This document provides an overview of hemophagocytic lymphohistiocytosis (HLH). It begins by introducing HLH and describing its characteristics such as fever, hepatosplenomegaly, and cytopenias. It then discusses the classification of primary and secondary HLH, epidemiology, genetic causes, clinical features, diagnostic guidelines, treatment protocols, and long-term follow up recommendations. For the patient presented, the document recommends following the HLH-2004 treatment protocol initially and considering continuation therapy or stem cell transplant depending on the disease response and severity.
Hemophagocytic Lymphohistiocytosis (HLH) is an aggressive and life threatening syndrome which results from excessive immune activation, that can rapidly deteriorate and lead to multiple organ failure and death.
Hemophagocytic Lymphohistiocytosis (HLH) is an aggressive and life threatening syndrome which results from excessive immune activation, that can rapidly deteriorate and lead to multiple organ failure and death.
Dr Abdullah Ansari
MBBS, MD Medicine
Aligarh Muslim University
Clinical case
Hemolytic Anemia
Intravascular vs extravascular hemolysis
Classification of hemolytic anemia
Approach to hemolysis
Patient history
Clinical features
Peripheral blood smear
Investigation
Treatment
- A new version of this lecture is available at: https://www.slideshare.net/MohammedGawad/thrombotic-microangiopathy-tma-in-adults-and-acute-kidney-injury-dr-gawad
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Hemophagocytic lymphohistiocytosis (hlh), Langerhans cell histiocytosis dr vi...Vijitha A S
Hemophagocytic lymphohistiocytosis (hlh)
Langerhans cell histiocytosis,Benign proliferation of mature histiocytes and uncontrolled phagocytosis of the platelet, erythrocytes, lymphocytes, and their hematopoietic precursors in the bonemarrow & other tissues
Dr Abdullah Ansari
MBBS, MD Medicine
Aligarh Muslim University
Clinical case
Hemolytic Anemia
Intravascular vs extravascular hemolysis
Classification of hemolytic anemia
Approach to hemolysis
Patient history
Clinical features
Peripheral blood smear
Investigation
Treatment
- A new version of this lecture is available at: https://www.slideshare.net/MohammedGawad/thrombotic-microangiopathy-tma-in-adults-and-acute-kidney-injury-dr-gawad
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
- Join our facebook group: www.facebook.com/groups/NephroTube
- Like our facebook page: www.facebook.com/NephroTube
- Follow us on twitter: www.twitter.com/NephroTube
Hemophagocytic lymphohistiocytosis (hlh), Langerhans cell histiocytosis dr vi...Vijitha A S
Hemophagocytic lymphohistiocytosis (hlh)
Langerhans cell histiocytosis,Benign proliferation of mature histiocytes and uncontrolled phagocytosis of the platelet, erythrocytes, lymphocytes, and their hematopoietic precursors in the bonemarrow & other tissues
One of my best friends (when I was a teenager) died of leukemia. Several advances have been made in the ensuing decades (see attached document). Watch this space for additional notes.
Management of acute lymphoblatic leukemia with light on etiology, clinical features, diagnosis and different aspects of management including chemotherapy and radiation therapy
This presentation contains all the updated information regarding ongoing treatment protocol, HSCT, Antibiotic prophylaxis, upcoming targeted therapies related to AML
Immunization of children with cancer is a burning topic. Not only concerned parents but also paediatric oncologists have so many questions and queries regarding this matter. This presentation will try to answer those questions with the help of recent and updated guidelines on immunization of both developed and developing countries.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
5. Hemophagocytic lymphohistiocytosis
• Hemophagocytic lymphohistiocytosis (HLH)
is a histiocytic disorder characterized by a
highly stimulated but ineffective, immune
response to antigens, which results in life
threatening cytokine storm & inflammatory
reaction.
• Uncommon.
• Aggressive.
• Life threatening.
13. Comparison
Points Primary Secondary
Age of onset Usually <1 year Usually >1 year
Nature Extensive disease activity causes
irreversible organ damage
Less aggressive than
primary
Presentation No specific diagnostic feature Can be fall in diagnostic
criteria
Laboratory findings Similar Similar
Treatment Similar Similar
14. Familial or Primary HLH
• Younger age at presentation (<1 year).
• Incidence: 1.2/1,000,000 per year.
• Median survival <2 months, if untreated.
• Divided into-
-Mutation at FHL loci
-Immunodeficiency syndromes.
15. Mutation at FHL Loci
• Several HLH gene mutations map to
loci that code for elements of the
cytotoxic granule secretion & release
pathway.
• These are labeled as Familial
Hemophagocytic Lymphohistiocytosis
(FHL) loci.
16. Primary HLH
Gene Syndrome Inheritance Protein
PRF1 FHL2 AR Perforin
UNC13D FHL3 AR Munc13-4
STX11 FHL4 AR Syntaxin 11
STXBP2 FHL5 AR Munc18-2
RAB27A GS2 AR RAB27A
LYST CHS1 AR LYST
SH2D1A XLP1 XL SAP
XIAP XLP2 XL XIAP
17. Non familial HLH
Infection associated hemophagocytic syndrome/IAHS
• Similar to those in FHLH.
• Innumerable pathogens
are associated.
18. Non familial HLH
Malignancy associated hemophagocytic syndrome/ MAHS
1. Development of a hemophagocytic
syndrome before &/during the treatment of
malignancy
Acute lymphoblastic leukemia
Acute myeloid leukemia
Multiple myeloma
Germ cell tumor
Thymoma
Carcinoma
2. Development of a hemophagocytic
syndrome with a masked
hematolymphoid malignancy in the
background
T/NK cell leukemia
Lymphoma
Large cell anaplastic lymphoma
Adult B cell lymphoma
Hematology oncology journal Janka etal 1998
19. Non familial HLH
Reactive HLH (Macrophage Activation Syndrome in
SLE/JRA/Other chronic conditions)
• Cause: Excessive activation & proliferation of mature
macrophages by triggering agent.
