Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
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Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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2. ANAEMIA IN PREGNANCY
Commonest medical disorder.
High incidence in underdeveloped countries
Increased Maternal morbidity & mortality
Increased perinatal mortality
3. ANAEMIA IN PREGNANCY
Definition: By WHO
Hb. < 11 gm /dl
(or haematocrit <32%).
Mild anaemia -------- 9 -10.9 gm /dl
Moderate anaemia--- 7-8.9 gm /dl
Sever anaemia-------- < 7gm /dl
Very sever anaemia-- < 4gm/dl
4. ETIOLOGY
There are 3 main causes:
1- Erythrocyte production: (hypo proliferative anemia )
. Fe deficiency
. Folic acid
. Vitamin B12
2- RBC destruction:
3- RBC loss:
90% anemia in pregnancy is due to Fe deficiency
5. Physiological changes in
pregnancy
• Plasama volume 50% (by 34weeks)
• But RBC mass only 25%
• Results in haemodilution :
• Hb
Haematocrit
RBC count
No change in MCV or MCH
2-3 fold increase in Fe requierment.
10-20 Fold increase in folate requirement
8. IRON DEFICIENCY ANAEMIA
Iron required for fetus and placenta ------- 500mg.
Iron required for red cell increment ------- 500mg
Post partum loss --------- 180mg.
Lactation for 6 months - 180mg.
Total requirement -------1360mg
350mg subtracted (saved as a result of
amennorrhoea)
So actual extra demand ----------------------1000mg
Full iron stores --------------------------------1000mg
9. ETIOLOGY OF IRON DEFICIENCY ANAEMIA
Depleted iron stores – dietary lack, chronic renal failure,
worm infestation, chronic menorrhagia
Chronic infections: ( like malaria)
Repeated pregnancies :
- with interval < 1 year
- blood loss at time of delivery
- multiple pregnancy.
CLINICAL FEATURES
Symptoms usually in severe anaemia
- Fatigue
- Giddiness
- Breathlessness
10. EFFECTS OF ANAEMA IN PREGNANCY
. Mother :
High output Cardiac failure (more likely if precelampsia
present. inadequate tissue oxygenation increase requirments
for excessive blood flow )
PPH
Predisposes to infection
Risk of thrombo-embolism
Delayed general physical recovery esp after c. section
Fetus: . IUGR
. Preterm birth
. LBW
. Depleted Fe store
. Delayed Cognitive function.
12. Serum iron decreased (<12 micro mol / l)
Total iron binding capacity :TIBC in non-pregnant
state is 33% saturated with iron .when serum iron
level fall ,<15% ofTIBC saturated.by fall in
saturation,the TIBC INCREASED.
S. ferritin :In healthy adults ferritin circulate in
plasma in range of 15_300 pg/l. in iron deficiency
anemia it is the first test to become abnormal.
INVESTIGATIONS
13. Serum transferrin receptor(TfR) : present on
all cells as transmembrane protien that binds
transferrin iron and transfer it to cell
interior. Increased in iron def. anemia.
Bone marrow examination.
RFTS/LFTS.
Urine for haemturia.
Stool examination for ova ,cyst and occult
blood.
14. MANAGEMENT
Objectives:
1- To achieve a normal Hb by end of pregnancy
2- To replenish iron stores
Two ways to correct anaemia:
I- Iron supplementation . Oral Fe
. Parenteral Fe
II- Blood transfurion
Choice of method:
It depends on three main factors:
Severity of the anaemia
Gestational Age.
Presence of additional risk factor
15. MANAGEMENT
Recommended supplementation for non-anaemiac
30 - 60mg /day of elemental iron
Anaemic gravidas 120 –240mg / per day
In tolerance to iron tablets – enteric coated tablet /
liquid suspension
Supplementation with folic acid + Vit C.
Therapeutic results after 3 weeks – rise in Hb %
level of 0.8gm/dl/ week with good compliance.
Treatment continued in the postpartum period to
fill the stores
16. MANAGEMENT
Severe anaemia: (Hb < 8gm/dl)- preferably
parenteral theraphy in the form of I/M or I/V iron
- I/M : ( Iron sorbitol) with “Z” technique
- I/V : (iron sucrose)
Iron neede =
(Normal Hb – Pt. Hb)* Wt in Kg*2.21+1000)
17. MANAGEMENT
Dose given I/M or I/V by slow push 100mg / day or the entire
dose given in 500 ml N/S slow I/V infusion over 1-6 hours
Marked increase in reticulocyte count expecred in 7-14 d
Blood transfusion:
may be required to treat severe anaemia near term or when
some other complication such as placenta praevia present.
Gross anaemia
Packed red cells transfusion (Under cover of loop
diuretic)
Exchange transfusion (Under cover of loop diuretic)
18. MANAGEMENT
Side effect of Fe Oral therapy:
. G. I upset.
. Constipation.
. Diarrhoea.
Parentral:
- skin discolouration
- local abscess
- allergic reaction
- Fe over load.
19. MEGALOBLASTIC ANAEMIA
Complicates upto 1% of pregnancies
Characterized by :
- RBC with high MCV
- White blood cells with altered morphology
(hypersegmented neutrophils).
