This document discusses screening, diagnosis, and counseling for hemoglobinopathies. It covers:
- The importance of screening to detect conditions early and identify carriers.
- Target populations and timing for screening, including newborn, childhood, adolescence, premarital, antenatal.
- Techniques for analysis including HPLC, IEF, CE, and DNA/protein methods.
- Benefits of newborn screening like preventing complications.
- Options for carrier couples like prenatal diagnosis, IVF, adoption.
- Counseling challenges for conditions like sickle cell disease in India.
- Various state and national programs and initiatives for controlling hemoglobinopathies.
Strategies To Reduce The Incidence Of Genetic Disorders In The Arab World By ...muzkara
Noor Conference | Global Knowledge Forum | http://www.noor.org.sa | Day 2 - Panel 3 - Strategies To Reduce The Incidence Of Genetic Disorders In The Arab World By Prof. Hossam E. Fadel, Noor
Strategies To Reduce The Incidence Of Genetic Disorders In The Arab World By ...muzkara
Noor Conference | Global Knowledge Forum | http://www.noor.org.sa | Day 2 - Panel 3 - Strategies To Reduce The Incidence Of Genetic Disorders In The Arab World By Prof. Hossam E. Fadel, Noor
Liao2011 phân tích máu cuống rốn để khẳng định chẩn đoán nhanh trước sinh bện...Võ Tá Sơn
CORD BLOOD ANALYSIS FOR RAPID PRENATAL CONFIRMATION OF Hb BART’S DISEASE USING THE SEBIA CAPILLARY ELECTROPHORESIS SYSTEM
Liao2011 phân tích máu cuống rốn để khẳng định chẩn đoán nhanh trước sinh bệnh Hb Bart's bằng cách sử dụng hệ thống điện di mao quản
bs võ tá sơn
bsvotason
bác sĩ võ tá sơn
What is Thalassemia Screening? Benefits of getting a Thalassemia screening?Heam Path
Thalassemia Screening is a high-level hereditary test directed on ordinary blood tests that assistance to assess whether an expected parent or an individual is a transporter of the Thalassemia quality or is impacted by the issue.
Diagnosis and Management of Congenital Adrenal Hyperplasia in the Child and A...Apollo Hospitals
Congenital adrenal hyperplasia is due to 21-hydroxylase deficiency in > 90% of cases. This is a very common
genetic disorder for which biochemical screening is now performed. The classical form occurs in 1:15,000–16,000
live births, while the nonclassical form occurs in 1:1000. Congenital adrenal hyperplasia is the most common cause
of primary adrenal insufficiency in childhood. Undertreatment of the condition leads to acute risk of adrenal crisis and to long-term risk of short adult stature and infertility, whereas overtreatment is associated with short stature, obesity and other effects of hypercortisolism, including, but not limited to, osteoporosis.
As long as knowledge on inherence, diagnosis and preventive measures are limited to very few people, it is difficult to control the spread of the genetic anomaly in our population. Apart from lack of comprehensive knowledge, The findings in this study showed a high level of general awareness about the existence of SCD but comprehensive knowledge about the cause and prevention was low and associated with vast misconceptions. A large percentage did not see its importance in influencing their marital decisions. Perhaps simple interventions that worked in the western countries can also work in India.
What are the Pitfalls of Ignoring a Patient’s Family Historykanew396
The process of collecting a patient’s family history helps engage and educate them about the possibility of a hereditary condition in the family. Going through the process of risk assessment also gives breathing room to a patient as they decide on genetic testing, which can be complicated.
1- Differentiate between primary and secondary sources and provide an.pdfcontact28
1. Differentiate between primary and secondary sources and provide an example for each one. 2.
Describe the similarities and differences between a research paper and a review paper. 4. Is the
following Abstract from a research article? Abstract People of African ancestry (Blacks) have an
increased risk of kidney failure due to numerous socioeconomic, environmental, and clinical
factors. Two variants in the APOL1 gene are now thought to account for much of the racial
disparity associated with hypertensive kidney failure in Blacks. However. this knowledge has not
been translated into clinical care to help improve patient outcomes and address disparities.
