According to my research, the best combined treatments for MM are botrezomib and thalidomide. Targeting the proteasome inside myeloma cells looks to be the most efficient way to fight this type of cancer
According to my research, the best combined treatments for MM are botrezomib and thalidomide. Targeting the proteasome inside myeloma cells looks to be the most efficient way to fight this type of cancer
Plasma cell disorders is a difficult topic where most residents and students confuse with regarding to differentiating between various types of para-proteinemias or plasma cell dyscrasias. This simple presentation will highlight the key points in differentiating, diagnosing these orders. Initial management principles are discussed as well.
It is a neoplasm of B-cell lineage; proliferation of the cells forms a monoclonal population of plasma cells and produces a single type of Ig/Ig fragment.
Plasma cell disorders is a difficult topic where most residents and students confuse with regarding to differentiating between various types of para-proteinemias or plasma cell dyscrasias. This simple presentation will highlight the key points in differentiating, diagnosing these orders. Initial management principles are discussed as well.
It is a neoplasm of B-cell lineage; proliferation of the cells forms a monoclonal population of plasma cells and produces a single type of Ig/Ig fragment.
Neuroblastoma diagnosis, treatment, complications, and further management. The main contents of this review have been accessed from MedScape. Please do not reprint or copy this material without permission from the copyright owner.
multiple myloma
By: Nader Amir Al-assadi
Supervised by : Dr/ Ghazi Alariqe
taiz university
Multiple myeloma (MM) is a plasma cell malignancy in which monoclonal plasma cells proliferate in bone marrow, resulting in an over abundance of monoclonal para protein (M protein), destruction of bone, and displacement of other hematopoietic cell lines.
The precise etiology of MM has not yet been established.
Roles have been suggested for a variety of factors, including genetic causes, environmental or occupational causes,radiation, chronic inflammation, and infection .
multiple myeloma
Pathophysiology
Malignant proliferation of plasma cells in the bone marrow.
Causes bone marrow destruction via infiltration, and bone destruction via ↑RANKL activity (causing ↑osteoclast activity).
A single clone of plasma cells produce large amounts of identical immunoglobulin (a 'paraprotein' or 'monoclonal band'), as well as free κ or λ light chains (also a 'paraprotein', or 'Bence Jones protein' if in the urine).
Classified by Ig class, with prevalence reflecting prevalence in normal blood: IgG (⅔), IgA (⅓), remainder IgM or IgD.
Immunoglobulin classes other than that of the proliferating clone are relatively low ('immunoparesis').
Epidemiology
Lifetime risk: 1/140.
Incidence steadily increases with age. Rare <55.
Slightly commoner in men.
2x commoner in blacks vs. whites.
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
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.
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.
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
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.
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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
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
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.
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.
3. Richard S.
51 year old male presented 8/95 with vague51 year old male presented 8/95 with vague
epigastric distress and weight loss of 5 lbs.epigastric distress and weight loss of 5 lbs.
Denies fevers, chills or back painDenies fevers, chills or back pain
PMH – neg.PMH – neg.
Meds – noneMeds – none
Smoking, alcohol – noneSmoking, alcohol – none
Works as a carpenterWorks as a carpenter
4. Physical Exam: BP= 134/84, Pulse = 70Physical Exam: BP= 134/84, Pulse = 70
Temp = 98.4 degreesTemp = 98.4 degrees
HEENT – negHEENT – neg
Neck – no lymphadenophyNeck – no lymphadenophy
Lungs – clear, Heart – no gallop or murmurLungs – clear, Heart – no gallop or murmur
Abdomen – nontender, no organomegalyAbdomen – nontender, no organomegaly
Rectal – normal, stool hemoccult negativeRectal – normal, stool hemoccult negative
Extremities – no edema or deformities, noExtremities – no edema or deformities, no
13. Multiple Myeloma
• monoclonal plasma cell proliferation
• monoclonal gammopathy
• decreased normal immunoglobulins
• osteolytic lesions
Things You Must Know
14. • M-spike
• Type of IgG
• IgG in 60% of cases
• IgA in 20% of cases
• IgD or IgE in rare cases
• Never IgM
• Bence-Jones protein in urine
• Decreased normal Ig
Laboratory Findings
28. • Solitary plasmacytoma
• Plasma cell leukemia
• Waldenström macroglobulinemia
• Lymphoplasmacytoid lymphoma
• IgM
• Hyperviscosity syndrome
• MGUS (Monoclonal gammopathy of
undetermined significance)
• Small M spike with no myeloma symptoms
• Occasionally transforms into myeloma
OTHER PLASMA CELL TUMORS
29. Richard
Serum protein electrophoresis:Serum protein electrophoresis:
Serum immunoelectrophoresisSerum immunoelectrophoresis
Urine immunoelectrophoresisUrine immunoelectrophoresis
30.
