This document provides information about beta thalassemia, including its classification, epidemiology, etiology, clinical features, diagnosis, complications, management, prognosis, and prevention. It begins by defining beta thalassemia as a genetic disorder of hemoglobin synthesis where there is reduced or absent production of beta globin chains. It then discusses the different types of beta thalassemia, the genetic basis and inheritance patterns, clinical presentation including anemia and organomegaly, diagnostic testing including blood counts and hemoglobin electrophoresis, complications related to iron overload, and long-term management through blood transfusions and chelation therapy. The document concludes with topics of prognosis, highlighting increased mortality risks, and prevention through carrier screening,
This presentation contains an overall review of Thalassemia and its Etiology, Inheritance, Symptoms and treatment
Done by: Faten Al-Sadek , Pharmacy student at Mohammed Al-Mana college for Health Sciences -MACHS
This presentation contains an overall review of Thalassemia and its Etiology, Inheritance, Symptoms and treatment
Done by: Faten Al-Sadek , Pharmacy student at Mohammed Al-Mana college for Health Sciences -MACHS
Thalassemia is a blood disorder passed down through families (inherited) in which the body makes an abnormal form or inadequate amount of hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen. The disorder results in large numbers of red blood cells being destroyed, which leads to anemia.
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.
Thalassemia is a blood disorder passed down through families (inherited) in which the body makes an abnormal form or inadequate amount of hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen. The disorder results in large numbers of red blood cells being destroyed, which leads to anemia.
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.
Thalassemia Unveiled: Insights into Diagnosis, Treatment, and Care.pptxNoorulainMehmood1
Thalassemia, a group of inherited blood disorders, presents a complex interplay of genetic mutations and clinical manifestations. This presentation delves into the intricacies of thalassemia, exploring its genetic underpinnings, clinical spectrum, diagnostic modalities, and therapeutic approaches. Through comprehensive analysis and case studies, attendees will gain a deeper understanding of thalassemia's impact on patients' lives and the latest advancements in management strategies.
Keywords:
Thalassemia
Genetic Disorders
Hemoglobinopathies
Blood Disorders
Anemia
Genetic Mutations
Clinical Spectrum
Diagnosis
Treatment Modalities
Transfusion Therapy
Iron Chelation Therapy
Genetic Counseling
Patient Care
Hematological Disorders
Research Advancements
approach to a patient with htalassemia by Hari SedaiHariSedai
what is thalassemia, typical case scenarion, pathophysiology, symptom, signs, investigation and treatment of thalasemmia and about thalaseemic hero of Nepal
case presentation on diagnosis of beta thalassemia majorDrShinyKajal
case history of 9 month old infant
Paediatric Clinical Approach to this case
examination
workup at blood centre
HPLC screening
laboratory findings
screening of father mother
prominent facial features
PBF and bone marrow findings
usg abdomen
xray skull
prbc transfusion therapy in thalassemia major
classification of thalassemia
national burden in india
pathogenesis- anemia skull bone iron overload
world thalassemia day
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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Cardiac conduction defects can occur due to various causes.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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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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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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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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Beta thalassemia and thalassemia prevention 2021
1. Beta Thalassemia
and
Prevention of Thalassemia
Classification, Epidemiology, Etiology
Clinical Features, Diagnosis, Complications,
Management, Prognosis, Prevention
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan
2. In the name of Our Creator
Allah,
the most Gracious,
the most Merciful
3. OBJECTIVES
• What is Beta Thalassemia ?
• What are the different types ?
• How to differentiate it from other childhood anemias ?
• What are its complications ?
• How to manage the Thalassemic child ?
6. Types of Hemoglobin
• Adult Hemoglobin (Hb A) – a 2 b 2
- 97 % in normal adults
• Adult Hemoglobin (Hb A2) – a 2 d 2
- < 3% in normal adults
- mild increase in Thalassemia carriers
• Fetal Hemoglobin (Hb F) – a 2 g 2
- 60 – 80 % at birth
- < 5 % at 6 months
- main hemoglobin in Thalassemia patients
7. Beta Thalassemia
• Genetic disorder of Hemoglobin synthesis
• Reduced or absent production of Beta globin chains
• Excess Alpha chains in RBCs damage the RBCs
• Decreased RBC survival
• Increased destruction of RBCs in bone marrow and
peripheral circulation
• Clinical anemia
10. Abnormal DNA
• 2 beta globin genes are on
Chromosome no 11
• Mutation in beta globin
gene results in Beta
Thalassemia
• One gene abnormal – Beta
Thalassemia carrier
• Both genes abnormal – Beta
Thalassemia disease
11. Beta Thalassemia – Genetic Transmission
• Thalassemia is autosomal
recessive
• Thalassemia patient gets
two abnormal genes – one
each from his parents
• Thalassemia carrier gets
one abnormal gene from
one of his parents
15. Autosomal Recessive Inheritance
• When both parents are
Thalassemia carriers, What
are the chances of the next
baby being affected ?
