Hemophilia is a hereditary bleeding disorder caused by deficiencies in clotting factors VIII or IX. It is passed from mothers to sons and manifests as prolonged or excessive bleeding from minor injuries. The document discusses the definition, incidence, pathophysiology, genetics, clinical manifestations including hemarthrosis and treatment including factor replacement of hemophilia. It is called the "Royal Disease" because Queen Victoria was a carrier who introduced the gene into European royal families, including the Russian Tsars, affecting heirs to those thrones.
Haemophilias: Medically Compromised Children in DentistryRajesh Bariker
Haemophilia is a group of hereditary genetic disorders that impair the body's ability to control blood clotting or coagulation, which is used to stop bleeding when a blood vessel is broken.
Coagulation cascade PowerPoint templates designed by skilled, experienced and professional graphic designers that are intended to solve the big issue of time consumption. These are fully editable slides and organized in a way to simplify the most complex topics and present it in an attractive manner. You can easily incorporate charts, diagrams and animations along with the content to these layouts in order to explore new technologies and trends of businesses in a unique way. All editable slides are digitally created to pinpoint and clarify the message, and summarize information regarding topic.
1-Overview of clotting mechanisms.
2-different lab investigation for bleeding disorder.
3-hemophilia, clinical presentation and its types.
4-Molecular basis and inheritance of hemophilia.
5-mechanisims of family and patient pedigree.
Factor v deficiency is rare
first described in a Norwegian patient in 1943, Identified by Dr. Paul Owren .
Fewer than 200 cases of congenital factor V deficiency have been reported worldwide since 1943.
inheritance of factor V deficiency is autosomal recessive.
usually only needed for severe bleeds or before surgery.
there is no concentrate containing only factor V.
fresh plasma or (FFP) infusions are used to correct the deficiency temporarily and should be given daily during a bleeding episode.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
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.
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
- 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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. Definition
Hemophilia- “love of bleeding”
2 types: A and B
Hemophilia A: X linked recessive
hereditary disorder that is due to
defective or deficient factor VIII
Hemophilia B: also X linked inherited
disorder due to deficiency of factor IX
3. Incidence
It is the second most common inherited
clotting factor abnormality (after von
Willebrand disease)
1 in 5000-10000 live male births
No difference between racial groups
5. Pathophysiology
F VIII is a cofactor for
intrinsic Xa
FvW is its carrier
Activated by Xa and
thrombin
Inactivated by activated
protein C in conjunction
with protein S
6. Genetics
Transmitted by females, suffered by males
The female carrier transmits the disorder to half their
sons and the carrier state to half her dtrs
The affected male does not transmit the disease to his
sons (Y is nl) but all his dtrs are all carriers
(transmission of defected X)
7. Genetics
In 1/3 of hemophiliac patients, there is
no family history of bleeding.
8. Clinical manifestations
Frequency and severity of bleeding are related to F VIII levels
Severity F VIII activity Clinical manifestations
Severe <1% Spontaneous hemorrhage from early
infancy
Freq sp hemarthrosis
Moderate 2-5% Hemorrhage sec to trauma or surgery
Occ sp hemarthrosis
Mild >5% Hemorrhage sec to trauma or surgery
Rare sp bleeding
9. Clinical Manifestations:
Hemarthrosis
The most common, painful and most physically,
economically and psychologically debilitating
manifestation.
Clinically:
Aura: tingling warm sensation
Excruciating pain
Generally affects one joint at the time
Most commonly: knee; but there are others as
elbows, wrists and ankles.
Edema, erythema, warmth and LOM
If treated early it can subside in 6 to 8 hs and
disappear in 12 to 24 hs.
Complications: Chronic involvement with joint
deformity complicated by muscle atrophy and
soft tissue contractures
10. Clinical Manifestations:
Hemarthrosis
Pathophysiology:
Bleeding probably starts from synovial vessels into
the synovial space.
Reabsorption of this blood is often incomplete leading
to chronic proliferative synovitis, where the synovium
is more thickened and vascular, creating a “target
joint” with recurrence of bleeding.
There is destruction of surrounding structures as
well-bone necrosis and cyst formations, osteophytes
Terminal stage: Chronic Hemophiliac arthropathy:
fibrous or bony ankilosing of the joint.
11. Clinical Manifestations
Hematomas
Subcutaneous and muscular
hematomas spread within
fascial spaces
May compress vital structures:
Muscle hematomas:
1)calf,2)thigh,3)buttocks,4)fore
arms
Psoas hematoma- if right
sided may mimic acute
appendicitis
Retroperitoneal hematoma:
12. Clinical manifestations
Intracranial hemorrhage
Leading cause of
death of hemophiliacs
Spontaneous or
following trauma
May be subdural,
epidural or
intracerebral
Suspect always in
hemophilic patient that
presents with unusual
headache
13. Clinical manifestations
Others
Gastrointestinal Bleeding:
Mucous Bleeding:
Epistaxis, gum bleeding.
Genitourinary Bleeding:
Frequently severe hemophiliac can experience
hematuria and a structural lesion should be ruled out.