31.
32.
33. Biology of Normal Plasma Cells
Plasmablasts in lymph nodes (IgM)Plasmablasts in lymph nodes (IgM)
Activated B cells in bone marrow (IgG, IgA)Activated B cells in bone marrow (IgG, IgA)
Differentiate into plasma cells (small inDifferentiate into plasma cells (small in
number, well-differentiated, characteristicnumber, well-differentiated, characteristic
phenotype, die by apoptosis)phenotype, die by apoptosis)
34. Biology of Malignant Plasma
Cells
Plasmablasts in lymph nodesPlasmablasts in lymph nodes
Plasmablasts in bone marrow (IgG, IgA)Plasmablasts in bone marrow (IgG, IgA)
Plasmablasts do not differentiate intoPlasmablasts do not differentiate into
plasma cells, continue to proliferate andplasma cells, continue to proliferate and
accumulate in marrow, produce largeaccumulate in marrow, produce large
amounts of immunoglobulins, normal deathamounts of immunoglobulins, normal death
of cells doesn’t occur, crowds out otherof cells doesn’t occur, crowds out other
cells – rbc precursors. Suppress antibodycells – rbc precursors. Suppress antibody
35.
36. Interleukin – 6
Essential for survival and growth ofEssential for survival and growth of
myeloma cellsmyeloma cells
Growth factor for myeloma cellsGrowth factor for myeloma cells
Also promotes survival of myeloma cells byAlso promotes survival of myeloma cells by
preventing spontaneous apoptosis.preventing spontaneous apoptosis.
Increased levels in myeloma patientsIncreased levels in myeloma patients
37. Clinical Features
80% of patients present with bone pain80% of patients present with bone pain
(low back, pelvis, or ribs). Pain is(low back, pelvis, or ribs). Pain is
associated with multiple lytic bone lesions.associated with multiple lytic bone lesions.
• Bruising or bleeding from decreasedBruising or bleeding from decreased
plateletsplatelets
• Infections from decreased levels of normalInfections from decreased levels of normal
immunoglobulinsimmunoglobulins
38.
39.
40. Clinical Features – con’t
Hypercalcemia from bone destructionHypercalcemia from bone destruction
50% of patients present with renal failure50% of patients present with renal failure
Hyperviscosity syndrome – caused by largeHyperviscosity syndrome – caused by large
amounts of circulating immunoglobulinsamounts of circulating immunoglobulins
causing purpura, confusion, decreasedcausing purpura, confusion, decreased
visionvision
Major causes of death – infection, renalMajor causes of death – infection, renal
failurefailure
Classic triad – anemia, bone pain, renalClassic triad – anemia, bone pain, renal
41. Criteria for Diagnosis
1) Bone marrow with >20% plasma cells OR1) Bone marrow with >20% plasma cells OR
2) Plasmacytoma plus one of the following:2) Plasmacytoma plus one of the following:
monoclonal protein in serum > 3 g/dlmonoclonal protein in serum > 3 g/dl
monoclonal protein in urinemonoclonal protein in urine
lytic lesionslytic lesions
3) Usual clinical features of myeloma3) Usual clinical features of myeloma
4) Exclude connective tissue diseases, chronic4) Exclude connective tissue diseases, chronic
infections, carcinoma, lymphoma, leukemiainfections, carcinoma, lymphoma, leukemia
44. Conventional Chemo-con’t
VAD – vincristine, doxyrubicin andVAD – vincristine, doxyrubicin and
dexamethasonedexamethasone
VAMP – vincristine, doxyrubicin andVAMP – vincristine, doxyrubicin and
methyprednisolonemethyprednisolone
Did not prolong survival more than otherDid not prolong survival more than other
regimensregimens
Excessive morbidity and mortality fromExcessive morbidity and mortality from
prolonged myelosupressionprolonged myelosupression
45. Autologous Peripheral Blood
Stem Cell Transplant - PBSC
Hematopoietic stem cells from peripheralHematopoietic stem cells from peripheral
bloodblood
Growth factors are given afterGrowth factors are given after
transplantationtransplantation
Safe – 1-2% death rate from the transplantSafe – 1-2% death rate from the transplant
Problem – contamination of the autologousProblem – contamination of the autologous
graft by myeloma cellsgraft by myeloma cells
46. High-Dose Therapy with Stem-cell
Transplant (1992)
Melphalan in high doses can induce completeMelphalan in high doses can induce complete
remissions in 20-30%. Death fromremissions in 20-30%. Death from
treatment alone is 10-30%.treatment alone is 10-30%.