GUARDD is a randomized trial to evaluate the effects and challenges of incorporating genetic
risk information into primary care. Hypertensive, non-diabetic, adults with self-reported African
ancestry. without kidney dysfunction, are recruited from diverse clinical settings and randomized
to undergo APOL1 genetic testing at baseline (intervention) or at one year (waitlist control).
Providers are educated about genomics and APOL1. Guided by a genetic counselor, trained staff
return APOL1 results to patients and provide low-literacy educational materials. Real-time
clinical decision support ols alert clinicians of their patients' APOL1 results and associated risk
status at the point of care. Our academiccommunity-clinical partnership designed a study to
generate information about the impact of genetic risk information on patient care (blood pressure
and renal surveillance) and on patient and provider knowledge, attitudes, beliefs, and behaviors.
GUARDD will help establish the effective implementation of APOLL risk-informed
management of hypertensive patients at high risk of CKD, and will provide a robust framework
for future endeavors to implement genomic medicine in diverse clinical practices. It will also add
to the important dialog about factors contributing to and may help eliminate racial disparities in.
kidney disease. True: False 5. Of the 3 titles listed below, which title(s) is suitable for a review
paper: a. Chronic Kidney Disease Diagnosis and Management b. Determining the Effects and
Challenges of Incorporating Genetic Testing into Primary Care Management of Hypertensive
Patients with African Ancestry c. Pharmacist Intervention for Blood Pressure Control in Patients
with Diabetes and/or Chronic Kidney Disease d. all of the above 6. Which reference style is used
for citing electronic journal articles. a. DOI b. APA c. NLM d. MLA e. all of the above f. none of
the above.
Twin study confirms virtually identical prenatal alcohol exposures can lead t...BARRY STANLEY 2 fasd
Abstract
Background: Risk of fetal alcohol spectrum disorder (FASD) is not based solely on the timing and level of prenatal alcohol exposure (PAE). The effects of teratogens can be modified by genetic differences in fetal susceptibility and resistance. This is best illustrated in twins.
Objective: To compare the prevalence and magnitude of pairwise discordance in FASD diagnoses across
monozygotic twins, dizygotic twins, full-siblings, and half-siblings sharing a common birth mother.
Methods: Data from the Fetal Alcohol Syndrome Diagnostic & Prevention Network clinical database was used. Sibling pairs were matched on age and PAE, raised together, and diagnosed by the same University of Washington interdisciplinary team using the FASD 4-Digit Code. This design sought to assess and
isolate the role of genetics on fetal vulnerability/resistance to the teratogenic effects of PAE by eliminating
or minimizing pairwise discordance in PAE and other prenatal/postnatal risk factors.
Results: As genetic relatedness between siblings decreased from 100% to 50% to 50% to 25% across the four groups (9 monozygotic, 39 dizygotic, 27 full-sibling and 9 half-sibling pairs, respectively), the prevalence of pairwise discordance in FASD diagnoses increased from 0% to 44% to 59% to 78%. Despite virtually identical PAE, 4 pairs of dizygotic twins had FASD diagnoses at opposite ends of the fetal alcohol spectrum—Partial Fetal Alcohol Syndrome versus Neurobehavioral Disorder/Alcohol-Exposed.
Conclusion: Despite virtually identical PAE, fetuses can experience vastly different FASD outcomes.
Thus, to protect all fetuses, especially the most genetically vulnerable, the only safe amount to drink is none at all.
Twin study confirms virtually identical prenatal alcohol exposures can lead t...BARRY STANLEY 2 fasd
Abstract
Background: Risk of fetal alcohol spectrum disorder (FASD) is not based solely on the timing and level of prenatal alcohol exposure (PAE). The effects of teratogens can be modified by genetic differences in fetal susceptibility and resistance. This is best illustrated in twins.
Objective: To compare the prevalence and magnitude of pairwise discordance in FASD diagnoses across
monozygotic twins, dizygotic twins, full-siblings, and half-siblings sharing a common birth mother.
