Hemoglobinopathies are inherited abnormalities of hemoglobin synthesis characterized by structurally abnormal hemoglobin variants. Sickle cell anemia is the prototype hemoglobinopathy caused by a single point mutation that results in production of abnormal hemoglobin S. This leads to polymerization of hemoglobin S molecules under conditions of low oxygen, causing distortion of red blood cells into a sickle shape and various complications. Other hemoglobinopathies include Hemoglobin C, E, and D disease, which typically have milder phenotypes.
A presentation made about Sickle cell disease by Yara Mostafa, Yasser Osama, Yaser Mostafa ,Ain shams university, Medicine faculty, first year students.
Normal & abnormal hemoglobin derivativesrohini sane
Comprehensive presentation on Normal & abnormal hemoglobin derivatives for medical ,dental ,biotechnology & pharmacology students Comparison of molecular aspects & absorption spectra of normal & Meth-Hb are illustrated. Congenital & acquired Meth hemoglobinemia is described. briefly.Treatment of Meth-hemoglobinemia is presented along with its biochemical basis.Formation & clinical manifestations of Carboxy-hemoglobinemia is illustrated.Identification of Carboxy-hemoglobin in a diagnostic laboratory has been described for perusal of technologists.Google images are used to convey the aspect in a lucid way.
A presentation made about Sickle cell disease by Yara Mostafa, Yasser Osama, Yaser Mostafa ,Ain shams university, Medicine faculty, first year students.
Normal & abnormal hemoglobin derivativesrohini sane
Comprehensive presentation on Normal & abnormal hemoglobin derivatives for medical ,dental ,biotechnology & pharmacology students Comparison of molecular aspects & absorption spectra of normal & Meth-Hb are illustrated. Congenital & acquired Meth hemoglobinemia is described. briefly.Treatment of Meth-hemoglobinemia is presented along with its biochemical basis.Formation & clinical manifestations of Carboxy-hemoglobinemia is illustrated.Identification of Carboxy-hemoglobin in a diagnostic laboratory has been described for perusal of technologists.Google images are used to convey the aspect in a lucid way.
challenges in interpreting abnormal hemoglobin study- the key is to correlate with patient age, ethnicity,RBC indices & morphology findings. Two tier approach for correct characterization of abnormal hemoglobins of HPLC &/or capillary electrophoresis.
challenges in interpreting abnormal hemoglobin study- the key is to correlate with patient age, ethnicity,RBC indices & morphology findings. Two tier approach for correct characterization of abnormal hemoglobins of HPLC &/or capillary electrophoresis.
Anemia is a condition where blood lacks healthy red blood cells (RBC), decreasing the competence of blood to carry oxygen to tissues.
In clinical medicine, it refers to decrease in the normal concentration of Haemoglobin (Hb). Anemia is caused by either – 1. A decrease in the production of RBCs (decreased erythropoiesis) or haemoglobin.
2. An increase in loss of blood.
3. Destruction of red blood cells (haemolytic anaemia).
Hemolytic anemia is decreased level of Erythrocytes in circulating blood (anemia) caused because of their accelerated destruction (haemolysis) extravascularly or intravascularly either due to intrinsic or extrinsic factors.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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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3. SICKLE CELL ANEMIA
• Prototype of hereditary
hemoglobinopathies. It occurs due to
production of a physiochemically abnormal
hemoglobin. It offers a protection against
malaria for unknown reasons.
• Nearly 20 million people affected in India.
• It is inherited as an autosomal recessive
trait.
• Presents as sickle cell trait (heterozygous)
and sickle cell disease(homozygous).
4. • Normal hemoglobin
2 alpha and 2 beta chains
form a 4 chain tetramer
• HbS:
Valine substituted for
glutamic acid in both beta
chains (HbSS).
This occurs due to single
point mutation at sixth
position of beta globin chain
which has thymine instead
of adenine.
5. •Due to the change in the amino acid
sequence,there is an alteration in
charge at the site.
•This allows for aggregation &
polymerisation of HbS
molecules.(formation of tactoids)
•Acidosis,Hb concentration,presence
of other types of Hb affect
polymerisation.
•It is a relatively reversible
phenomenon but with repeated cycles
it becomes irreversible.
PATHOGENESIS
7. CLINICAL COURSE
• Disease is not evident in newborns.
