Trinity Kings World Leadership: The Law of the Inner Circle: Jesus prepared M...Terrell Patillo
Deuteronomy 1:13-15
Amplified Bible, Classic Edition (AMPC)
13 Choose wise, understanding, experienced, and respected men according to your tribes(family groups), and I will make them heads over you.
14 And you answered me, The thing which you have spoken is good for us to do.
15 So I took the heads of your tribes(family groups), wise, experienced, and respected men, and made them heads over you, commanders of thousands, and hundreds, and fifties, and tens, and officers according to your tribes(family groups).
Spice Boss-5505 is a dual SIM phone with 4.5 cm Screen Display. It comes with a digital camera to capture images and record videos. For connectivity, the phone has WAP, GPRS and Bluetooth. Other features include 1200 mAh battery, audio video player, FM, auto call recorder,torch and 16GB expandable memory.
Semilla agustiniana 6 de julio
San Agustin es sinduda uno de los Padres de la antigüedad con mayor profundidad espiritual y existencial. Saborear sus pensamientos es como dar al alma un aroma que difícilmente se pierde.
Como melhorar a monetização de jogos e aplicativosLuís Medeiros
Muitas vezes, produtores de jogos e aplicativos mobile conquistam um bom número de usuários, mas não conseguem aproveitar o potencial dessa audiência por não escolherem a forma de monetização mais adequada aos seus negócios.
Nesta palestra serão apresentadas as diversas opções de monetização disponíveis no mercado, apontando vantagens, desvantagens e exibindo breves análises de casos de uso para cada uma.
Ao final da palestra, a expectativa é que você tenha informações suficientes para decidir qual é o caminho mais apropriado para monetizar o seu produto mobile.
Trinity Kings World Leadership: The Law of the Inner Circle: Jesus prepared M...Terrell Patillo
Deuteronomy 1:13-15
Amplified Bible, Classic Edition (AMPC)
13 Choose wise, understanding, experienced, and respected men according to your tribes(family groups), and I will make them heads over you.
14 And you answered me, The thing which you have spoken is good for us to do.
15 So I took the heads of your tribes(family groups), wise, experienced, and respected men, and made them heads over you, commanders of thousands, and hundreds, and fifties, and tens, and officers according to your tribes(family groups).
Spice Boss-5505 is a dual SIM phone with 4.5 cm Screen Display. It comes with a digital camera to capture images and record videos. For connectivity, the phone has WAP, GPRS and Bluetooth. Other features include 1200 mAh battery, audio video player, FM, auto call recorder,torch and 16GB expandable memory.
Semilla agustiniana 6 de julio
San Agustin es sinduda uno de los Padres de la antigüedad con mayor profundidad espiritual y existencial. Saborear sus pensamientos es como dar al alma un aroma que difícilmente se pierde.
Como melhorar a monetização de jogos e aplicativosLuís Medeiros
Muitas vezes, produtores de jogos e aplicativos mobile conquistam um bom número de usuários, mas não conseguem aproveitar o potencial dessa audiência por não escolherem a forma de monetização mais adequada aos seus negócios.
Nesta palestra serão apresentadas as diversas opções de monetização disponíveis no mercado, apontando vantagens, desvantagens e exibindo breves análises de casos de uso para cada uma.
Ao final da palestra, a expectativa é que você tenha informações suficientes para decidir qual é o caminho mais apropriado para monetizar o seu produto mobile.
The poetry of my own on Ahle-bait a.s. is presenting. As soon as the poetry comes in my mind, I am going to include in this collection named Shan-e-Ahlebait.
Outcome Statement and Recommendations: Responsible Business Forum On Food And...Global Initiatives
ASEAN BEYOND 2015: COLLABORATION FOR EQUITABLE GROWTH
Feeding a global population of 9 billion by 2050 will require transformational changes to our farming and agricultural systems, already under pressure from climate change and water scarcity. The Responsible Business Forum on Food and Agriculture explores innovative and collaborative approaches to improving agricultural productivity and environmental sustainability across key commodity value chains.
Global leaders gather from business, government and NGOs to make recommendations for increasing agricultural productivity, whilst improving rural livelihoods and reducing environmental impacts. Agricultural commodities addressed includes – aquaculture, coffee, dairy, maize, rice and tea. Working groups produce recommendations on sustainable land use, equitable opportunity for small-holder farmers, increasing productivity and improving rural livelihoods.
