This document discusses adolescent health issues and disorders of puberty. It defines adolescence as the period between ages 10-19. Key health problems discussed include nutritional issues like anemia, obesity, and eating disorders; reproductive issues like teenage pregnancy and infections; sexually transmitted diseases; and mental health problems such as depression, psychosis, and anxiety disorders. The document also provides an in-depth overview of precocious and delayed puberty, their causes, types, and treatment approaches.
precocious puberty is one of the grey areas for pediatricians and gyenecologists. this is an attempt to answer some of the questions the content is references taken from authorative textbooks
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
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- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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precocious puberty is one of the grey areas for pediatricians and gyenecologists. this is an attempt to answer some of the questions the content is references taken from authorative textbooks
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
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
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Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
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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
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
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2. DEFINITION- ADOLESCENCE
WHO – age period between 10-19 years for both sexes , married and
unmarried people
Phase of human development encompassing the transition from
childhood to adulthood
Origin from latin word – to grow into maturity
4. Adolescent health problems
• NUTRITIONAL
• REPRODUCTIVE
• SEXUAL TRANSMITTED DISEASES
• MENTAL HEALTH PROBLEMS
• BEHAVIOUR PROBLEMS
5. NUTRITIONAL ADOLESCENT PROBLEM
• UNDERNUTRITION
• - leads to impaired growth , anemia , iodine deficiency
• IRON DEFICIENCY ANEMIA
• Prevalence in adolescent girls range from 40-42%
• Reason for IDA
• 1. increased requirement for growth
• 2. menstrual loss
• 3. dislike of iron rich food etc
6. • obesity:
• Prevalence of obesity and overweight is 11.1% and 14.2%
• Prevalence is higher in boys
• EATING DISORDER
• Bulimia nervosa
• Anorexia nervosa
• Binge –eating
7. REPRODUCTIVE PROBLEMS
• TEENAGE PREGNANCY ( 16- 19% of total pregnancy )
• Genital tract infection
• Preterm labour
• Intrauterine growth restricted babies
•
Abortion related problems
• Unsafe abortion
•
9. SEXUALLY TRANSMITTED DISEASES
• HIVAIDS – young people between 10-25 make 50% of new HIV infection
• - syphilis
• - gonorrhea
• 1 out 20 adolescents in india – STD
10. MENTAL HEALTH PROBLEMS
• DEPRESSION AND SUICIDE
• PSYCHOSIS
• MANIA
• CONDUCT DISORDER
• ANXIETY DISORDER
11. PRECOCIOUS PUBERTY
• THE TERM PRECOCIOUS PUBERTY IS RESERVED FOR GIRLS WHO EXHIBIT
ANY SECONDARY SEX CHARACTERESTICS BEFORE THE AGE OF 8 OR
MENSTRUATE THE BEFORE THE AGE OF 10.
12. WHAT ARE THE TYPES OF PRECOCIOUS PUBERTY?
1- Central / true precocious puberty
2-Peripheral /GnRH independent precocious puberty
3-Incomplete precocious puberty
13. CENTRAL PRECOCIOUS PUBERTY
• CPP is physiologically normal pubertal development that occur at an early age
• GnRH dependent
GnRH pulses gonadotropins ↑↑ ovarian estrogen production & eventual ovulation
• It follows the pattern of pubertal changes that occur in normal puberty
• More common in girls than boys
14. CAUSES OF CPP
1-Idiopathic ----- 80-90%
2-CNS tumors
a-Hypothalamic hamartomas
• A congenital malformation
• The most common type of CNS tumor that cause CPP
• Size & shape do not change significantly over time
• May be associated with seizures (the intrahypothalamic type)
• Rapidly progressing CPP in a child < 2 Y suggest this Dx
• GnRH Rx is satisfactory & safe
b-Optic gliomas
c-Craniopharyngioma
d-Dysgerminoma
e-Epindymoma
f-ganglioneuroma
16. TREATMENT OF CPP
Purpose of treatment
• To gain normal adult height
(Pt with CPP will have an ultimately shortened adult height)
• Amelioration of the psychosocial consequences of size
unrealistic adult expectations
Who should be treated?
