Cervical cancer arises from the transformation zone of the cervix due to persistent HPV infection. It is the 4th most common cancer in women worldwide but more common in developing countries. Screening programs using Pap smears have reduced incidence and mortality in developed nations. Treatment depends on staging and may include LEEP, radical hysterectomy, radiation, chemotherapy, or a combination. Prognosis depends on stage, with 5-year survival rates ranging from over 90% for stage I to less than 20% for stage IV.
The Cervical Cancer is the second most common cancers and it can be easily prevented by timely screening & proper education, awareness program for women.
HPV Vaccination, Cerviocal Cancer : Do we need it
for Prevention of cervical cancer &
other HPV related diseasesm,
Presentation Outlines
Cervical cancer disease burden
Prevention with HPV vaccination
Vaccination of sexually active women
Opportunity of Postpartum HPV vaccination
Importance of genital warts prevention
Real world effectiveness data
Safety of HPV vaccine
The Cervical Cancer is the second most common cancers and it can be easily prevented by timely screening & proper education, awareness program for women.
HPV Vaccination, Cerviocal Cancer : Do we need it
for Prevention of cervical cancer &
other HPV related diseasesm,
Presentation Outlines
Cervical cancer disease burden
Prevention with HPV vaccination
Vaccination of sexually active women
Opportunity of Postpartum HPV vaccination
Importance of genital warts prevention
Real world effectiveness data
Safety of HPV vaccine
cervical cancer is the worlds most leading cause for the death of women. so knowledge regarding that disease will help us to prevent that disease to some extent.
cervical cancer is the worlds most leading cause for the death of women. so knowledge regarding that disease will help us to prevent that disease to some extent.
Globally, over 600,000 new cases and 300,000 deaths were estimated for cervical cancer in 2020 .
Third most common gynecological cancer in Palestine.
Palestine has a higher age-standardized mortality rate than other countries in the region
A brief discussion over CA Cervix. All newest updates in management protocol and revised by reknowned gynecologistts. Very much helpful for both under and post graduate students/Doctors.
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
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.
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
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.
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
- 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
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!
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.
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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. Definition
• Cervical cancer is a preventable HPV-related
malignancy of the uterine cervical mucosa.
• Cervical mucosa: mean tumor arise from epithelium, i.e: type of
tumor is carcinoma (SCC or adenocarcinoma but SCC is the much
more common type).
• The tumor precisely arise from what’s called TZ.
• HPV – related: b/c of HPV is the most important aetiological factor.
• b/c the natural course of the disease is well known, so it deserve to
have screening test, so the disease is preventable condition.
2
3. Epidemiology
• Cervical cancer is the fourth most common
malignancy in women worldwide.
• More common in developing countries b/c of
early sexual activity due to early marriage, low
socioeconomic state & poor nutrition.
• Incidence mainly in women aged between 20 &
49 years with peak incidence in women aged 40-
49 years & the declines gradually thereafter.
3
4. Epidemiology (Cont.)
• Incidence higher in black people & mortality is
twice higher than white people.
• Incidence less in muslems & jewishs.
• In developed countries, the incidence start to
decline in the last decades b/c of screening
program.
4
5. Aetiology
• The cancer occur following CIN which is widely
regarded as a necessary precursor lesion for
carcinoma of cervix.
• CIN is a histological diagnosis and needs
persistent cervical infection with HPV to develop.
• There are about 15 high risk oncogenic subtypes
of HPV, the most common being 16, 18, 31, and
33 & much more common are 16 & 18.
5
6. Risk factors
• Strong:-
• HPV infection (most common factor ever)
• Age group: women aged between 20 & 49 years with peak
incidence in women aged 40-49 & the declines gradually
thereafter.
• HIV infection.
• Early onset of sexual activity (younger than 18).
• Multiple sexual partners.
• Cigarette smoking (as promoter/ precipitating factor).
• Immunosuppression.
6
7. Risk factors (Cont.)
• Weak:-
• All other STDs.
• Oral contraceptive use (adenocarcinoma).
• High parity.
• uncircumcised male partner.
• micronutrient malnutrition.
• low serum folate.
