Find the powerpoint (PPt.) on Benign hyperplasia of Prostate with proper explanation and references were taken from the well known Books (Bailey and Love textbook of Surgery and others).
Find the powerpoint (PPt.) on Benign hyperplasia of Prostate with proper explanation and references were taken from the well known Books (Bailey and Love textbook of Surgery and others).
A benign (not cancer) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hyperplasia and BPH.
Urinary incontinence simply means involuntary leaking of urine.
Incontinence can range from leaking just a few drops of urine to complete emptying of the bladder.
Social and hygienic problem.
A benign (not cancer) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hyperplasia and BPH.
Urinary incontinence simply means involuntary leaking of urine.
Incontinence can range from leaking just a few drops of urine to complete emptying of the bladder.
Social and hygienic problem.
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
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.
Follow us on: Pinterest
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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- 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 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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
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
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
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
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.
2. INTRODUCTION
Urinary outflow obstruction and stasis with reflux of urine is of significant
importance in urological disorders because of their effects on renal functions
May lead to :
hydronephrosis
recurrent infection
Renal failure
Stone formation
Negatively affect quality of life significantly
BOO explained as decreased urine flow less than 10ml/sec. it is urodynamic concept
,over time will result in increased voiding intravesical pressure > 80 cm H2O.
Can occur in all age groups and both gender,but the etiology is different.
Common problem in elderly male population
2
4. MICTURITION
• Filling phase
• The walls of ureters contain smooth muscle arranged in spiral ,longitudinal and
circular bundles ,but no distinct layers.
• Regular peristaltic contractions occurring one to five times per minute move the
urine to the bladder.
• The ureters pass obliquely through the bladder wall and also there are no
ureteral sphnicters as such,this configuration keeps the ureters closed except during
the perstaltic wave preventing reflux of urine from the bladder.
• Expected bladder capacity =30+(age in yrs x 30) ml.
4
5. CONT…
• Emptying phase
• Contraction of the circular muscle ,detrusor muscle is mainly responsible in
this phase
• Internal urethral sphincter: smooth muscle bundles on either side of proximal
urethra .
• External urethral sphincter : skeletal muscle sphincter at membranous
urethra.
5
8. ETIOLOGY OF BOO
• In adults the etiologies are acquired
• Mostly primary in the urinary tract but can be secondary to extrinsic lesions
invading or compressing the urinary passage
• BPH
• Urethral stricture
• Prostatic ca
• Bladder neck contracture
• Pelvic masses invading or compressing bladder outlet
• Neurogenic bladder
• UB neck ca
• Stone diseases
•
8
9. ANATOMY OF PROSTATE
• Prostate :
• Accessory gland of male reproductive system (add secretion to seminal fluid)
• Measures 4x3x2cm as inverted cone shape
• Weight about 20 gram normally-
• Five lobes (ant., Post., median/middle, 2 lateral)
• Three zones (peripheral, transitional and central)
• Two capsules: true(condensation of peripheral part), false capsule
• Situated b/n UB and urogenital diaphragm
9
10. BLOOD SUPPLY
Arteries ;inferior vesical,middle rectal,and internal pudendal artery
branchs:
Veins form a prostatic plexus which receives the dorsal vein of the penis
and drains into the internal iliac vein
Lymphatic drainage is primarily to the obturator and internal iliac nodes
10
12. BENIGN PROSTATIC
HYPERPLASIA(BPH)
• BPH is one of the most common disease in aging men and common cause of
LUTS/BOO.
• 50% men over 50 years
• 90% men over 80 years
• Only 40% may complain symptoms
13
14. CONT…
• Testosterone diffuses into prostate and stromal epithelial cells. Within
epithelial cells, it binds directly to the androgen receptor.
• In prostate stromal cells, the majority binds to 5AR (type II) on the nuclear
membrane, is converted to DHT, and then binds (with greater affinity and, therefore,
greater potency than testosterone) to the androgen receptor in the stromal cell.
• Some of the DHT formed in the stromal cells diffuses out of these cells and
into nearby epithelial cells (a paracrine action). Thereby inducing transcription of
androgendependent genes and subsequent protein synthesis.
