1) Multiple myeloma is a plasma cell neoplasm characterized by monoclonal proliferation of plasma cells that present with skeletal lesions. It most commonly involves the spine, ribs, and pelvis.
2) Risk factors include age over 60, male sex, and genetic and environmental factors. Presenting symptoms include bone pain, anemia, renal failure, and hypercalcemia.
3) Diagnosis involves blood and urine tests showing monoclonal proteins, bone marrow biopsy with over 10% plasma cells, and imaging showing lytic bone lesions. Treatment aims to control the disease and improve quality of life using chemotherapy, steroids, immunotherapy, and stem cell transplantation.
Multiple myeloma is the most common primary malignant bone tumor in the world. It is usually seen in elderly individuals of >40 years. In this presentation, all the important aspects of Multiple myeloma have been discussed extensively and in brief..
Multiple myeloma is the most common primary malignant bone tumor in the world. It is usually seen in elderly individuals of >40 years. In this presentation, all the important aspects of Multiple myeloma have been discussed extensively and in brief..
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.
Multiple myeloma is mostly a disease of the elderly. It is a form of haematological cancers that affects the Lymphocytes, and causes abnormal proliferation of plasma cells within the bone marrow, thus replacing the marrow, and is associated with multiple organ dysfunction.
This presentation is an introduction to the disease. It however leaves out the specific haematological treatment, because by that point, patient should have been referred to haematology.
Approach to Pancytopenia with cases.pptxYogeetaTanty1
Approach to pancytopenia with case based discussion and brief details regarding each condition. Causes of pancytopenia. Details of congenital causes of aplastic anemia.
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
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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
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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
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.
4. ETIOLOGY
• UNKNOWN
• Genetic factors – deletion of 13q14,mutation of p53 and Rb gens
• Environmental factors
• Chronic inflammations
• Infections
• Radiations
5. PATHOPHYSIOLOGY
• The pathological and clinical features of myeloma are due to
1. Tissue infiltration of abnormal plasma cells
2. Production of large amount of abnormal immunoglobulins
3. Impairment of immunity
6. MYELOMA BONE DISEASE
• In myeloma bone lesions could be
1. Discrete lytic lesion
2. Widespread osteopenia
3. Multiple lytic lesions
• Higher the number of lesions – poor prognosis
• Most common sites – Spine > ribs > pelvis, skull and long bones
• In spine primarily involves body
• INCREASED OSTEOCLASTIC ACTIVITY AND DECREASED OR ABSCENT
OSTEOBLASTIC ACTIVITY IS THE MAIN PATHOLOGY
7. MYELOMA BONE DISEASE
In contrast to normal bone remodeling , the coupling between
osteoclast and osteoblast is lost in MM
INCREASED DECREASED
OSTEOCLASTIC OSTEOBLASTIC
ACTIVITY ACTIVITY
BONE RESOPTION
8. MYELOMA BONE DISEASE
The main difference of MM from other metastatic bone disease is
Decreased or absent osteoblastic activity
In MM increased osteoclastic activity is due to
1. Increased production of RANKL
2. Increased production of other cytokines which promote bone
resorption(IL1,IL6,TNF)
3. Suppression of Osteoprotegerin(OPG)
9. CLINICAL FEATURES
• Asymptomatic in 30%
• Bone pain M/C
• Intermittent initially , later becomes
constant
• Worse with activity/wt bearing , thus
worse during day time
• Generalized malaise
• Weight loss
• Anemia,Thrombocytopenia
• Renal failure
• Hypercalcemia m/c
• Deposition of BJ proteins
• amyloidosis
17. INVST…
• MRI
• Most sensitive for bone lesions
• PET Scan
• Most sensitive for extramedullary disease
CROSS SECTIONAL IMAGING(CT,PET,MRI) > SKELETAL SURVEY
18. INVT….
• Bone scan
• Less useful
• Appears as cold
• Bone marrow examination
• Hypercellular
• Sheets of plasma cells- small round blue cells with CART WHEEL shaped
nucleus and abundant cytoplasm with a perinuclear halo
• >10% plasma cells
• Immunophenotype – CD56+
• Cytogenetics
19. WHEN TO SUSPECT
• Patient of advanced age (>60) with bone pain and pathological # at unusual
sites not associated with trauma & which does not improve with treatment,
Bone pain with lytic lesions discovered on routine skeletal films
• Increase serum protein conc; or presence of M protein in blood or urine
• Unexplained anemia with no h/o blood loss/hemolysis/anemia of chronic d/s
with normal Vit B12 and folate and iron studies
• Hypercalcemia
• Renal impairment-no clear explanation including pre renal causes,primary renal
disorders or obstructive conditions.
20. DIAGNOSTIC CRITERIA – International
myeloma working group
• Clonal bone marrow plasma cells ≥ 10 % OR Biopsy proven
plasmacytoma
Plus one of the following (CRAB/MDE)
• C- Hypercalcemia, Serum Ca >11 mg/dl
• R- Renal insufficiency – serum creatinine > 2 mg/dl
• A-Anemia, Hb <10g/dl
• B-Bone lesions, one or more osteolytic lesions ≥ 5mm
OR
21. DIAGNOSTIC CRITERIA
Any one or more of the biomarkers of malignancy
• Clonal bone marrow plasma cell ≥ 60%
• Involved:uninvolved serum free light chain ratio ≥ 100
• > 1 focal lesions on MRI
26. Solitary plasmacytoma
• Single skeletal lesion
• No plasma cells in bone marrow
• No end organ damage
• Can progress to MM
27. BAD PROGNOSIS
• Age > 65
• Hb < 10 g/dl
• Albumin <3 g/dl
• Serum β2 microglobulin > 4 mg/dl
• Platelet count < 1.5L
• Involvement of more than three bones
28. TREATMENT
• MM is not curable
• The goal of the treatment is Disease control and improved quality of
life
31. TARGATED THERAPY
Targets the cancer specific genes,proteins or the tissue environment
that contributes to cancer growth and survival
• Proteasome inhibitors
• Bortezomib
• Histone deacetylase inhibitors
• Panobinostat
• Monoclonal antibodies
• Elotuzumab
• Daratumumab
33. BONE MODIFYING AGENTS
• BISPHOSPHONATES
1. Pamidronate
90 mg iv over 2 hours every 3 – 4 weeks
2. Zoledronic acid
4 mg iv over 15 minutes every 3 – 4 weeks
S/E
1. Renal toxicity
2. Osteonecrosis of jaw
• DENOSUMAB- RANKL inhibitor
34. 2. BONE MARROW STEM CELL
TRANSPLANTATION
• 2 TYPES
1. Autologous- patients own stem cell
2. Allogenic-Donated stem cell
35. 3. RADIATION THERAPY
• Patients with bone pain when chemotherapy is not effective
• Not a disease directed treatment
• Used to treat bone disease if there impending or actual pathological
fractures
4. SURGERY
36. 5. SUPPORTIVE CARE
• Prevention and treatment of infections
• Monitoring,Prevention and management of complications
• Transfusions
