Polycythemia, essential thrombocythemia, and myelofibrosis are three distinct myeloproliferative neoplasms (MPNs) that affect the bone marrow's production of blood cells. Here's a brief overview of each condition:
1. **Polycythemia (Polycythemia Vera):**
- Polycythemia vera (PV) is a disorder where the bone marrow produces too many red blood cells, white blood cells, and platelets. This leads to an increased thickness of the blood (hyperviscosity), which can cause complications like blood clots, strokes, and heart attacks.
- Symptoms may include fatigue, weakness, headaches, dizziness, itching (especially after a warm bath), and redness or a bluish tint to the skin.
- Treatment aims to reduce the risk of blood clots and manage symptoms. It may include phlebotomy (removing blood to lower red cell count), medications to suppress bone marrow activity, and aspirin to reduce clotting.
2. **Essential Thrombocythemia (ET):**
- Essential thrombocythemia is characterized by the overproduction of platelets in the bone marrow. This condition can lead to abnormal blood clotting or bleeding.
- Symptoms may include headaches, dizziness, tingling or numbness in the hands or feet, vision changes, and easy bruising or bleeding.
- Treatment focuses on reducing the risk of blood clots and managing symptoms. This may involve medications to lower platelet counts, such as hydroxyurea or anagrelide, as well as aspirin therapy.
3. **Myelofibrosis:**
- Myelofibrosis is a condition where the bone marrow is replaced by fibrous tissue, leading to a decrease in the production of normal blood cells. It is often associated with anemia, enlarged spleen, and abnormal blood cell counts.
- Symptoms may include fatigue, weakness, abdominal discomfort due to an enlarged spleen, easy bruising or bleeding, and frequent infections.
- Treatment aims to manage symptoms and improve quality of life. This may involve medications to reduce spleen size and control symptoms, blood transfusions for anemia, and, in some cases, stem cell transplant for eligible patients.
These conditions are chronic and require ongoing monitoring and management by healthcare professionals, often including hematologists or oncologists. Treatment plans are tailored to each individual based on factors such as age, overall health, disease progression, and risk of complications.
Chronic myelogenous leukemia ( CML )
Tests to be done in order to differentiate CML from other dieases with common clinical features.
It's pathogenesis, clinical presentation and features of diagnostic tests.
Methods of treatment. Prognosis of a disease according to "Sokal" score
Mastering Wealth: A Path to Financial FreedomFatimaMary4
### Understanding Wealth: A Comprehensive Guide
Wealth is a multifaceted concept that extends beyond mere financial assets. It encompasses a range of elements including money, investments, property, and other valuable resources. However, true wealth also includes non-material aspects such as health, relationships, and personal fulfillment. This guide delves into the various dimensions of wealth, exploring how it can be created, sustained, and enjoyed.
#### Defining Wealth
Traditionally, wealth is defined as the abundance of valuable resources or material possessions. It includes financial assets like cash, savings, stocks, bonds, and real estate. However, a broader understanding of wealth considers factors such as personal well-being, emotional health, social connections, and intellectual growth. This holistic view recognizes that true wealth is not solely about accumulating money but also about enhancing one's quality of life.
#### The Importance of Financial Wealth
Financial wealth remains a critical component of overall wealth. It provides security, freedom, and the ability to pursue opportunities. Key elements of financial wealth include:
1. **Savings**: Money set aside for future use. It is crucial for emergencies, large purchases, and financial goals.
2. **Investments**: Assets purchased with the expectation that they will generate income or appreciate over time. Common investments include stocks, bonds, mutual funds, real estate, and businesses.
3. **Income**: Regular earnings from work, investments, or other sources. Consistent income is essential for maintaining and growing wealth.
4. **Debt Management**: Effectively managing debt ensures that it does not erode financial wealth. This includes paying off high-interest debt and using credit wisely.
#### Creating Wealth
Creating wealth involves generating and accumulating financial and non-financial resources. The process can be broken down into several key strategies:
1. Education and Skill Development: Investing in education and skills enhances earning potential. Higher education, professional certifications, and continuous learning can lead to better job opportunities and higher salaries.
2. Entrepreneurship: Starting and running a successful business can be a significant source of wealth. Entrepreneurship requires innovation, risk-taking, and effective management.