15
15. CONT…
• Slow and insidious changes occur in two main types
• Overgrowth of glandular elements
• Overgrowth of connective tissue elements
• Initial hyprtrophy =detrusor decompensation==poor bladder
tone=diverticula formation==increasing urine volume
(reflux)=hydronephrosis and upper tract dysfunction.
16
16. PATHOPHYSIOLOGY CONT…….
• Dynamic component of BPO: 1-adrenoceptor-mediated prostatic
smooth muscle contraction. Smooth muscle accounts for
approximately 40% of the area density of the hyperplastic prostate and
human prostate contracts following administration of alpha adrenergic
agonists.
• Static component of BPO: mediated by the volume effect of BPE
17
17. BENIGN PROSTATIC HYPERPLASIA
SYMPTOMS AND SIGNS
• Lower urinary tract symptoms can be described as:
● Voiding symptoms
● hesitancy
● poor flow
● intermittent stream – stops and starts;
● dribbling (including after micturition);
● sensation of poor bladder emptying;
● episodes of near retention.
• Storage symptoms
● frequency;
● nocturia;
● urgency;
● urge incontinence;
● nocturnal incontinence
• Haematuria and acute urinary retention may be the presenting complaint
18
18. CONT…
• Approach to the patient
• Detailed history –urinary diary
• DRE –
• Labs-PSA,cr, cbc,U/A
• Flow rate measurement :
• Upper tract scan
• Cystourethroscopy
• Pressure flow studies –predict outcome after TURP (OPTIONAL)
• Post-void residual urine volume (PVR) -Along with serum creatinine, it indicates whether
watchful waiting is safe. PVR volume is <350mL,( no surgery)
•
•
19
20. MANAGEMENT
• Goals of treatment
• To improve bothersome symptoms.
• To prevent symptom progression.
• To reduce long-term complications (urinary retention, renal insufficiency).
• The management is based on severity of the symptoms as well the availability of
treatment modalities.
• Initially offer lifestyle modification advice (e.g. advice on fluid intake, sugar control)
• mild or moderate bothersome LUTS—discuss active surveillance
- reassurance, lifestyle advice, no immediate treatment,
-regular follow-up
#active intervention (conservative management, drugs, surgery).
21
21. CONSERVATIVE MANAGEMENT
• Storage symptoms: If overactive bladder (OAB) suspected, offer
supervised bladder training, advice on fluid intake, lifestyle advice and,
if needed, containment products, i.e. pads or sheaths; offer supervised
pelvic floor exercises for stress incontinence —continue for
at least 3 months before considering other options.
• Voiding symptoms: offer intermittent self-catheterization (ISC) before
indwelling or suprapubic catheterization if less invasive means fail to
correct LUTS consider medical and surgical interventions.
22
22. DRUG TREATMENT
• Offer drug treatment where conservative options are unsuccessful or
inappropriate; take account of comorbidities and current treatments;
23
23. CONT…..
• Alpha blocker classification
Alpha blockers are categorized by their selectivity for the AR and by their
elimination half-life.
• Non-selective: phenoxybenzamine—effective symptom control, but
high side effect profile.
• α1: prazosin, alfuzosin, indoramin.
• Long-acting α1: terazosin, doxazosin, alfuzosin SR.
• Subtype selective: tamsulosin—relatively selective for α1a-AR subtype
compared to the α1b subtype.
• Percentage of patients who respond to alpha blockers
Patients are able to perceive a 4-point improvement in IPSS. If ‘response’
is defined as >25% improvement in symptoms relative to placebo, most
studies describe response rates of 30–40%.
24
24. 5α-REDUCTASE INHIBITORS
• 5α-reductase inhibitors inhibit the conversion of testosterone to DHT, the
more potent androgen in the prostate .
• causes shrinkage of the prostatic epithelium and, therefore, a reduction in prostate
volume.
• finasteride ,dutasteride
• Can be used in combination with alpha blocker.
25
25. MINIMALLY INVASIVE MANAGEMENT OF
BPH:
• The two broad categories of alternative surgical techniques are minimally invasive
and invasive.
• All are essentially heat treatments, delivered at variable temperature and power and
producing variable degrees of coagulative necrosis (minimally invasive) of the
prostate or vaporization of prostatic tissue (invasive).
