This document provides an overview of multiple myeloma, including its definition, signs and symptoms, diagnostic tests, prognosis, risk factors, and treatment options. Multiple myeloma is a type of blood cancer that develops from plasma cells in the bone marrow. It causes symptoms like bone pain or fractures, anemia, and kidney problems. Diagnosis involves blood and urine tests, bone marrow biopsy, and imaging tests. Prognosis depends on factors like beta-2-microglobulin and albumin levels. Treatment may include chemotherapy, radiation, stem cell transplantation, corticosteroids, and newer drugs like thalidomide.
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.
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.
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.
Amir T. Fathi, MD, Jenna Moran, NP, and Richard Dickens, MS, LCSW-R, prepared useful Practice Aids pertaining to acute myeloid leukemia for this CME/MOC/CNE activity titled "The Oncologist, Nurse, and Patient Partnership in AML: Multiple Perspectives on Integrating Targeted Therapy Into Care." For the full presentation, monograph, complete CME/MOC/CNE information, and to apply for credit, please visit us at http://bit.ly/2Dg4myq. CME/MOC/CNE credit will be available until December 4, 2019.
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
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
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.
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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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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
4. Multiple myeloma is a
cancer that begins in
plasma cells, a type of
white blood cell.
These cells are part of
immune system, which
helps protect the body
from germs and other
harmful substances.
4
9. Prognosis:
The simplest measure of prognosis in MM is
based on blood levels of two markers:
beta-2-microglobulin and albumin.
In general, higher levels of beta-2-
microglobulin and lower levels of albumin
are associated with a poorer prognosis.
9
10. Multiple myeloma may be classified into one of three categories:
• Monoclonal gammopathy of undetermined significance (MGUS) –
this condition is a sort of “pre-multiple myeloma,” meaning that
the excess protein is present but the level of plasma cells is low.
MGUS is by itself harmless, but about 16 percent of individuals
with it develop multiple myeloma over time.
Solitary plasmacytoma - myeloma in only one spot or a single
tumor
Asymptomatic or smoldering multiple myeloma – the blood tests
and bone marrow biopsy show the presence of multiple myeloma
but symptoms are not present.
Symptomatic multiple myeloma
Staging a cancer means determining its extent. Is the multiple
myeloma confined to the bone marrow, or has the cancer spread
to other parts of the body like the bones? The stage of the cancer
determines what types of treatment will be needed. Because
multiple myeloma can be widespread, its staging is often based
on a rough measure of how much cancer is in the body.
10
11. Risk factors:
As well as MGUS, certain things can increase
your risk of developing multiple myeloma,
including:
• age – your risk of developing multiple
myeloma increases as you get older; most
cases are diagnosed at around the age of 70,
and cases affecting people under 40 are rare
• gender – men are more likely to develop
multiple myeloma than women
• ethnicity – multiple myeloma is about twice
as common in black populations compared
with white and Asian populations
11
12. When to start treatment? — Multiple
myeloma can remain stable for prolonged
periods of time. Individuals with early
myeloma who have no symptoms.
Individuals with a related condition, called
monoclonal gammopathy of undetermined
significance (MGUS), do not require
treatment, although long-term follow-up
is needed.
However, once symptoms develop,
treatment with one or more of the options
is recommended for almost all patients.
12
13. Treatment:
Individuals with MGUS or no symptoms are usually observed
through regular physical examinations and blood tests, but
are not treated. Individuals who have symptoms may be
treated with:
Chemotherapy drugs – these may include Cytoxan
(cyclophosphamide), Alkeran (melphalan), or
corticosteroids such as prednisone. The combination of
Thalomid (thalidomide) and Decadron (dexamethasone)
has also been an effective treatment.
Radiation therapy
Stem cell (bone marrow) transplantation – the individual
receives healthy bone marrow to replace the diseased bone
marrow.
An anti-cancer drug called Velcade (bortezomib)
In addition, the individual may receive treatment for
symptoms, such as receiving a blood transfusion to treat
anemia or antibiotics to treat infections
13
14. Is stem cell transplantation an
option? —
Because of the risk of toxic and even fatal
complications related to stem cell
transplantation, not everyone with
multiple myeloma is a candidate for stem
cell transplantation.
14
16. In most patients with multiple myeloma who have one or
more of the following factors are NOT considered eligible
for transplantation:
●Age >77 years
●Direct bilirubin >2.0 mg/dL (an elevated bilirubin level
indicates that the liver may not tolerate the high dose
chemotherapy required before transplantation)
●Serum creatinine >2.5 mg/dL unless on chronic stable
dialysis (; those with poor kidney function may not tolerate
high dose chemotherapy)
However, these factors are guidelines; the decision regarding
transplant eligibility should be made by the patient and
physician after discussing the potential risks, benefits, and
the needs and wishes of the patient.
16
18. Case :
47 old female ,known osteoporotic
Presented with left femur fracture since 10
days
• Xray showed fracture with osteolytic
lesion
• Hx of NSID use
• Hx of weight loss and decrease appetite
18
19. -Subjective:
MRN:2099303
Age :47 years old
Gender: female
CC (chief complaint): fracture in left thigh
since 10 days.
FH(family history):non
SH(social history):married and non
smoker
PMH (past medical history): osteoporosis,
Vit.D def. and hyperuricemia.
Current medication: non
19
20. -Obejective :
PE( physical examination):
She was ill and lying on left side
High :154 Cm
Weight :66 Kg
Conscious alert oriented
Look in pain {pain score 8/10}
20
Blood
pressure
Respiratory
rate
Pulse rateTempreture
170/80 mm hg20105
beat/min
37 C
22. Drugs such as thalidomide , lenalidomide ,
bortezomib , carfilzomib , ixazomib , and
pomalidomide have emerged as important
options for treatment of myeloma
Newer drugs
Chemotherapy drugs used in multiple myeloma
include melphalan , cyclophosphamide ,
Doxorubicin , and liposomal doxorubicin .
Chemotherapy
Corticosteroids include dexamethasone or
prednisone.
Corticosteroids
Stem cell transplantation can be done using one's
own stem cells (autologous) or using cells from a
close relative or matched unrelated donor
(allogeneic). In multiple myeloma, most
transplants performed are of the autologous kind
Stem cell
transplantation
Elotuzumab and daratumumab are antibodies
that target multiple myeloma cells
Immunotherapy
22
Assessment: