This document summarizes information about cervical cancer screening in Malaysia. It discusses that cervical cancer is the 3rd most common cancer in Malaysian women. The main screening method used is the Pap smear, but newer methods like HPV testing and visual inspection are also presented. Guidelines for cervical cancer screening in Malaysia currently recommend Pap smear every 3 years for women ages 20-65, but the program could be improved as screening rates remain low and cervical cancer incidence has not decreased. The document reviews natural history, risk factors, screening modalities and their strengths/limitations, as well as guidelines for screening in Malaysia and other countries.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
Welcoming remarks by Dr Osborne E Nyandiva on Symposium: Cervical cancer and its prevention
Co-Presenter Dr Giama. We are happy to present to you this very crucial discussion on Cancer.
Cervical cancer is a type of cancer that develops in a woman's cervix (the entrance to the womb from the vagina).
Cancer of the cervix often has no symptoms in its early stages. If you do have symptoms, the most common is unusual vaginal bleeding, which can occur after sex, in between periods or after the menopause.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
Welcoming remarks by Dr Osborne E Nyandiva on Symposium: Cervical cancer and its prevention
Co-Presenter Dr Giama. We are happy to present to you this very crucial discussion on Cancer.
Cervical cancer is a type of cancer that develops in a woman's cervix (the entrance to the womb from the vagina).
Cancer of the cervix often has no symptoms in its early stages. If you do have symptoms, the most common is unusual vaginal bleeding, which can occur after sex, in between periods or after the menopause.
Cervical cancer kills 270,000 women each year — mainly women in the developing world and in the prime of their productive lives. But cervical cancer is preventable by screening asymptomatic women for precancerous cervical lesions and treating the lesions before they progress to invasive disease. In other words, those deaths are largely preventable. Studies suggest that even if a woman were screened for cervical cancer only once in her lifetime between the ages of 30 and 40, her risk of cancer would be reduced by 25-36%.
Say no to cervical cancer-PUBLIC Awareness-Life Care Centre_Dr.Sharda JainLifecare Centre
Cervical Cancer in INDIA
Say no to cervical cancer
Dr.Sharda Jain
Life Care Centre
PUBLIC Awareness_Dr.Sharda Jain
HPV Infection
HPV Vaccination
Cervical Screening
SEE & TREAT Programme tp Prevent Cervical Cancer
The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used in gynecology to detect premalignant and malignant (cancerous) processes in the ectocervix. http://docturs.com/dd/pg/groups/2392/cervical-smear-test-pap-test/
Cervical cancer kills 270,000 women each year — mainly women in the developing world and in the prime of their productive lives. But cervical cancer is preventable by screening asymptomatic women for precancerous cervical lesions and treating the lesions before they progress to invasive disease. In other words, those deaths are largely preventable. Studies suggest that even if a woman were screened for cervical cancer only once in her lifetime between the ages of 30 and 40, her risk of cancer would be reduced by 25-36%.
Say no to cervical cancer-PUBLIC Awareness-Life Care Centre_Dr.Sharda JainLifecare Centre
Cervical Cancer in INDIA
Say no to cervical cancer
Dr.Sharda Jain
Life Care Centre
PUBLIC Awareness_Dr.Sharda Jain
HPV Infection
HPV Vaccination
Cervical Screening
SEE & TREAT Programme tp Prevent Cervical Cancer
The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used in gynecology to detect premalignant and malignant (cancerous) processes in the ectocervix. http://docturs.com/dd/pg/groups/2392/cervical-smear-test-pap-test/
Cervical Cancer is common worldwide , ranking 3rd among all malignancies for women.
Second leading cause of cancer death.
Most of these cancers stem from infection with the Human Pappiloma Virus (HPV).
Nulife module 6 screening for malignancies editedManinder Ahuja
These six modules from 2-7 are on mid life health care of women and were made with intention of training general gynecologist and other speciality into care of mid life women and have Mid Life OPD cards as mainstay of care.
