inst/entry_level/modals.R

# *------------------------------------------------------------------
# | PROGRAM NAME: modals.R
# | DATE: 29/03/2018
# | CREATED BY:  David Granjon
# *----------------------------------------------------------------
# | PURPOSE:  This code provide all modals needed to generate the
# |           introduction to each case study
# *-----------------------------------------------------------------
# | UPDATES: 29/05/2018 (last update)
# |
# |
# *------------------------------------------------------------------

# Modal for primary hyperparathyroidism
modal_php1 <- modalDialog(
  title = tagList(
    "About Primary Hyperparathyroidism",
    HTML(
      paste0(
        '<button type="button" class="btn btn-default pull-right" data-dismiss="modal">
         <i class="fa fa-close"></i>
         Dismiss
        </button>'
      )
    )
  ),
  withMathJax(

    tags$i(
      "As shown in the figure, parathyroid hormone (PTH)",
      HTML(paste0("<b>synthesis</b>")), "and", HTML(paste0("<b>secretion</b>")), "are
      tightly regulated. Known regulators of PTH synthesis include plasma
      levels of 1,25(OH) vitamin  D3 (\\([D_3]_p\\)),
      which inhibit PTH synthesis, and  plasma levels of phosphate (\\([P_i]_p\\))
      that promote it. Plasma levels of calcium (\\([Ca^{2+}]_p\\))
      further modulate (inhibit) PTH secretion into the blood stream through
      the action of the calcium sensing receptor (CaSR). As a result PTH secretion
      is blunted in hypercalcemia (elevated  \\([Ca^{2+}]_p\\)) while it is
      stimulated in hypocalcemia. The relationship between PTH secretion
      and \\([Ca^{2+}]_p\\) is defined by a sigmoidal decreasing curve,
      according to the figure below."
    ),

    tags$br(), tags$br(),

    fluidRow(
      column(6, align = "left",
        tags$a(href = "modal_php1/modal_php1_2.svg", target = "_blank",
          tags$img(src = "modal_php1/modal_php1_2.svg")
        )
      ),
      column(6, align = "right",
        tags$a(href = "modal_php1/modal_php1_3.svg", target = "_blank",
          tags$img(src = "modal_php1/modal_php1_3.svg")
          )
      )
    ),

    tags$br(),

    fluidRow(
      column(2, align = "left",
        tags$a(href = "modal_php1/modal_php1_1.svg", target = "_blank",
             tags$img(src = "modal_php1/modal_php1_1.svg")
        )
      ),
      column(10,
             tags$i(
               "Contrary to humans who have 4 parathyroid glands
                (PTHg), rats have only 2. Primary hyperparathyroidism
                (PHP1), is characterized by an oversecretion of PTH despite
                elevated \\([Ca^{2+}]_p\\) (which should normally abolish
                its secretion). PHP1 can be due to a solitary
                adenoma in parathyroid glands, which is the
                case in 90-95% of clinical cases. However, this can be
                sometimes due to familial genetic disorders
                (5%) or parathyroid carcinoma (1%).")
      )
    ),

    tags$br(),
    tags$i("During PHP1, \\([Ca^{2+}]_p\\) is expected to rise, while
           \\([P_i]_p\\) drops. PHP1 can be cured using cinacalcet which reduces
           PTH secretion, thereby blunting its effect on Ca and Pi homeostasis.
           Ultimately, parathyroid surgery can be a definitive treatment.
           Yet is it possible (but rare) that the tumor reappears."),
    tags$br(),
    tags$br(),
    tags$i("In the following case study, you will be able to explore
           the regulation mechanisms and consequences of PHP1. Note that
           a rat model of primary hyperparathyroidism already exists
           and can be found here."),
    tags$a(href = "https://www.ncbi.nlm.nih.gov/pubmed/3591940", target = "_blank",
           "https://www.ncbi.nlm.nih.gov/pubmed/3591940")
  ),
  size = "m",
  footer = NULL
)