3. Investing: Making smart investments is essential for wealth creation. This involves understanding different types of investments, assessing risks, and making informed decisions. Diversifying investments can reduce risk and increase potential returns.
4. Saving and Budgeting: Effective saving and budgeting help accumulate wealth over time. Setting financial goals, creating a budget, and sticking to it are foundational steps in wealth creation.
5. Real Estate: Investing in property can provide rental income and capital appreciation. Real estate is a tangible asset that can hedge against inflation
Más contenido relacionado
Similar a MPNs; Definition, Types of MPN Mutations, Aetiology, Clinical features, CML
Chronic myelogenous leukemia ( CML )
Tests to be done in order to differentiate CML from other dieases with common clinical features.
It's pathogenesis, clinical presentation and features of diagnostic tests.
Methods of treatment. Prognosis of a disease according to "Sokal" score
Mastering Wealth: A Path to Financial FreedomFatimaMary4
### Understanding Wealth: A Comprehensive Guide
Wealth is a multifaceted concept that extends beyond mere financial assets. It encompasses a range of elements including money, investments, property, and other valuable resources. However, true wealth also includes non-material aspects such as health, relationships, and personal fulfillment. This guide delves into the various dimensions of wealth, exploring how it can be created, sustained, and enjoyed.
#### Defining Wealth
Traditionally, wealth is defined as the abundance of valuable resources or material possessions. It includes financial assets like cash, savings, stocks, bonds, and real estate. However, a broader understanding of wealth considers factors such as personal well-being, emotional health, social connections, and intellectual growth. This holistic view recognizes that true wealth is not solely about accumulating money but also about enhancing one's quality of life.
#### The Importance of Financial Wealth
Financial wealth remains a critical component of overall wealth. It provides security, freedom, and the ability to pursue opportunities. Key elements of financial wealth include:
1. **Savings**: Money set aside for future use. It is crucial for emergencies, large purchases, and financial goals.
2. **Investments**: Assets purchased with the expectation that they will generate income or appreciate over time. Common investments include stocks, bonds, mutual funds, real estate, and businesses.
3. **Income**: Regular earnings from work, investments, or other sources. Consistent income is essential for maintaining and growing wealth.
4. **Debt Management**: Effectively managing debt ensures that it does not erode financial wealth. This includes paying off high-interest debt and using credit wisely.
#### Creating Wealth
Creating wealth involves generating and accumulating financial and non-financial resources. The process can be broken down into several key strategies:
1. Education and Skill Development: Investing in education and skills enhances earning potential. Higher education, professional certifications, and continuous learning can lead to better job opportunities and higher salaries.
2. Entrepreneurship: Starting and running a successful business can be a significant source of wealth. Entrepreneurship requires innovation, risk-taking, and effective management.
3. Investing: Making smart investments is essential for wealth creation. This involves understanding different types of investments, assessing risks, and making informed decisions. Diversifying investments can reduce risk and increase potential returns.
4. Saving and Budgeting: Effective saving and budgeting help accumulate wealth over time. Setting financial goals, creating a budget, and sticking to it are foundational steps in wealth creation.
5. Real Estate: Investing in property can provide rental income and capital appreciation. Real estate is a tangible asset that can hedge against inflation
- 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
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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.
TEST BANK For Timby's Introductory Medical-Surgical Nursing, 13th American Ed...kevinkariuki227
TEST BANK For Timby's Introductory Medical-Surgical Nursing, 13th American Edition by Donnelly-Moreno, Verified Chapters 1 - 72, Complete Newest Version.pdf
TEST BANK For Timby's Introductory Medical-Surgical Nursing, 13th American Edition by Donnelly-Moreno, Verified Chapters 1 - 72, Complete Newest Version.pdf
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
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
Why invest into infodemic management in health emergenciesTina Purnat
A lecture discussing the challenge of health misinformation and information ecosystem in public health, how this impacts demand promotion in health, and how this then relates to responding to misinformation and infodemics in health emergencies. Appended with lots of tools, guidance and resources for people who want to do more reading.
EATING DISORDERS (Psychiatry-7)by dr Shivam sharma.pptxShivam Sharma
For any queries ,contact shvmshrm@outlook.com
---
## Introduction to Eating Disorders
Welcome to this comprehensive presentation on Eating Disorders, a critical and often misunderstood area of mental health. This presentation is designed to provide in-depth knowledge and insights into the various aspects of eating disorders, making it valuable for both postgraduate medical aspirants preparing for the INI-CET and the general public seeking to understand these complex conditions.
