Hematopoietic stem cell transplantation involves transplanting stem cells from bone marrow, peripheral blood, or umbilical cord blood to a recipient. There are two main types: autologous transplants using the patient's own stem cells and allogeneic transplants using donor stem cells. Allogeneic transplants from related donors have the best outcomes. The transplant process involves conditioning with chemotherapy and/or radiation, stem cell infusion, a neutropenic phase making the patient susceptible to infection, engraftment as the donor cells establish, and a post-engraftment period monitoring for complications like graft-versus-host disease.
Graft versus host disease (GVHD) is an immune mediated disease due to complex interaction between donor (lymphoid tissue) and recipient’s immunity occurring after transplantation.
Two types
Acute (less than 100 days)
Chronic (more than 100 days)
There are many types of cancer treatment. The types of treatment that patient receive will depend on the type of cancer, stage of cancer and how advanced it is.
Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy.
Graft versus host disease (GVHD) is an immune mediated disease due to complex interaction between donor (lymphoid tissue) and recipient’s immunity occurring after transplantation.
Two types
Acute (less than 100 days)
Chronic (more than 100 days)
There are many types of cancer treatment. The types of treatment that patient receive will depend on the type of cancer, stage of cancer and how advanced it is.
Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy.
Hematopoietic Stem Cells Transplantation for Multiple MyelomaWan Ning
Hematopoietic stem cells transplantation is a FDA-approved stem cells based therapy whereby it is usually performed for cancer patients. For an example, Multiple Myeloma.
Post-transplant lymphoproliferative disorder/disease (PTLD) is a B-cell proliferation disorder following infection with EpsteineBarr virus due to therapeutic immunosuppression after organ transplantation. The more intense the immunosuppression, the higher the incidence of PTLD and the earlier it occurs. The cornerstone of successful treatment of PTLD is reduction or withdrawal of immunosuppression.
The goal of a successful transplant has beep accomplished in more than three fourths of the children with end-stage kidney disease treated in a special program undertaken at Los Angeles Childrens Hospital some years ago. In general, rehabilitation both physical and psychologic and growth have been highly satisfactory, the latter especially when transplantation was carried out before puberty. Although the number of children with end-stage renal disease ESRD in need for renal transplantation is small compared with adults, the problem associated with renal transplant in children are numerous, varied, and often peculiar. Pre-emptive transplantation has recently been growing in popularity as it avoids many of the associated long-term complications of ESRD and dialysis. Changes in immunosuppression to more potent agents over the years will have affected transplant outcome there is also evidence that tacrolimus is more effective than cyclosporine. This review will discuss the short- and long-term complications such as acute and chronic rejection, hypertension, infections, and malignancies as well as factors related to long-term graft function. Chronic allograft nephropathy is the leading cause of renal allograft loss in pediatric renal transplant recipients. It is likely that it reflects a combination of both immune and nonimmune injury occurring cumulatively over time so that the ultimate solution will rely on several approaches. Transplant and patient survival have shown a steady increase over the years. The major causes of death after transplantation are cardiovascular disease, infection and malignancy. Transplantation in special circumstances such as children with abnormal urinary tracts and children with diseases that have the potential to recur after transplantation will also be discussed in this review. Non-compliance with therapeutic regimen is a difficult problem to deal with and affects patients and families at all ages, but particularly so at adolescence. Growth may be severely impaired in children with ESRD which may result in major consequences on quality of life and self-esteem a better height attainment at transplantation is recognized as one of the most important factors in final height achievement. Sangeeta Dewangan "Renal Transplantation in Children" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21432.pdf
Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/21432/renal-transplantation-in-children/sangeeta-dewangan
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
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
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.
Follow us on: Pinterest
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
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
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.
2. Definition
Any procedure where hematopoietic stem
cells of any donor and any source are
given to a recipient with intention of
repopulating/replacing the hematopoietic
system in total or in part.
3. Types of Transplant
Autologous (your own cells)
Allogeneic
cells from another person
Sibling
Unrelated Donor
Parent or relative
or source: Umbilical cord
5. Best Allogeneic Blood/Bone Marrow
Donor is a brother or sister
Only 25% of patients are that lucky!
There is a 1 in 4 chance that any child will
match another child of the same parents
the formula for knowing whether there is a
donor (1-(3/4)n
)
In 1% of cases, a parent may be a donor
because of shared HLA types
Major obstacle in the treatment of
patients who would benefit from an
allogeneic transplant.
6.
7.
8. Bone Marrow
Standard source of hematopoietic cells
for more than 30 years.
Transplant physicians may select
marrow because:
Extensive clinical data are available about
marrow transplant outcomes
Extensive information is available about
the marrow donation experience
10. Peripheral Blood Stem Cells
Autologous transplants rely almost
exclusively on PBSC rather than marrow due
to:
Easier collection of cells
More rapid hematopoietic recovery
Decreased costs
We also use this method in certain instances
for allogeneic transplants in pediatrics.
13. Umbilical Cord Blood
Physicians may consider umbilical cord blood
a good choice particularly for patients who
need an unrelated donor and have an
uncommon HLA type or are in urgent need of
a transplant.