Methods: Data from the Fetal Alcohol Syndrome Diagnostic & Prevention Network clinical database was used. Sibling pairs were matched on age and PAE, raised together, and diagnosed by the same University of Washington interdisciplinary team using the FASD 4-Digit Code. This design sought to assess and
isolate the role of genetics on fetal vulnerability/resistance to the teratogenic effects of PAE by eliminating or minimizing pairwise discordance in PAE and other prenatal/postnatal risk factors.
Results: As genetic relatedness between siblings decreased from 100% to 50% to 50% to 25% across the four groups (9 monozygotic, 39 dizygotic, 27 full-sibling and 9 half-sibling pairs, respectively), the prevalence of pairwise discordance in FASD diagnoses increased from 0% to 44% to 59% to 78%. Despite virtually identical PAE, 4 pairs of dizygotic twins had FASD diagnoses at opposite ends of the fetal alcohol spectrum—Partial Fetal Alcohol Syndrome versus Neurobehavioral Disorder/Alcohol-Exposed.
Conclusion: Despite virtually identical PAE, fetuses can experience vastly different FASD outcomes.
Thus, to protect all fetuses, especially the most genetically vulnerable, the only safe amount to drink is none at all.
Liao2011 phân tích máu cuống rốn để khẳng định chẩn đoán nhanh trước sinh bện...Võ Tá Sơn
CORD BLOOD ANALYSIS FOR RAPID PRENATAL CONFIRMATION OF Hb BART’S DISEASE USING THE SEBIA CAPILLARY ELECTROPHORESIS SYSTEM
Liao2011 phân tích máu cuống rốn để khẳng định chẩn đoán nhanh trước sinh bệnh Hb Bart's bằng cách sử dụng hệ thống điện di mao quản
bs võ tá sơn
bsvotason
bác sĩ võ tá sơn
What is Thalassemia Screening? Benefits of getting a Thalassemia screening?Heam Path
Thalassemia Screening is a high-level hereditary test directed on ordinary blood tests that assistance to assess whether an expected parent or an individual is a transporter of the Thalassemia quality or is impacted by the issue.
Diagnosis and Management of Congenital Adrenal Hyperplasia in the Child and A...Apollo Hospitals
Congenital adrenal hyperplasia is due to 21-hydroxylase deficiency in > 90% of cases. This is a very common
genetic disorder for which biochemical screening is now performed. The classical form occurs in 1:15,000–16,000
live births, while the nonclassical form occurs in 1:1000. Congenital adrenal hyperplasia is the most common cause
of primary adrenal insufficiency in childhood. Undertreatment of the condition leads to acute risk of adrenal crisis and to long-term risk of short adult stature and infertility, whereas overtreatment is associated with short stature, obesity and other effects of hypercortisolism, including, but not limited to, osteoporosis.
As long as knowledge on inherence, diagnosis and preventive measures are limited to very few people, it is difficult to control the spread of the genetic anomaly in our population. Apart from lack of comprehensive knowledge, The findings in this study showed a high level of general awareness about the existence of SCD but comprehensive knowledge about the cause and prevention was low and associated with vast misconceptions. A large percentage did not see its importance in influencing their marital decisions. Perhaps simple interventions that worked in the western countries can also work in India.
What are the Pitfalls of Ignoring a Patient’s Family Historykanew396
The process of collecting a patient’s family history helps engage and educate them about the possibility of a hereditary condition in the family. Going through the process of risk assessment also gives breathing room to a patient as they decide on genetic testing, which can be complicated.
1- Differentiate between primary and secondary sources and provide an.pdfcontact28
1. Differentiate between primary and secondary sources and provide an example for each one. 2.
Describe the similarities and differences between a research paper and a review paper. 4. Is the
following Abstract from a research article? Abstract People of African ancestry (Blacks) have an
increased risk of kidney failure due to numerous socioeconomic, environmental, and clinical
factors. Two variants in the APOL1 gene are now thought to account for much of the racial
disparity associated with hypertensive kidney failure in Blacks. However. this knowledge has not
been translated into clinical care to help improve patient outcomes and address disparities.
