This document discusses monoclonal gammopathy of undetermined significance (MGUS), a premalignant condition characterized by a monoclonal plasma cell proliferation and monoclonal paraprotein in the blood. It describes the incidence, risk factors, pathophysiology, clinical features, investigations, diagnosis, differential diagnosis, natural history, risk factors for progression, risk stratification, and management of MGUS. It also discusses smoldering multiple myeloma, a related condition with a monoclonal paraprotein level >3g/dL and/or >10% plasma cells in the bone marrow without symptoms of multiple myeloma.
Urine analysis is an integral part of a clinical laboratory. automation techniques in urine biochemistry, their priniciplas and microscopy along with their advantages and disadvantages are outlined.
INTRODUCTION Myeloma cells majorly discharge antibodies known as paraprotein (Durie et al., 1975). To make a diagnosis of myeloma, physicains will observe for this paraprotein in the blood or urine(Fisher,1938) .Once the patient have been diagnosed with myeloma, physicians will regularly assess the paraprotein levels to monitor the disease (Fudenberg et al., 1971). Disorders characterised by the production of a paraprotein majorly include monoclonal gammopathy of undetermined significance (MGUS), multiple myeloma and Waldenströms Macroglobulinaemia (Grabar et al., 1953). Paraproteins may also be a feature of CLL (Chronic lymphocytic leukemia), or amyloidosis. MGUS is a diagnosis of exclusion: 4% of over the age of 72 and 5% of over the age of 85 have a paraprotein which is frequently found incidentally and not allied with symptoms or physical findings (Hills, 1966).
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.
Urine analysis is an integral part of a clinical laboratory. automation techniques in urine biochemistry, their priniciplas and microscopy along with their advantages and disadvantages are outlined.
INTRODUCTION Myeloma cells majorly discharge antibodies known as paraprotein (Durie et al., 1975). To make a diagnosis of myeloma, physicains will observe for this paraprotein in the blood or urine(Fisher,1938) .Once the patient have been diagnosed with myeloma, physicians will regularly assess the paraprotein levels to monitor the disease (Fudenberg et al., 1971). Disorders characterised by the production of a paraprotein majorly include monoclonal gammopathy of undetermined significance (MGUS), multiple myeloma and Waldenströms Macroglobulinaemia (Grabar et al., 1953). Paraproteins may also be a feature of CLL (Chronic lymphocytic leukemia), or amyloidosis. MGUS is a diagnosis of exclusion: 4% of over the age of 72 and 5% of over the age of 85 have a paraprotein which is frequently found incidentally and not allied with symptoms or physical findings (Hills, 1966).
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.
challenges in interpreting abnormal hemoglobin study- the key is to correlate with patient age, ethnicity,RBC indices & morphology findings. Two tier approach for correct characterization of abnormal hemoglobins of HPLC &/or capillary electrophoresis.
Fluid cytology in serous cavity effusionstashagarwal
The intrathoracic and intraperitoneal organs are covered by a single layer of mesothelial cells, which is continuous with the lining of the thoracic and peritoneal cavities. The potential space between the two layers of epithelium contains a small amount of lubricating fluid.
Serous fluid lies between the membranes lining the body cavities(parietal) and those covering the organs within the cavities(visceral).
Production and reabsorption are normally at a constant rate. They are influenced by
Changes in osmotic and hydrostatic pressure in the blood.
Concentration of chemical constituents in the plasma
Permeability of blood vessels and membranes.
An accumulation of fluid, called an effusion, results from an imbalance of fluid production and reabsorption. This fluid accumulation in the pleural, pericardial, and peritoneal cavities is known as serous effusion.
This presentation in mainly focused of understanding of automation and its utility in cytopathology. It will be very usefull for postgraduate in pathology, cytopathologist and cytotechnicians.
cytochemical stains. CML versus Leukamoid. LAP score. NAP score. Hematology, Hematopathology. Lab technology. Pahology. Medical Laboratory. White cell stains
challenges in interpreting abnormal hemoglobin study- the key is to correlate with patient age, ethnicity,RBC indices & morphology findings. Two tier approach for correct characterization of abnormal hemoglobins of HPLC &/or capillary electrophoresis.
Fluid cytology in serous cavity effusionstashagarwal
The intrathoracic and intraperitoneal organs are covered by a single layer of mesothelial cells, which is continuous with the lining of the thoracic and peritoneal cavities. The potential space between the two layers of epithelium contains a small amount of lubricating fluid.
Serous fluid lies between the membranes lining the body cavities(parietal) and those covering the organs within the cavities(visceral).
Production and reabsorption are normally at a constant rate. They are influenced by
Changes in osmotic and hydrostatic pressure in the blood.
Concentration of chemical constituents in the plasma
Permeability of blood vessels and membranes.
An accumulation of fluid, called an effusion, results from an imbalance of fluid production and reabsorption. This fluid accumulation in the pleural, pericardial, and peritoneal cavities is known as serous effusion.
This presentation in mainly focused of understanding of automation and its utility in cytopathology. It will be very usefull for postgraduate in pathology, cytopathologist and cytotechnicians.
cytochemical stains. CML versus Leukamoid. LAP score. NAP score. Hematology, Hematopathology. Lab technology. Pahology. Medical Laboratory. White cell stains
Newer biomarkers,techniques & their inclusion in 2016 WHO classification for leukaemia/lymphomas increases the responsibility of the pathologists, requiring to develop an integrated multidisciplinary approach for reporting.
