1. Pancytopenia is defined as a reduction in red blood cells, white blood cells, and platelets below the normal range.
2. The most common causes of pancytopenia include megaloblastic anemia, infections, hypersplenism, aplastic anemia, drug-induced pancytopenia, and acute myeloid leukemia.
3. Evaluation of pancytopenia involves a complete blood count, peripheral smear, bone marrow aspiration and biopsy to determine if the bone marrow is aplastic, infiltrated, or displaying dysplastic changes which can help identify the underlying cause.
Aplastic anemia is one of the stem cell disorder which leads to pancytopenia in the peripheral blood and decrease production of all cell line in bone marrow. it require bone marrow transplantation to cure the patient.
Aplastic anemia is one of the stem cell disorder which leads to pancytopenia in the peripheral blood and decrease production of all cell line in bone marrow. it require bone marrow transplantation to cure the patient.
lupus nephritis is a autoimmune disease, commonly seen in adult and child and the medical or nursing care is also very important for this type of disease condition.
Pancytopenia is a reduction in the number of RBC, WBC and platelet. It's a combination of anaemia, leukopenia and thrombocytopenia. Pancytopenia caused by Decreased bone marrow function and increased peripheral destruction. diseases are diagnosed by physical examination, complete blood counting, peripheral smear examination, bone marrow examination and other special methods. Treatment to pancytopenia is treated to anaemia, thrombocytopenia and leukopenia
lupus nephritis is a autoimmune disease, commonly seen in adult and child and the medical or nursing care is also very important for this type of disease condition.
Pancytopenia is a reduction in the number of RBC, WBC and platelet. It's a combination of anaemia, leukopenia and thrombocytopenia. Pancytopenia caused by Decreased bone marrow function and increased peripheral destruction. diseases are diagnosed by physical examination, complete blood counting, peripheral smear examination, bone marrow examination and other special methods. Treatment to pancytopenia is treated to anaemia, thrombocytopenia and leukopenia
Basic approach to a case of anemia. Investigations to do and to arrive at the diagnosis. (Management not discussed). Peripheral smear findings with pictures are included.
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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.
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.
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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.
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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.
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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
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
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
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The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
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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
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
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
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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. 10/1/2018 4
Pancytopenia
Definition
Reduction in the number of red cells,
white cells (neutrophils) and platelets in the
peripheral blood below the lower limits of the age.
Therefore it is combination of
(anemia, leucopenia and thrombocytopenia)
Hb<13.5 in ♂ & 11.5 in♀
Leucocyte count< 4000
Platelet count <150000
5. Severe pancytopenia
Absolute neutrophil count < 500/cmm
Platelet count < 20,000/cmm
Corrected reticulocyte count < 1%.
Urgent full investigation in 1st 24-48 h
9. 1. Megaloblastic anemia
2. Infections
3. Hypersplenism
4. Aplastic anemia
5. Drug induced pancytopenia
6. Acute myeloid leukemia
Common causes in developing countries
10. Infections:
(HIV, tuberculosis, hepatitis viruses, EBV,
CMV)
Hypersplenism: causes
congestive splenomegaly
(cirrhosis, congestive heart failure),
malaria,leishmaniasis,thalassaemia and
Hodgkin’s disease
Most frequent haematologicmanifestation of SLE
normocytic and normochromicanaemia.
Leukopenia is also common and
almost always consists of lymphopenia
and not granulocytopenia.
11. history
• History and associated symptoms
Exam..
Inv1
Inv2
• General
• Systemic
• CBC with PBS, Reticulocyte count
• B12/Folate , LFT,Hepatic serology, Coagulation
profile, combs test, HIV .
• BM aspiration and biopsy
• Cytogenetics (if required)
Inv
3 • Special investigations to confirm the diagnosis
14. Symptoms/Findings
Related to the cause of
pancytopenia
eg:
Splenomegaly: Hypersplenism, lymphoma,
leukemia, myelofibrosis etc
Lymphadenopathy: Lymphoma , leukemia,SLE etc
Atrophic glossitis: Megaloblastic anaemia
Others
10/1/2018 14
15. History
Duration of symptom
Long (MDS)
Short (aplastic anemia)
History of transfusion
History of hemoglobinurea
Dietary history
Exposure to
Radiation – Chemotherapy ( MDS , AML)
Drugs :
Anti cancer-anti thyroid-antibiotic(aplastic anemia)
Barbiturates , phenytoin ( B12, Folic acid)
16. History
Age- inherited cause of bone marrow failure
Jaundice (hepatitis viruses)
Joint pain, rash,photosensitivity (lupus)
Bonepains (acute leukemias)
Night sweats (Hodgkins disease)
malaise, weightloss (tuberculosis,malignancy)
Joint Pain – (SLE)
17. General examination
A thorough physical exam is required
Eye examination: retinal hemorrhage
leukemic infiltrations
Pallor (Anemia)
Jaundice (hepatitis-PNH-cirrhosis)
Oral examination
Stomatitis or cheilitis (neutropenia , B12 deficiency)
Gingival hyperplasia (leukemia)
Oral candidiasis or pharyngeal exudate (neutropenia)
18. Abdominal examination :organomegaly
lymphadenopathy
skin examination : malar rash Petichae
purpura hypo or hyperpigmentation
Musculoskelatal system :
short stature abnormal thumb
(fanconi anemia)
Synovitis/swelling (SLE)
Sternal tenderness (acute leukemia)
Signs of chronic liver disease.
General examination
20. Pancytopenia +Backpain+Hypercalcemia+
old age (multiple myeloma)
Pancytopenia + Malar rash or GN+ = SLE
pancytopenia + HSM = Leukemia
Recurrent oral ulcers and chronic diarrhoea
may point towards HIV infection.
Loss of height (multiple myeloma)
21. FINDINGS OCCURENCE
Lymphadenopathy
Lymphoma, Hodgkin lymphoma, also
viral----typically abscent in aplastic a
infection.
Splenomegaly Not found in MDS or Aplastic
anemia. Typical in
Myeloproliferative disorders,
sometimes in acute leukemia.
Hepatomegaly Myeloproliferative disorders,
Lymphoma
Mediastinal bulk Lymphoma,
Hodgkin’s disease
Bony tenderness
Multiple Myeloma,
Metastasis
22. A standard battery of evaluation tests include:
COMPLETE BLOOD COUNT w indices
PERIPHERAL SMEAR
Reticulocyte Count
LiverFunctionTest &Hepatic Serology
Coagulation Profile,Bleeding Time, D-dimer
(combs test)
Serum B12 & Folate level
Serum HIV . ANA.
bone marrow
23. Anisocytosis & Poikilocytosis.
WBCs and RBCs Precursors
Platelets
Increased or decreased granulation in
neutrophils
Hypo/Hypersegmentation in neutrophils
28. Examination of bone marrow is always
indicated in cases of pancytopenia unless the
cause is otherwise apperent(e.g established
liver disease with PHTN)
B.M examination:
ASPIRATE
TREPHINE BIOPSY
29. BONE MARROW EXAMINATION
Specifically, bone marrow aspirate permits examination of:
•Cytology
Megaloblastic change,
Dysplastic changes,
Abnormal cell infiltrates
•Immunophenotyping : antigen or marker on cells surfaces e.g
(Leukemias, Lymphoproliferative disorders)
•Cytogenetics : structure of chromosome
•Myelodysplasia, Leukemias,
Lymphoproliferativedisorders
30. Bone marrow is diagnosic for :
Multiplemyeloma
Myelofibrosis
A leukemic leukemia
Aplastic anemia
Seideroblastic anemia
31. CELULARITY OF BONE MARROW
The differential diagnosis of pancytopenia are based on
cellularity of bone marrow:
Normocellular: 50-70% hematopoietic cells &30-50%fat
Hypocellular: excessive amount of fat cells
Hypercellular: 80-100% cells with little fat
Hypo ----indicates decreased production of blood cells
Hyper --indicates ineffective production or increased
destruction or sequestration of blood cell