Abnormal uterine bleeding can have various causes and presentations. It includes heavier or longer than normal periods, bleeding between periods or after menopause. Evaluation involves history, examination, and tests to identify potential issues like fibroids, pregnancy complications, or endocrine disorders. Treatment depends on the underlying cause but may involve hormonal therapy, surgical procedures like endometrial ablation, or hysterectomy in some cases.
Abnormal uterine bleeding can occur when a woman experiences a change in menstrual loss, or the degree of loss or vaginal bleeding pattern differs from that experienced by the age-matched general female population
AUB is not restricted to menstrual bleeding that is abnormally heavy, but includes bleeding that is abnormal in TIMING
Menstrual cycle irregularities can have many different causes. For some women, use of birth control pills can help regulate menstrual cycles. However, some menstrual irregularities can't be prevented. Regular pelvic exams can help ensure that problems affecting your reproductive organs are diagnosed as soon as possible.
Abnormal uterine bleeding can occur when a woman experiences a change in menstrual loss, or the degree of loss or vaginal bleeding pattern differs from that experienced by the age-matched general female population
AUB is not restricted to menstrual bleeding that is abnormally heavy, but includes bleeding that is abnormal in TIMING
Menstrual cycle irregularities can have many different causes. For some women, use of birth control pills can help regulate menstrual cycles. However, some menstrual irregularities can't be prevented. Regular pelvic exams can help ensure that problems affecting your reproductive organs are diagnosed as soon as possible.
The term metrorrhagia is often used for irregular menstruation that occurs between the expected menstrual periods. Oligomenorrhea is the medical term for infrequent, often light menstrual periods (intervals exceeding 35 days). Amenorrhea is the absence of a menstrual period in a woman of reproductive age.
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.
- 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
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
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
2. Bleeding is considered to be abnormal in the
following situations:
• Bleeding between periods
• After sex
• Spotting any time in the menstrual cycle
• Bleeding that is heavier than normal or prolonged duration
• Bleeding after menopause
3. Definitions
Abnormal uterine bleeding includes the following:
• Menorrhagia – increase in the volume or duration or both. Menstrual cycle
is regular.
• Polymenorrhoea – normal volume and duration of menstruation but
shortened cycle – decreased interval <25 days
• Metrorrhagia – bleeding independent of menstrual pattern. Volume not
usually excessive.
• Menometrorrhagia – increased flow during menstruation and between
menstrual periods. No pattern. Flow may become continuous.
• Oligomenorrhoea – normal volume and duration of menstruation but
lengthened cycle >35 days
5. Dysfunction Uterine Bleeding
Bleeding in the absence of organic disease.
Ovulatory:
Due to problems with corpus luteum
1. Poor formation or function of corpus luteum
• Leads to decreased secretion of oestrogen and progesterone during
the luteal phase (second half) of cycle.
• In addition there is irregular ripening of endometrium.
• Presents with premenstrual spotting, menorrhagia, or
polymenorrhoea.
6. Ovulatory DUB cont
2. Irregular shedding of endometrium
• Persistence of corpus luteum therefore persistent progesterone
secretion during menstruation.
• Prolonged luteal phase.
• Therefore postmenstrual spotting occurs – bleeding continues
intermittently for several days after normal menstrual flow has
stopped.
• Associated with menorrhagia or oligomenorrhoea.
7. DUB cont
Anovulatory
Bleeding is not preceded by ovulation therefore luteal secretory changes
absent.
1. Excessive oestrogen stimulation of endometrium
• Progesterone absent therefore it can’t counter effects of oestrogen.
• Results in endometrial hyperplasia and no bleeding during this time.
• Eventually oestrogen levels fluctuate and decrease leading to heavy
bleeding from the hyperplastic endometrium.
• Cyclical and regular OR acyclical and irregular OR prolonged amenorrhoea
follow by bouts of metropathia haemorrhagica (excessive bleeding).
8. Anovulatory DUB cont
2. Inadequate oestrogen stimulation
• Circulating oestrogen levels low
• Therefore endometrium proliferation is present to a lesser degree
• Waxing and waning of oestrogen production leading to drop in
oestrogen level. Endometrium cannot be maintained – bleeding
occurs.
• Acyclical and irregular
9. Pregnancy related bleeding
• Miscarriage: the ending of a pregnancy before viability of foetus is
reached. Presents with vaginal bleeding that ranges from light to
heavy and is accompanied by abdominal and back pain – according to
stage of miscarriage.
• Ectopic pregnancy: is implantation of blastocyst anywhere other than
the endometrial lining of uterine cavity. Presents with amenorrhoea
followed by vaginal bleeding and abdominal pain.