For more details: http://www.responsiblebusiness.com/events/responsible-business-forum-hanoi/
Episode 28 : Project Management Contract
most important document for the execution of a project.
project management - know very well, includes all important issues regarding supply and services
Fulfillment of requirements, review the contractual situation, to claim the respective extra costs
project engineers :
mastered the fundamental aspects of the contractual arrangements for negotiated with subcontractor
depends on the relevant information of the team members.
actual contract arrangement - trained and experienced traders and lawyers
Fédération Internationale des Ing é-nieurs - Conseils ” (FIDIC)
take equally into account the interests of Conditions of Contract for Works of Civil Engineering and Construction Conditions of Contract for Electrical an Mechanical Works
jus strictum (binding law) and jus dispositivum (modifiable law).
SAJJAD KHUDHUR ABBAS
Ceo , Founder & Head of SHacademy
Chemical Engineering , Al-Muthanna University, Iraq
Oil & Gas Safety and Health Professional – OSHACADEMY
Trainer of Trainers (TOT) - Canadian Center of Human
Development
The Illusive Staffing Metric: Quality of HireCielo
Leading up to the recession, research indicated that a few, but growing number of companies were starting to measure “Quality of Hire.” A lot of the research in this area points out the positive benefits of employing a quality of hire approach as part of an overall talent management strategy.
The poetry of my own on Ahle-bait a.s. is presenting. As soon as the poetry comes in my mind, I am going to include in this collection named Shan-e-Ahlebait.
Outcome Statement and Recommendations: Responsible Business Forum On Food And...Global Initiatives
ASEAN BEYOND 2015: COLLABORATION FOR EQUITABLE GROWTH
Feeding a global population of 9 billion by 2050 will require transformational changes to our farming and agricultural systems, already under pressure from climate change and water scarcity. The Responsible Business Forum on Food and Agriculture explores innovative and collaborative approaches to improving agricultural productivity and environmental sustainability across key commodity value chains.
Global leaders gather from business, government and NGOs to make recommendations for increasing agricultural productivity, whilst improving rural livelihoods and reducing environmental impacts. Agricultural commodities addressed includes – aquaculture, coffee, dairy, maize, rice and tea. Working groups produce recommendations on sustainable land use, equitable opportunity for small-holder farmers, increasing productivity and improving rural livelihoods.
For more details: http://www.responsiblebusiness.com/events/responsible-business-forum-hanoi/
Episode 28 : Project Management Contract
most important document for the execution of a project.
project management - know very well, includes all important issues regarding supply and services
Fulfillment of requirements, review the contractual situation, to claim the respective extra costs
project engineers :
mastered the fundamental aspects of the contractual arrangements for negotiated with subcontractor
depends on the relevant information of the team members.
actual contract arrangement - trained and experienced traders and lawyers
Fédération Internationale des Ing é-nieurs - Conseils ” (FIDIC)
take equally into account the interests of Conditions of Contract for Works of Civil Engineering and Construction Conditions of Contract for Electrical an Mechanical Works
jus strictum (binding law) and jus dispositivum (modifiable law).
SAJJAD KHUDHUR ABBAS
Ceo , Founder & Head of SHacademy
Chemical Engineering , Al-Muthanna University, Iraq
Oil & Gas Safety and Health Professional – OSHACADEMY
Trainer of Trainers (TOT) - Canadian Center of Human
Development
The Illusive Staffing Metric: Quality of HireCielo
Leading up to the recession, research indicated that a few, but growing number of companies were starting to measure “Quality of Hire.” A lot of the research in this area points out the positive benefits of employing a quality of hire approach as part of an overall talent management strategy.
6. 3 שנים טרם הדימום
אישפוז עקב כאבי בטן ב LUQומותן שמאלי
החמרה בטרומבוציטופניה ובהמוליזה
CT SCANבטן
7.
