This document discusses Langerhans cell histiocytosis (LCH), a rare disease characterized by abnormal proliferation of Langerhans cells. Some key points:
- LCH was first reported in 1893 and involves abnormal accumulation of dendritic cells called Langerhans cells in various organs.
- It most commonly affects bone, skin, lungs, and lymph nodes. Annual childhood incidence is 4-9 cases per million.
- Diagnosis requires demonstrating Birbeck granules or markers like CD1a on affected cells. Treatment depends on severity and organ involvement, ranging from surgery to chemotherapy. Prognosis is generally good, especially for isolated bone lesions.
chronic myeloid leukemia, CML, epidemiology, BCR ABL1 gene, philadelphia chromosome, t(9;22), CML incidence, etiology of CML, pathophysiology of CML, phases of CML, treatment of CML, Allogenic stem cell transplant, TKI therapy for CML, Sokal index for CML,
pathology of round cell tumours of osseo articular system like ewings sarcoma, mesenchymal chondrosarcoma,small cell osteosarcoma, plasma cell neoplasms and other hematopoietic malignancies. how immunochemistry os playing pivotal role in differential diagnosis.
chronic myeloid leukemia, CML, epidemiology, BCR ABL1 gene, philadelphia chromosome, t(9;22), CML incidence, etiology of CML, pathophysiology of CML, phases of CML, treatment of CML, Allogenic stem cell transplant, TKI therapy for CML, Sokal index for CML,
pathology of round cell tumours of osseo articular system like ewings sarcoma, mesenchymal chondrosarcoma,small cell osteosarcoma, plasma cell neoplasms and other hematopoietic malignancies. how immunochemistry os playing pivotal role in differential diagnosis.
What is Lymphoma?
Malignant lymphoma is a term given to tumors of the lymphoid system and specifically of lymphocytes and their precursor cells
i.e.
Cancer of the lymphatic system.
Many lymphomas are known to be due to specific genetic mutations.
Introduction
Epidemiology
Etiology
Manifestations
TNM staging
Squamous cell carcinoma is defined as malignant epithelial neoplasm exhibiting squamous differentiation as characterised by the formation of keratin and/or the presence of intercellular bridges.
( Pindborg et al, 1997).
What is Lymphoma?
Malignant lymphoma is a term given to tumors of the lymphoid system and specifically of lymphocytes and their precursor cells
i.e.
Cancer of the lymphatic system.
Many lymphomas are known to be due to specific genetic mutations.
Introduction
Epidemiology
Etiology
Manifestations
TNM staging
Squamous cell carcinoma is defined as malignant epithelial neoplasm exhibiting squamous differentiation as characterised by the formation of keratin and/or the presence of intercellular bridges.
( Pindborg et al, 1997).
Cancer is the name given to a collection of related diseases. In all types of cancer, some of the body's cells begin to divide without stopping and spread into surrounding tissue.
My son had Wiskott Aldrich Syndrome (WAS). He had a bone marrow transplant in August 2006. His WAS is healed. This presentation was designed by some grad students. Some of the content is from my blog and it pictures my son, David. http://www.davidmcnally.blogspot.com
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 .
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
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
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
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.
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.
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.
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
2. LCH is a disorder characterised by clonal
proliferation of cells in the mononuclear
phagocyte system.
In 1893, first reported case of Hand schuller
christian disease
In 1985, LCH replaced the term histiocytosis-X
coined in 1953
3. Includes the syndromes:
Hand-Schuller-Christian syndrome,
Letterer-Siwe disease,
Eosinophilic granuloma,
Hashimoto-Pritzker syndrome
In 1994, involved histiocytes in LCH lesions ::
CLONAL
4. Annual childhood incidence of LCH : 4-9
cases/ million
More common & severe in children
In <5yrs age : multisystem is involved
Indicence in adults : 1-2 cases/million
Slight predominance of cases in males
5. Associated with-
family h/o benign tumors
maternal UTI during pregnancy
blood transfusions during infancy
neonatal infections, solvent exposure,etc
LCH patients have a predisposition to cancer
and vice versa.
6. Basic histologic lesion :
granulomatous ; lesion containing
histiocytes, mature eosinophils &
lymphocytes
Neutrophils, giant cells & plasma cells (+/-)
Initially lesions are proliferative & dominated
by histiocytes
Necrosis, xanthomatous changes & fibrosis
may occur; later LC may not be demonstrable
7. The langerhans cell is the sine qua non of the
diagnostic lesion
The presence of fascin, confirms their
derivation from dentritic cells.
Demonstation of LC is essential for Dx
8. LCH cells or pathologic LC are less
differentiated & more activated type of
dendritic cells
9. Confirmation of LC
1. requires Birbeck granules on electron M/S
2. Demonstration of CD1a & CD 207
(Langerin) on IHC
13. Confirmation of LC
1. requires Birbeck granules on electron M/S
2. Demonstration of CD1a & CD 207
(Langerin) on IHC
Others expressed are- S-100 protein, Ia-like
antigen, CD101.
14. Focal accumulation of LC, macrophages, lymphocytes &
eosinophils suggest that LCH is immunologically
mediated
Cytokines secreted by Langerhans cells- IL-1, PGE2,
ACE, TGF-β1, IL-2.