GUARDD is a randomized trial to evaluate the effects and challenges of incorporating genetic
risk information into primary care. Hypertensive, non-diabetic, adults with self-reported African
ancestry. without kidney dysfunction, are recruited from diverse clinical settings and randomized
to undergo APOL1 genetic testing at baseline (intervention) or at one year (waitlist control).
Providers are educated about genomics and APOL1. Guided by a genetic counselor, trained staff
return APOL1 results to patients and provide low-literacy educational materials. Real-time
clinical decision support ols alert clinicians of their patients' APOL1 results and associated risk
status at the point of care. Our academiccommunity-clinical partnership designed a study to
generate information about the impact of genetic risk information on patient care (blood pressure
and renal surveillance) and on patient and provider knowledge, attitudes, beliefs, and behaviors.
GUARDD will help establish the effective implementation of APOLL risk-informed
management of hypertensive patients at high risk of CKD, and will provide a robust framework
for future endeavors to implement genomic medicine in diverse clinical practices. It will also add
to the important dialog about factors contributing to and may help eliminate racial disparities in.
kidney disease. True: False 5. Of the 3 titles listed below, which title(s) is suitable for a review
paper: a. Chronic Kidney Disease Diagnosis and Management b. Determining the Effects and
Challenges of Incorporating Genetic Testing into Primary Care Management of Hypertensive
Patients with African Ancestry c. Pharmacist Intervention for Blood Pressure Control in Patients
with Diabetes and/or Chronic Kidney Disease d. all of the above 6. Which reference style is used
for citing electronic journal articles. a. DOI b. APA c. NLM d. MLA e. all of the above f. none of
the above.
Twin study confirms virtually identical prenatal alcohol exposures can lead t...BARRY STANLEY 2 fasd
Abstract
Background: Risk of fetal alcohol spectrum disorder (FASD) is not based solely on the timing and level of prenatal alcohol exposure (PAE). The effects of teratogens can be modified by genetic differences in fetal susceptibility and resistance. This is best illustrated in twins.
Objective: To compare the prevalence and magnitude of pairwise discordance in FASD diagnoses across
monozygotic twins, dizygotic twins, full-siblings, and half-siblings sharing a common birth mother.
Methods: Data from the Fetal Alcohol Syndrome Diagnostic & Prevention Network clinical database was used. Sibling pairs were matched on age and PAE, raised together, and diagnosed by the same University of Washington interdisciplinary team using the FASD 4-Digit Code. This design sought to assess and
isolate the role of genetics on fetal vulnerability/resistance to the teratogenic effects of PAE by eliminating
or minimizing pairwise discordance in PAE and other prenatal/postnatal risk factors.
Results: As genetic relatedness between siblings decreased from 100% to 50% to 50% to 25% across the four groups (9 monozygotic, 39 dizygotic, 27 full-sibling and 9 half-sibling pairs, respectively), the prevalence of pairwise discordance in FASD diagnoses increased from 0% to 44% to 59% to 78%. Despite virtually identical PAE, 4 pairs of dizygotic twins had FASD diagnoses at opposite ends of the fetal alcohol spectrum—Partial Fetal Alcohol Syndrome versus Neurobehavioral Disorder/Alcohol-Exposed.
Conclusion: Despite virtually identical PAE, fetuses can experience vastly different FASD outcomes.
Thus, to protect all fetuses, especially the most genetically vulnerable, the only safe amount to drink is none at all.
Twin study confirms virtually identical prenatal alcohol exposures can lead t...BARRY STANLEY 2 fasd
Abstract
Background: Risk of fetal alcohol spectrum disorder (FASD) is not based solely on the timing and level of prenatal alcohol exposure (PAE). The effects of teratogens can be modified by genetic differences in fetal susceptibility and resistance. This is best illustrated in twins.
