This document discusses hematological malignancies in children. It notes that acute leukemia accounts for 30% of childhood cancers and is the most common, with acute lymphoblastic leukemia (ALL) making up 80% of cases. Overall incidence is about 1 in 2,000 children per year in the UK. Cure rates have improved to around 80% depending on the specific cancer, with ALL having a better prognosis than acute myeloid leukemia. The document outlines the main types of hematological malignancies in children including ALL, AML, non-Hodgkin's lymphoma, and Hodgkin's lymphoma. It describes symptoms, diagnostic evaluations including blood tests and biopsies, and general treatment approaches including induction, consolidation, and maintenance
UAEU - CMHS - Hematology-Oncology Course - MMH 302 - HONC 320. Education material for medical students - It cover basic principles of hematology and oncology, including CAR-T and gene editing. It can be used for study and review. It illustrates main principles of hematology and oncology.
UAEU - CMHS - Hematology-Oncology Course - MMH 302 - HONC 320. Education material for medical students - It cover basic principles of hematology and oncology, including CAR-T and gene editing. It can be used for study and review. It illustrates main principles of hematology and oncology.
acute leukemia
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Paroxysmal Nocturnal Hemoglobinuria (PNH) - A Pathologic SurveyJackson Reynolds
Slides from a Microsoft PowerPoint® presentation I delivered covering the basic clinical presentation, diagnosis, pathogenesis/pathophysiology, treatment, and prognosis of paroxysmal nocturnal hemoglobinuria (PNH). This presentation was given on October 3, 2018 at the Medical College of Georgia, Augusta Campus to an audience of clinical pathologists and second-year MD candidates.
This presentation is about chronic lymphocytic leukemia (CLL), its epidemiology and incidence, staging, molecular characteristics, clinical features and management.
acute leukemia
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For Health benefits and medicine videos Subscribe youtube channel - https://www.youtube.com/playlist?list=PLKg-H-sMh9G01zEg4YpndngXODW2bq92w
Paroxysmal Nocturnal Hemoglobinuria (PNH) - A Pathologic SurveyJackson Reynolds
Slides from a Microsoft PowerPoint® presentation I delivered covering the basic clinical presentation, diagnosis, pathogenesis/pathophysiology, treatment, and prognosis of paroxysmal nocturnal hemoglobinuria (PNH). This presentation was given on October 3, 2018 at the Medical College of Georgia, Augusta Campus to an audience of clinical pathologists and second-year MD candidates.
This presentation is about chronic lymphocytic leukemia (CLL), its epidemiology and incidence, staging, molecular characteristics, clinical features and management.
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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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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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
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
- 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
2. Facts and figures
Acute leukemia accounts for approximately 30 percent of all childhood malignancies
and is the most common cancer in children.
Of which 80% is caused by ALL, 15% by AML and the remaining 5% - HL, NHL, Juvenile
myelomonocytic leukemia etc.
Overall incidence stands at roughly 1 in 2000 ~ 400 children newly diagnosed cases
per year in the UK.
Cure rates based on recent data and treatment developments stands at around 80% -
varies depending on which cancer. Eg: ALL has better prognosis with cure rate of 80%
while AML has a cure rate of 50-60%.