### Objectives:
1. **Understanding Eating Disorders**: Gain a clear understanding of what eating disorders are, their types, and their distinguishing characteristics.
2. **Etiology and Risk Factors**: Explore the underlying causes and risk factors that contribute to the development of eating disorders.
3. **Clinical Features and Diagnosis**: Learn about the clinical features, diagnostic criteria, and the importance of early detection.
4. **Management and Treatment**: Review the current approaches to managing and treating eating disorders, including medical, psychological, and nutritional interventions.
5. **Prevention and Awareness**: Discuss strategies for prevention, early intervention, and increasing awareness about eating disorders.
This presentation aims to bridge the gap between academic knowledge and practical understanding, providing you with the tools to recognize, diagnose, and effectively manage eating disorders. Whether you are preparing for a medical exam or seeking to educate yourself or others about these serious conditions, this presentation will equip you with essential information and practical insights.
Let's begin our journey into understanding eating disorders and the significant impact they have on individuals and society.
---
For any queries ,contact shvmshrm@outlook.com
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.
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
2. Objectives
• Definition of MPN
• Types of MPN
• Mutations of MPN
• Aetiology of MPN
• Clinical features of MPN
• CML and Philadelphia Chromosome
• Definition of each type
3. List of Contents:
• Definition
• Types
• PV
• ET
• MF
• CML and Philadelphia Chromosome
• Summary or conclusion
• Question
4. Myeloproliferative Neoplasms
MPNs (PV, ET, MF)
• Clonal hematopoeitic disorders
• Proliferation of one or more of myeloid lineages:
– Granulocytic
– Erythroid
– Megakaryocytic
5. Aetiology
Single acquired mutation of the cytoplasmic
tyrosine kinase Janus-associated kinase 2
(JAK2) (Val 617 Phe).
JAK2 mutation in:
All patients with Polycythemia Vera
and in 50% of those with Essential
Thrombocythemia and Idiopathic
Myelofibrosis
6. In MPN
• There are Relatively normal maturation of the cells
• Each type closely related to each other.
• Evolution from one entity into another occurs during
the course of the disease.
• Special risk of leukemic transformation
7. Activation of JAK2
Proliferation of cell
Receptor
Hemopoietic
growth factors
JAK2
Protein
Progenit
or cell
RBC Granulocyte
Megakaryocyte
Platelet
NORMALLY
8. Activation of JAK2
& Proliferation
of the cell
Without growth
factor
Receptor
Hemopoietic
growth factors
JAK2
Protein
MUTATION
Progenit
or cell
RBC Granulocyte
Megakaryocyte
Platelet
JAK2 Mutation
9. Bone marrow stem cell
Clonal abnormality
Granulocyte
precursors
Red cell
precursors
Megakaryocytes Reactive
fibrosis
Essential
thrombocytosis
(ET)
Polycythaemia
vera
(PV)
Myelofibrosis
AML
Chronic myeloid
leukemia
70%
10% 10%
30%
10. Polycythemia Vera
Definition of polycythemia
Its increase in the Hb concentration above the
upper limits of normal range for the patient age and
sex.
• Raised packed cell volume (PCV)
• Male > 52% (normally 40-52%)
• Female > 48% (normally 36-48%)
Classification
• Absolute(Total red cell volume & total plasma volume increased
» Polycythaemia vera
» Secondary polycythaemia
» Idiopathic erythrocytosis
• Apparent or relative
11. Polycythemia Vera
Polycythemia Vera is a clonal stem cell disorder
characterized by increased red cell production
• Abnormal clones behave autonomous
• Same abnormal stem cell give rise to granulocytes and
platelets
12. Clinical features
- The increased PCV leads to:
• an increased blood viscosity, Hyperviscosity
• abnormal platelet–endothelial contact increase thrombotic risk.
• Neurological features
Over and above the consequences of occlusive vascular lesions, the
sluggish cerebral blood flow secondary to the increased PCV is
thought to underlie features such as headaches, drowsiness,
insomnia, amnesia, tinnitus, vertigo, chorea and even depression.
• Transient visual disturbances also occur.