Human papiloma virus and its association to Cervical Cancer
HPV in Saudi Arabia .
Currently I am working in Arar Central Hospital, in Arar city
In Saudi Arabia.
Please do not hesitate to contact us if you require any further information.
Alsultany@hotmail.com
Diabetes is a rapidly and serious health problem in Pakistan. This chronic condition is associated with serious long-term complications, including higher risk of heart disease and stroke. Aggressive treatment of hypertension and hyperlipideamia can result in a substantial reduction in cardiovascular events in patients with diabetes 1. Consequently pharmacist-led diabetes cardiovascular risk (DCVR) clinics have been established in both primary and secondary care sites in NHS Lothian during the past five years. An audit of the pharmaceutical care delivery at the clinics was conducted in order to evaluate practice and to standardize the pharmacists’ documentation of outcomes. Pharmaceutical care issues (PCI) and patient details were collected both prospectively and retrospectively from three DCVR clinics. The PCI`s were categorized according to a triangularised system consisting of multiple categories. These were ‘checks’, ‘changes’ (‘change in drug therapy process’ and ‘change in drug therapy’), ‘drug therapy problems’ and ‘quality assurance descriptors’ (‘timer perspective’ and ‘degree of change’). A verified medication assessment tool (MAT) for patients with chronic cardiovascular disease was applied to the patients from one of the clinics. The tool was used to quantify PCI`s and pharmacist actions that were centered on implementing or enforcing clinical guideline standards. A database was developed to be used as an assessment tool and to standardize the documentation of achievement of outcomes. Feedback on the audit of the pharmaceutical care delivery and the database was received from the DCVR clinic pharmacist at a focus group meeting.
WRI’s brand new “Food Service Playbook for Promoting Sustainable Food Choices” gives food service operators the very latest strategies for creating dining environments that empower consumers to choose sustainable, plant-rich dishes. This research builds off our first guide for food service, now with industry experience and insights from nearly 350 academic trials.
Artificial Reefs by Kuddle Life Foundation - May 2024punit537210
Situated in Pondicherry, India, Kuddle Life Foundation is a charitable, non-profit and non-governmental organization (NGO) dedicated to improving the living standards of coastal communities and simultaneously placing a strong emphasis on the protection of marine ecosystems.
One of the key areas we work in is Artificial Reefs. This presentation captures our journey so far and our learnings. We hope you get as excited about marine conservation and artificial reefs as we are.
Please visit our website: https://kuddlelife.org
Our Instagram channel:
@kuddlelifefoundation
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https://www.linkedin.com/company/kuddlelifefoundation/
and write to us if you have any questions:
info@kuddlelife.org
Natural farming @ Dr. Siddhartha S. Jena.pptxsidjena70
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UNDERSTANDING WHAT GREEN WASHING IS!.pdfJulietMogola
Many companies today use green washing to lure the public into thinking they are conserving the environment but in real sense they are doing more harm. There have been such several cases from very big companies here in Kenya and also globally. This ranges from various sectors from manufacturing and goes to consumer products. Educating people on greenwashing will enable people to make better choices based on their analysis and not on what they see on marketing sites.
Willie Nelson Net Worth: A Journey Through Music, Movies, and Business Venturesgreendigital
Willie Nelson is a name that resonates within the world of music and entertainment. Known for his unique voice, and masterful guitar skills. and an extraordinary career spanning several decades. Nelson has become a legend in the country music scene. But, his influence extends far beyond the realm of music. with ventures in acting, writing, activism, and business. This comprehensive article delves into Willie Nelson net worth. exploring the various facets of his career that have contributed to his large fortune.
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Introduction
Willie Nelson net worth is a testament to his enduring influence and success in many fields. Born on April 29, 1933, in Abbott, Texas. Nelson's journey from a humble beginning to becoming one of the most iconic figures in American music is nothing short of inspirational. His net worth, which estimated to be around $25 million as of 2024. reflects a career that is as diverse as it is prolific.