• Next child suffering from
Thallasemia
= 25 % chances
18. b-Thalassemia in Pakistan
b-thalassaemia major is a major public health problem in
Pakistan
• Carrier rate 5-8 %
• 7-11 million carriers in the country
• ~100,000 patients (Only 28000 are registered)
• 6000 thousands new patients/year
• Each Pt needs 26 units blood/year i.e.
• 2.5 Million Unit blood is needed/year to support these patients
» ( Ahmad S et al Br J Haematol 1996)
21. Case Scenario
• A 18 months old child
presents to the OPD with
the complaints of poor
feeding and frequent crying
for the last 6 months.
• On examination, weight of
the child is 8 kg. He has
marked pallor on his
tongue and hands. His
abdomen is distended. Liver
and spleen are palpable by
8 cm each below the costal
margin.
22. Beta Thalassemia Major
• Most common Hemolytic anemia in Pakistan
• Severe hemolysis
• Anemia starts in first six months of life
• Spleen enlarged early
• Significant bony changes develop gradually
23. Beta Thalassemia Major – Clinical Features
• Anemia (mild to severe, may be masked by blood transfusion)
• Jaundice (unconjugated, in some cases)
• Hepato-Splenomegaly
• Bony deformities (due to Bone Marrow expansion in poorly
transfused children of Thalassemia major)
• Iron-overload results in dark skin complexion
28. Beta Thalassemia – Lab Diagnosis
• Hb and RBC count low
• Anemia is microcytic hypochromic (MCV, MCH, MCHC are low)
• Reticulocyte Count increased > 2 %
• Peripheral blood film shows target cells and Normoblasts
• Bone Marrow exam (rarely needed) shows Erythroid
Hyperplasia
29. Peripheral film in Thalassemia Major
• Anisocytosis, poikilocytosis
• Microcytosis, Hypochromia
• Reticulocytes increased
• Target cells, Normoblasts
30. Hemoglobin in Beta Thalassemia
• Beta globin chains not produced
• Hb A (a 2 b 2) is reduced
• Beta Thalassemia patients - Hb F (a 2 g 2) is increased to 20 – 90 %
• Beta Thalassemia carriers - Hb A2 (a 2 d 2 )is increased to > 3.5 %
32. Detection of Thalassemia Minor (carriers)
• Carriers are asymptomatic or may have mild anemia
• Carriers detected by Hb electrophoresis which shows raised
Hb A2 to > 3.5 %
• Diagnosis of parents as Thalassemia Carriers helps to confirm
the diagnosis of Thalassemia in the child
33. Beta Thalassemia – Genetic Diagnosis
• Detection of Thalassemia gene mutations in peripheral blood
samples
• Usually blood of patient, mother and father is analyzed for
detection of common mutations
• DNA analysis performed at major labs in Pakistan
42. Beta Thalassemia – Management
• Blood Transfusions
• Iron Chelation Therapy
• Hydroxyurea
• Splenectomy
• Bone Marrow Transplant
43. Beta Thalassemia – Blood Transfusions
• Needed for developing Anemia
• Packed cells transfused
• Usually monthly transfusions
• Requirement increases with age
• Allergic reactions are common
• Iron overload is major complication
44. Beta Thalassemia – Iron Chelation Therapy
• Started when serum ferritin > 1000 ng/ml
• Deferasirox (oral)
• Deferioxamine (subcutaneous infusions by infusion pump)
• Deferiprone (oral)
45. Beta Thalassemia – Hydroxyurea
• Anti-metabolite medication
• Inhibits DNA synthesis
• Increases Hb F production
• Hydroxyurea decreases blood transfusion requirement in 70 %
children with Thalassemia
• Some patients remain transfusion free with mild to moderate
anemia
46. Beta Thalassemia – Splenectomy
• Indications
• Massive splenomegaly
• Blood packed cells transfusion requirement more than 200
ml/kg/yr
• Splenectomy
Decreases blood transfusion requirement
• Predisposes to infections
• Does not cure the disease
47. Beta Thalassemia – Bone Marrow Transplant
• Curative treatment for Beta Thalassemia
• Facilities being developed in Pakistan
• Cost Rs 2 – 3 million
• Success rate 60-80 %
• High risk procedure
• Matched HLA sibling donor needed
49. Prognosis of Thalassemia in Pakistan
• High morbidity (sickness)