• low vitamin C and E levels.
• alcohol abuse.
• low socioeconomic status.
7
8. Pathophysiology
• The main site of the cancer is TZ.
• TZ: zone at which transformation from squamous
epithelium to columnar one occur at SCJ.
• This continuous metaplasia suggest high mitotic activity
in this area making TZ is the most susceptible site for the
cancer in the cervix.
• This continuous metaplasia kept by acidic PH of vagina,
so as the age of female progress, then metaplasia tend to
creep upward gradually.
8
9. Pathophysiology (Cont.)
• Therefore, in young female TZ lies in
ectocervix while in older female
(postmenopause) lies in endocervix.
• In presence of presistent HPV infection in
addition to co-factor as smoking, metaplasia
will change to dysplasia & then driving CIN.
9
13. Prevention
• Safe sexual health and effective barrier
contraception.
• Vaccines against HPV-16/18:-
• Vaccination can be done in female aged between 9 to 45 yrs but
recommended age for vaccination is 11 to 12 yrs for all adolescents.
• Regular screening by cervical smear.
13
14. Screening
• The NHS Cervical Screening Programme (NHSCSP)
presented since the 1980s.
• Regular cervical screening reduces the risk of death from
cervical carcinoma by 75% (but does not eliminate it).
• cervical cancer Screening is cytological study based on
the natural course of cervical cancer as it detect
possibility of CIN (dysplasia) & depend on cervical smear
(aka; pap smear).
14
15. Types of abnormalities seen in smear:-
• Dyskaryosis
• Increased nuclear/cytoplasmic ratio
• Koilocytosis
• Poikylocytosis
• Mitosis
• Inflammation
All these
changes
suggest
presence of
dysplasia
15
16. Cervical smear – normal cytology. Cervical smear – severe dyskaryosis.
16
17. Results of cervical smear
• Normal
• Abnormal:-
• Inflammation: HPV infected cells + inflammatory cells.
• Dysplasia
o LSIL: HPV infected cells + mild dysplasia
suggesting possibility of CIN-1 on biopsy.
o HSIL: HPV infected cells + moderate dysplasia
suggesting possibility of CIN-2 or CIN-3 on biopsy.
o Cancer: HPV infected cells + severe grades of
dysplasia suggesting invasion on biopsy.
• CIN-1: 1/3
thickness
• CIN-2: 2/3
thickness
• CIN-3: full
thickness
17
19. • The USPSTF and the ASCCP guideline now recommend
screening in women from age 21 to 65 years as following:-
o For general population (low risk group): every 3 years.
o For high risk group (HPV infection, early sexual activity, smoker……etc): annually.
o After subtotal hysterectomy, after Tx of benign lesion or CIN: annually.
• In 2012, USPSTF guideline introduce HPV test which indicated as a
part of screening program with pap smear provided that screening
performed each 5 years instead of 3 years or can be indicated in
women with borderline nuclear changes in smear or unsatisfactory
smear results in highly suspicious women clinically.
19
20. Spread
• Direct/ local spread (infiltration) :-
o Upwards or down: to body of uterus or vagina.
o Lateral (dangerous): to parametria (including LN) & may affect ureter.
o Ant. or post: to bladder or rectum (ulcer, hge, fistula, edema).
• Distant spread/ metastasis by lymphatic: once para-
arotic LN involved, then this signify poor prognosis &
case is incurable.
• Distant spread/ metastasis by blood (rare & late): BLBL.
20
21. Diagnosis
History & examination:-
• Key diagnostic factors:
o presence of risk factors (common).
o abnormal vaginal bleeding (common).
o postcoital bleeding/ contact bleeding (common).
o pelvic pain, dyspareunia (uncommon).
o cervical mass (uncommon).
o cervical bleeding (uncommon).
21
22. Diagnosis (Cont.)
• Other diagnostic factors:
o mucoid or purulent vaginal discharge (common).
o bladder, renal, or bowel obstruction (uncommon).
o bone pain (uncommon).
o Other manifestations of local or distant spread
(uncommon).
o Other manifestations of complications (uncommon).
