acute leukemia
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acute leukemia
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Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
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!
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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.
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
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.
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
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
3. Myeloid Neoplasms
• Acute myeloid leukemia (AML)-- Immature
myeloid cells (blasts)
• Myeloproliferative neoplasms--increased or
dysregulated growth(one or more of the
formed elements)
• Myelodysplastic syndromes (MDS)--dysplastic
marrow precursors and peripheral blood
cytopenias.
4. Cont…
• Both MDS and myeloproliferative neoplasms
often transform to AML,
• AML and MDS often arise from an
asymptomatic precursor called CHIP
• Clonal hematopoieis of indeterminant
prognosis (CHIP)-- Normal blood counts
despite the presence of one of more clonal
acquired “driver” mutations in myeloid cells in
the blood and the marrow.
5. Myelodysplastic Syndromes
• A group of clonal stem cell disorders
characterized by maturation defects that are
associated with ineffective hematopoiesis
and a high risk of transformation to AML.
• The marrow usually is hypercellular or
normocellular, but the peripheral blood shows
one or more cytopenias.
• Most cases are idiopathic
6. ETIOLOGY AND PATHOPHYSIOLOGY
• Environmental exposures such as radiation
and benzene
• Secondary, therapy-related MDS—
-late toxicity of cancer treatment,
-radiation and
-the radiomimetic alkylating agents such as
busulfan, nitrosourea, or procarbazine (with a
latent period of 5–7 years), or the DNA
topoisomerase inhibitors (2-year latency)
7. Cont…
• Acquired aplastic anemia,Fanconi anemia, and
other constitutional marrow failure diseases
can evolve into MDS
• MDS is a disease of aging, suggesting random
cumulative intrinsic and environmental
damage to marrow cells.
• Cytogenetic abnormalities are found in one-
half of patients,
8. Cont…
• Recurrently mutated genes are:-
a) Epigenetic factors.
b) RNA splicing factors.(SF3B1)
c) Transcription factors.
• In addition, roughly 10% of MDS cases have loss-of
function mutations in the tumor suppressor gene TP53.
• Both primary MDS and therapy-related MDS are
associated with Chromosomal abnormalities:-
Monosomies 5 and 7,
deletions of 5q, 7q, and 20q,
and trisomy 8.
9. Cont…
• 5q– deletion leads to heterozygous loss of a
ribosomal protein gene (ribosomal protein
gene mutations cause Diamond-Blackfan
anemia,like much MDS characterized by
deficient erythropoiesis).
10. CLINICAL FEATURES
• Anemia dominates the early course--gradual
onset of fatigue and weakness, dyspnea, and
pallor,
• But at least one-half of patients are
asymptomatic, and their MDS is discovered
only incidentally on routine blood counts.
• Previous chemotherapy or radiation exposure
is an important historic fact.
11. Cont…
• Fever and weight loss should point to a
myeloproliferative rather than myelodysplastic
process.
• MDS in childhood is rare and, when
diagnosed, implicates an underlying genetic
disease.
• Children with Down syndrome are susceptible
to MDS as well as leukemia.
12. • The mean age at onset is older than 70 years.
• Secondary or therapy-related MDS is not age
related.
• Dysplastic changes can be observed in normal
individuals, and they can occur with vitamin
deficiencies and as drug effects.
13. Cont…
• A family history may indicate a hereditary
form of sideroblastic anemia, Fanconi anemia,
or a telomeropathy.
• Inherited GATA2 mutations, as in the
MonoMAC syndrome also can cause MDS in
young patients
14. Cont…
• The physical examination--signs of anemia;
approximately 20% of patients have
splenomegaly.
• Sweet’s syndrome (febrile neutrophilic
dermatosis)
• In the younger patient, stereotypical anomalies
point to a constitutional syndrome
-short stature,
-abnormal thumbs in Fanconi anemia;
-early graying in the telomeropathies;
-cutaneous warts in GATA2 deficiency.
18. • WHO classification:
-Blast percentage
-Erythroid predominant leukemias are now
largely regarded as MDS;
• A single somatic mutation, in SF3B1, is now a
feature of sideroblastic anemias
• Identification of somatically mutated genes and
their correlation with clinical outcomes is
increasingly important in defining classification,
prognosis, and targeting therapy.
19.
20. LABORATORY STUDIES
• Blood –
• Anemia is present in most cases, either alone or as part of
bi- or pancytopenia;
• Isolated neutropenia or thrombocytopenia is more unusual.
• Macrocytosis is common, as in most marrow failure
disease.
• Platelets also are large and lack granules.
