The Pathogenesis Pie - Universitas Hasanuddin · The Pathogenesis Pie 12 General study goals...

The Pathogenesis PieThe Pathogenesis Pie

1

Mechanisms of Disease 1

2013-2014

Module overview Thursday September 19th 2013; 14:30

Barge room

Sandra Arend, Main coordinator

(Dept. of Infectious Diseases)

Ingeborg Bajema, coordinator (Dept. of Pathology)

Astrid van Halteren, coordinator (Dept. of Pediatrics)

The Pathogenesis Pie

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What you will find out

Place in the curriculum

The why and what

Study methods

Competences

Structure of the module

How we examine


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Bachelor year 2


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Why study Mechanisms of Disease?

Causes Mechanisms Diseases

?

?

?

? ?


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Why study Mechanisms of Disease?

Causes Mechanisms Diseases

?

?

?

? ?

Why? How? What?


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7 basic mechanisms of disease The Pathogenesis Pie

Mechanisms of disease 1 Mechanisms of disease 2


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Immunology

PathologyInfectious

Diseases

Immunology

PathologyInfectious

Diseases


9



Immunology

Infectious

Diseases Pathology

Pharmacology


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Immunology

Infectious

Diseases Pathology

Pharmacology

LOGO


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Acute and chronic

inflammation

Disordered immunity

(immunodeficiency

and immunopathology)

Cell/tissue injury and

repair

Haemodynamic

disorders

Congenital

abnormalities (genetic,

non-genetic)

Metabolic and

degenerative

disorders

Growth disorders

(neoplastic, non-

neoplastic)


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General study goals (module book pg 9)

GENERAL GOALS

Normal host defense, response and repair mechanisms

Histology of these response, consequences

Classification, structure of micro-organisms

Pathogenesis of infections

Pathogenesis of failing or overresponsiveness of immune system

Immunology of transplantation, clinical problems

Interpretation of diagnostic tests

Themes Relates to

competences

(**)STUDY GOALS: The student

1. describes individual components and interactions between components of the defense mechanisms which underlie

normal response and repair mechanisms for the maintenance of tissue homeostasis

I K 1

2. recognizes and classifies histological features of acute or chronic inflammation, necrosis and repair responses, and

deduces the consequences of these processes for tissue/organ function

I T 1

3. categorizes different classes of micro-organisms, describes the structural characteristics and relates structural

components to physiology of micro-organisms

I, II T 1

4. explains the pathogenesis of diseases that result from an interaction between the immune system and pathological

stimuli, with focus on microorganisms, and deduces the clinical symptoms that result from this interaction

I, II T 1,2

5. categorizes the causes of failing defense mechanisms and overresponsiveness of the immune system (type I-IV

allergies and auto-immune diseases) and explains the pathogenesis and clinical symptoms of diseases resulting

from these disorders

I, II, III, IV T 1,2

6. distinguishes the immunological principles of solid organ transplantation and transplantation of the hematopoetic

system, names factors which affect transplantation outcome and describes the pathogenesis of clinical problems

associated with transplantation

I, VI B 1

7. given a description of diagnostic test results in a study population, the student interprets these results, calculates

sensitivity, specificity and positive/negative predictive value and predicts the effect of a change in pretest

probability on these parameters

II, III, IV T 1,6

8. analyzes a scientific paper on immunological or infectious diseases subject II, III, IV T 1,6

For a number of infections and immune disorders that are part of the module (listed in the Module book), the

student

9. recognizes characteristic clinical presentations II, III, IV, VI K 1,7

10. explains the pathogenesis II, III, IV, VI T 1,7

11. selects appropriate diagnostic and therapeutic options II, III, IV, VI T 1,4,7

12. given a microscopic image, the student names the most likely microorganism, infectious syndrome, or immune

disorder

II, III, IV, VI B 1

13. analyzes the infection chain (reservoir, source, transmission route and host factors) and applies the principles of

prevention and control of infectious diseases to concise but realistic problems and situations

V T 1,3,4,5,6,7

Subjects from previous modules

recognizes normal cells, tissues and organs;

describes normal temperature and blood pressure regulation

1

KBT*

14. K


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Themes

I The immune system and its opponents

II Infectious diseases

III Allergy

IV Auto-immunity

V Prevention and control of infectious diseases

VI Transplantation


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Theme I; the immune system

Complement Immuno-

globulins

T cells

-Th1

-CTL

INNATE ADAPTIVE

CELLULAR

HUMORAL

Granulocytes

Macrophages

NK cells


Calor Rubor Tumor Dolor Functio laesa 15

Theme I, Inflammation


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lymphocytes

D

macrophages plasma cells

granulocytes

Theme I, cells in inflammation


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Theme I, types of inflammation

