МЕТHODOLOGICAL INSTRUCTION
FOR THE V-th YEAR STUDENTS
foreign students faculty
LESSON № 3 (6 hours)
Theme 3: Basics of the transplantation immunity. Immunology of reproduction. Immune forms of infertility.
Aim: to form the general picture of the clinical immunogenetics and transplantology, to know clinical features, diagnostics, treatment and prevention of graft rejection.
Professional motivation: Transplantation immunology is a fast developing branch of immunology. Its understanding is necessary for doctors of different specialities. Transplantation immunology is also a key to understanding of immunology of pregnancy and autoimmunity.
Methodology of Practical Class
Introduction by the teacher, control the initial level of knowledge – 09.00-09.30
Individual students’ work with patients – 09.30-12.00
Break – 12.00-12.30
Seminar (discussion of theoretical questions, practical work with patients) – 12.30-14.00
Break – 14.00-14.15
Individual work 1415-1500 (students who didn`t pass the tests in Moodle system, complete the individual work).
Algorithm of students’ communication with patients with pathology in subject (communication skills):
During examination of the patient students have to use such communicative algorithm:
Complaints and anamnesis taking in patients
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing.
4. Take complaints and anamnesis in a patient.
5. Explain to the patient results of his/her lab tests correctly and accessibly.
6. Explain to the patient your actions concerning him/her (the necessity of hospitalization, certain examinations and manipulations), which are planned in future.
7. Conversation accomplishment.
Objective examination:
Physical methods of examination of patients with internal diseases
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing.
4. Explain to a patient, what examinations will be carried out and get his/her informed consent.
5. Find a contact with the patient and make an attempt to gain his/her trust.
6. Inform about the possibility of appearing of unpleasant feelings during the examination.
7. Prepare for the examination (clean warm hands, cut nails, warm phonendoscope, etc.).
8. Examination (demonstration of clinical skill).
9. Explain to the patient results of his/her lab tests correctly and accessibly.
10. Conversation accomplishment.
Estimation of laboratory and instrumental investigations
Informing about the results of examination of patients with internal diseases
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing.
4. Explain to a patient results of his/her lab tests correctly and clearly.
5. Involve the patient into the conversation (compare present examination results with previous ones, clarify whether your explanations are clearly understood).
Planning and prognosis the results of the conservative treatment
Friendly facial expression and smile.
1. Gentle tone of speech.
2. Greeting and introducing.
3. Correct and clear explanation of necessary treatment directions.
4. Discuss with a patient the peculiarities of taking medicines, duration of their usage, possible side effects; find out whether your explanations are clear for him/her or not.
5. Conversation accomplishment.
WORK 1: Curation of the thematic patient. The student estimates results of laboratory and instrumental investigations, makes a differential diagnosis and formulates the clinical diagnosis, based on the diagnostic criteria of the disease.
WORK 2: Assessment of indications and contraindication to the transplantation. Selection of the pair “donor-recipient”.
WORK 3: Curation of the case of infertility.
Individual Students Program
1. Terms of transplantation.
2. MHC and HLA structure.
3. Donor-recipient selection.
4. Mechanism and clinic of graft versus host reaction.
5. Mechanisms and types of graft rejection.
6. Clinical manifestations of acute graft rejection.
7. Clinical manifestations of sub acute graft rejection.
8. Clinical manifestations of chronic graft rejection.
9. Immunologic monitoring of host and graft response.
10. Immunosuppressive therapy in recipients.
11. Genetic regulation of immune response.
12. HLA association with chronic diseases.
13. Immunological causes of infertility.
14. Treatment of infertility.
Seminar discussion of theoretical issues:
1. Concepts, terminology (auto-,allo-, transplantant).
2. Posttransplantation infectious complications, diagnostic criteria. Imunosupressive therapy: mechanisms of action, principles destination, complications.
