Carcinoid tumours originate from hormone-producing cells in the digestive system or lungs and can cause carcinoid syndrome. Carcinoid syndrome is characterized by flushing, diarrhea, and other symptoms due to excess hormone production. Diagnosis involves tests of urine or blood for biomarkers like 5-HIAA. Treatment focuses on reducing symptoms using somatostatin analogues and potentially includes procedures to reduce tumour size. Management of carcinoid syndrome requires a multidisciplinary approach.
Has cancer science got you stumped and overwhelmed? Leading gynecologic oncologist, Dr. Don Dizon, takes us to cancer college in this webinar. He explains the science behind ovarian cancer, how it develops, how it's diagnosed, and how ovarian cancer treatments work.
Has cancer science got you stumped and overwhelmed? Leading gynecologic oncologist, Dr. Don Dizon, takes us to cancer college in this webinar. He explains the science behind ovarian cancer, how it develops, how it's diagnosed, and how ovarian cancer treatments work.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
EATING DISORDERS (Psychiatry-7)by dr Shivam sharma.pptxShivam Sharma
For any queries ,contact shvmshrm@outlook.com
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## 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
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
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
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
Carcinoid Syndrome.pptx
1. Carcinoid Syndrome and
Endocrinology
Dr Vikram Singh Chauhan(MD, DM)
Consulting Endocrinologist: Dr
Chauhan’s Clinic and Jabalpur Hospital
& Research Center, Jabalpur
2. Carcinoid Tumours and Syndrome
• Carcinoid tumours (neuroendocrine
neoplasms) usually originate in hormone-
producing cells that line the small intestine or
other parts of the digestive tract; also occur in
the pancreas, lungs (bronchial carcinoid);
rarely testes or ovaries
• Carcinoid syndrome: diverse set of symptoms
due to excess hormones produced by
carcinoid tumours
3. Epidemiology
• Occurs mainly in gastrointestinal or lung related
NEN
• Incidence of carcinoid syndrome- 1 :100 000
population¹
• Carcinoid syndrome: prevalence of ~20% in
NENs²
• Small intestine(42%), rectum(27%),
bronchopulmonary(25%), stomach(8.7%)3
1. The Lancet Oncology, 18(4), 525–534. 2017
2. Neuroendocrinology, 90(4) 349–363 2009
3. Cancer 97:934–959 2003
4. • Carcinoid syndrome function of:
-- Tumour mass
-- extent and localization of metastases
-- localization of the primary tumour
• Most common in tumours originating in small
intestine and proximal colon: 40%-60% patients
with these tumours experience syndrome¹
• Less common: bronchial, midgut, rectal
• Syndromic patients: liver metastasis²
1. Am J Cardiol. 21:376-387 1968 2. J Am Med Assoc. 186:905-907 1963
5. Clinical Features
• Diarrhoea: occurs in ~80%
• Secretory– fluid & electrolyte imbalance
possible
• Due to increased GI motility caused by
hormones of tumour: serotonin, tachykinins,
histamines, kallikrein, and prostaglandins,
can stimulate peristalsis, electromechanical
activity and intestinal tone
Semin Gastrointest Dis. 10:156-172 1999
6. Clinical Features
• Flushing: ~70%
• 4 described types:
-- Erythematous: midgut carcinoid, disease onset
-- Violaceous: midgut carcinoid, later stages
-- Prolonged: malignant bronchial carcinoids
-- Bright red: gastric carcinoids(ECLomas)
• Usual areas: face, neck, and upper chest
Am J Cardiol. 21:376-387 1968
7. Clinical Features