Early Life and Musical Beginnings
Humble Origins
Willie Hugh Nelson was born during the Great Depression. a time of significant economic hardship in the United States. Raised by his grandparents. Nelson found solace and inspiration in music from an early age. His grandmother taught him to play the guitar. setting the stage for what would become an illustrious career.
First Steps in Music
Nelson's initial foray into the music industry was fraught with challenges. He moved to Nashville, Tennessee, to pursue his dreams, but success did not come . Working as a songwriter, Nelson penned hits for other artists. which helped him gain a foothold in the competitive music scene. His songwriting skills contributed to his early earnings. laying the foundation for his net worth.
Rise to Stardom
Breakthrough Albums
The 1970s marked a turning point in Willie Nelson's career. His albums "Shotgun Willie" (1973), "Red Headed Stranger" (1975). and "Stardust" (1978) received critical acclaim and commercial success. These albums not only solidified his position in the country music genre. but also introduced his music to a broader audience. The success of these albums played a crucial role in boosting Willie Nelson net worth.
Iconic Songs
Willie Nelson net worth is also attributed to his extensive catalog of hit songs. Tracks like "Blue Eyes Crying in the Rain," "On the Road Again," and "Always on My Mind" have become timeless classics. These songs have not only earned Nelson large royalties but have also ensured his continued relevance in the music industry.
Acting and Film Career
Hollywood Ventures
In addition to his music career, Willie Nelson has also made a mark in Hollywood. His distinctive personality and on-screen presence have landed him roles in several films and television shows. Notable appearances include roles in "The Electric Horseman" (1979), "Honeysuckle Rose" (1980), and "Barbarosa" (1982). These acting gigs have added a significant amount to Willie Nelson net worth.
Television Appearances
Nelson's char
Micro RNA genes and their likely influence in rice (Oryza sativa L.) dynamic ...Open Access Research Paper
Micro RNAs (miRNAs) are small non-coding RNAs molecules having approximately 18-25 nucleotides, they are present in both plants and animals genomes. MiRNAs have diverse spatial expression patterns and regulate various developmental metabolisms, stress responses and other physiological processes. The dynamic gene expression playing major roles in phenotypic differences in organisms are believed to be controlled by miRNAs. Mutations in regions of regulatory factors, such as miRNA genes or transcription factors (TF) necessitated by dynamic environmental factors or pathogen infections, have tremendous effects on structure and expression of genes. The resultant novel gene products presents potential explanations for constant evolving desirable traits that have long been bred using conventional means, biotechnology or genetic engineering. Rice grain quality, yield, disease tolerance, climate-resilience and palatability properties are not exceptional to miRN Asmutations effects. There are new insights courtesy of high-throughput sequencing and improved proteomic techniques that organisms’ complexity and adaptations are highly contributed by miRNAs containing regulatory networks. This article aims to expound on how rice miRNAs could be driving evolution of traits and highlight the latest miRNA research progress. Moreover, the review accentuates miRNAs grey areas to be addressed and gives recommendations for further studies.
2. Introduction
Cervical cancer is the 3rd most frequent cancer among Malaysian
women.
The National Cancer Registry in 2006 reported that the age
standardized incidence (ASR) of cervical cancer was 12.2 per
100,000 women.
The proportion of deaths due to cervical cancer among all forms of
cancer deaths has been steadily increasing.
In 1998, cervical cancer was ranked 8th as cause of deaths in
Malaysia.
By 2006, deaths due to cervical cancers was ranked 3rd .
12.2 deaths for every 100,000 women dying from any form of
cancer was due to cervical cancer.
(National Cancer Registry Malaysia, 2006)
3. Preventable?-Yes
This increase in morbidity and mortality due is
unwarranted not only because:
- The definitive cause of cervical cancer is now
known i.e primarily due to high risk HPV
infection.
- The disease takes a long time to develop after
initial infection.