• 2-4 months : Symptoms of Hemolytic Anemia start
developing like anemia, jaundice. This
is parallel to replacement of HbF by
HbS.
• 5-6 months : Symptoms arising due to infarction
and ischemia start developing.
• By the age of 5 yrs almost 95% are functionally
asplenic.
8. INFARCTION
• Slow, tortuous circulation leads to repeated
infarctions.
• Effects of the HbS polymerisation, infarction and
ischemia are seen in most of the body organs :
• Bones
• Spleen
• Kidney
• Lungs
• Liver
• Brain
9. DACTYLITIS
(HAND-FOOT SYNDROME)
• First overt manifestation
• Painful, usually symmetric
swelling with erythema of
dorsa of hands & feet.
• Sudden in onset and lasts
for 1-2 weeks.
• Needs medical attention.
• Radiographic changes
appear 2-3 weeks after
appearance of symptoms.
10. •Marked congestion of
the red pulp due to
trapping of sickled red
cells in splenic cords.
•The spleen is palpable
in most of the children
by the age of 9 months.
(increased almost up to
500gms.)
SPLENIC INVOLVEMENT
11. • Continued scarring causes
progressive shrinkage of the
spleen. Finally leading to
autosplenectomy
• Hence they are more prone
to infection
• Penicillin prophylaxis is begun
at 3 months.
12. ACUTE CHEST SYNDROME
•Presents with
tacypnea,fever,cough,chest
pain,arterial O2
desaturation.
•Can mimic
pneumonia,pulmonary
embolism.
•Thought to reflect in situ
sickling within the lung
causing temporary and
permanent dysfunction.
13. PNEUMONIA
Frequently seen in children with SCA, has high severity
because of the relative immunodeficiency. The
commonest organism is pneumococcus.
15. OTHER FEATURES
•Abdominal crises: severe abdominal pain & signs of peritoneal
irritation.
•Aplastic crises: infection in adult sicklers with parvovirus B19
results in severe red cell aplasia.
•Liver cells may undergo sequestration with severe pain due to
capsular stretching.
•Aseptic necrosis of head of femur,humerus.
•Chronic osteomyelitis: Salmonella sp. most frequently seen
organism.
16. •Chronic leg ulcers: seen in adult sicklers. Non healing
ulcers usually present on the medial aspect of leg.
•Eyes: retinal infarcts, preretinal hemorrhage.
•Kidney:limited capacity of H+
excretion,hematuria,hypoastheniuria.
•CNS:strokes, focal deficits may occur.
•Priapism: due to pooling of blood in corpora cavernosa.
17. DIAGNOSIS
• Evidence of red cell destruction:
• peripheral blood smear
• plasma haptoglobin,hemopexin
• Evidence of red cell generation:
• reticulocytosis, extramedullary
hematopoeisis
• Laboratory diagnosis
• Blood picture
19. LAB DIAGNOSIS
• SICKLE TEST:Red cells with HbS take a sickle
shape when mixed with a freshly prepared solution
of the reducing agent sodium metabisulphite.(2%)
Giving an appearance of turbidity.
• SOLUBILITY TEST:Hb added to solution of
sodium dithionite(reducing agent) in phosphate
buffer.Turbidity shows presence of HbS.
• Hb ELECTROPHORESIS
21. BLOOD PICTURE
• Hb : 6-9gm%, may be lower
• Anemia: normocytic,normochromic
• MCV,MCH: Normal
• Stained film:Moderate
anisopoikilocytosis,sickle cells,oval cells,occ
target cells,Howell-Jolly bodies
• Reticulocytosis (10-20%)
22.
23. MANAGEMENT
•Vaso-occlusive crises managed by aggressive
rehydration, oxygen therapy, adequate analgesia and
antibiotics.
•Prophylactic antibiotics: Penicillin prophylaxis to
protect against infections which are lethal in presence
of asplenia.
•Vaccination against pneumococcus, hepatitis B and
haemophilus.
24. • Transfusion to suppress HbS production and
maintain HbS levels below 30%.
• Fetal Hb induction with hydroxyurea
(hydroxycarbamide) replaces some HbSS with
HbF. As high level of HbF inhibits polymerization
• Bone marrow or stem cell transplant appears to be
potentially curative.
• PROPHYLAXIS Factors that promote sickling
should be avoided that is hypoxia, dehydration,
acidosis etc.