•
26
26. CONT…
• Transurethral microwave
thermotherapy (TUMT)
• Transurethral radiofrequency needle
ablation (TUNA) of the prostate
• Transurethral electrovaporization of
the prostate (TUVP)
• as effective as TURP for symptom control
and relief of BOO,
• Holmium laser enucleation of the prostate
(HoLEP)
•
27
27. TURP AND OPEN PROSTATECTOMY
• Indications for TURP
• Bothersome LUTS that fail to respond to changes in lifestyle or
medical therapy.
• Recurrent acute urinary retention.
• Renal impairment due to BOO (high-pressure chronic urinary retention).
• Recurrent haematuria due to BPE.
• Bladder stones due to prostatic obstruction.
• Open prostatectomy
Indications
• Large prostate (>100gm).
• TURP not technically possible (e.g. limited hip abduction).
• Failed TURP (e.g. because of bleeding).
• Urethra too long for the resectoscope to gain access to the prostate.
• Presence of bladder stones which are too large for endoscopic
cystolitholapaxy, combined with marked enlargement of the prostate.
28
29. URETHRAL STRICTURES AND STENOSES
• A urethral stricture is a scar in the subepithelial tissues of the corpus
spongiosum which constricts the lumen of the urethra and make it narrower.
• The 2nd commonest cause of Lower urinary tract obstruction in sub Saharan Africa
• Age range 2o-40 years
• Female -Uncommon ~3%
30
The transition zone surrounds the urethra proximal to the ejaculatory ducts. The central zone surrounds the ejaculatory ducts and projects under the bladder base. The peripheral zone constitutes the bulk of the apical, posterior, and lateral aspects of the prostate. The anterior fibromuscular stroma extends from the bladder neck to the striated urethral sphincter.
Peripheral zone (PZ), central zone (CZ) and transitional zone (TZ) at apex of pre-prostatic sphincter (PPS). Seminal vesicles (SV) and ducti deferentes (DD) fuse to form ejaculatory ducts opening alongside verumontanum (V).
The seminal vesicles lie just cephalad to the prostate under the base of the bladder. They are about 6 cm long and quite soft. Each vesicle joins its corresponding vas deferens to form the ejaculatory duct. The ureters lie medial to each, and the rectum is contiguous with their posterior surfaces.
Peripheral zone: Nearly 75% of the glandular prostate, the peripheral zone surrounds most of the central zone and much of the urethra; in other words, it surrounds the posterior and lateral areas of the prostate gland. Its glands drain into the prostatic urethra.
Central zone: The central zone, which is nearly 25% of the glandular prostatic parenchyma, envelops the ejaculatory ducts and extends toward the base of the urinary bladder.
Transitional zone: This zone is less than 5% of the glandular prostate. The transition zone is composed of two minute glandular regions which are lateral to the preprostatic sphincter and directly related to the proximal urethral segment. The periurethral region is related to this zone and to the junction of the proximal and distal urethral segments. Periurethral ducts, which are responsible for the genesis of benign prostatic hyperplasia, are present.
Stroma ;The anterior fibromuscular stroma is nonglandular. It constitutes ⅓ of the prostatic tissue within the prostatic capsule but is in continuity with the detrusor muscle of the neck of the urinary bladder. It is heavily fixed with the anterior surfaces of the three glandular zones, and represents the periurethral gland region.
Three capsule:
The true capsule is a very thin covering surrounding the gland in toto.
The false capsule (periprostatic fascia or prostatic sheath) is an extraperitoneal fascia (visceral layer of endopelvic fascia).
The peripheral part of the prostate becomes compressed by BPH against the surrounding endopelvic connective tissue(true and false capsules), forming a surgical capsule (pathologic capsule). When enucleation of the prostate is performed, the plane between the compressed peripheral tissue and the adenomatous tissue permits removal of the adenoma, leaving behind the peripheral condensed prostatic tissue and the anatomic capsule.
Between the true and false capsules is a venous plexus, the prostatic or pudendal venous plexus present.
A typical history and a flow rate <10 mL/s(for a voided volume of >200 mL;
Finasteride is a competitiveinhibitor of the enzyme 5α-reductase (type II isoenzyme), which convertstestosterone to DHT. Finasteride, therefore, lowers serum and intraprostatic DHT levels. Epristeride is a dual inhibitor of 5α-reductase. Whetherit has any clinically significant advantages over finasteride remains to beestablished.