Precipitating factors for flushing:
--Stress
-- Stimulation of the vagus nerve by brushing
of teeth or mastication
-- Ingestion of alcohol or tyramine-containing
foods such as cheese, coffee, chocolate, nuts,
avocado, bananas, and red wine
EurJ Endocrinol 177(5): 219–229 2017
9. Clinical Features
• Abdominal Pain: ~40%; related to mesenteric
fibrosis
• Wheezing/bronchospasm: 10-20%; related to
hormone excess
• Palpitations: upto 30 minutes
• Itching/skin rashes: histamine related
Endocrine Reviews, vol. 25, no. 3, pp. 458–511, 2004
10. Clinical Features
• Carcinoid Heart Disease: plaque-like
thickenings of the endocardium, valve leaflets,
atria, and ventricles¹,2
• 10% to 20% of the patients1,2
• Stenosis and regurgitation
• New collagen beneath endothelium of
endocardium: almost pathognomonic for
carcinoid heart disease1
1. Circulation. 77:264-269 1988
2. Am J Med. 36:5-34 1964
11. Clinical Features
• Carcinoid Heart Disease: Right sided fibrosis—
in patients with liver metastases who usually
also have the carcinoid syndrome
• Correlation between circulating levels of
serotonin and tachykinins and degree and
frequency of carcinoid heart lesions
• NT-proBNP: best diagnostic and prognostic
marker of carcinoid heart disease1
1. Int J Cardiol. 173:29-32 2014
12. Carcinoid Crisis
• Spontaneously or during induction of anesthesia,
embolization procedures, chemotherapy, or
infection
• Characterized by
--Severe flushing
--Diarrhea
--Hypotension
--Hyperthermia
--Tachycardia
• Octreotide (IV or SC) given pre, intra, and post op
N Engl J Med. 313:1229-1230 1985
13. Clinical Features
• Cushing syndrome: ectopic ACTH/CRH--
pulmonary and thymic carcinoids
• Acromegaly: ectopic GHRH-- foregut carcinoids
• Gastric carcinoids:
--Type 1—chronic atrophic gastritis
--Type 2– ZES
--Type 3– sporadic, more malignant, no
hypergastrinemia
17. Classification of Carcinoid Tumours
Williams Textbook of Endocrinology(14th Ed., pg 1693)by S Melmed, Elsevier.
18. Diagnosis
• 24 hour urinary 5HIAA
• Less sensitive, more specific
• Serum CgA: more sensitive and less specific
than urinary 5HIAA
• Platelet serotonin levels
• Plasma NSE: less sensitive and specific than
CgA; useful in lung NENs and NENs with higher
proliferation
20. Localization
• Whole-body SRS: preferred initial modality
earlier: 111In-DTPA-Phe-octreotide
(Octreoscan)
• 68Ga-DOTATATE/TOC-PET scanning: higher
sensitivity than Octreoscan
• CT/MRI: for liver metastasis
• 18F-DOPA-PET scanning using 11C5HTP: useful
to monitor therapy results
International Journal of Endocrine Oncology, 6(2). https://doi.org/10.2217/ije-
2019-0001
21. Treatment
• Tumour reduction and symptomatic control
• Long-acting somatostatin analogues:
cornerstones
• Bind to SSTR1, SSTR5, SSTR3: Lower growth factor
production & antiproliferative effect
• Octreotide, Octreotide LAR, Lanreotide
• Reduction in tumour size demonstrated with high
dose therapy
• Tachyphylaxis, GI side effects, gallstone
development
22. Treatment
• Interferon alpha 2a and alpha 2b
• Biochemical control and size reduction
• Can be combined with somatostatin
analogues
• Chronic fatigue syndrome, anemia,
luekopenia, thrombocytopenia, autoimmunity
development
23. Treatment
• Chemotherapy:
--Streptozotocin plus 5-fluorouracil
--Doxorubicin
--Cisplatin plus etoposide
--Dacarbazine plus 5-fluorouracil
--Temozolomide
• Attempted in foregut carcinoids(more
malignant)
• Cancer. 68:227-232 1991
• Ann Oncol. 6:77-79 1995
• Cancer. 83:372-378 1998
• Clin Cancer Res. 13:2986-2991 2007