GM-CSF, IL-3, IL-8, IL-10 and tumor necrosis factor-α.
15. Reasoning of LCH being immunologically mediated is
supported by histologic abnormalities of thymus and
disturbances of immunoregulation in patients with
active disease.
Both the relative and absolute numbers of
suppressorT lymphocytes (CD8 cells) are decreased
Deficiency of T-suppressor cells may disrupt the
mechanism for termination of immune response.
Failure of this homeostatic mechanism could result in
unrestrained macrophage proliferation.
16. More than half of the cases harbor the BRAF
V600E mutation.
17. Proliferative:
Typical of acute disseminated LCD.
Encountered in skin in petechiae, hemorrhagic or
crusted papules.
Characterised by extensive infiltrates of LC
involving epidermis or below it.
18.
19. Granulomatous:
Typical of chronic focal / multifocal disease.
Encountered MC in infiltrative plaques and nodules in
scalp, genital areas, axilla,soft tissue and bony lesions.
Extensive aggregates of LC extending deep into
dermis.
Plenty of eosinophills,mostly in clusters.
Macrophages, neutrophils, lymphocytes, plasma cells
and multinucleate giant cells.
20.
21. Xanthomatous reaction: uncommon
Seen in Hand-Schuller-Christian disease.
In the dermis, numerous foamy cells with varying
number of LC and some eosinophills.
Multinucleate giant cells frequently present
( foreign body, touton type)
22. Eosinophilic granuloma: syndrome characterised by
single or multiple bone lesions in the absence of visceral
involvement.
Letterer-Siwe disease: when granulomas involve liver,
spleen, lymph nodes, skin,CNS, BM, bones.
Hand-Schuller-Christian disease: triad of multiple bone
lesions, exophthalmos and diabetes insipidus.
23. (Based on :
a) number of organ systems involved and the
b) number of sites involved within an organ system)
Unifocal eosinophilic granuloma (i.e., single system,
single site disease)
Multifocal eosinophilic granuloma (i.e., single system,
multiple-site disease)
Acute disseminated histiocytosis (i.e., multisystem
disease)
24. Solitary to widely disseminated
Median age at diagnosis is 3 to 6 years.
Children younger than 1 year old often present with
multiple organ involvement.
About 70% cases of LCH in children involve a single
organ system, with bone being the MC site
bone, skin, soft tissue, lymph nodes, spleen, liver , lungs
25. MC involved organ
Skull MC site : children & adult
Mild discomfort at the site
Vertebral lesions : risk of injury to the spinal
cord
Radiographically, the lesions produces
“punched out” appearance.
26. It occurs in about one third of patients overall
common feature of acute disseminated disease.
typically vesiculopustular and may have a
hemorrhagic crust.
The rash has a predilection for scalp, postauricular
areas & diaper areas.The back, axilla and intertriginous
areas
28. A rash indistinguishable from that seen in
acute disseminated histiocytosis
a congenital, self-limited phenomenon not
associated with skeletal or visceral disease
birth / 2 or 3 weeks of life
numerous over scalp and face
Langerhans cells present in biopsy material
Spontaneous regression ; complete healing
Prognosis: excellent without therapy
29. predilection for the hypothalamic nuclei and
cerebellum
By contiguous spread of skull lesion into brain
substance
S/S ataxia, nystagmus, seizures,cranial nerve deficits
and spastic paresis.
Infiltration of the hypothalamus, pituitary stalk or
posterior pituitary by LC => diabetes insipidus.
Growth retardation due to GH deficiency
30. THYROID : goitre & hypothyroidism
LIVER : abnormal LFT , Histologically, triaditis,bile
duct proliferation and fibrosis.
Lymph node & spleen
LUNGS : Primary pulmonary histiocytosis : disease of
young & middle aged adults. Ass with smoking
BONE MARROW : anemia, neutropenia ,
thrombocytopenia
32. It is made by
Clinical features
Radiological features
CXR, R/E blood, LFT, RFT, BM examination,
HRCT chest
But BIOPSY is essential for diagnosis.
Demonstration of Birbeck granules or langerin
and/or CD1a on the surface of LC is a must.
33. HISTIOCYTES SHOW NUCLEARAND
CYTOPLASMIC STAINING FOR S100 PROTEIN.
CD1A IMMUNOREACTIVITY (CELL MEMBRANE
STAINING)
LANGERIN :THECELL MEMBRANEANDGOLGI, IN
A GRANULAR PATTERN.
34. Excellent
Unifocal bone disease: complete resolution.
Prognostic variables :
Age (younger than 2 years being a liability),
No of organ involved
function of involved organs.
“Risk organ” involvement: hematopoietic system,
spleen, liver, and lungs.
“CNS risk lesions”(those involving the craniofacial
bones) : higher risk of DI.
35. Children with single-system disease (e.g.
eosinophilic granuloma of bone): only
curettage.
Aggressive disease: multiagent chemotherapy
: vinblastine, vincristine, 6-mercaptopurine,
alkylating agents, anthracyclines,
methotrexate and etoposide.
36. Recurrence: multiple courses of chemotherapy.
“Special site” involvement (risk of pathological
fracture or theaten an important function): low- dose
radiotherapy.
Recurrent progressive LCH refractory to
conventional therapy: allogeneic hematopoietic stem
cell transplantation.