Acute Inflammation

Neutrophils

Oedema

Congested vessels

Pus

Tumor/rubor/dolor/calor

Functio laesa

Chronic Inflammation

Lymphocytes

Tissue destruction

Attempts at healing:

Fibrosis

Blood vessels

Granuloma

Macrophages

Giant Cells

Lymphocytes

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Theme I. Cell injury, adaptation, cell

death

Hypertrophy

Hyperplasia

Metaplasia

Atrophy


Theme I. Microorganisms

Prion Virus Bacterium Protozoa Fungi Helminths

Base NA: 103 104-5 106 107 108 109

Single protein

Induces a

change

in protein

conformation

Set of proteins

and nucleic

acid

Uses living cells

Single cell

prokaryote

Single-cell

eukaryote

Multi-cellular

eukaryote


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Example theme II

Complement Immuno-

globulins

T cells

-Th1

-CTL

INNATE ADAPTIVE

CELLULAR

HUMORAL

Granulocytes

Macrophages

NK cells


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Example theme II

Complement Immuno-

globulins

T cells

-Th1

-CTL

INNATE ADAPTIVE

CELLULAR

HUMORAL

Granulocytes

Macrophages

NK cells


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Granulocytopenia

Necrotizing gingivitis


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Granulocytopenia

Aspergillus pneumonia Necrotizing gingivitis

Tip: Look up how it is acquired and

which structure is responsible for transmission

biopsy culture microscopy of culture


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2 1

M.o. Host Outcome

ComplementImmuno-

globulins

T cells

-Th1

-CTL

Granulocytes

Macrophages

NK cells

virus

ba

cte

ria

pro

tozo

fungus

worm

S. pyogenes

S. aureus Complement

Immuno-

globulins

T cells

-Th1

-CTL

Granulocytes

Macrophages

NK cells


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2 1

M.o. Host Outcome

ComplementImmuno-

globulins

T cells

-Th1

-CTL

Granulocytes

Macrophages

NK cells

virus

ba

cte

ria

pro

tozo

fungus

worm

S. pyogenes

S. aureus Complement

Immuno-

globulins

T cells

-Th1

-CTL

Granulocytes

Macrophages

NK cells

S. pyogenes

S. aureus


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Acute and chronic

inflammation

Disordered immunity

(immunodeficiency



repair

Haemodynamic

disorders

Congenital


non-genetic)

Metabolic and

degenerative

disorders

Growth disorders

(neoplastic, non-

neoplastic)

Competences

1= Medisch deskundige (Medical expert)

2= Communicator (Communicator)

3= Samenwerker (Collaborator)

4= Organisator (Manager)

5= Gezondheidsbevorderaar (Health advocate)

6= Academicus (Scholar)

7= Beroepsbeoefenaar (Professional)

70%

5%

15%


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Acute and chronic

inflammation

Disordered immunity

(immunodeficiency



repair

Haemodynamic

disorders

Congenital


non-genetic)

Metabolic and

degenerative

disorders

Growth disorders

(neoplastic, non-

neoplastic)

Competences








Medical expert: Based on immunopathological or

infection problem or case • Recognize disease or syndrome

• Mechanism-based analysis

• Explain symptoms and signs / clinical reasoning

• Diagnostic plan (DD) and interpret results

• Therapeutic principles

• Apply principles of prevention and control

Health advocate: • Apply knowledge ~ determinants of health and disease

• Analyze infection chain and design plan for prevention and control

•Know Public Health Law (reportable infectious diseases)

•Source finding and elimination

•Interruption of transmission

•Principles regarding isolation measures

•Prophylaxis, passive immunization, vaccination

MENU

70%

5%

15%


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Acute and chronic

inflammation

Disordered immunity

(immunodeficiency



repair

Haemodynamic

disorders

Congenital


non-genetic)

Metabolic and

degenerative

disorders

Growth disorders

(neoplastic, non-

neoplastic)

Competences








Scholar: • Analyse and interpret scientific publication

• Apply epidemiological principles to infectious problems

• Apply statistical concepts relevant for interpretation of diagnostic tests

Professional: • Behaviour, objectivity and confidentiality during patient demonstrations

• Preparation for and timely attendance of practicals and work groups

MENU

70%

5%

15%


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Study methods and study load Nr. hours