9. Acute lymphoblastic leukemia
Overlap between leukemic and lymphoblastic – which means involving a
combination of blood and lymph nodes
Collectively referred to as ALL/LBL
Arises from Pre-B cells or T-cell precursors
Most common form in childhood, especially in age group of 2-5 years old
Blasts on PBF/BMA
10. Acute myeloid leukemia
Second most common hematological maglinancy in children
Stable incidence in childhood with increasing rates in adolescence, overall more
common in adults
Arises from myeloid precursors
Subdivided into 7 different morphologies based on the French American British (FAB)
classification system
Has a known association with Down’s Syndrome – 10 to 20 times greater risk as
compared to a child without DS
Features on peripheral blood film/bone marrow aspirate
More than 20% blasts, which may be myeloblasts, promyelocytes, monoblasts,
promonocytes, promonocytes, megakaryoblasts
11. Non Hodgkin's lymphoma
Divided into
Lymphoblastic (T-cell) – presenting with anterior mediastinal mass
Mature B cell (Burkitt) – has associated with EBV
Large cell lymphoma
Majority are high grade and aggressive requiring prompt diagnosis and
treatment
Associated with hypercalcemia
12. Hodgkin’s lymphoma
Increasing incidence with age
High association with EBV infection
Classical histology of Reed Sternberg cells in a lymph node biopsy
16. Symptoms and signs
Tend to present with non specific sign and symptoms depending on when the child presents to you
Main challenge is to not falsely diagnose the child as having a typical self limiting viral illness
However, there are recognized features of acute leukemias/lymphomas that should raise the suspicion
of an attending clinician. Studies show that a child with acute leukemia would at least have one of the
following
Fever
Pallor
Bruising
Hepato-splenomegaly or isolated organomegaly
Lymphadenopathy
Musculoskeletal pain – bone pain
Parents complaints – ‘something just doesn’t seem right with my child’
22. Investigations – important ones first
Full blood count
Peripheral blood smear
Lymph node biopsy
Bone marrow biopsy
CXR
23. Peripheral blood smear
Report should be obtained as urgent as possible
White blood cells
Mature neutrophils have segmented nucleus with 2 to 5 lobes joined by a thin filament. Less mature
forms include bands (stab, juvenile) forms, metamyelocyte, myelocyte, promyelocyte and myeloblast in
that order. The cytoplasm of a mature neutrophil is pink or nearly colorless and possesses moderate
azurophilic and specific granules.
In a ALL, morphology may vary from small cells with scant cytoplasm, condensed nuclear chromatin, and
indistinct nucleoli to larger cells with moderate amounts of cytoplasm, dispersed chromatin, and
multiple nucleoli; coarse azurophilic cytoplasmic granules may be present.
In AML, myeloblasts are immature cells with large nuclei, usually with prominent nucleoli, and a variable
amount of pale blue cytoplasm. Typically, myeloid blasts have more abundant cytoplasm compared with
lymphoid blasts and may have Auer rods or granules present.
The appearance of lymphoblasts in biopsy specimens is relatively uniform, but the cells may include
round, oval, indented, or convoluted nuclei, finely dispersed chromatin, and nucleoli that can range
from inconspicuous to prominent.
24. Other investigations
Bloods
Renal profile
Ca, Po4
Liver function test
Coagulation profile
LDH
Uric acid
Sampling
Biopsy –lymph nodes
Bone marrow aspirate
Lumbar puncture
Special tests
Cytogenetic studies
Immunohistochemistry
Cytochemistry
Imaging
CXR
CT Scan
MRI
26. Management
General principle of
Induction +/- CNS treatment
Consolidation or intensification
Maintenance
Drug regimes differ based on protocols
Oncologic emergencies can occur prior, during or after treatment
Once disease has remitted, monitor during maintenance phase with regular FBC,
if counts do not improve, consider repeat BMAT
28. References
UpToDate
Chris, M., Hall, G., & Clarke, R. T. (2009). Acute leukaemia in children: Diagnosis
and management. BMJ, 338.
MOH. (2018) Synopsis of childhood cancer incidence in Malaysia (2007-2011).
Paediatric Protocol 4th Edition
A. (2004). PERIPHERAL BLOOD FILM - A REVIEW. NCBI, 12(2).
https://www.uptodate.com/contents/acute-myeloid-leukemia-in-children-and-adolescents?search=hematologic%20malignancy&source=search_result&selectedTitle=15~150&usage_type=default&display_rank=15#H449859963
Acute leukaemia in children: diagnosis
and management
Chris Mitchell,1 Georgina Hall,1 Rachel T Clarke2