Unlike most other types of cancer, it is preventable
when precursor lesions are detected and treated.
Therefore, screening can reduce both the incidence
and mortality of cervical cancer.
4. Impact of cervical cytology screening on the incidence of invasive cervical
cancer in the United States.In Kurman R (ed): Blavstein’s Pathology of the
Female Genital Tract. 5th ed. New York, Springer-Verlag, 2002.
5. Screening modalities: Natural history
models
A clear understanding of the natural history of cervical
cancer is a key to planning and implementing a rationale
screening programme.
6. Risk factor for cervical cancer
Genital infection with a high-risk HPV
type.
Early onset of sexual activity.
Multiple sexual partners.
Cigarette smoking.
Immunocompromised.
Low socioeconomic.
7. 99.7% of all cervical cancer cases are associated with
persistent infection with high-risk HPV types.
HPV types 16 and 18 are the most common high-risk types
and account for 70% of all cervical cancer cases
worldwide.
-50% as a result of HPV-16 infection .
-20% as a result of HPV-18 infection.
11. Screening-Cytology
The mainstay of cervical cancer
screening for the last 60 years
has been the Papanicolaou test.
The Papanicolaou test, also
known as Pap smear, was
developed in the 1940s by
Georgios Papanikolaou.
It involves exfoliating cells from
the transformation zone of the
cervix to enable examination of
these cells microscopically for
detection of cancerous or
precancerous lesions.
1883-1962
13. The optimal Pap smear contains:
Sufficient mature and
metaplastic squamous cells to
indicate adequate sampling
from the whole of the
transformation zone.
Sufficient endocervical cells
to indicate that:
- the upper limit of the
transformation zone was
sampled
- to provide a sample for
screening of
adenocarcinoma and its
precursors
14. When to Perform
The best time is:
Any time after the cessation of the period.
Avoid smear-taking during menstruation.
Avoid in the presence of obvious vaginal infection.
Avoid within 48 hours of use of vaginal creams or
pessaries or douching.
Avoid within 24 hours of intercourse.
Avoid lubrication or cleaning of cervix with
preliminary pelvic examination.
Good communication with the pathologist is essential.
17. Which Spatula?
Choose the contoured
end of the spatula that
best conforms to the
anatomy of the cervix
and the location of the
transformation zone
24. LBC vs Pap Test
Increase in sensitivity up to 12% better for the detection of abnormalities of
low-grade squamous intraepithelial lesions with LBC compared with the
Pap smear.
No difference between the specificity of LBC and Pap smear.
The English pilot study showed a statistically significant decrease in the
number of inadequate samples, from 9.1% with Pap slides to an average of
1.6% with LBC (87% reduction, p < 0.0001)
Reduced the pressure on the workforce because of fewer inadequate and
clearer to read samples.
Reduced levels of anxiety in women because fewer need repeat tests and
because they receive their results more quickly.
Remnant cells may be use for additional test e.g HPV DNA testing.
25.
26. Visual Inspection
Involves 3 different
approaches:
Visual inspection of
cervix with acetic acid
(VIA).
Visual inspection with
magnification (VIAM).
Visual inspection after
application of Lugol’s
iodine (VILI).
27. VIA
Applying 3% to 5% acetic acid and apply to the cervix liberally.
When acetic acid is applied to normal squamous epithelium, little
coagulation occurs in the superficial cell layer, as this is sparsely
nucleated.
Areas of CIN and invasive cancer undergo maximal coagulation
due to their higher content of nuclear protein (in view of the large
number of undifferentiated cells contained in the epithelium).
This prevent light from passing through the epithelium. As a
result, the sub-epithelial vessel pattern is obliterated and the
epithelium appears densely white.
In CIN, acetowhite is restricted to the transformation zone close
to the squamocolumnar junction, while in cancer it often involves
the entire cervix.
30. VILI
Lugol iodine is applied over the cervix.
Squamous epithelium contains glycogen, whereas precancerous lesions
and invasive cancer contain little or no glycogen.