Lectures 40 40

Seminars 4 4

Patient demonstrations 6 6

E-learning modules 12 6

Practicals 2 4

Work groups 5 10

SUBTOTAL 66

Self-study, SSA and preparations 96

Test exams 6 3

Component exams 3 1

Final exam 1 3

TOTAL 173

Average of 4 hours

of self-study, 4 days

of each week


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Study load by method and week

I

MM

UNO

LOG

YPATH

OLO

GY

INFE

CTIO

US D

ISEASES

P

HARM

ACO

THERAPY

SEM

INAR

PATI

ENT

DEM

O

SELF

STU

DY A

SSIG

NM

ENT

PRACTI

CAL

WO

RK G

RO

UP

E-L

EARNIN

GSUM

MATI

VE E

XAM

T

EST E

XAM

WEEK 1 x x x x x x

WEEK 2 x x x x x x x x x

WEEK 3 x x x x x x x x x x



WEEK 6 x x x x x x x x

LECTURES

IM

MUNO

LOG

YPATH

OLO

GY

INFE

CTIO

US D

ISEASES

P

HARM

ACO

THERAPY

SEM

INAR

PATIE

NT D

EM

O

SELF

STU

DY A

SSIG

NM

ENT

PRACTI

CAL

WO

RK G

RO

UP

E-L

EARNIN

GSUM

MATIV

E E

XAM

T

EST

EXAM

WEEK 1 5 4 1 1 12 0,5

WEEK 2 1 10 1 1 16 2 2 0,5

WEEK 3 1 1 2 1 16 2 2 2 0,3 0,5

WEEK 4 3 4 2 1 1 16 2 0,3 0,5

WEEK 5 2 1 1 20 2 2 2 0,3 0,5

WEEK 6 2 2 1 1 16 2 3 0,5

study hrs 11 12 13 4 4 6 96 4 10 6 4 3

TOTAL 173

LECTURES


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Schedule by week

IMMUNOLOGY

PATHOLOGY

INFECTIOUS DISEASES

PHARMACOTHERAPY

PATIENT DEMO

Self-study assignments

PRACTICALS

WORK GROUPS

E-learning

TEST

IMMUNOLOGY

PATHOLOGY

INFECTIOUS DISEASES

PHARMACOTHERAPY

PATIENT DEMO


PRACTICALS

WORK GROUPS

E-learning

TEST


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Schedule by week

IMMUNOLOGY

PATHOLOGY

INFECTIOUS DISEASES

PHARMACOTHERAPY

PATIENT DEMO


PRACTICALS

WORK GROUPS

E-learning

TEST


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Schedule by week

IMMUNOLOGY

PATHOLOGY

INFECTIOUS DISEASES

PHARMACOTHERAPY

PATIENT DEMO


PRACTICALS

WORK GROUPS

E-learning

TEST


34

Schedule by week

IMMUNOLOGY

PATHOLOGY

INFECTIOUS DISEASES

PHARMACOTHERAPY

PATIENT DEMO


PRACTICALS

WORK GROUPS

E-learning

TEST


35

Blackboard

All lectures, seminars

E-learning

Logistical aspects


36

Blackboard

All lectures, seminars

E-learning

Logistical aspects


37

Exam plan overview

Week 1 Week 2 Week 6 Week 3 Week 4 Week 5

Summative tests

Formative tests Feedback

Lecture room

with voting boxes

Feedback is direct

Via Blackboard

Feedback via Seminar


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Component exams during WG/Practical

Week 1 Week 2 Week 3 Week 4 Week 5

final 1 3 2

Summative tests

Work group

1 3 4 2 5

Practicals

A B

Instructions

& materials

Training all

Themes and

Subjects

Week 6

Instructions

& materials


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Component exams during WG/Practical

Week 1 Week 2 Week 3 Week 4 Week 5

final 1 3 2

Summative tests

Work group

1 3 4 2 5

Practicals

A B

Max.

5 points

Week 6

Max.

5 points

Max.

5 points Max.

95 points

TOTAL max. 110 points


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MD1 Module committee

INFECTIOUS DISEASES Sandra Arend , coordinator

Lisette van Lieshout (parasitology), also line competence Health advocate

Jairo Gooskens (bacteriology)

Jutte de Vries (virology)

IMMUNOLOGY Astrid van Halteren, coordinator section immunology

Arjan Lankester (pediatrics)

Peter Nibbering (infectious diseases

PATHOLOGY Ingeborg Bajema, coordinator section pathology

Sjoerd van Duinen (pathology)

Marlies Reinders (nephrology)

PHARMACOLOGY Robert Rissmann

Marleen Hessel

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