The document discusses anemia, defining it as a hemoglobin level below 130g/L for men and 120g/L for women. Anemia is initially classified based on erythropoiesis, which involves EPO production, iron availability, bone marrow proliferative capacity, and red blood cell maturation. Causes of anemia include blood loss, hemolysis, bone marrow diseases, and deficiencies. Evaluation involves history, exam, blood tests of cell counts and indices, smear examination, iron studies, and bone marrow analysis. Treatment depends on the underlying cause.
Aplastic anemia is one of the stem cell disorder which leads to pancytopenia in the peripheral blood and decrease production of all cell line in bone marrow. it require bone marrow transplantation to cure the patient.
Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly
Aplastic anemia is one of the stem cell disorder which leads to pancytopenia in the peripheral blood and decrease production of all cell line in bone marrow. it require bone marrow transplantation to cure the patient.
Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly
Edema is defined and its mechanism explained with reference to the Starling's forces. The causes of localized edema and anasarca discussed.
In history taking, the site and distribution of edema, its duration, association with pain, variability, systemic illness, drug intake, trauma, radiation discussed.
The local and systemic examination described. The approach to investigation including lab tests and imaging explained.
Finally, management is discussed in short.
A comparison between Nephritic and Nephrotic syndrome from Professor Hossam Mowafy Internal Medicine textbook nephrology section, Please inform me if there is any error or wrong information include.
Hereditary spherocytosis is an inherited condition related to RBC destruction. its diagnosis is require to differentiate immune hemolytic anemia and G-6-P-D deficiency anemia
Acute kidney injury (AKI) is a potentially life-threatening
syndrome that occurs primarily in hospitalized patients
and frequently complicates the course of critically ill
patient.
Acute Kidney Injury is is (abrupt) reduction in kidney functions as evidence by changed in laboratory values; serum creatinine, blood urea nitrogen(BUN)and urine output
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Edema is defined and its mechanism explained with reference to the Starling's forces. The causes of localized edema and anasarca discussed.
In history taking, the site and distribution of edema, its duration, association with pain, variability, systemic illness, drug intake, trauma, radiation discussed.
The local and systemic examination described. The approach to investigation including lab tests and imaging explained.
Finally, management is discussed in short.
A comparison between Nephritic and Nephrotic syndrome from Professor Hossam Mowafy Internal Medicine textbook nephrology section, Please inform me if there is any error or wrong information include.
Hereditary spherocytosis is an inherited condition related to RBC destruction. its diagnosis is require to differentiate immune hemolytic anemia and G-6-P-D deficiency anemia
Acute kidney injury (AKI) is a potentially life-threatening
syndrome that occurs primarily in hospitalized patients
and frequently complicates the course of critically ill
patient.
Acute Kidney Injury is is (abrupt) reduction in kidney functions as evidence by changed in laboratory values; serum creatinine, blood urea nitrogen(BUN)and urine output
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
It is a neoplasm of B-cell lineage; proliferation of the cells forms a monoclonal population of plasma cells and produces a single type of Ig/Ig fragment.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
3. Anemia – The World Health Organisation
defines anemia as a hemoglobin level < 130
g/L (13g/dL) in men and <120g/L (12g/dL)
in women.
The critical elements of erythropoesis are
used for the initial classification of anemia.
4.
5. EPO production
Iron availability
Proliferative capacity of the bone marrow
Effective maturation of red cell precursors
http://www.oncoprof.net/Generale2000/g09_Chimiotherapie/Complements/g09-gb_comp56.html
6. Often found during routine screening
Acute blood loss – Hb/HCT does not reflect
the volume of blood loss
◦ Mild – No symptoms. Enhanced oxygen delivery by
changes in pH and increased CO2
◦ 10-15% - hypotension and decreased organ
perfusion
◦ >30% - postural hypotension, tachycardia
◦ >40% - hypovolemic shock: confusion, dyspnoea,
diaphoresis
7. Acute hemolysis
◦ Intravascular hemolysis: acute back pain, free
hemoglobin in plasma and urine, renal failure
Moderate anemia
◦ Fatigue
◦ Loss of stamina
◦ Breathlessness
◦ Tachycardia on physical exertion
◦ Symptoms may not appear in young, healthy
patients until hemoglobin is 7-8 g/dL
8. Diseases in which patient presents with
anemia
◦ Infections
◦ Rheumatoid Arthritis
◦ Cancer
◦ Lymphoproliferative disorders (CLL, B cell
neoplasm)
Anemia – a major sign of disease
9. Evaluation by History:
◦ Symptoms of known diseases causing anemia:
Gastric ulceration
Rheumatoid arthritis
Renal failure
◦ Duration of symptoms:
Hemoglobinopathies in longer duration
◦ Treatment history
Medications for pain, hematinics
◦ Nutritional history
15. A reliable measure of red cell production
Patient’s reticulocyte is compared with
expected reticulocyte counts
In established anemia, reticulocyte count of
less than two-three times is an inadequate
marrow response
Reticulocyte correction needs to be done for
anemia (1)
And shift cells (2), If polychromatophilic cells are not
seen on the blood smear, the second correction is not
required.