Stem-cell transplant after high doseStem-cell transplant after high dose
Melphalan (with or without radiation) canMelphalan (with or without radiation) can
produce a 30-50% complete remission inproduce a 30-50% complete remission in
newly diagnosed patients. Problems – onlynewly diagnosed patients. Problems – only
58% of patients over 60 could tolerate.58% of patients over 60 could tolerate.
48. New Agents
ThalidomideThalidomide
First used with advanced and refractoryFirst used with advanced and refractory
myeloma (2001)myeloma (2001)
Now used for newly diagnosed disease inNow used for newly diagnosed disease in
combination with high-dose melphalan andcombination with high-dose melphalan and
double stem-cell transplant (2005)double stem-cell transplant (2005)
52. New Supportive Therapies
Biphosphonates – inhibit bone resorption,Biphosphonates – inhibit bone resorption,
treats bone lesions and hypercalcemia.treats bone lesions and hypercalcemia.
Erythropoietin – helps anemia andErythropoietin – helps anemia and
decreases need for transfusions.decreases need for transfusions.
53. Future Approaches
Interleukin-2, Interleukin-4, InterferonInterleukin-2, Interleukin-4, Interferon
gamma- pilot studies show no benefit.gamma- pilot studies show no benefit.
Anti-interleukin-6Anti-interleukin-6
Initial studies produced some effect but noInitial studies produced some effect but no
lasting benefit.lasting benefit.
Further trials underwayFurther trials underway
54. Future approaches – con’t
ImmunotherapyImmunotherapy
Monoclonal immunoglobulins in anMonoclonal immunoglobulins in an
individual patient may have a tumor-individual patient may have a tumor-
specific antigen.specific antigen.
T-cells seem to recognize the idiotypes ofT-cells seem to recognize the idiotypes of
the patients myeloma protein.the patients myeloma protein.
IgG from patient transferred to a boneIgG from patient transferred to a bone
marrow donor then patient receivedmarrow donor then patient received
transplant. Two years later patient hastransplant. Two years later patient has
remained well with minimal M component.remained well with minimal M component.
55. Prognosis
15 % die within 3 months of diagnosis15 % die within 3 months of diagnosis
Subsequent death rate 15% per yearSubsequent death rate 15% per year
Causes of death- marrow replacement withCauses of death- marrow replacement with
pancytopenia (16%), renal failure (10%),pancytopenia (16%), renal failure (10%),
sepsis (14%), acute leukemia (5%), othersepsis (14%), acute leukemia (5%), other
chronic illnesses unrelated to myelomachronic illnesses unrelated to myeloma
(23%)(23%)
56. Richards’ Treatment
8/95 Melphalan and Prednisone cycles8/95 Melphalan and Prednisone cycles
started. M = 6.6 g%started. M = 6.6 g%
9/95 M = 3.96 Creatinine = 1.29/95 M = 3.96 Creatinine = 1.2
4/96 M = 1.954/96 M = 1.95
5/96 M = 2.4 Bone Marrow 7% plasma5/96 M = 2.4 Bone Marrow 7% plasma
cellscells
8/96 M = 1.858/96 M = 1.85
57. Richards’ Treatment Cont’
2/97 M = 2.52/97 M = 2.5
4/97 M = 4.05 Bone Marrow shows 44%4/97 M = 4.05 Bone Marrow shows 44%
plasma cellsplasma cells
5/97 VAD started5/97 VAD started
7/97 M = 3.87/97 M = 3.8
8/97 Bone lesions noted pelvis and femur8/97 Bone lesions noted pelvis and femur
1/98 M = 3.9 Bone marrow shows 20%1/98 M = 3.9 Bone marrow shows 20%
plasma cellsplasma cells
58. Richards’ Treatment Cont’
4/98 M = 5.24/98 M = 5.2
Allogenic bone marrow transplant afterAllogenic bone marrow transplant after
Cytoxan and whole body radiation at MayoCytoxan and whole body radiation at Mayo
Clinic (brother was donor)Clinic (brother was donor)
Post-transplant renal failure andPost-transplant renal failure and
pulmonary hemorrhage.pulmonary hemorrhage.
Died 6/6/98Died 6/6/98