• Gestational trophoblastic disease: abnormal proliferation of the
trophoblast – range from benign to malignant. Complete mole will
present with vaginal bleeding between 11th and 25th week of
pregnancy as well as persistent and excessive nausea and vomiting.
11. Genital Tract Pathology
• Congenital uterine abnormalities: Mullerian duct abnormalities (uterus and
upper 2/3 of vagina) may present with menorrhagia or spasmodic
dysmenorrhoea.
• Trauma
• Infection
• Endometriosis: functioning endometrial tissue is implanted outside the
uterine cavity. Presentation may include dysmenorrhea, dyspareunia,
infertility, dysuria, and pain during defecation but depends on where
implant occurs.
• Adenomyosis: presence of endometrial tissue in myometrium. Presents
with menorrhagia, dysmenorrhoea, metrorrhagia.
12. • Benign neoplasms: Fibroids can cause menorrhagia or
menometrorrhagia.
• Malignant neoplasms: Carcinomas and sarcomas, as well as hormone-
producing tumours
15. Aetiology according to age
• Prepubertal child: Consider precocious puberty, nonmenstrual
bleeding (due to foreign bodies, vaginitis, tumours), and bleeding
disorders
• Adolescent: Most common cause is anovulatory dysfunctional uterine
bleeding. The first 30 to 40 cycles are anovulatory (first 2-3 years).
Also consider pregnancy, infection, hormonal birth control, and
bleeding disorders.
16. • Reproductive age (20-40 years): causes to consider are uterine
fibroids, uterine adenomyosis, endometrial polyps, pregnancy, cancer,
infection, bleeding disorders, hormonal contraception, and medical
illnesses.
• Post-menopausal (>40 years): Causes to consider are anovulatory
DUB, malignant or benign neoplasms, infection of the uterus, use of
blood thinners or anticoagulants
17. Approach to Abnormal Uterine Bleeding
History:
• Menstrual history: LNMP, normal cycle, any changes in cycle, clots,
symptoms of ovulation, post-coital bleeding, intermenstrual bleeding,
menopause
• Sexual history: sexually active, coitarche, number of partners,
contraceptive use, STIs
• Gynae: any previous problems, medication, pap smears
• Obs: parity, infertility
• Medical: bleeding disorders, endocrine disorders, diabetes,
hypertension, HIV
18. • Drugs: anti-coagulation, contraception, HRT
• Surgical: previous operations
• Family: bleeding disorders, cancer of endometrium or breast
• Social: smoking
19. On Examination
• General: Shock, petechiea, purpura, endocrine stigmata, PCOS
• Breast
• Abdomen: pregnancy, liver and spleen (bleeding disorders), mass
• Pelvic: Local lesions in vulva, vagina, cervix, uterus and adnexa. PR
(bleeding). If virgo intacta – ultrasound, PR
21. Management
Acute Bleed
Resuscitate if necessary:
• ABC
• 2 wide bore IV lines
• FBC, U&E, type and screen
• Order 4 units of blood – 2 stat
• Catheterise
22. Hormonal Therapy
• Oral progestogen
For acute episode of anovulatory uterine bleeding. 10-30mg daily 7-10 days
Arrests bleeding within 24-36 hours
Converts uterus from a proliferative endometrium to secretory endometrium
• High dose oestrogen
Day 1: 1 tablet 5 times daily
Day 2: 1 tablet 4 times daily
Day 3: 1 tablet 3 times daily
Continue until 1 tablet taken daily and bleeding stops
Include anti-iemetic
23. • Surgical therapy
Uterine curettage temporarily arrests the haemorrhage. Bleeding
recurs within a few months.
24. Definitive Management
Medical management of menorrhagia
• Antifibrinolytic drugs
Tranexamic acid
Prevents breakdown of clots
Useful where oestrogen/progesterone therapy contraindicated
• NSAIDs decrease bleeding by 35-40%
Mefenamic acid 500mg TDS OR Brufen 400mg TDS
Where hormone therapy contraindicated
25. • COC
Reduce bleeding by 53%
Mechanism may be by inducing endometrial atrophy
Maintain cycle control
• Progestogens
Anovulatory DUB where oestrogen contraindicated
• Intrauterine system
• Danazol
Direct inhibition of sex hormone steroid synthesis
• Gonadotropin-releasing hormone analogues
Inhibit release of FSH and cause suppression of ovarian steroid hormone
production
26. Surgical Management
Patients in whom medical management is ineffective or unmanageable
side effects
• Endometrial ablation
Safe alternative to hysterectomy
Destroys stratum basalis layer of endometrium therefore preventing
regeneration
Methods include laser ablation, endometrial resection, and various
balloon techniques
27. • Hysterectomy
Definitive management for abnormal uterine bleeding in following
patients:
Completed their families and over age 45
Medical management failed
Premalignant conditions of cervix/endometrium
Failed endometrial ablation