22
23. Diagnosis (Cont.)
Investigations:-
• 1st test to order:
ResultsTest
mass or bleeding.vaginal or speculum examination
• Raised edge, irregular contour.
• Abnormal blood vessels (mosaic or punctate).
• Aceto-white areas with acetic acid.
• Yellow-areas with Schiller iodine.
colposcopy
Confirms diagnosis histologically and identifies
subtype.
biopsy
Indicated when pap smear positive but unsatisfactory.HPV testing23
27. Diagnosis (Cont.)
• Differential diagnosis:-
o HPV infection
o Pelvic infection
o Nabothian cyst
o Glandular hyperplasia
o Mesonephric remnants
o Endometriosis
o Cervical polyp
o Cervical fibroid
27
28. FIGO system for staging of cervical cancer
• Stage 0: CIN, preinvasive lesion/ no invasion of
BM.
• Stage 1: confined to cervix:
o Stage 1a: microscopic disease/ invasive carcinoma
but not diagnosed unless by biopsy.
o Stage 1b: macroscopic disease/ visible invasive
carcinoma.
28
29. FIGO system for staging of cervical
cancer (Cont.)
• Stage 2: extend/infiltrate beyond cervix but
not to pelvic side wall (parametria) or extend
to upper 2/3 of vagina:
o Stage 2a: infiltrate upper 2/3 of vagina.
o Stage 2b: infiltrate parametria.
29
30. FIGO system for staging of cervical
cancer (Cont.)
• Stage 3: extend/ infiltrate pelvic side wall or
lower 1 /3 of vagina or associated with non-
functioning kidney or hydronephrosis:
o Stage 3a: infiltrate lower 1 /3 of vagina.
o Stage 3b: infiltrate pelvic side wall or associated
with non-functioning kidney or hydronephrosis.
30
32. FIGO system for staging of cervical
cancer (Cont.)
• Stage 4: extend out of true pelvis or infiltrate
bladder or rectum:
o Stage 4a: locally advanced/ extend to adjacent
organ as bladder or bowel.
o Stage 4b: distant metastasis/ extent out of true
pelvis.
32
33. UICC staging by TMN system
Less commonly used. T staging corresponds to FIGO
staging.
• TX, NX, MX: primary tumor, nodes, or metastases
not assessed.
• N0, M0: Nodes or metastases not involved.
• N1, M1: Nodes or metastases involved.
• Tis: Carcinoma in situ (correspond to higher
grades of CIN).
33
34. Treatment
Patients with cervical cancer classified according stage of disease
at time of presentation for therapeutic purposes into:-
• Non-pregnant patients:-
o Microinvasive disease: stage Ia1.
o Early stage disease: stage Ia2 to IIa.
o Locally advanced disease: stage IIb to IVa.
o Metastatic disease: stage IVb.
• Pregnant patients: same stages & all of them are treated by
same lines of treatment.
In non-
pregnant
patient, each
stage has its
own line of
treatment.
34
37. Complications
• Bleeding.
• Bladder instability after radical hysterectomy
• Radiation complications: vaginal stenosis, atrophy,
fibrosis, bladder instability, lymphoedema & bowel or
bladder fistulae.
• Leg oedema after lymphadenectomy.
• Excision & ablation techniques complications: preterm
birth.
• Long term sexual dysfunction.37
38. Prognosis
• Most recurrence happens within 2 years.
• The 5-year survival depends on the stage of the
tumor:
o Stage IA1 - 100%.
o Stage IB2-IIB - 50% to 70%.
o Stage III - 30% to 50%.
o Stage IV - 5% to 15%.
38
39. Abbreviations:
• USPSTF: United States Preventive Services Task Force
• ASCCP: American Society for Colposcopy and Cervical Pathology
• FIGO: International Federation of Gynecology and Obstetrics
• UICC: International Union Against Cancer
Sources:
• Oxford Handbook of Obstetrics and Gynaecology 3rd Ed. (2013)
• BMJ: Cervical Cancer: Nov 10, 2017
• Gynaecology by Ten Teachers, 19th Ed. (2011)
• Ain-Shams University Gynaecology curriculum (2013)
• Kasr-Alainy University Gynaecology curriculum (2014)
39