13. Polycythemia Vera
Laboratory features and morphology
• Hb, PCV (HCT), and Red cell mass increased
• Increased neutrophils and platelets
• NAP score normal or increased
• Serum uric acid high (gout)
• Circulating erythroid precursors (nucleated RBC)
• Hypercellular bone marrow
• Low serum erythropoietin
14. Secondary polycythemia
• Caused by compensatory erythropoietin ↑ in
- high altitudes
- pulmonary disease and alveolar hypoventilation
- cardiovascular disease.
- increased affinity Hb (familial polycythemia)
- heavy cigarette smoking.
• Caused by inappropriate erythropoietin increase in
- renal disease.
- tumours such as uterine fibroma, hepatocellular
carcinoma, cerebellar haemangioma.
17. Essential Thrombocythemia (ET)
Primary thrombocytosis / idiopathic thrombocytosis
• Clonal myeloproliferative disease of megakaryocytic
lineage
• Sustained thrombocytosis >450 x 10 9/L & often >1000 x 10 9/L
• Increase megakaryocytes in the BM
• Thrombotic or/and hemorrhage episodes
• 2.5 cases/100,000
• M:F 2:1
• Median age at diagnosis: 60
18. Investigations
ET is a diagnosis of exclusion
• Rule out other causes of elevated platelet
count
• Infection
• Tissue damage (surgery)
• Chronic inflammation
• Malignancy
19. Blood film Bone marrow
increase platelet increase megakaryocyte
Essential Thrombocythemia
(ET)
20. Essential thrombocythemia
Primary thrombocytosis / idiopathic thrombocytosis
• Treatment
• Anticoagulant for thrombosis
• Chemotherapy to decrease platelet count
• Disease course and prognosis
• 25 % develops myelofibrosis
• Acute leukemia transformation
• Death due to cardiovascular complication
21. Myelofibrosis
Chronic idiopathic myelofibrosis
• Progressive fibrosis of the marrow & increase connective tissue
element
• Extramedullary erythropoiesis
– Spleen
– Liver
• Abnormal megakaryocytes which will stimulate fibroblasts &lead to
marrow fibrosis due to stimulation of platelet derived growth factor
& other protiens secreted by megakayocytes & platelets.
• 1/3 of patients have previous history of PV & some present with
clinical &lab features of both disorders.
22. Myelofibrosis
Investigations
• Anemia
• High WBC at presentation
• Later leucopenia and thrombocytopenia
• Leucoerythroblastic blood film
• Tear drops red cells
• Bone marrow aspiration- Failed due to fibrosis
• Trephine biopsy- fibrotic hypercellular marrow
• Increase in NAP score
• Transformation to acute myeloid leukaemia occurs
in 10-20% of patients
• High serum uric acid and LDH levels
24. Treatment
• Blood transfusions and regular folic acid
• Hydroxyurea
• Danazol
• Splenectomy
• The median survival is 3.5 years
• causes of death include heart failure, infection and leukemic
transformation.
25. Chronic Myeloid Leukemia
clonal disorder that results from a stem cell abnormality
marked proliferation of mature and maturing granulocytes.
• Most common adult leukemia
in Western world
• Slight Male predominance
26. • The disease accounts for around 15% of leukemia.
• Median age at presentation 50
• May occur at any age.
• Philadelphia Chromosome
t(9;22) is Positive in
more than 90%
• This translocation is
diagnostic of CML
27. What is Philadelphia Chromosome?
• Is the chromosome which result from the
t(9;22)(q34;q11)part of the Abelson proto-oncogene (ABL)
is moved from chromosome 9 to the (BCR) gene on
chromosome 22 & part of chromosome 22 moves to
chromosome 9.
• The abnormal chromosome 22 is
the Ph Chromosome code for
abnormal tyrosine kinase
Tyrosine Kinase leads to persistent
proliferation of the white cells
Philadelphia
Chromosome
28. Summary or Conclusion:
• MPNs:Clonal hematopoeitic disorders
• Proliferation of one or more of myeloid lineages:
– Granulocytic
– Erythroid
– Megakaryocytic
• Define chronic Myeloid leukemia
• Define Philadelphia chromosome
29. Questions?
• Define MPN
• Mention types of MPNs
• What are the diagnostic criteria for PV, ET and
MF?
• What are the investigations of each type
• THANK YOU