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
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.
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!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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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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
3. WHAT’S MGUS??
MGUS describes premalignant
disorder characterized by
Limited monoclonal plasma cell
proliferation
Stable monoclonal paraprotien in
serum or less commonly in urine
Absence of clinicopathological
evidence of MM,WM,AL or LPDs.
5. EPIDEMIOLOGY
Age. The risk of increases with age. The
highest incidence is among adults age 85
and older.
Race. Blacks are more likely to
experience this condition than are
whites.
Sex. more common in men than it is in
women.
Family history.
6. PATHOPHYSIOLOGY
Pathologically, the lesion in MGUS is in fact
very similar to that in multiple myeloma.
There is a predominance of clonal plasma
cells in the bone marrow with an
abnormal immunophenotype (CD38+
CD56+ CD19−) mixed in with cells of a
normal phenotype (CD38+ CD56−
CD19+); in MGUS, on average more than
3% of the clonal plasma cells have the
normal phenotype, whereas in multiple
myeloma, less than 3% of the cells have
the normal phenotype
7. Pathogenesis
Approximately 50% of patients with MGUS and SMM have
primary translocations in the clonal plasma cells
involving the immunoglobulin heavy chain (IgH)
locus on chromosome 14q32 (IgH translocated
MGUS/SMM
The most common partner chromosome loci and genes
dysregulated in these translocations are: [cyclin D1
gene]), [cyclin D3 gene])
Deletion of chromosome 13, a major prognostic factor
in multiple myeloma, is seen in up to 50% of patients
with MGUS by interphase fluorescent in situ
hybridization; hence, the presence of this abnormality
cannot be used to differentiate MGUS from multiple
myeloma
8. It is felt that these translocations are important
pathogenetically in initiating and sustaining
clonal proliferation.
The precipitating event for these translocations
may be related to infection or immune
dysregulation, and likely occurs during IgH
switch recombination or somatic hypermutation
The pathogenesis in 40%–50% of MGUS and
SMM with no evidence of IgH translocations
(IgH non-translocated MGUS/SMM) is unclear.
10. CLINICAL FEATURES
Asymptomatic
No abnormal physical findings
Incidental discovery : ESR /↑
globlin↑
Neuropathy may be ass attributed
to monoclonal gammopathy
Thrombotic events
11. INVESTIGATIONS
exclude CRAB
FBC: no anemia or other cytopenia
Chemistry : RFT, s Ca++↔
Serum protein electrophoresis:IgG 70%,IgM 15%,
IgA12%,biclonal 3%,LC<1%
Immunoglobulin quantitation :immunoparesis
SFLC:~30% have abn ĸ:λ ratio
Urine electrophoresis:
Skeletal survey:normal
Serum β2 microglobulin:normal
BMA or trephine biopsy:indicated if abn
FBC,RFT,sCa, SFLC,sk survey,non IgG
paraprotein,paraprotein>15g/L
12. DIAGNOSIS
All 4 criteria must be met :
1. Serum monoclonal protein <3g/dL
2. BM plasma cells <10%
3. No evidence of other B cell LPDs
4. No myeloma related end organ or
tissue impairment ie CRAB
18. RISK STRATIFICATION
1. Assess patient for each of three
risk factors
Abnormal serum free light chain ratio
(SFLC)
Serum M protein ≥ 1.5 g/dL
M protein not of IgG subtype
19. 2. Sum the number of risk factors
to determine risk category and
prognosis
20. MANAGEMENT
NO treatment
Follow up every 6m then annually
(FBC, renal function ,serum Ca+
+ ,serum Igs, paraprotein
quantitation ,SFLC)
24. PATHOGENESIS
Almost all have either translocation
involving IgH (50%) or
hyperdiploidy(40%)
Angiogenesis is greater than MGUS
but less than in MM
25. CLINICAL & LABORATORY
FEATURES
Absence of signs & symptoms
FBC : Hb >10 gm/dL
S. creat <130 micromol /L ,normal
s Ca++
β2 microglobulin :normal / minimal rise
BMA: >10% plasma cells
BM cytogenetics
Skeletal radiology :normal
26. DIAGNOSTIC CRITERIA
Paraprotein > 3gm/dl and / or
plasma cells in BM >10%
No evidence of other B cell LPD
No myeloma related end organ or
tissue impairment
28. RISK FACTORS FOR EARLY
PROGRESSION
Shorter time ass with:
Serum paraprotein >3g/dL
IgA protein type
Urinary BenceJones proteinuria>50mg/d
BM plasmacytosis>25%
Suppression of uninvolved Ig
SFLC<0.125 or >8
Abn MRI
29. RISK STRATIFICATION
A scoring system has been developed
using 2 parameters
1. Quantity of paraprotein <3 vs.>3 g/dL
2. Type of paraprotein IgG vs.IgA
Another scoring system using 3
parameters
1. BM plasmacytosis>10%
2. Serum M protein>3g/dL
3. SFLC ratio <0.125 or >8
30. MANAGEMENT
Chemotherapy is not indicated
No benefit for therapy before
symptomatic disease
Follow up every 3-4 months
Clinical trials early treatment with
bisphosphonate, thalidomide and
lenalidomide ??? Delay progression
Editor's Notes
Pathogenesis and progression of monoclonal gammopathies.