# Modal for hypoparathyroidism
modal_hypopara <- modalDialog(
  title = tagList(
    "About hypoparathyroidism",
    HTML(
      paste0(
        '<button type="button" class="btn btn-default pull-right" data-dismiss="modal">
        <i class="fa fa-close"></i>
        Dismiss
        </button>'
      )
    )
  ),
  "This is the reverse situation of primary hyperparathyroidism. Therefore, it is
  characterized by a loss of function of parathyroid gland, which can be congenital,
  due to a surgery in the thyroid area (thyroidectomy), or to an immune disease.
  Notice that, only one gland would be able to maintain normal PTH and calcium
  levels. Hypoparathyroidism triggers hypocalcemia as well as hyperphosphatemia
  (or at the uper bound of the normal range).
  Additionally, 1,25(OH)D3 levels are low. In some cases, hypoparathyroidism may
  lead to cardiac failure, mental dysfunctions. Treatments include intravenous
  calcium injection (calcium-gluconate, calcium-carbonate), as well as vitamin D3
  supplementation (1,25(OH) vitamin D3, also known as calcitriol is the active form
  and the faster). Besides, diuretics help in avoiding the hypercalciuria due to
  vitamin D3 supplementation. Indeed, PTH effect on renal calcium reabsorption is
  significantly lowered. Hyperphosphatemia is cured by reducing phosphate intake.",
  tags$a(href = "modal_hypopara/modal_hypopara.svg", target = "_blank",
    tags$img(src = "modal_hypopara/modal_hypopara.svg")
  ),
  "In the following case study, you will be able to explore the regulation
  mechanisms and consequences of hypoparathyroidism.
  Finally, be careful not to mingle hypoparathyroidism and pseudo-hypoparathyroidism,
  the later being associated with a resistance to the parathyroid hormone action.",
  "You can find extra informations here:",
  tags$br(),
  tags$a(href = "http://www.nejm.org/doi/full/10.1056/NEJMcp0803050", target = "_blank",
         "http://www.nejm.org/doi/full/10.1056/NEJMcp0803050"),
  size = "m",
  footer = NULL
)

# Modal for vitamin D3 deficiency
modal_hypoD3 <- modalDialog(
  title = tagList(
    "About vitamin D3 deficiency",
    HTML(
      paste0(
        '<button type="button" class="btn btn-default pull-right" data-dismiss="modal">
        <i class="fa fa-close"></i>
        Dismiss
        </button>'
      )
    )
  ),
  "As shown in the figure below, vitamin D3 synthesis's pathway is complex and has
  two main origins: a reaction between UV rays and skin and from the food (vitamin D3,
  vitamin D2). The storage form of vitamin D is 25(OH)D, also known as calcidiol, whose
  conversion into calcitriol (active form of vitamin D3) is extremely regulated.
  Vitamin D deficiency refers to a deficiency in the storage form, namely 25(OH)D,
  which may be due to a reduced skin synthesis, a decreased intake, liver failure,
  chronic kidney disease, nephrotic syndrom.
  About 1 billion of people on earth have vitamin D deficiency.",
  tags$a(href = "modal_hypoD3/modal_hypoD3.svg", target = "_blank",
    tags$img(src = "modal_hypoD3/modal_hypoD3.svg")
  ),
  "Vitamin D deficiency causes hypocalcemia, hypophosphatemia as well as high PTH levels
  (secondary hyperparathyroidism).
  This may result in bone diseases such as osteoporosis as well as osteopenia.
  To treat vitamin D deficiency, a common approach is to use vitamin D supplements.
  However, inadequat treatment may result in massive hypercalcemia, hypercalciuria,
  with the risk of kidney stones formation, mainly if the treatment is extended.
  In the following case study, you will be explained all mechanisms and consequences
  involved during vitamin D3 deficiency.",
  "You can find extra informations here:",
  tags$br(),
  tags$a(href = "http://www.nejm.org/doi/full/10.1056/NEJMra070553", target = "_blank",
         "http://www.nejm.org/doi/full/10.1056/NEJMra070553"),
  tags$a(href = "http://www.nejm.org/doi/pdf/10.1056/NEJMp1608005", target = "_blank",
         "http://www.nejm.org/doi/pdf/10.1056/NEJMp1608005"),
  tags$a(href = "http://www.nejm.org/doi/full/10.1056/NEJMc063341#t=article", target = "_blank",
         "http://www.nejm.org/doi/full/10.1056/NEJMc063341#t=article"),
  size = "m",
  footer = NULL
)

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