.

There’s the same kidney disease in Wegener’s granulomatosis and microscopic polyangiitis. But Wegener’s has greater involvement of organs above the diaphragm than microscopic polyangiitis.

From Wikipedia:

It is now widely presumed that the anti-neutrophil cytoplasmic antibodies (ANCAs) are responsible for the inflammation in GPA.[12] The typical ANCAs in GPA are those that react with proteinase 3, an enzyme prevalent in neutrophil granulocytes.[7] In vitro studies have found that ANCAs can activate neutrophils, increase their adherence to endothelium, and induce their degranulation that can damage endothelial cells. In theory, this phenomenon could cause extensive damage to the vessel wall, in particular of arterioles.[12]

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1 settimana fa ho provato il #massimale di #panca 100% soddisfato 😎 (presso Mantua, Italy)

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