Usually caused by :
- Folate deficiency may occur after exposure
to sulfa drugs or hydroxyurea
- Vitamin B12 deficiency
20. FOLATE DEFICIENCY ANAEMIA
At cellular level
Folic acid reduced to Dihydrofolicacid then
Tetrahydro-folicacid . (THF) e is required for cell
growth & division.
So more active tissue reproduction & growth more
dependant on supply of folic acid.
So bone marrow and epithelial lining are therefore
at particular risk.
21. FOLATE DEFICIENCY ANAEMIA
Folic acid deficiency more likely if
. Woman taking anticonvulsants.
. Multiple pregnancy.
. Hemolytic anemia; thalasemia H.spherocytosis
Maternal risk:
Megaloblastic anemia
Fetal risk:
Pre-conception deficiency cause neural
tube defect and cleft palate etc.
23. FOLATE DEFICIENCY ANAEMIA
Daily folate requirement for :
Non pregnant women -- 50 -100 microgram
Pregnant woman –-------- 300-400 microgram
Usually folic acid present in diets like fresh fruits
and vegetables and destroyed by cooking.
Folate deficiency:
- 0.5-1.0mg folic acid/day
If F/Hx. of neural tube defect
- 4mg folic acid/day.
24. Vitamins B12 Deficiency
It is rare
Occurs in patients with gastrectomy , ileitis, illeal
resection, pernicious anaemia, intestinal parasites.
Diagnosis:
Peripheral smear
Vitamin B12 level < 80 pico g/ml
Treatment of B12 Deficiency:
Vit B12 1mg I/M weekly for 6 weeks.
25. HAEMOGLOBINOPATHIES.
Normal adult Hb. after age of 6 month,
HbA---97%, HbA2---(1.5-3.5%), HbF2--<1%.
4 Globin chains associated with haem complex.
Hb. A = 2 alpha +2 beta globin chains.
Hb.A2= 2alpha+2 delta globin chains.
Hb.F = 2 alpha+ 2 gamma globin chains.
Hb. synthesis is controlled by genes.
Alpha chains by 4 gene,2 from each parent.
Beta chains by 2 genes ,1 from each parent.
26. HAEMOGLOBINOPATHIES
DEFINITION:
Inherited disorders of haemoglobin.
Defect may be in:
- Globin chain synthesis------thallassemia.
- Structure of globin chains-sickle cell disease.
Hb.abnormalities may be:
- Homozygous = inherited from both parents.
(Sufferer of disease)
- Hetrozygous = inherited from one parent.
(Carrier/trait of disease)
27. THALASSAEMIAS
The synthesis of globin chain is partially or
completely suppressed resulting in reduced Hb.
content in red cells,which then have shortened life
span.
TYPES:
- Alpha thalassaemia.
- Beta thalassaemia:
. Major
. minor
28. Beta thallassemia minor
Beta Thallassemia trait
Heterozygous inheritance from one parent.
Most frequent encountered variety.
Partial suppression of the Hb. synthesis.
Mild anaemia.
Investigations: Hb----around 10 g/dl.
Red cell indices: low MCV.
low MCH.
normal MCHC.
Diagnostic test: Hb. Electrophoresis.
29. Beta Thallassemia Minor
Management:
Same as normal woman in pregnancy.
Frequent Hb. Testing.
Iron & folate supplements in usual dose.
Parenteral iron should be avoided. because of
iron overload.
If not responded ---I/M folic acid.
blood transfusion close to time of delivery.
30. Beta Thallassaemia Major
Homozygous inheritance from both parents.
Sever anaemia.
Diagnosed in paediatric era.
T/m: is blood transfusion.
ALPHA THALASSAEMIA:
Both heterozygous & homozygous forms exist.
Alpha thallassaemia trait.
HbH disease.
Alpha thallassaemia major.
31. SICKLE CELL SYNDROME.
Autosomally inherited .
Structural abnormality.
HbS - susceptible to hypoxia, when oxygen
supply is reduced.
Hb precipitates & makes the RBCs rigid &
sickle shaped.
Heterozygous----HbAS.
Homozygous-----HbSS.
Compound heterozygous---HbSC etc.
32. Sickle Cell Disease (SCD)
Sickeling crises frequently occurs in pregnancy,
puerperium &in state of hypoxia like G/A and Hag.
Increased incidance of abortion and still birth
growth restriction, premature birth and intrapartum
fetal distress with increased perinatal mortality.
Sickle cell trait:(carrier state)
Does not pose any significance clinical problems
33. SCD
Diagnosis:
- Hb. Electrophoresis
- Sickledext test is screening test
Management:
- No curative Tx.
- only symptomatic
- Well hydration, effective analgesia, prophylactic
antibiotics, O2 inhalation, folic acid, oral iron
supplement (I/V iron is C/I), blood transfusion
34.
35. Management During labour
Comfortable Position
Adequate analgesia
O2 inhalation
Low threshold of assisted delivery
Avoid ergometrine
Prophylactic antibiotics
Continue iron &folate therapy for 3 mo after
delivery
Appropriate contraceptive advice