3. New immunological methods of diagnosis and therapy in transplantation.
4. The System “father – mother”, “mother – fetus.” Immune status of pregnant women.
5. Immune form of infertility. Causes and immunological mechanisms, immunodiagnostic.
6. Immunological methods of treatment.
Test evaluation and situational tasks:
1. Hyperacute graft rejection occurs due to:
A. preexisting antibodies
B. T-cytotoxic lymphocytes
C. NK-cells
D. T-suppressors
E. None of above
2. Acute graft rejection occurs due to:
A. preexisting antibodies
B. antibodies produced after transplantation C. NK-cells
D. T-suppressors
E. None of above
3. Chronic graft rejection occurs due to:
A. preexisting antibodies
B. T-cytotoxic lymphocytes
C. antibodies produced after transplantation
D. T-suppressors
E. None of above
4. What type of drugs are not usefull for graft rejection prevention:
A. corticosteroids
B. cytotoxics
C. antilymphocyte globulin
D. non-steroid anti-inflammatory drugs
E. antilymphocyte serum
5. What diseases are not contraindication for liver transplantation:
A. malignancy
B. terminal renal insufficiency
C. terminal cardiovascular insufficiency
D. terminal liver insufficiency
E. polyorganic failure
6. The most selective immunosuppressive drug is:
A. azathiprine
B. cyclosporin
C. metotrexat
D. mercaptopurine
E. cyclophosphamidum
7. GVHD (graft versus host reaction) occurs due to incorrect selection of:
A. heart
B. kidney
C. bone marrow
D. lymphatic node
E. lung
8. GVHD (graft versus host reaction) occurs due to incorrect selection of:
A. bones
B. kidney
C. intestine
D. lymphatic node
E. lung
9. Class I of HLA antigens contains of the next locci:
A. A, B and C
B. DR, DP and DQ
C. A, B, C, E, F and G
D. A, B, C and D
E. A, B, C, D and DR
10. Class II of HLA antigens contains of the next locci:
A. A, B and C
B. DR, DP and DQ
C. A, B, C, E, F and G
D. A, B, C and D
E. A, B, C, D and DR
Initial level of knowledge and skills are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions (the instructor has tests & situational tasks): will be controlled with the tests and questions by the tutor.
Students should know:
1. Language of transplantation.
2. HLA structure and functions.
3. The laws of transplantation.
4. Graft-versus-host disease.
5. Clinical manifestations and treatment of acute graft rejection.
6. Clinical manifestations and treatment of subacute graft rejection.
7. Clinical manifestations and treatment of chronic graft rejection.
8. The main principles of graft monitoring.
9. Graft rejection prevention.
10. The general principles of graft rejection treatment.
Students should be able to:
1. To evaluate results of donor-recipient selection.
2. Diagnose and treat acute graft rejection.
3. Diagnose and treat subacute graft rejection.
4. Diagnose and treat chronic graft rejection.
5. Monitor of graft and host response.
6. Prevent and treat opportunistic reactions in recipients.
Correct answers of test evaluations and situational tasks: 1A, 2B, 3B, 4D, 5D, 6B,
References.
А – Basic:
1. Stephen Holgate. Martin Church. David Broide Fernando
2. Mark Peakman. Diego Vergani. Basic and Clinical Immunology with STUDENT. – Imprint: Churchill Livingstone Published: – April 2009.
3. Roderick Nairn, Matthew Helbert. Immunology for medical students / Hardboun – 2012 –326 p.
4. Web -sites:
a. http://intranet.tdmu.edu.ua : Basics of the transplantation immunity. Immunology of reproduction. Immune forms of infertility.
b. http://emedicine.medscape.com/
B – Additional:
1. Linda Cox. Allergen Immunotherapy, An Issue of Immunology and Allergy Clinics.- / Published: May 2011.- Hardbound, – 312 p.
2. Dédée Murrell. Autoimmune Diseases of the Skin, An Issue of Immunology and Allergy Clinics. – Imprint: Saunders.- Published: May 2012.
Methodical instruction has been worked out by assoc. prof. Volodymyr Horodetskyy
Methodical instruction was discussed and adopted at the Department sitting: “