14. Laboratory diagnosis
Deficit can be quantitative or qualitative
General Lab: prolonged aPTT, nl PT and BT
Mixing studies: aPTT corrects with normal
plasma
Clotting assays: F VIII activity, expressed in
% of normal DecreasedQUANTITATIVE
Immunoassays: “Cross Reactive Material”
Positive- there is an antigen similar to the F
VIII protein- QUALITATIVE
15. Differential Diagnosis
Clinically impossible to differentiate from Hemophilia
B- FIX def- Christmas’ disease
Type 2N vWD
Affected patients present with low levels of factor VIII
(usually 5 to 15 percent of normal
Should be suspected in families in which an
autosomal recessive (rather than X-linked)
inheritance pattern is seen.
16. Carrier detection and
Antenatal diagnosis
Family history: if we follow the inheritance
pattern a female is a carrier if she:
Has an hemophilic father
Has two hemophilic sons
Has one hemophilic son and has a family
history
Has a son but no family history, there is a
67% chance that she is.
17. Carrier detection and
Antenatal diagnosis
Coagulation based assays:
Generally heterozygous females have <50% f VIII
levels but if normal it can’t be excluded
DNA based assays:
Southern blot can detect the inversion in intron 22
If negative for that, there is the need for DNA
sequencing
For prenatal diagnosis: DNA testing on choronic villi
samples obtained by biopsy at week 12
18. Treatment
General Considerations
Avoidance of aspirin and
NSAIDs if at all possible
sometimes it is difficult
because of the painful
hemarthrosis
No IM injections
Counseling for patient and
family, both genetic and
psychosocial, encouraging
normal socialization
19. Treatment
Factor replacement
Replacement of F VIII/ IX is the cardinal step to
prevent or reverse acute bleeding episodes
Dosing: Replacement products can be given on the
basis of body weight or plasma volume ( aprox 5% of
body weight)
1 U/ml = 100% factor activity
In a severe hemophiliac, to raise F VIII to 100%
activity or 1 U/ml, we need 50 U/kg
20. Treatment
Factor replacement
Sources of F VIII
Plasma
• FFP was used as the only replacement therapy until
1960s.
• Not really much effective since it could only raise f
VIII to 20%, by giving the patient many liters
• Patients used to have to spend most of their time in
the hospital
21. Treatment
Factor replacement
Cryoprecipitate
• By mid 1960s
• cold insoluble material obtained from plasma
contained high levels of F VIII and fibrinogen,
achieving a major advance in hemophilia treatment
• 1 unit of FFP prepared by cryoprecipitate contains
50-120 U of VIII
Plasma Derived f VIII prepared by monoclonal
antibodies.
22. Treatment
Others
Antifibrinolyitic Agents
Epsilon aminocaproic acid
Inhibit fibrinolysis by inhibiting plasminogen activator
Adjuvant therapy for dental procedures
Contraindicated in hematuria
Desmopressin
Transient increase in F VIII levels in pts with mild
hemophilia(2-4 times above baseline)
Mechanism: release from endothelial storage sites
Repeated administration results in a diminished
response- tachyphylaxis
Side effects: hyponatremia, facial flushing and headache
23. Course and prognosis
Replacement therapy has its
complications and includes:
Development of F VIII antibodies
Liver disease resulting from hepatitis B
and C
Infection with HIV
25. History
Why the Royal disease?
This is because Queen Victoria, Queen of England from 1837 to
1901, was a carrier.
Most likely a spontaneous mutation since the duke of Kent (her
father) was not affected and her mother did not have any
affected children from the previous marriage.
Her eighth child, Leopold, had hemophilia and suffered from
frequent hemorrhages. These were reported in the British
Medical Journal in 1868.
Leopold died of a brain hemorrhage at the age of 31, but not
before he had children. His daughter, Alice, was a carrier and
her son, Viscount Trematon, also died of a brain hemorrhage in
1928.
The British family descends from Victoria’s first child Edward
who was not affected. Hence this house is disease free.
26. History
Why the Royal disease?
Beatrice, Victoria’s youngest child had two
hemophilic sons and a daughter- Victoria
Eugene that was a carrier
She introduced the hemophilia gene into the
Spanish royal family by marrying king Alfonso
XIII.
By this time, Queen Victoria’s blood was
recognized as “defective” and the king may
have been warned about Eugene’s carrier
state. However, Royalty was more important
than X chromosomes.
27. History
Why the Royal disease?
Alexandra, Queen Victoria's granddaughter, married
Nicholas, the Tsar of Russia in the early 1900's.
Alexandra, the Tsarina, was a carrier of hemophilia
and her first son, the Tsarevich Alexei, was an
hemophiliac
The monk Rasputin gained great influence in the
Russian court, partly because he was the only one
able to help the young Tsarevich. He used hypnosis
to relieve Alexei's pain.
It is speculated that the illness of the heir to the
throne, the strain it placed on the Royal family, and
the influence of the corrupt and alcoholic monk
Rasputin were all factors leading to the Russian
Revolution of 1917.