Patients may have bleeding symptoms despite seemingly
adequate numbers due to functional platelet abnormality
21. • Neutrophils are hypogranulated; have
hyposegmented, ringed, or abnormally
segmented nuclei;
contain Döhle bodies;
and may be functionally deficient.
• Circulating myeloblasts usually correlate with
marrow blast numbers, and their quantity is
important for classification and prognosis.
• The total white blood cell count (WBC) is
usually normal or low, except in chronic
myelomonocytic leukemia.
22. Bone Marrow
• The bone marrow is usually normal or
hypercellular,
but in about 20% of cases it is sufficiently
hypocellular to lead to confusion with
aplastic anemia.
• No single characteristic feature of marrow
morphology distinguishes MDS,
• Dyserythropoietic changes (especially
nuclear abnormalities) and
Ringed sideroblasts in the erythroid lineage;
23. J. Marrow films. Prussian blue
stain. Ring sideroblasts. Wright stain. Erythroid hyperplasia with macroerythroblasts.
K. Marrow film. Prussian blue
stain. Ring sideroblasts.
24. • Hypogranulation and hyposegmentation in
granulocytic precursors, with an increase in
myeloblasts; and megakaryocytes showing reduced
numbers of or disorganized nuclei.
• Megaloblastic nuclei and defective hemoglobinization
in the erythroid lineage are common.
• Prognosis strongly correlates with the proportion of
marrow blasts.
• Cytogenetic analysis and fluorescent in situ
hybridization can identify chromosomal abnormalities.
25.
26. DIFFERENTIAL DIAGNOSIS
• Deficiencies of vitamin B12 or folate should be
excluded
• Copper deficiency can lead to cytopenias and
dysplastic marrows of varying cellularity
• Marrow dysplasia can be observed in acute viral
infections, drug reactions, or chemical toxicity but
should be transient.
• More difficult are the distinctions between
hypocellular MDS and aplasia or between RA with
excess blasts and early acute leukemia.
• The WHO considers 20% blasts in the marrow as the
criterion that separates AML from MDS.
27. PROGNOSIS
• The median survival varies
5q– or sideroblastic anemia--Years
RA with excess blasts or severe pancytopenia
associated with monosomy 7--Months
• The International Prognostic Scoring System, revised in
2012 assists in making predictions.
• Most patients die as a result of complications of
pancytopenia and not due to leukemic transformation;
one-third succumb to diseases unrelated to their MDS.
28. Cont…
• Poor prognostic indicators
-Precipitous worsening of pancytopenia,
-Acquisition of new chromosomal abnormalities
on serial cytogenetic determination,
-Increase in the number of blasts, and
-Marrow fibrosis
• Prognosis of therapy-related MDS, regardless of
type, is extremely poor, and most patients will
progress within a few months to refractory AML.
29. TREATMENT
• Only hematopoietic stem cell transplantation
offers cure of MDS.
• MDS has been regarded as particularly
refractory to cytotoxic chemotherapy
regimens
• Like AML in the older adult, drug toxicity is
frequent and often fatal, and remissions if
achieved are brief.
30. Cont…
• Epigenetic modulators--
• The hypomethylating agents Azacitidine and
Decitabine
• Azacitidine improves blood counts and
survival in MDS, compared to best supportive
care.
• Used in high-risk patient who is not a
candidate for stem cell transplant
31. Cont…
• Lenalidomide-- Effective in reversing anemia in
MDS patients with 5q– syndrome;
• Toxicities -- Myelosuppression and
Deep vein thrombosis &
pulmonary embolism
32. Cont…
• ATG, cyclosporine, and the anti-CD52
monoclonal antibody alemtuzumab are
especially effective in younger MDS patients
(<60 years old) with more favorable IPSS
scores and who bear the histocompatibility
antigen HLA-DR15.
33. Cont…
• EPO alone or in combination with G-CSF can
improve hemoglobin levels,. particularly in
those with low serum EPO levels who have no
or a modest need for transfusion
34. SUPPORTIVE CARE
• Infection in the presence of severe neutropenia--
parenteral, broad-spectrum antibiotics.
• When indwelling plastic catheters become
contaminated, vancomycin should be added .
• Menstruation should be suppressed either by
oral estrogens or nasal follicle-stimulating
hormone/luteinizing hormone antagonists.
• Aspirin and other NSAIDS-- avoided in the
presence of thrombocytopenia
35. Cont…
• RBCs should be transfused -- usually at a
hemoglobin value of 70 g/L (90 g/L if there is
underlying cardiac or pulmonary disease);
• A regimen of 2 units PCV every 2 weeks will
replace normal losses in a patient without a
functioning bone marrow.
• In chronic anemia, the iron chelators,
deferoxamine and deferasirox,
-should be added at approximately the 50th
transfusion