Objective: To compare the prevalence and magnitude of pairwise discordance in FASD diagnoses across
monozygotic twins, dizygotic twins, full-siblings, and half-siblings sharing a common birth mother.
Methods: Data from the Fetal Alcohol Syndrome Diagnostic & Prevention Network clinical database was used. Sibling pairs were matched on age and PAE, raised together, and diagnosed by the same University of Washington interdisciplinary team using the FASD 4-Digit Code. This design sought to assess and
isolate the role of genetics on fetal vulnerability/resistance to the teratogenic effects of PAE by eliminating or minimizing pairwise discordance in PAE and other prenatal/postnatal risk factors.
Results: As genetic relatedness between siblings decreased from 100% to 50% to 50% to 25% across the four groups (9 monozygotic, 39 dizygotic, 27 full-sibling and 9 half-sibling pairs, respectively), the prevalence of pairwise discordance in FASD diagnoses increased from 0% to 44% to 59% to 78%. Despite virtually identical PAE, 4 pairs of dizygotic twins had FASD diagnoses at opposite ends of the fetal alcohol spectrum—Partial Fetal Alcohol Syndrome versus Neurobehavioral Disorder/Alcohol-Exposed.
Conclusion: Despite virtually identical PAE, fetuses can experience vastly different FASD outcomes.
Thus, to protect all fetuses, especially the most genetically vulnerable, the only safe amount to drink is none at all.
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
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Temporomandibular Joint By RABIA INAM GANDAPORE.pptx
screening prenatal test counseling in Hemoglobinopathies Thalasemia.pptx
1. Dr Ebin Roshan Paul
Screening, Prenatal diagnosis and
Counselling of Hemoglobinopathies
2. Screening for Hemoglobinopathies
Why screening important ?
1. Early detection and intervention of Thal.Major, severe
form of Thal.Intermedia, SCD will help to reduce the
mortality and morbidity of condition, also improves the
QoL.
2. Detection of carrier status will help to prevent birth of
an affected child in future.
3. Target population, Timing and
strategies
No single strategy can meet the need of population.
Population selection and timing of test is important will
determine options for future.
4.
5. Newborn screening
DBS spot card used / EDTA - heel prick/cord blood
4 good quality spots
Ideally within 24 hours of collection
With proper labelling place of birth and MR number
prior transfusion if any
family of origin and demographics
antenatal result if present
6. Techniques for Analysis
Primary Screening on DBS card
1. HPLC
2. Isoelectric Focusing (IEF)
3. Capillary Electrophoresis (CE)
A second line test needed on the same sample to validate
findings – protein sequence analysis ( mass spectrometry) or
DNA analysis
7. Screening is not a diagnostic test and not have 100%
sensitivity and specificity.
HPLC and IEF are the preferred methods for newborn
screening on the basis of cost-benefit analysis.
8.
9. Benefits of NB screening
Lethal complications can occur in presymptomatic age.
Early detection and comprehensive care mortality and
morbidity.
Prophylactic penicillin and PCV vaccination for SCD to
prevent pneumococcal sepsis.
10.
11. Childhood (6months-6years)
Universal screening for severe anaemia ( <7mg/dl )
Thal.Major and SCD can be identified, Thal.Intermedia not
picked up
Cost effective and since preschool children, approached
through Anganwadi.
12. Adolescence
Prior intense education programme before screening
Benefits: time to adapt with information, future partner
selection choices, helps to remove stigmatization.
Those who cannot avoid marriage with carrier prenatal
diagnostics and other choices.
Pilot project in Uttrakhand showed high acceptance and
retention of information by adolescence.
13. Premarital population
Not applicable to all society due to fear and stigmatisation.
Options provided are either avoiding the marriage or go
with prenatal diagnosis before each pregnancy.
Religious beliefs and local customs can also influence in
decision.
14. Prenatal Diagnosis
Carrier couples
First started by globin chain synthesis analysis in fetal blood
around 1970s by placental aspiration.
Biochemical and molecular analysis used for PND.
RDB and ARMS for mutation detection.