• Pt. with early puberty (<6Y) , accelrated growth & advanced
skeletal age should be treated, (bone age >2Y>chronologic
age. Menarche <8Y
• Pt. with early onset but without indication that puberty is advancing should be followed up
17. 1-THE TREATMENT OF CHOICE IS A GnRH ANALOGUE
• GnRH agonists (zoladex) bind to GnRH receptors
( competitive inhibition ) down regulation of receptor function
gonadotropin secretion inhibition of the
HPO axis estrogen secretion regression of the
manifestation of puberty
• The goal of therapy is complete suppression of gonadotropin
secretion prepubertal GnRH stimulation test result
• Adult Ht of Rx pt. > untreated
• Adult Ht is related to skeletal age at the onset of Rx
• Adult Ht of Rx pt. is still < target Ht / predicted Ht
18. • Rx is continued until the progress of puberty is age appropriate
• Best statural outcome pt. treated until bone age 12 -12.5 years
• Growth hormone may be added to Rx
• After discontinuation of Rx resumption of puberty occurs &
precedes at a normal pace
• Side effects: local injection reaction & sterile abscess
2-Medroxyprogestrone acetate
• Used in the past
• Supress the progression of puberty & menses
• NO effect on skeletal maturation & adult height
19. PSYCHOSOCIAL CONSEQUENCES
OF PRECOCITY
1-Children with PP are taller & appear older than their peers unrealistic
expectation from parents , teachers & others child will be under stress
2-They perceive them selves as different however this does not have any long
term effect & they do well psychologically
3-Sexual maturity at an immature age make them vulnerable to be victims of
sexual abuse
20. PERIPHERAL PRECOCIOUS PUBERTY
PPP / Pseudo PP
• GnRH independent
• Due to inappropriate sex hormone secretion or exposure
to exogenous sex steroids
• LH & FSH levels are low prepubertal , while estrogen
• May present with some or all of the physical changes
of puberty
CAUSES
A-Exogenous sex steroids or gonadotropins
B-Abnormal secretion of gonadotropins (rare)
eg. Tumors secreting hCG (teratoma)
21. C-Functioning ovarian tumors UNCOMMON
• Granulosa cell 70% present with PP
• Granulosa-theca cell
• Mixed germ cell usually benign
• Present with rapid progression of breast development ,
vaginal bleeding & abdominal pain
• Palpable mass & dulling of vaginal mucosa
• Estradiol level excessively elevated
• U/S, CT, MRI, are helpful in confirming the Dx
• Rx Excision regression of 2ry sexual cha
22. • Malignant ovarian tumors are responsible for 2-3% of all cases of precocious
pseudopuberty (PPP) in girls.
• The most common are the granulosa cell tumors
23. CONT’D C-Functioning ovarian tumors
• Cystadenoma May produce estrogen
• Gonadoblastoma or androgn or both
• Lipoid Rare
D-Functional ovarian cysts
• Secrete estrogen breast development
• Rupture or resolution estrogen vaginal bleed
• Surgery should be avoided
E-Adrenal tumors RARE
F-Congenital adrenal hyperplasia
G-CHRONIC 1RY HYPOTHYROIDISM
• TSH acts on FSH receptors PPP
• RX thyroxin resolution of the PPP
25. 1-TREAT THE CAUSE (IF POSSIBLE)
2-Drugs
• Testolactone aromatase inhibitor , inhibit conversion of testosterone to
estrogen 35mg/kg/D 3 divided doses
• Ketoconazole inhibit steroid biosynthesis 200mg tds
• Cyproterone acetate Potent progestin & antiandrogen, inhibit androgens at
the receptor level / supress gonadal & adrenal steroidogenesis :
antigonadotrophic 100 mg/m2 2 divided doses
26. • Spironolactone inhibit androgens at the receptor level, ovarian
androgen production, antimineralocorticoid 50-100mg bd
• Medroxyprogestrone acetate
Girls with prolonged PPP prolonged exposure of the CNS to estrogen central precocious
puberty CPP
27. DELAYED PUBERTY
• Definition:
-Absence of pubertal development /No breast development by age 13
-No menarche by age 15
-No menarche by 3 years after the onset of
breast development
-Lack of progression to next Tanner stage in
a year
Sexual hair onset does not mean the onset of puberty / it is due to adrenal androgen secretion