• Patients need significant medical support and resources
• Life span shortened due to multiple complications
• High mortality
0
20
40
60
80
100
120
2 4 6 8 10 12 14 16 18 20 22 24 25
1996
2006
52. Prevention of Thalassemia
• Carrier Screening – detect Thalassemia carriers in population
by Extended Family Carrier Screening
• Genetic Counselling – guide parents to understand genetic
transmission of disease
• Prenatal Diagnosis – detect Thalassemia before birth by
chorion villus biopsy
53. Prevention of Thalassemia - Carrier Screening
Types
• Mass population screening – screen all population - (5%
carriers)
• Screening in Pregnancy – screen all pregnant women……if
they are positive, screen their husbands - (5% carriers)
• Extended Family Screening – screen all members of extended
family of Thalassemia patients - (30 % carriers)
• Family members are likely to have common genes
54. Prevention of Thalassemia
Extended family Carrier Screening
• Detect Thalassemia Carriers in families of Thalassemia
patients by carrier screening (blood tests)
• Carrier screening of married couples to know the risk of birth
of Thalassemia children in their family
• Carrier screening before marriage to know the risk of birth of
Thalassemia children after marriage
• Carrier screening before marriage to avoid marriage between
Thalassemia carriers
55. Prevention of Thalassemia
Extended family Carrier Screening
Fig: 9.8. Coefficient of inbreeding and thalassaemia screening in the members of Family No: 5. (NA=not available for testing).
(S. Ahmed et al, NEJM 2002)
56. • Identify the carriers
• Genetic Counselling
about risk of birth of
Thalassemic child
• Offer prenatal diagnosis to
the affected couples
Prevention of Thalassemia - Genetic Counseling
57. Prevention of Thalassemia - Genetic Counseling
• To understand and adapt to medical, familial and
psychological consequences of Genetic Disease
• Understanding the chance of passing a genetic condition on to
children.
• To help the family learn more about the Thalassemia and
how it can affect the family.
• Guiding through decision-making about genetic testing, family
planning, or medical planning.
• Finding supportive resources to help manage a genetic
condition.
58. Prevention of Thalassemia – Prenatal Diagnosis
• Both parents are Thalassemia carriers
• Chorion villus biopsy to get fetal DNA at 8-10 weeks of LMP /
Gestation
• Genetic / DNA analysis to detect presence of Thalassemia in
fetus
59. Identify Couple at Risk
Pregnancy
Fetal Sampling
Lab Diagnosis
Affected Fetus Normal Fetus
Termination of Pregnancy
Prevention of Thalassemia – Prenatal Diagnosis
61. Medical Ethics
Abortion / Termination of Pregnancy
• Medical ethics for Muslims is related to Islamic jurisprudence
or Fiqh based on Consensus view of scholars
62. Islamic view of Abortion
Abortion
is allowed to be performed
Prior to 120 days
from the start of conception
if
Fetus is having a proven, serious, untreatable
congenital malformation
or
is likely to develop serious disease or handicap after
birth
65. Unmarried Persons
• Know your Thalassemia status by a simple Blood Test (CBC
and Hb electrophoresis) before marriage
• If you are a Thalassemia carrier, know the Thalassemia status
of your “Would be” before marriage
• If both “Would be” parents are Thalassemia carriers, Prenatal
testing in every pregnancy
66. Married couples
• If married, both Husband and Wife get tested for Thalassemia
• If both parents Thalassemia carriers, Prenatal testing
(diagnosis before birth) for every pregnancy
69. Take Home Message
• Thalassemia is common in our children
• Anemia and Splenomegaly are important signs on
physical examination
• Hemoglobin Electrophoresis with increased HbF in blood
is required for diagnosis
• We need to focus on Prevention of Thalassemia in our
country
• Every person should know his Thalassemia carrier status