HLA mismatch is better tolerated – even with
haploidentical donors
Available more quickly than marrow or PBSC
unrelated donors
Reduced incidence and severity of GVHD
14. Diseases that we transplant in
children
Autologous
Relapsed Hodgkins Disease
Relapsed Non Hodgkins Lymphoma (NHL)
Stage IV Neuroblastoma
Relapsed Ewings Sarcoma
Investigational
Metastatic Ewings Sarcoma
Medulloblastoma, other brain tumors
Autoimmune Diseases (SLE)
15. Allogeneic Transplant
Indications in Children
Malignant Diseases
AML CR1 – Matched Sibling
High Risk ALL CR1 (Ph+ ALL)
Relapsed or Refractory AML or ALL
Chronic myelogenous leukemia
Juvenile myelomonocytic leukemia
Myelodysplastic syndromes
16. Allotransplant for Non-Malignant
Diseases
Inherited metabolic disorders -
Adrenoleukodystrophy, Hurler syndrome,
metachromatic leukodystrophy, osteopetrosis, and
others
Inherited immune disorders - Severe combined
immunodeficiency, Wiskott-Aldrich syndrome, and
others
Inherited red cell disorders - Pure red cell
aplasia, sickle cell disease, beta-thalassemia, and
others
Marrow failure states - Severe aplastic anemia,
Fanconi anemia, and others
17. Factors influencing the
outcome of HSCT
Disease factors
stage
Patient - related factors
Age
Donor - related factors
Histopompatibility (HLA)
Sex
Viral status (CMV positivity)
Peri-transplant factors
Conditioning
GVHD prevention
Stem cell source and content
Post-transplant factors
19. Harvesting Stem Cells
Adult stem cells obtained by large volume marrow
biopsy/aspiration (1-2L)
Cord blood stem cells obtained at delivery by sterile
emptying umbilical cord and placenta into blood
donation bag
Increasingly obtained by processing of peripheral
blood of patients and healthy donors
Isolated in “real time” from blood after stimulation with
blood cell growth factors
Stem cells can be frozen for up to 5-10 years
20. Conclusion
Stem cells can be derived from adult, cord blood and
eventually embryonic stem cells
Stem cell transplantation can both support highly intensive
chemotherapy and promote highly effective immunotherapy
Recent advances in stem cell transplantation allow therapy
more tailored to disease and patient
Improved supportive care measures expand transplant to
more patients
Expanded applications capitalizing on stem cell plasticity
are feasible
23. Conditioning Phase
The conditioning period typically lasts 7-10
days.
The purposes are (by delivery of
chemotherapy and/or radiation)
to eliminate malignancy
to provide immune suppression to prevent
rejection of new stem cells
create space for the new cells
Radiation and chemotherapy agents differ in
their abilities to achieve these goals.
24. Stem cell processing and
infusion
Infusion - 20 minutes to an hour, varies
depending on the volume infused. The stem
cells may be processed before infusion, if
indicated. Depletion of T cells can be
performed to decrease GVHD.
Premedication with acetaminophen and
diphenhydramine to prevent reaction.
25. Stem cell processing and
infusion
Infused through a CVL, much like a blood
transfusion.
Anaphylaxis, volume overload, and a
(rare) transient GVHD are the major
potential complications involved.
Stem cell products that have been
cryopreserved contain dimethyl sulfoxide
(DMSO) as a preservative and potentially can
cause renal failure, in addition to the
unpleasant smell and taste.
26. Neutropenic Phase
During this period (2-4 wk), the patient
essentially has no effective immune system.
Healing is poor, and the patient is very
susceptible to infection.
Supportive care and empiric antibiotic therapy
are the mainstays of successful passage
through this phase.
27. Engraftment Phase
During this period (several weeks), the
healing process begins with resolution
of mucositis and other lesions acquired.
In addition, fever begins to subside, and
infections often begin to clear. The
greatest challenges at this time are
management of GVHD and prevention
of viral infections (especially CMV).
28. Post-engraftment Phase
This period lasts for months to years.
Hallmarks of this phase include the
gradual development of tolerance,
weaning off of immunosuppression,
management of chronic GVHD, and
documentation of immune
reconstitution.
29. Graft versus Host Disease (GVHD)
• If donor cells see the host cells as foreign,
the donor cells will attack the host.
• Skin, gut, and liver most likely to be
affected.
• Acute < 100 days after the transplant
• Chronic > 100 days
30. What are risk factors for GVHD?
HLA match / mismatch
Lymphocytes in graft
Inadequate immune suppression
Other???
31. Couriel et al, Cancer 2004.
Acute Graft versus Host Disease of Skin
35. Other Problems Encountered
Hemorrhagic Cystitis
VOD (venoocclusive disease of the
liver) or SOS (solid organ syndrome)
Organ Toxicity (lung, heart, kidney)
Idiopathic Pneumonia Syndrome
Editor's Notes
(do you want a slide per problem?)
Do you want a separate slide per problem, or is this sufficient?