15. Fetal DNA sampling methods CVS (>11wks)
Amniocentesis (>16 wks)
Cordocentesis (18-20wks)
Pre-requisite are Pre-test counselling and written
informed consent of couple
Carrier status of both parents
Blood group of mother to prevent Rh
incompatibility if present.
16. Choice for “at risk couple”
Prenatal testing is a choice ( mutation studies of parents and
then analysing the fetus affected or not, then giving
counselling and option of termination of affected fetus)
When not feasible due to ethical and cultural issues
not to have children
adoption
in vitro fertilisation ( PGD ) and AI
17. Limitations of PND
No test are absolute ( 2% error )
Decision of termination of an already established
pregnancy is usually difficult and create emotional stress
Post test counselling is very important for emotional stress
in future.
18.
19. Antenatal population
Universal screening should be offered with CBC in first
antenatal visit in all levels.
MCV(<80), MCH(<27), relative high RBC count, normal RDW
HbA2 and HbF analysis advised
If carrier status noted, then husbands evaluated for “at risk
couples” and if detected PND based on Gestational age.
20. Cascade screening
Siblings and extended family of patients and carriers
Uttrakhand project found this more effective in screening
for carriers and detect “couple at risk”.
Some parents unwilling to communicate diagnosis and
misinformed relatives may stay away from affected family
so need proper counselling.
21.
22. Genetic counselling
An educational process that seeks to assist affected and/or
other at-risk individuals to understand the nature of the
genetic disorder, its transmission and the options available
in management and family planning.
(Kelly, 1986; Harper, 2004).
23. Counselling should be in simple/local language, removing
tensions, misconceptions, social stigma.
Taking a proper family history and pedigree.
Couples should be reassured of getting healthy baby after
prenatal intervention (at risk couples).
Information about procedure and its risk associated (pre-test
counselling)
24. Those who cannot choose termination due to religious and cultural
issues should be given options of PGD, artificial insemination with non
carrier, adoption, not to have children.
Nature of condition, predicted phenotype, severity, treatment options
should be discussed (post-test counselling).
Implication of carrier status and recurrence chances in subsequent
pregnancy (25:50:25) should be discussed.
25. Screening and risk assessment of family/relatives and HLA
matching if planning transplantation.
In “multi level consanguinity” risk assessment is difficult and
chances of having other recessive or dominant condition to co
exist is high.
Usual screening for hemoglobinopathies may miss detecting
these conditions. Should be included in counselling.
26. Beta Thalassemia
Thal.Intermedia wide range of spectrum ranging from
features of T.minor to T.major
To assess the predictable phenotype and severity
evaluation of α γ δ genes also necessary.
Ratio of α to non α chains (β/δ/γ) correlates with the
clinical phenotype severity. (α : non α chain)
27. α thal in β homozygous condition can have mild clinical
condition than β homozygous alone ( excess α chain ) and
decreases the severity.
Coexisting HPFH with β thal homozygous can have a milder
phenotype. Free α will go and bind with γ chain.
“δ/β double heterozygous” can have HbA2 normal and
resemble like α thal heterozygous.
“α/β double heterozygous” can have normal RBC indices
and elevated HbA2 level.
28. HbE disease (EE)
Counselling asymptomatic, no anaemia, no haemolysis,
no SM
Parental screening is mandatory for heterozygous status
(AE) and beta thalassemia status
Main differential diagnosis at birth is Hb Eβ0 but it will
symptomatic after the disappearance of HbF.
29. Hb E trait (AE)
1) Counsel baby will not have any health problems. Repeat
test advised at 6 month to confirm.
2) In future before marriage partner has to be screened for
hemoglobinopathies.
3) Parental screening is advised, to check beta thalassemia
status and assess future risk of having a HbE/Beta
thalassemia baby.
30. HbE-Beta Thal / HbE- β+ or β0
Wide range of phenotype from Thal major (severe) mild
forms of Thal Intermedia Thal minor (mild)
Majority will be moderate severity. Hb 6-7 g/dl. CF similar
to Thal Intermedia. Usually not need transfusion. Iron
overload may occur in future.