Iodine is glycophilic and is taken up by the squamous epithelium, staining it
mahogany brown or black.
Columnar epithelium does not change color, as it has no glycogen.
Immature metaplasia and inflammatory lesions are at most only partially
glycogenated and, when stained, appear as scattered, ill-defined uptake
areas.
Precancerous lesions and invasive cancer do not take up iodine (as they
lack glycogen) and appear as well-defined, thick, mustard or saffron yellow
areas.
33. VIA vs VIAM vs VILI
VILI has the highest specifity, detecting 75 per cent
of all cases of HSIL compared with VIA and VIAM
which detected less than two third of cases.
VILI has higher sensitivity. The pooled sensitivity of
VILI 91.8 per cent (range 76-97.3%) compared to
those of VIA (76.9%) and VIAM (64.2%).
The yellow colour changes associated with a
positive VILI test result could be recognized with
much greater ease by trained health workers
compared with the acetowhite lesions associated
with VIA.
34. Management
Offer to treat immediately, (without
colposcopy or biopsy, known as the
“test-and-treat” or “single-visit”
approach).
Refer for colposcopy and biopsy and
then offer treatment if a precancerous
lesion is confirmed.
35. HPV Testing
HPV cannot be grown in culture and
detection of the virus relies on a variety
of techniques used in immunology,
serology, and molecular biology.
2 assays most widely used:
PCR with generic primers
The Hybrid Capture 2 assay.
36. HPV DNA Testing – Hybrid Capture
Assay
The Hybrid Capture assay (hc2) is a batch test
based on hybridization in a solution of long
synthetic RNA probes.
-Probe B is complementary to the
genomic sequence of 13 high-risk types
(HPV-16,-18, -31,-33, -35, -39, - 45, -
51, -52, -56, -58, -59 and -68).
-Probe A measures 5 low-risk (6, 11,
42,43,44) HPV types.
37. HPV DNA analysis - Sampling
Helthcare provider/Self
sample
Residual from LBC
38.
39. HPV DNA testing vs Cytology
The HPV testing was:
More sensitive in
detecting CIN2+ than
cytology (96.1% vs.
53.0%)
Less specific (90.7%
vs. 96.3%).
40. Figure 1. A meta-analysis of seven primary HPV screening studies in six European countries investigated the
negative predictability of screening tests. After three years, the incidence of CIN3 was about 5 per 1,000 for
women who were negative for cytology tests. For women who were negative for HPV at baseline, by 72
months the incidence of CIN3 was about 2.5 per 1,000. Co-testing had marginally better predictability than HP
43. Screening Guidelines: HPV Testing – Who &
When
Prevalence of high-risk HPV and incident cases of
cervical cancer in the U.S., 2003–2005. Surveillance
Epidemiology and End Results (SEER) data for
incident cases among females aged 15 to 19 years and
50 to 64 years
46. Screening Guideline- Past, Current,
Future
Cervical cancer screening in
Malaysia began in 1969, after
the intergration of the family
planning services into the
Maternal and Child Health
Program of the MOH.
It has expanded across the
country following the
launching of the “Active
Lifestyle” campaign, in 1995.
In 1998 “National Pap Smear
Screening Programme” was
setup, it offers screening to all
eligible women aged 20-65
years old for the first 2 years
than 3 yearly is the result is
normal.
The agencies involved:
National Population and Familly
Development Board (LPPKN)
University hospitals & Government
Private clinics and hospitals.
Military hospitals and other non-
governmental.
NGOs
Agencies such as Federation of
Family Planning.
Association of Malaysia and National
Cancer Society.
47. Current
Pap smear screening services had been
available for some time, nevertheless
studies have shown that half of all women
who died of cervical cancer did not
undergo Pap smear in the past five years
(Adeeb et al, 2008).
Reported that no reduction in the
prevalence of cervical cancer has been
noted in the country. (Wong et al.2008)