25. OTHER
HEMOGLOBINOPATHIES
•Hemoglobin H. Hemoglobin H is a tetramer composed of
four beta globin chains. Hemoglobin H occurs only with
extreme limitation of alpha chain availability. Hemoglobin H
forms in people with three-gene alpha thalassemia
•Hemoglobin Barts. Hemoglobin Barts develops in fetuses
with four-gene deletion alpha thalassemia. Due to this
deletion no alpha chain is produced. The gamma chains
produced during fetal development combine to form gamma
chain tetramers. These molecules transport oxygen poorly.
Most individuals with four-gene deletion thalassemia and
consequent hemoglobin Barts die in utero (hydrops fetalis).
26. •Hemoglobin C. Hemoglobin C results from a
mutation in the beta globin gene and is the
predominant hemoglobin found in people with
hemoglobin C disease. (a2bC
2).It has Lysine for
glutamic acid at 6th position in beta chain.
Hemoglobin C disease is relatively benign, producing a
mild hemolytic anemia and splenomegaly. Hemoglobin
C trait is benign.
•Hemoglobin E. This variant results from a mutation
in the hemoglobin beta chain. People with hemoglobin
E disease have a mild hemolytic anemia and mild
splenomegaly. Hemoglobin E trait is benign.
27. •Hemoglobin D: It has the glutamic acid at
the 121st position on the beta chain instead of
glutamine. It is relatively benign, producing a
mild hemolytic anemia and splenomegaly.
•Other examples: Hb-Koln, Hb-Zurich, Hb-
Sydney, HbO-Arab etc.
28. What is thalassemia?
• Genetic blood disorder resulting in a mutation or
deletion of the genes that control globin production.
• Normal hemoglobin is composed of 2 alpha and 2 beta
globins
• Mutations in a given globin gene can cause a decrease
in production of that globin, resulting in deficiency
• aggregates become oxidized damage the cell
membrane, leading either to hemolysis, ineffective
erythropoiesis, or both.
• 2 types of thalassemia: alpha and beta.
29. Demographics
• The thalassemia gene may be maintained in the
human population, in part because of the greater
immunity of heterozygous individuals against
malaria and is found in parts of the world where
malaria is common
• These include Southeast Asia, China, India,
Africa, and parts of the Mediterranean.
30. Alpha Thalassemia
• mutation of 1 or more of the 4 alpha globin
genes on chromosome 16
• severity of disease depends on number of genes
affected
• results in an excess of beta globins
31. Silent Carriers (heterozygotes +/-)
• 3 functional alpha globin genes
• No symptoms, but thalassemia could potentially
appear in offspring
32. Alpha Thalassemia Trait
• 2 functional globin genes
• results in smaller blood cells that are lighter in
colour
• no serious symptoms, except slight anemia
33. Hemoglobin H Disease
• 1 functional globin gene
• results in very lightly coloured red blood cells
and possible severe anemia
• hemoglobin H is susceptible to oxidation,
therefore oxidant drugs and foods are avoided
• treated with folate to aid blood cell production
35. Beta Thalassemia
• mutations on chromosome 11
• hundreds of mutations possible in the beta
globin gene, therefore beta thalassemia is more
diverse
• results in excess of alpha globins
36. Beta Thalassemia Trait
• slight lack of beta globin
• smaller red blood cells that are lighter in colour
due to lack of hemoglobin
• no major symptoms except slight anemia
37. Beta Thalassemia Intermedia
• lack of beta globin is more significant
• bony deformities due to bone marrow trying to make
more blood cells to replace defective ones
• causes late development, exercise intolerance, and
high levels of iron in blood due to reabsorption in the GI
tract
• if unable to maintain hemoglobin levels between 6 gm/dl
– 7 gm/dl, transfusion or splenectomy is recommended
38. Beta Thalassemia Major
• complete absence of beta globin
• enlarged spleen, lightly coloured blood cells
• severe anemia
• chronic transfusions required, in conjunction with
chelation therapy to reduce iron (desferoxamine)
39. More Permanent Options
Bone Marrow Transplants
Replacing patient’s marrow with donor marrow
First performed on thalassemia patient in 1981
Difficult, because donor must be exact match for
recipient
Even a sibling would only have a 1 in 4 chance of
being a donor
Cord Blood Transplants
Rich in stem cells
Also needs to be an exact match