Coinheritance of α thal with HbE-β thalassemia result less
severity and milder phenotype. Reduces the α chain and
reduces the α : non α chain imbalance.
31. Coinheritance of determinants that increase HbF
expression can also decrease the severity of HbE-β
thalassemia.
Association of milder forms of β+ thalassemia (with
production of some β chain) are also have milder forms of
HbE-β thalassemia.
32. Hb SE
Compound heterozygous SE.
Mild chronic haemolytic anaemia, vaso-occlusive crisis are
rare. Usually presents at second decade of life.
Few cases reported all over world, 8 cases from south
India.
33. HbS-Beta Thal ( HbS / β+ or β0 )
compound heterozygous (βs/βthal)
Only few cases reported tribal population India.
Tribal areas: Asymptomatic or mild with a few vaso-occlusive
crisis. Most were having β0 mutation with associated α
thalassemia prevalence. (Mukherjee 2010)
Non tribal areas: noted severe β+ mutation and clinically more
severe than the tribal area. (Mukherjee 2010)
34. SCD – counselling dilemmas
India
Situation in India is different. SCD is prevalent mainly
scheduled caste and tribe population who are in low SES,
living in illiteracy, poverty and have local religious beliefs.
Need extensive counselling in local language, visual aids to
create awareness and need for testing.
Unlike β Thal the clinical severity is much less predictable in
SCD. India has a very variable range of clinical presentation.
Very few follow up data.
35. Presence of the Arab-Indian haplotype, higher HbF levels
and the presence of associated α-thalassemia mitigate the
severity of the disease in some tribal groups and it is not
always predictable. (Mukherjee 2000,2002)
Most often cases parents opt termination in homozygous
fetus there are chance that some may have a milder
phenotype and can live up to a reasonable age with
disease. (Colah 2005)
37. Various programmes and
Initiatives
Jai Vigyan programme : by ICMR covering 6 states
(Maharashtra, Gujarat, Karnataka, West Bengal, Punjab,
Assam). Beta thal carrier frequency 0 - 9.3%. Assam HbE
prevalence 41-66%.
West Bengal Thalassaemia Control Programme (WBTCP) :
2 nodal centres and 21 centres. Beta Thal prevalence 4 to
10%. Started prenatal analysis.
38. Sankalp India Foundation: Bangalore based NGO blood
donation, chelation aid, thalassemia relief, Bone marrow
transplant aid.
Gujarat TCP by Red Cross Society: screening in college and
schools. Started PND centres.
Maharashtra: 4 district started screening, prevention and
treatment for Thalassemia and SCD.
39. Punjab : “Project Rainbow” ( Center, State, NGO,
Corporate, patients-parents groups ) for care of
Thalassemia patients.
“ThalCare” : Web based platform by Sankalp Foundation
for thalassemia management. Used here
“Thalaman”: software developed to store and assimilate
data online.
40. “Thalassochip” : diagnostic tool for beta thalassemia based
on aaryed primer extension ( APEX). Help to identify beta
thal mutation and Hb variants on a low operating cost.
41. Sickle cell anaemia control programme (SCACP)
Gujarat : started in 2006, mainly targeting tribal
population. All antenatal are given screening on
“Mamta Divas” – a special immunisation day, if found
carriers then father is screened and given counselling.
Colour coded cards are given for people based on
status.
42. Road map ahead.....
Need of education and awareness generation in rural and
urban areas of various states.
Most of data from hospital and selected population not
reflect actual disease burden. Several states and ethnic
groups, community not screened and “micro mapping”
needed in every state.
43. Adequate centres, trained staffs and counsellors need.
Providing hands on training at regular intervals.
Establishment of more day care centres as patient load
increasing.
Encouragement of bone marrow transplant in low risk
patients and affordable families. Establishment in
government set up.
44. Joint and sincere effort from Center, State, Various NGO’s ,
Corporate houses, patient support groups backed by
political support for the implementation of the National
Control Programme.