8. לסיכום
Bleeding from gastric varices
Past history
Splenic and portal vein thrombosis
Coombs negative hemolytic anemia
Thrombocytopenia
Acute inferior wall MI
Aplastic anemia
11. Paroxysmal nocturnal
hemoglobinuria (PNH)
Prevalence 1 per 106
Men and women are affected equally
Average age at time of diagnosis 42 years
Diagnosis delayed on average by 3 years
13. Diagnosis
Flow cytometry - method of choice
Highly sensitive and specific
Best method for assessing clone size
Not affected by blood transfusions / lysis
Ham test, Sucrose lysis test
15. Thrombosis in PNH
40%-50% of patients
Leading cause of mortality
Usually involve the venous system
Arterial thrombosis is also increased
Related to the clone size
17. GI involvement in PNH
Recurrent bouts of abdominal pain
Cholelithiasis – bilirubin stones
Dysphagia
Secondary sclerosing cholangitis
18. Tendency to Bleed Thrombophilia
• Thrombopenia • Portal vein thrombosis
• Bleeding varices • Portal hypertension
To anticoagulate or not to anticoagulate?
19.
20. Treatment of thrombosis
Primary prophylactic anticoagulation –
never proven to prevent thrombosis
Acute thrombosis
Indication for heparin
Sometimes thrombolytic therapy
(in acute Budd-Chiari syndrome)
Williams Hematology, 8th Marshall A. Lichtman 2008
21. Treatment of thrombosis
Thrombocytopenia complicates treatment
Relative contraindication
Transfusions of platelets to a safe range
Patients with thrombosis should be
anticoagulated indefinitely
Williams Hematology, 8th Marshall A. Lichtman 2008
22. Historical management of
PNH – supportive treatment
Red cell transfusions
Iron supplementation
Folic acid supplementation
Steroids - limited efficacy, high toxicity
Bone marrow transplantation
23. Prognosis
Survival 50% at 15 years after diagnosis
15% - pancytopenia - aplastic anemia
1% - 5 % develop AML
Myelodysplastic syndrome
24.
25. SOLIRIS (eculizumab) Humanized
First in Class Anti - C5 Antibody
Human Framework Regions
C
H1
Hinge
CL
Complementarity Determining Regions
(murine origin)
CH2
Human IgG4 Heavy Chain
Human IgG2 Heavy Chain
Constant Regions 2 and 3
Constant Region 1 and Hinge
CH3
26. Lectin Pathway Classical Pathway Alternative Pathway
Carbohydrate Structures On -Antibodies Bound To Antigen -Microbial Membranes
Pathogens / Damaged Host Cells -Immune Complexes -Bacterial LPS
MBL, MASP-1, MASP-2 C1q, C1r, C1s C3
C4 + C2 C4 + C2 Factor B + D
C3 convertases
C4b2a, C3bBb
C3 C3a -Weak Anaphylatoxin
-Immune Complex And
Apoptotic Body Clearance C3b
-Microbial Opsonization
C5 convertases
C4b2a3b, C3bBb3b
-Potent Anaphylatoxin
Target of Eculizumab C5a -Leukocyte
C5 X Chemotaxis
C6,C7,C8,C9 -Cell Activation
C5b-9
-Cell Activation
-Cell Lysis
27. Eculizumab
Highly effective in reducing hemolysis
Decreases or eliminates need for
blood transfusions
Improves fatigue and quality of life
Reduces the risk of thrombosis
28. Reduction in thrombotic events
Principal Investigator: There were fewer thrombotic
events with eculizumab treatment than during the
Thrombotic events (n)
same period prior to treatment
Pre-eculizumab treatment Eculizumab treatment
1
Hillmen P et al. Blood 2007; 110: 4123-4128; 2Brodsky RA et al. Blood 2008; 111: 1840-1847;
29. בחזרה לחולה...
לאחר הדימום לא חודש הטיפול בקומדין
תרומבוציטופניה סביב -0002, 0 ללא דימומים
מתן דם כל 6-5 שבועות בגלל המוליזה
ב- 0102 הותחל טיפול ב - Eculizumab
מספר שבועות לאחר מכן, ירידת , LDHהפחתה
בעירויי דם ושיפור משמעותי באיכות החיים
30. לסיכום
חולה עם יל"ד פורטלי על רקע PNH
דילמה של טיפול בנוגדי קרישה בחולה עם
דימום, טרומבופיליה ותרומבוציטופניה
טיפול חדש ב- Eculizumabויתרונותיו