• Observed in:
-Rheumatological diseases
-Infection
-Neoplasm
21. Clinical features
Most common early findings Less common
Fever (91%) Lymphadenopathy (17%)
Splenomegaly (98%) Skin rash (7%)
Hepatomegaly (94%) Neurological abnormalities
(Irritability, Convulsion, neck
stiffness, hypotonia, hypertonia,
cranial nerve palsies)
Clinical features are similar regardless of whether an underlying
genetic defect has been identified
23. Diagnostic guidelines of HLH
The diagnosis HLH can be established if 1 of either 1 or 2
below is fulfilled:
Hemophagocytic lymphohistiocytosis study group 2004
24. 1. Molecular diagnosis of HLH
Pathologic mutations of –
PRF1
UNC13D
MUNC18-2
Rab27a
STX11
SH2D1A
BIRC4
25. 2. Diagnostic criteria for HLH fulfilled
(5/8 criteria)
a. Initial diagnostic criteria
i. Fever
ii. Splenomegaly
iii. Cytopenias (affecting ≥2 of 3 lineages in PBF):
• Hb: <9g/dl
• Platelets <1,00,000/mm3
• Neutrophils <1000/mm3
iv. Hypertriglyceridemia and/or hypofibrinogenemia:
• Fasting TG >3.0 mmol/l (i.e. >265 mg/dl)
• Fibrinogen <1.5 g/l
v. Bone marrow/spleen/lymph nodes: Hemophagocytosis
vi. No evidence of malignancy
b. New diagnostic criteria
i. Low or absent NK-cell
activity (according to local
laboratory reference)
ii. Ferritin >500 μg/l
iii. Soluble CD25 (i.e., soluble
IL-2 receptor) >2400 U/ml
27. Diagnostic approach
• Clinical
Complete history:
Family history (consanguinity, previous
childhood deaths in this family/relatives, late
miscarriages of mother), recent infections &
vaccinations, previous bouts with similar
symptoms, fever (duration and level),
neurological symptoms (including irritability,
ataxia, convulsions), edema, jaundice, skin rash.
29. Investigation
Baseline evaluations for all patients:
• CBC with PBF, reticulocytes, S. ferritin
• Liver function test
• Coagulation profile
• Lipid Profile
• Renal function test and serum electrolytes
• Soluble IL-2 receptor (sCD25) (suggested if available).
30. Investigations
• Immunoglobulin levels
• Spinal tap
– cell and protein content
– morphological & immunological
analyses (if cells in CSF)
• Infection screening
• Bone marrow aspiration (hemophagocytosis)
• Fine needle aspiration biopsy of an enlarged lymph
node/liver.
31. Investigation
• NK-cell activity
• Molecular diagnosis (perforin, hMunc 13-4 and relevant other
genes).
Others:
• GFR
• HLA-typing of the patient and the family
• Imaging - Abdominal ultrasound (or CT)
– Chest X-ray (or CT of the chest)
– MRI of brain.
34. Additional treatment in Secondary HLH
• Infection associated HLH:
Find out the causative agent & treat accordingly.
-Bacterial: Appropriate broad spectrum antibiotic.
-Viral:
Antiviral drug
EBV: Rituximab.
35. Additional treatment in Secondary HLH
• Malignancy associated HLH:
-Before treatment:
Therapy of malignancy &/ infection.
Early addition of dexamethasone.
-In association with infection during chemotherapy:
Cessation of chemo (if disease under control)
Treatment of infection.
36. Additional treatment in Secondary HLH
• Macrophage activation syndrome (Reactive HLH):
-Prompt treatment of the underlying disorder
-Corticosteroid
-IVIG
Anakinra & other cytokine directed therapy.
-If still no improvement: HLH regimen
37. Curative therapy
Allogeneic stem cell transplant
Indication:
• Familial HLH
• Non familial HLH: Poor responder
Reactivation of disease.
Timing: When the disease is non-active (cont. therapy).
38. Outcome after SCT in HLH-2004
Hemophagocytic lymphohistiocytosis study group 2004
43. Appropriate measures
If it is unknown (primary/2ndary) & thorough investigation
revealed no underlying malignancy/bacterial/parasitic infection &
no other cause of the immune-activation:
• Initial therapy (whether a viral infection is associated or not).
• Treatment is stopped after 8 weeks, if the disease has had a
complete resolution. If active disease, then continuation
therapy.
• If the disease is severe and persistent, or reactivating,
continuation therapy and SCT is suggested.
Hemophagocytic lymphohistiocytosis study group 2004
44. Subsequent therapy (non-SCT pt)
• Continuation therapy (week 9-40).
• Prolong the intervals between each etoposide &
dexamethasone pulse from 2-4 wks, & continue CSA as
previously. Thus, the patient will receive alternating
treatment every 2nd week (instead of weekly) with VP-16 or
dexamethasone pulse.
• Continue CSA and dexa only, in doses & interval as wk 9-40.
• Continue with CSA or dexa only.
Hemophagocytic lymphohistiocytosis study group 2004
45. Reactivation therapy
• Intensify therapy (restart from wk 2, but the initial
therapy may be less than 8 wks & then continue with
modified continuation therapy.
• Intrathecal therapy (in CNS-reactivation).
• Dexamethasone daily, also between the dexa-pulses,
in continuation therapy.
• Early SCT is then suggested.
Hemophagocytic lymphohistiocytosis study group 2004