17. Premature release of recticulocytes are due to
EPO stimulation
Severe chronic hemolytic anemia – RPI
increases upto six to sevenfold. Confirms
appropriate response to EPO, normal
functioning marrow and iron availability
If reticulocyte production index < 2, suggests
a defect in marrow proliferation or maturation
19. Marrow aspirate
◦ M/E ratio
◦ Cell morphology
◦ Iron stain
Marrow biopsy
◦ Cellularity
◦ Morphology
20. Required in patients with normal iron status
with hypoproliferative anemia
Can be used to diagnose primary bone
marrow diseases: myelofibrosis, infiltrative
diseases
Hematocrit Production Reticulocytes (incl. Marrow M:E
Index corrections) ratio
45 1.0 1 3:1
35 2.0-3.0 4.8%/3.8/2.5 2:1 – 1:1
25 3.0-5.0 14%/8/4.0 1:1 – 1:2
15 3.0-5.0 30%/10/4.0 1:1 – 1:2
21. Can be stained to confirm iron status (ferritin
/ hemosiderin).
Other laboratory tests maybe indicated
depending on the type of anemia.
Normal Iron Stain
http://www.rightdiagnosis.com/phil/html/iron-deficiency-anemia/2657.html
22.
23. 75% of all anemias
Absolute or relative bone marrow failure
Causes:
◦ Mild to moderate iron defeciency
◦ Inflammation
◦ Marrow damage
◦ Ineffective EPO production (impaired renal function,
IL-1, hypothyroidism, diabetes mellitus, myeloma)
◦ Normocytic normochromic, occasionally microcytic
hypochromic
24. Investigations:
◦ S. Iron
◦ TIBC
◦ RFT
◦ TFT
◦ Bone Marrow biopsy/aspiration
◦ Serum Ferritin
◦ Iron stain of bone marrow
25. Anemia of chronic inflammation:
◦ S. Iron: Low
◦ TIBC: normal or low
◦ Transferrin saturation: Low
◦ S. Ferritin: Normal – High
Iron defeciency anemia
◦ S. Iron: Low
◦ TIBC: High
◦ Transferrin: Low
◦ S. Ferritin: Low
26. Leukemia and lymphoma, marrow aplasia
◦ Peripheral smear
◦ Bone marrow biopsy
Bone marrow biopsy in Acute Leukemia
http://wikidoc.org/index.php/Bone_marrow_examination
27.
28. Features:
◦ Anemia with low reticulocyte count
◦ Macro or microcytosis on smear
◦ Abnormal red-cell indices
Two categories:
◦ Macrocytic – nuclear abnormalities
◦ Microcytic – cytoplasmic abnormalities
Ineffective erthropoeisis due to destruction in
marrow
Bone marrow shows erythroid hyperplasia
29. Nuclear maturation disorders:
◦ Folate or Vitamin B12 defeciency, drug damage
(methotrexate), myelodysplasia
◦ Alcohol causes macrocytosis with variable degree of
anemia due to folate defeciency
Cytoplasmic maturation disorders:
◦ Severe iron defeciency, thallassaemias
Iron defeciency: Low reticulocyte
index, microcytosis, Serum Iron profile can be used to
differentiate from thallassaemias
30. Myelodysplasia:
◦ Macro or microcytosis
◦ Iron ring in mitochondria
◦ Sideroblasts on marrow stain
◦ Iron studies can help differentiate from other
conditions
31.
32. Red cell production indices > 2.5 or normal
Polychromatophilic macrocytes on smear
Red cells indices: Normocytic to Macrocytic
due to increased reticulocytes
Acute blood loss: Not associated with
increased reticulocyte production because of
time required for EPO production
Subacute blood loss: Moderate reticulocytosis
Chronic blood loss: Iron defeciency with
increased red cell production
33. Least common form of anemia
High reticulocyte count – marrow able to sustain
erythropoesis with efficient recycling of iron in
case of extravascular hemolysis
Intravascular hemolysis – Paroxysmal nocturnal
hemoglobinuria – Loss of iron may limit marrow
response
Hemoglobinopathies like sickle cell
disease/thallassemias present a mixed picture
and may have a high reticulocyte count which is
low compared to marrow hyperplasia.
34. Acute: specific patterns like autoimmune
hemolysis, glutathione reductase.
Inherited hemolytic anemias: have a lifelong
history of typical of disease process
Chronic hemolytic diseases like hereditary
spherocytosis may present with complication
of increased red cell destruction (bilrubin
gallstones, splenomegaly).
Susceptible to aplastic crises
35. Differential diagnosis of acute or chronic
hemolysis requires careful investigation of
family history and specialised laboratory tests
like hemoglobin electrophoresis or screening
for red cell enzymes.
Acquired defects in red cell survival – may
requires testing of indirect antiglobulin test,
cold agglutinin titres to detect hemolytic
antibodies or complement mediated
destruction.
36. Mild to moderate anemia: Treatment once
specific diagnosis in made
Acute causes may require treatment before
diagnosis is made.
Some causes of anemia are multifactoral and
it is important to check iron status before and
during treatment.
37. 43yrs / F, k/c/o Beta Thal Carrier
Generalised weakness x 7 days
Hb – 6.4g% (17/6)
7.0/26.4% on admission, 7 days later after
starting Mumfer
Tot RBC: 4.42 x 106 cells/mm3
MCV – 60 fl [78-98]
MCH – 16pg [27-32]
MCHC 27% [31-34]
TLC: 8000cells/cumm, N46 L44 M7 E2.1 B0.1
Plt: 289,000/cumm
38. RBC: Microcytic Hypochromic with many
ovalocytes, few dacryocytes and schistocytes
WBC: normal maturation
Platelets: adequate in number
Parasites: not seen
Corrected Retic count = 4 x 9/12 = 3
39. Harrison’s Principles of Internal Medicine,
18th Edition